Helen L. Jordan

Improved awareness and appropriate use of non-occupational post-exposure prophylaxis (nPEP) for HIV prevention following a multi-modal communication strategy

BackgroundIn May 2005, the Western Australian Department of Health (WA Health) developed a communication strategy to improve the awareness and appropriate use of non-occupational post-exposure prophylaxis (nPEP) in WA. The communication strategy included the development of an nPEP information pamphlet, the establishment of a 24 hour nPEP phone line and the distribution of the WA Health nPEP guidelines to health professionals. The communication strategy was aimed at gay men, people in sero-discordant relationships, people living with HIV, injecting drug users and health care providers with patients from these populations. This evaluation aimed to assess the awareness and appropriate use of nPEP in WA before and after the commencement of the nPEP communication strategy.MethodsA program logic method was used to identify the immediate (short-term) and ultimate (long-term) outcomes of the communication strategy. The achievement of these outcomes was evaluated using data from website statistics, a survey of ‘sexuality sensitive’ doctors, statistics published in Perth Gay Community Periodic Surveys (PGCPS) and data from the WA nPEP database. A χ2 test for trend was conducted to identify any significant changes in the ultimate outcome indicators pre- and post-strategy.ResultsnPEP awareness among gay men in the PGCPS initially increased from 17.2% in 2002 to 54.9% in 2008, then decreased to 39.9% in 2010. After the commencement of the communication strategy, the proportion of nPEP prescriptions meeting the eligibility criteria for nPEP significantly increased (61.2% in 2002-2005 to 90.0% in 2008-2010 (p < .001)). The proportion of nPEP recipients who completed the prescribed course of nPEP (46.6% in 2002-2005 to 66.9% in 2008-2010 (p = .003)) and the proportion who received a post-nPEP HIV test three to four months after the first visit for nPEP (38.8% in 2002-2005 to 51.9% in 2008-2010 (p = .023)) also increased.ConclusionsSince the introduction of the nPEP communication strategy, the delivery and appropriate use of nPEP have significantly improved in WA. In the 2008-2010 period, an improvement in HIV testing of nPEP recipients at three month follow-up was reported for the first time in WA. However, there is a need for ongoing activities to raise nPEP awareness among gay men.

Influence of High-Dose Estrogen Exposure during Adolescence on Mammographic Density for Age in Adulthood

High-dose estrogen exposure during adolescence has been hypothesized to increase a womans breast cancer risk, possibly mediated through an increase in mammographic density, a well-established breast cancer risk factor. In 2006 to 2007, we conducted a retrospective study of women assessed for tall stature as an adolescent between 1959 and 1993. Eligible participants were ages ≥40 years and treated during adolescence with 3 mg diethylstilbestrol or 150 μg ethinyl estradiol daily or untreated. Mammograms from 167 treated and 142 untreated women were digitized. Total breast area, dense area, nondense area, and percent density were measured using a computer thresholding technique. Data on potential determinants were collected from medical records and telephone interview. Treated women had, on average, 17% lower dense area (P = 0.032). Means (95% confidence intervals) adjusted for age and body mass index for treated and untreated women were 24.5 cm2 (21.8-27.2) and 29.1 cm2 (26.0-32.4), respectively. There was no difference in adjusted means (95% confidence intervals) between treated and untreated women for nondense area [71.7 cm2 (66.2-77.7) versus 70.5 cm2 (64.7-76.9); P = 0.78], percent dense area [24.8% (22.4-27.4) versus 27.7% (24.8-30.7); P = 0.16], or total area [105.6 cm2 (100.1-111.4) versus 109.3 cm2 (103.1-115.8); P = 0.41], respectively. High-dose estrogen exposure during adolescence appears to curtail growth of mammographically dense tissue and therefore is unlikely to increase breast cancer risk through mechanisms related to mammographic density. Cancer Epidemiol Biomarkers Prev; 19(1); 121–9

Empirical evolution of a framework that supports the development of nursing competence

AIM The aim of this study was to refine a framework for developing competence, for graduate nurses new to paediatric nursing in a transition programme. BACKGROUND A competent healthcare workforce is essential to ensuring quality care. There are strong professional and societal expectations that nurses will be competent. Despite the importance of the topic, the most effective means through which competence develops remains elusive. DESIGN A qualitative explanatory method was applied as part of a mixed methods design. METHODS Twenty-one graduate nurses taking part in a 12-month transition programme participated in semi-structured interviews between October and November 2013. Interviews were informed by data analysed during a preceding quantitative phase. Participants were provided with their quantitative results and a preliminary model for development of competence and asked to explain why their competence had developed as it had. RESULTS The findings from the interviews, considered in combination with the preliminary model and quantitative results, enabled conceptualization of a Framework for Developing Competence. Key elements include: the individual in the team, identification and interpretation of standards, asking questions, guidance and engaging in endeavours, all taking place in a particular context. CONCLUSION Much time and resources are directed at supporting the development of nursing competence, with little evidence as to the most effective means. This study led to conceptualization of a theory thought to underpin the development of nursing competence, particularly in a paediatric setting for graduate nurses. Future research should be directed at investigating the framework in other settings.

Local Food Environments, Suburban Development, and BMI: A Mixed Methods Study

More than half the world’s population now live in urban settlements. Worldwide, cities are expanding at their fringe to accommodate population growth. Low-density residential development, urban sprawl, and car dependency are common, contributing to physical inactivity and obesity. However, urban design and planning can modify urban form and enhance health by improving access to healthy food, public transport, and services. This study used a sequential mixed methods approach to investigate associations between food outlet access and body mass index (BMI) across urban-growth and established areas of Melbourne, Australia, and identify factors that influence local food environments. Population survey data for 3141 adults were analyzed to examine associations, and 27 interviews with government, non-government, and private sector stakeholders were conducted to contextualize results. Fast food density was positively associated with BMI in established areas and negatively associated in urban-growth areas. Interrelated challenges of car dependency, poor public transport, and low-density development hampered healthy food access. This study showed how patterns of suburban development influence local food environments and health outcomes in an urbanized city context and provides insights for other rapidly growing cities. More nuanced understandings of the differential effect of food environments within cities have potential to guide intra-city planning for improving health and reducing inequities.

Abstract A130: Effect of high-dose estrogen exposure in adolescence on mammographic density in adulthood.

Abstracts: Frontiers in Cancer Prevention Research 2008 A130 Background Since adolescence is an important stage of mammary development, exposure to high-dose estrogens at this time may have long-term effects on breast tissue and therefore mammographic density. It is well-established that women with greater mammographic density for age and BMI are at an increased risk of breast cancer. Methods We conducted a retrospective cohort study of women from the Australian Tall Girls Study who were 40 years or older and had been assessed for tall stature during adolescence between 1959 and 1993. Eligible women included 263 who had been treated during adolescence with high-dose estrogens and 254 who had not been treated. Treated women had received one of two types of estrogen: 3mg diethylstilbestrol (DES) daily, or 150 μg ethinyl estradiol (EE). A mammogram within the previous two years was obtained from 167 treated women (mean age 48.4 yrs) and 142 untreated women (mean age 46.2 yrs). The total area of the breast image and the area of mammographically dense tissue (dense area), and hence non-dense area and percent mammographic density (PMD), were calculated from digitally scanned cranio-caudal mammographic films using a computer thresholding technique. Reproductive history, lifestyle factors, hormone exposure, treatment and anthropometric data were collected from medical records and by telephone interview using a structured questionnaire. Results After adjusting for age and BMI, treated women had, on average, 17% lower dense area (p=0.03); adjusted means for treated and untreated women were 24.5 cm2 (95% CI: 21.8, 27.2) and 29.1 cm2 (95% CI: 26.0, 32.4), respectively. There was no difference in adjusted means between treated and untreated women for non-dense area [71.7 cm2 (95% CI: 66.2, 77.7) versus 70.5 cm2 (64.7, 76.9); p=0.78], PMD [ 24.8 % (95% CI: 22.4, 27.4) versus 27.7% (95% CI: 24.8, 30.7); p=0.16], or total area [105.6 cm2 (95%CI: 100.1,111.4) vs 109.3 cm2 (95%CI: 103.1,115.8); p=0.41]. Conclusion High-dose estrogen treatment for tall stature in adolescence is unlikely to increase risk of breast cancer through mechanisms related to mammographic density. Citation Information: Cancer Prev Res 2008;1(7 Suppl):A130.