Text message communication in primary care research: a randomized controlled trial

Background. Text message communication is increasingly used in clinical practice but rarely in research. Particularly in young people, this method of participation in primary care research appears both feasible and acceptable. However, previous experience shows that text messaging for research may lead to lower response rates. Aim. To test the hypothesis that text message communication in primary care research does not lead to lower response rates compared to a paper-based method. Methods. This randomized controlled trial took place in 26 randomly selected practices in Victoria, Australia. Consecutive patients aged 16-24 years attending general practice appointments were recruited as part of a larger study on patients' perspectives. Patients owning a mobile phone were randomized to receive a question about satisfaction with the consultation either by text message or on a card completed before leaving the practice. Logistic regression was used to estimate the effect on the response rate of using text message rather than the card method, adjusting for clustering within practices and for differences in baseline characteristics among participants. Results. In total, 402 of 409 eligible young people agreed to participate and were randomized to either receive a text message (n = 193) or a card enquiry (n = 209). The response rate was 80.2% [95% confidence interval (CI): 73.3-87.1%] with text message and 85.6% (95% CI: 79.6-91.7%) with the card. The adjusted odds of responding (odds ratio: 0.62; 95% CI: 0.30-1.27) were not significantly lower in the group using text messaging compared to the group using the card response method. Conclusion. These findings offer new perspectives for use of text message communication to gather information from patients in primary care researc

Drinking patterns of adolescents who develop alcohol use disorders: results from the Victorian adolescent health cohort study

Objective: We identify drinking styles that place teensat greatest risk of later alcohol use disorders (AUD).Design: Population-based cohort study.Setting: Victoria, Australia.Participants: A representative sample of 1943adolescents living in Victoria in 1992.Outcome measures: Teen drinking was assessed at6 monthly intervals (5 waves) between mean ages 14.9and 17.4 years and summarised across waves as none,one, or two or more waves of: (1) frequent drinking(3+ days in the past week), (2) loss of control overdrinking (difficulty stopping, amnesia), (3) bingedrinking (5+ standard drinks in a day) and (4) heavybinge drinking (20+ and 11+ standard drinks in a dayfor males and females, respectively). Young AdultAlcohol Use Disorder (AUD) was assessed at 3 yearlyintervals (3 waves) across the 20s (mean ages 20.7through 29.1 years).Results: We show that patterns of teen drinkingcharacterised by loss of control increase risk for AUDacross young adulthood: loss of control over drinking(one wave OR 1.4, 95% CI 1.1 to 1.8; two or morewaves OR 1.9, CI 1.4 to 2.7); binge drinking (one waveOR 1.7, CI 1.3 to 2.3; two or more waves OR 2.0, CI1.5 to 2.6), and heavy binge drinking (one wave OR2.0, CI 1.4 to 2.8; two or more waves OR 2.3, CI 1.6 to3.4). This is not so for frequent drinking, which wasunrelated to later AUD. Although drinking was morecommon in males, there was no evidence of sexdifferences in risk relationships.Conclusions: Our results extend previous work byshowing that patterns of drinking that represent loss ofcontrol over alcohol consumption (however expressed)are important targets for intervention. In addition tocurrent policies that may reduce overall consumption,emphasising prevention of more extreme teenagebouts of alcohol consumption appears warranted

Primacy of effective communication and its influence on adherence to artemether-lumefantrine treatment for children under five years of age: a qualitative study.

BACKGROUND\ud \ud Prompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the drug. Although some community based studies have reported fairly high levels of adherence, data on factors influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was carried-out to explore the provider's instructions to caretakers, caretakers' understanding of the instructions and how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule.\ud \ud METHODS\ud \ud A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were held with providers that included prescribers and dispensers; and caretakers whose children had just received AL treatment. Information was collected on providers' instructions to caretakers regarding dose timing and how to administer AL; and caretakers' understanding of providers' instructions.\ud \ud RESULTS\ud \ud Mismatch was found on providers' instructions as regards to dose timing. Some providers' (dogmatists) instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some doses in awkward hours and completing treatment several hours before the scheduled time. Other providers (pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment guidelines do not provide explicit information on how to address the various scenarios found in the field. A communication gap was also noted in which some important instructions on how to administer the doses were sometimes not provided or were given with false reasons.\ud \ud CONCLUSIONS\ud \ud There is need for a review of the national malaria treatment guidelines to address local context. In the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the course of their work. Further research is needed to determine the implication of completing AL treatment prior to scheduled time

Experiences of learning through collaborative evaluation from a masters programme in professional education

This paper presents findings from a collaborative evaluation project within a masters programme in professional education. The project aimed to increase knowledge of research methodologies and methods through authentic learning where participants worked in partnership with the tutor to evaluate the module which they were studying. The project processes, areas of the course evaluated and the data collection methods are outlined. The findings focus on key themes from evaluating the effectiveness of using a collaborative evaluation approach, including: enhanced student engagement; creativity of the collaborative evaluation approach; equality between the tutor and students; and enhanced research skills. Discussion focuses on the outcomes and effectiveness of the project and tutor reflections on adopting a collaborative approach. This paper highlights lessons from the project relevant to those interested in staff-student partnership approaches and those facilitating postgraduate learning and teaching programmes and educational research courses

The frequency of dwarf galaxy multiples at low redshift in SDSS versus cosmological expectations

We quantify the frequency of companions of low-redshift (0.013 55 arcsec, projected separations r_p 1:4) steadily increases with decreasing Primary stellar mass, whereas the cosmological “Major Merger rate” (per Gyr) has the opposite behaviour. We conclude that cosmological simulations can be reliably used to constrain the fraction of dwarf mergers across cosmic time

A longitudinal study of the association of adolescent polydrug use, alcohol use and high school non-completion

Aims Failure to complete high school predicts substantial economic and social disadvantage in adult life. The aim of this study was to determine the longitudinal association of mid-adolescent polydrug use and high school non-completion, relative to other drug use profiles. Design A longitudinal analysis of the relationship between polydrug use in three cohorts at grade 9 (age 14-15 years) and school non-completion (reported post-high school). Setting A State-representative sample of students across Victoria, Australia. Participants A total of 2287 secondary school students from 152 high schools. The retention rate was 85%. Measurements The primary outcome was non-completion of grade 12 (assessed at age 19-23 years). At grade 9, predictors included 30-day use of eight drugs, school commitment, academic failure and peer drug use. Other controls included socio-economic status, family relationship quality, depressive symptoms, gender, age and cohort. Findings Three distinct classes of drug use were identified-no drug use (31.7%), mainly alcohol use (61.8%) and polydrug use (6.5%). Polydrug users were characterized by high rates of alcohol, tobacco and cannabis use. In the full model, mainly alcohol users and polydrug users were less likely to complete school than non-drug users [odds ratio (OR)= 1.54, 95% confidence interval (CI)= 1.17-2.03) and OR= 2.51, 95% CI= 1.45-4.33), respectively, P< 0.001]. These effects were independent of school commitment, academic failure, peer drug use and other controls. Conclusions Mid-adolescent polydrug use in Australia predicts subsequent school non-completion after accounting for a range of potential confounding factors. Adolescents who mainly consume alcohol are also at elevated risk of school non-completion

Study protocol: imaging brain development in the Childhood to Adolescence Transition Study (iCATS)

BackgroundPuberty is a critical developmental phase in physical, reproductive and socio-emotional maturation that is associated with the period of peak onset for psychopathology. Puberty also drives significant changes in brain development and function. Research to date has focused on gonadarche, driven by the hypothalamic-pituitary-gonadal axis, and yet increasing evidence suggests that the earlier pubertal stage of adrenarche, driven by the hypothalamic-pituitary-adrenal axis, may play a critical role in both brain development and increased risk for disorder. We have established a unique cohort of children who differ in their exposure to adrenarcheal hormones. This presents a unique opportunity to examine the influence of adrenarcheal timing on brain structural and functional development, and subsequent health outcomes. The primary objective of the study is to explore the hypothesis that patterns of structural and functional brain development will mediate the relationship between adrenarcheal timing and indices of affect, self-regulation, and mental health symptoms collected across time (and therefore years of development).Methods/DesignChildren were recruited based upon earlier or later timing of adrenarche, from a larger cohort, with 128 children (68 female; M age 9.51 years) and one of their parents taking part. Children completed brain MRI structural and functional sequences, provided saliva samples for adrenarcheal hormones and immune biomarkers, hair for long-term cortisol levels, and completed questionnaires, anthropometric measures and an IQ test. Parents completed questionnaires reporting on child behaviour, development, health, traumatic events, and parental report of family environment and parenting style.DiscussionThis study, by examining the neurobiological and behavioural consequences of relatively early and late exposure to adrenarche, has the potential to significantly impact our understanding of pubertal risk processes.<br /

Impact of early intervention on the population prevalence of common mental disorders:20-year prospective study

BACKGROUND: The potential for early interventions to reduce the later prevalence of common mental disorders (CMD) first experienced in adolescence is unclear. AIMS: To examine the course of CMD and evaluate the extent to which the prevalence of CMD could be reduced by preventing adolescent CMD, or by intervening to change four young adult processes, between the ages of 20 and 29 years, that could be mediating the link between adolescent and adult disorder. METHOD: This was a prospective cohort study of 1923 Australian participants assessed repeatedly from adolescence (wave 1, mean age 14 years) to adulthood (wave 10, mean age 35 years). Causal mediation analysis was undertaken to evaluate the extent to which the prevalence of CMD at age 35 years in those with adolescent CMD could be reduced by either preventing adolescent CMD, or by intervening on four young adult mediating processes: the occurrence of young adult CMD, frequent cannabis use, parenting a child by age 24 years, and engagement in higher education and employment. RESULTS: At age 35, 19.2% of participants reported CMD; a quarter of these participants experienced CMD during both adolescence and young adulthood. In total, 49% of those with CMD during both adolescence and young adulthood went on to report CMD at age 35 years. Preventing adolescent CMD reduced the population prevalence at age 35 years by 3.9%. Intervening on all four young adult processes among those with adolescent CMD, reduced this prevalence by 1.6%. CONCLUSIONS: In this Australian cohort, a large proportion of adolescent CMD resolved by adulthood, and by age 35 years, the largest proportion of CMD emerged among individuals without prior CMD. Time-limited, early intervention in those with earlier adolescent disorder is unlikely to substantially reduce the prevalence of CMD in midlife