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Biomedical subjects

G Bowes

Publications and source records attributed to G Bowes.

At least 19 recordsLinked to original sources
PubMed1998

Measles-mumps-rubella and hepatitis B vaccination uptake in adolescents: a survey in metropolitan Melbourne.

OBJECTIVE: To measure the uptake of preadolescent measles-mumps-rubella (MMR) and adolescent hepatitis B vaccinations and assess the influence of certain demographic factors on the uptake of these vaccines. DESIGN: Prevalence surveys of uptake rates of preadolescent (school Year 6; age 10-11 years) MMR and adolescent (school Year 9; age 13-14 years) hepatitis B vaccination. SETTING: City of Darebin, an inner northern metropolitan region of Melbourne, 1996. SUBJECTS: 1160 Year 6 school students (580 boys) and 1102 Year 9 school students (548 boys). INTERVENTION: School-based vaccination program administered by Darebin Council. RESULTS: 83% of Year 6 students were vaccinated with the MMR vaccine (84.1% of girls and 81.9% of boys). 71.6% of Year 9 students completed the full course of hepatitis B vaccination (68.9% of boys and 74.2% of girls). There was a higher uptake of MMR in non-government primary schools, but no other demographic factors (sex, economic status, non-English-speaking background, parental education, school class size) were associated. CONCLUSIONS: These uptake rates do not meet National Health and Medical Research Council (NHMRC) recommendations. Further study is required to determine and quantify the factors that affect vaccination uptake in adolescence. Programs may then be developed to improve vaccination uptake.

Adolescent↗
PubMed1998

The course of early smoking: a population-based cohort study over three years.

AIMS: To examine the uptake and course of smoking in a representative adolescent cohort. DESIGN: Six-wave cohort study. PARTICIPANTS: Secondary school students initially aged 14-15 years at 44 schools in the state of Victoria, Australia. MEASUREMENTS: Computerized questionnaire including 7-day retrospective recall for tobacco use. FINDINGS: Prevalence rates for smoking in the past month rose from 25% to 31% and daily smoking 9% to 18% across the 3-year follow-up. Forty-five per cent of the sample smoked at some point but only 18% were daily smokers at the end-point. High rates of short-term cessation were observed for both experimental and daily smokers, but 70% of daily smokers relapsed within 12 months. Occasional smoking at the outset was the strongest predictor of later daily smoking and was also predictive of lower cessation and higher relapse rates. Parental divorce and parental daily smoking were associated with smoking at the outset and parental smoking was strongly predictive of the course of daily smoking. In contrast, prevalence rates of smoking in a subject's school did not significantly predict either smoking initiation or subsequent course. Female daily smokers were half as likely as males to cease smoking, a finding that accounted for gender differences in smoking prevalence in this sample. CONCLUSIONS: The strength of association between occasional and later daily smoking indicates the importance of primary prevention but the variability in the early course indicates that there should be much scope for promotion of adolescent efforts to quit. Both the diminished likelihood of smoking cessation in young women and parental influences on smoking course deserve further exploration.

Adolescent↗
PubMed1998

Young people with spina bifida: transfer from paediatric to adult health care.

An expectation of health care for young people with disability is that quality coordinated care continues to be available as they pass from the paediatric to the adult health care system. While individual clinicians provide this service well, the widespread absence of coordinated multidisciplinary care for young people with spina bifida in the adult health care system is a major deficiency. This paper describes the planning and implementation that underpinned the transfer of 10 young people with spina bifida from a paediatric to an adult service. The range of structural, financial and 'cultural' barriers that need to be overcome before patients can be successfully transferred is highlighted; lessons learned from this model may serve to facilitate the development of other transfer services.

Adolescent↗
PubMed1998

Changes in growth CO2 result in rapid adjustments of ribulose-1, 5-bisphosphate Carboxylase/Oxygenase small subunit gene expression in expanding and mature leaves of rice

The accumulation of soluble carbohydrates resulting from growth under elevated CO2 may potentially signal the repression of gene activity for the small subunit of ribulose-1,5-bisphosphate carboxylase/oxygenase (rbcS). To test this hypothesis we grew rice (Oryza sativa L.) under ambient (350 &mgr;L L-1) and high (700 &mgr;L L-1) CO2 in outdoor, sunlit, environment-controlled chambers and performed a cross-switching of growth CO2 concentration at the late-vegetative phase. Within 24 h, plants switched to high CO2 showed a 15% and 23% decrease in rbcS mRNA, whereas plants switched to ambient CO2 increased 27% and 11% in expanding and mature leaves, respectively. Ribulose-1,5-bisphosphate carboxylase/oxygenase total activity and protein content 8 d after the switch increased up to 27% and 20%, respectively, in plants switched to ambient CO2, but changed very little in plants switched to high CO2. Plants maintained at high CO2 showed greater carbohydrate pool sizes and lower rbcS transcript levels than plants kept at ambient CO2. However, after switching growth CO2 concentration, there was not a simple correlation between carbohydrate and rbcS transcript levels. We conclude that although carbohydrates may be important in the regulation of rbcS expression, changes in total pool size alone could not predict the rapid changes in expression that we observed.

Journal Article↗
PubMed1998

Quality-of-life assessment in children and adolescents with asthma.

Health-related quality of life has become an essential part of health outcome measurement in chronic disorders. However, it is only recently that health professionals have focused on quality-of-life assessment in children and adolescents. Several generic, as well as the asthma-specific quality-of-life instruments specifically designed for use in children and adolescents are reviewed in this article with particular regard to the conceptual and methodological features of the measures and their applicability in clinical studies. The recently published Child Health Questionnaire is a useful generic instrument to comprehensively assess quality of life, in particular when comparing young people with different chronic disorders. The Pediatric Asthma Quality-of-life Questionnaire has shown responsiveness to change over time, but it lacks age-specificity with regard to psychosocial issues and comprehensiveness of quality-of-life assessment. In contrast, the Childhood Asthma Questionnaire provides three different versions for different target ages. However, its generic part is not reflective of the respondent's health status. The other asthma-specific instruments have major conceptual deficiencies when used as a single measure for quality-of-life assessment. In the absence of a single ideal instrument, the use of batteries of quality-of-life instruments is therefore recommended and further research is required to identify the impact that age and developmental status have on quality-of-life assessment.

Adolescent↗
PubMed1998

Depression, anxiety, and smoking initiation: a prospective study over 3 years.

OBJECTIVES: This report considers the extent to which depression and anxiety predict smoking onset in adolescence. METHODS: A 6-wave cohort design was used to study a sample of 14- and 15-year-old students (n = 2032) drawn from 44 secondary schools in the state of Victoria, Australia. The students were surveyed between 1992 and 1995 with a computerized questionnaire that included a 7-day retrospective diary for tobacco use and a structured psychiatric interview. RESULTS: Experimental smokers were 29 times more likely than non-smokers to make a transition into daily use in the subsequent 6 months. Depression and anxiety, along with peer smoking, predicted initiation of experimental smoking. Specifically, depression and anxiety accentuated risks associated with peer smoking and predicted experimentation only in the presence of peer smoking. CONCLUSIONS: The finding that experimental smoking is an overwhelmingly strong predictor of later daily smoking focuses attention on smoking initiation. Depressive and anxiety symptoms are associated with higher risks for initiation through an increased susceptibility to peer smoking influences. Promoting the psychological well-being of adolescents and addressing perceived interpersonal benefits of smoking may play a role in the prevention of adolescent tobacco use.

Adolescent↗
PubMed1997

Caring for the terminally ill adolescent.

Terminally ill adolescents, a heterogeneous group, face unique problems in coming to terms with the prospect of death and dying. In parallel, the psychosocial sequelae of a terminal illness in the adolescent, and their effects on the family and health professionals, present unique challenges for management. Using a developmental framework, we examine issues surrounding the care of dying adolescents and present strategies for their management.

Adolescent↗
PubMed1997

Childhood asthma and lung function in mid-adult life.

The longitudinal lung function data in 286 subjects from a 28 year follow-up of childhood asthma is reported. Airway obstruction in mid-adult life was present mainly in those with moderately severe asthma. Subjects who had been wheeze free for at least 3 years, even if asthma had been persistent in childhood, had normal lung function and no increased bronchial reactivity. Only two subjects, both with persistent asthma from childhood, failed to show an improvement in FEV1 of greater than 10% following inhalation of a beta-adrenergic agonist. Subjects with relatively mild asthma who had not taken inhaled steroids did not appear to be disadvantaged with respect to lung function.

Adult↗
PubMed1997

Adolescent suicidal behaviours: a population-based study of risk.

BACKGROUND: Reports of adolescent suicidal behaviour have generally derived from clinical settings but population-based studies are likely to provide a clearer epidemiological view. METHODS: Non-fatal suicidal behaviours were studied in 1699 Australian 15- to 16-year-old secondary school students at 44 schools in the state of Victoria, Australia. Self-reported episodes of self-harm were characterized using items from the Beck Suicide Intent Scale. RESULTS: The 12 month weighted prevalence estimate for deliberate self-harm was 5.1%. The commonest forms were self-laceration (1.7%), self-poisoning (1.5%) and deliberate recklessness (1.8%). Self-poisoning and self-laceration were commoner in girls. The prevalence of 'true suicide attempts' was 0.2%. Most self-harmers did not perceive death as likely, plan self-harming episodes at length or inform others of the episodes. Psychiatric morbidity had the strongest association with self-harm, an association which held for all subtypes. Antisocial behaviour and substance abuse were associated with self-harm in girls but not boys. Sexual activity was independently associated with self-harm in both genders. CONCLUSIONS: Deliberate self-harm was common but the great majority of episodes were not 'true suicide attempts'. It is, therefore, possible that attributable mortality and morbidity may be greater in self-harmers without definite suicidal intent.

Adolescent↗
PubMed1997

Chronic illness in adolescents: transfer or transition to adult services?

It is widely believed that the improved survival of young people with chronic diseases will be associated with the development of appropriate services within the adult healthcare domain. There is, however, little evidence to suggest that this is happening at a rate commensurate with clinical requirements. This paper highlights the multiplicity of barriers that impede the development of transition services to facilitate the transfer of medical care from the paediatric to the adult domain. Different models of transition care are described, and the terms 'transfer' and 'transition' are differentiated. The clinical demand for service development is highlighted, as well as the need for specific research in this area of healthcare delivery.

Adolescent↗
PubMed1997

Acne in Victorian adolescents: associations with age, gender, puberty and psychiatric symptoms.

OBJECTIVES: This study aimed to examine the associations between the frequency and severity of self-reported acne and age, gender, puberty and psychiatric symptoms in Victorian adolescents. METHODOLOGY: A sample of secondary schoolchildren in Victoria, Australia were surveyed using a computerized questionnaire. Developmental and psycho-social factors associated with acne were recorded and analysed using logistic regression. RESULTS: The Victorian Adolescent Health Survey (1992) recorded the frequency and severity of self-reported acne in 2491 students. Frequency of acne increased with age and pubertal development. For females commencement of menstruation was associated with increased frequency of acne. Asian born male students were less likely to report acne than Australian born males. Acne severity was coded into mild (students reporting acne sometimes on back or face) and moderate (students reporting acne often on face or back). Students reporting moderate acne were more likely to report a high level of psychiatric symptoms and were in the later stages of puberty. CONCLUSIONS: This study confirms an association between the frequency and severity of self-reported acne and stage of pubertal development. It showed also that students reporting moderate acne were more likely to report psychiatric symptoms of depression and anxiety.

Acne Vulgaris↗
PubMed1997

Adolescent dieting: healthy weight control or borderline eating disorder?

Dieting in adolescent girls is ubiquitous but its health significance is uncertain. On the one hand it might be seen as promoting healthy weight control and on the other it might be considered as a risk factor for eating disorders. Dieting levels were systematically assessed in a representative group of 2525 Australian teenagers and classified using item response theory. In this group, 38% of girls and 12% of boys were categorised as intermediate dieters; 7% of girls and 1% of boys fell into a group of extreme dieters. Body mass carried a strong positive association with intermediate dieting. Most female dieters, nevertheless, fell within a normal weight range. Psychiatric morbidity was the clearest factor associated with extreme dieting and 62% of extreme dieters reported high levels of depression and anxiety. Extreme dieting might reasonably be viewed as lying on a spectrum with clinical eating disorders. Most dieting is unjustified on the grounds of appropriate weight control and appears to reflect a widespread striving of teenage girls towards body shapes at the lower end of age-adjusted norms.

Adolescent↗
PubMed1997

Comparison of oral bambuterol and terbutaline in elderly patients with chronic reversible airflow obstruction.

Bambuterol, a carbamate prodrug of terbutaline, is the first once-daily oral beta 2-agonist. The effect/side effect ratio of bambuterol oral solution was compared with terbutaline mixture in elderly patients with chronic reversible obstructive airways disease. The study was of a double-blind, crossover, randomized design and consisted of a 4-7-day run-in period followed by four consecutive treatment periods each of 2 weeks. The treatments were bambuterol solution 20 mg nocte (B20), 10 mg nocte (B10), terbutaline mixture 3 mg t.i.d., (T), and placebo solution (P). Patients measured daily peak expiratory flow rate (PEFR), asthma symptoms, use of inhaled beta 2-agonist, and tremor. Of 84 patients, 66 completed all periods. Mean age was 67 years (60-90), basal FEV1 1.49 L, and reversibility of FEV1 30%. Ninety-four percent of the patients used inhaled/oral steroids in constant dosage. All treatments were significantly more effective than placebo. B20 resulted in higher morning PEFR than T (306 +/- 2.9 L/min vs. 297 +/- 2.9 L/min), while B10 gave equivalent results to T. No differences were seen in the use of inhaled beta 2-agonist. Less shortness of breath was experienced during the night with B20 and during the day with B10 compared with placebo. Both B20 and T produced more tremor than B10 and P. In elderly patients with chronic reversible airways obstruction once-daily bambuterol (10-20 mg) has a better effect/side effect ratio than 3 mg terbutaline thrice daily.

Administration, Oral↗
PubMed1996

Barriers to effective primary health care for adolescents.

OBJECTIVES: To assess general practitioners' (GPs') perceptions of barriers in the health care system that hinder provision of effective adolescent health care; and to assess the training needs of GPs for a future education program in adolescent health issues. DESIGN: Retrospective questionnaire survey. METHODS: A 66-item questionnaire was mailed during May and June 1995 to a random stratified sample of 997 rural and urban Victorian GPs. A Practice Assessment Task enabling respondents to fulfil Royal Australian College of General Practitioners' quality assurance requirements was mailed on return of completed questionnaires if requested. RESULTS: The response rate was 72.4%. After adjusting for stratified sampling, 77% (95% confidence interval [CI], 73%-81%) of respondents favoured individual Medicare cards for adolescents from the age of 16. Thirty-eight per cent (95% CI, 34%-43%) were less willing to charge for longer consultations because they feared Health Insurance Commission (HIC) investigation. Most respondents indicated that their undergraduate training in adolescent mental health issues was inadequate and 64% (95% CI, 61%-68%) found it difficult to obtain advice about complex mental health problems. An interest in continuing medical education in adolescent health issues was expressed by 82% (95% CI, 79%-86%) of respondents. CONCLUSIONS: Individual Medicare cards should be automatically issued to adolescents from the age of 16 to improve their ability to access health care. Revision of the Medicare rebate system and clarification of HIC's investigative functions may improve GP's effectiveness in adolescent consultations. Undergraduate medical and GP training should include curriculum relevant to adolescent health care.

Adolescent↗