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S M Sawyer

Publications and source records attributed to S M Sawyer.

At least 19 recordsLinked to original sources
PubMed2006

Improving medical student performance in smoking health promotion: effect of a vertically integrated curriculum.

The majority of medical schools have curricula that address the health effects of smoking. However, there are many gaps in smoking education, especially in relationship to vertical integration. The authors aimed to determine whether medical students would better address adolescent smoking within a vertically integrated curriculum in comparison with the previous traditional curriculum. They studied two groups of fifth-year students; one group received a specific smoking intervention. Each group consisted of the entire cohort of students within the Child and Adolescent Health rotation of a newly designed medical curriculum. Two groups of students from the previous traditional undergraduate curriculum were available for direct comparison, one of which had received the same teaching on adolescent smoking. An objective structured clinical examination station was used to measure adolescent smoking enquiry. Intervention students in the new curriculum were more likely to enquire about smoking in the objective structured clinical examination than students who did not receive the intervention (p < 0.005). New curriculum students performed better than students from the previous curriculum, whether or not they had received the smoking intervention (p < 0.001). This study suggests that integrated undergraduate teaching can improve student clinical behaviours with regard to opportunistic smoking enquiry in adolescents.

Adolescent↗
PubMed2006

Parity and decreased use of oral contraceptives as predictors of asthma in young women.

BACKGROUND: Asthma is more prevalent among males in childhood, but females report higher rates in adulthood. The reasons are unknown; although it has been hypothesized that hormonal factors may explain this sex-dependent risk of adult-onset asthma. OBJECTIVE: To determine whether a woman's reproductive history or use of oral contraceptives is associated with adult-onset asthma. METHODS: In 1991-1993, we surveyed 681 women aged 29-32 years randomly sampled from participants first surveyed at age 7 years by the 1968 Tasmanian Asthma Survey, a study of all children born in 1961 and attending school. Current asthma was defined as reporting asthma or wheezy breathing in the past 12 months. RESULTS: In women who did not have asthma or wheezy breathing by age 7 years, 13% had current asthma. The risk of current asthma in these who were parous increased with the number of births (odds ratio (OR) 1.50 per birth, 95% confidence interval (CI) 1.01-2.23 P=0.04) while women with one birth were at a lower risk than nulliparous women (OR 0.46 95% CI 0.2-1.06, P=0.07). Independent of parity, the risk decreased by 7% (95% CI 0-13%) per year of oral contraceptive pill use in all women. In women who did have asthma or wheezy breathing by age 7 years, neither reproductive history nor oral contraceptive pill use predicted current asthma. CONCLUSION: Our observation that parity and decreased oral contraceptive use predict asthma in women, is consistent with the hypothesis that the asthma that develops after childhood is in part a response to endogenous and exogenous female hormones. This may be due to alterations of cytokine responses by the pregnant state, triggering adult-onset asthma in women.

Adult↗
PubMed2006

Adolescent and young adult cancer: a revolution in evolution?

The optimal management of adolescent and young adult cancer has been the subject of vigorous debate in paediatric and adult cancer community for many years. This debate is rapidly coming to the boil. There is international recognition that not only is cancer in young people on the rise but also that improvements in outcomes of cancer in young people lag well behind the advances that have been achieved for both children and older adults in the past 30 years. The underlying problems appear to relate to a complex set of interactions between the health-care system and the prevalence of cancer in this age group and the unique psychosocial and educational needs of this population. This article explores why we should be concerned about Australian health outcomes in this group and considers how best we might respond to these concerns.

Adolescent↗
PubMed2006

Research with bereaved parents: a question of how not why.

BACKGROUND: There is tension around the notion of research with bereaved parents. While it is recognised that the care of children with palliative care needs will only improve with better understanding of parent perspectives, the vulnerability of bereaved parents is equally recognised as a challenge to ethical research. An emerging literature suggests that research can be safely and ethically conducted with bereaved families, if performed sensitively. However, little is known about what research processes might enhance ethical research practice in this field. AIM: To explore the impact of the research process on bereaved parents, and to identify what elements enhance the experience of research participation. METHODS: This qualitative study used in-depth interview techniques with the bereaved parents of children who had died from a range of conditions. RESULTS: Interviews took place with 69 parents from 45 eligible families (70% of 64 selected eligible families) of children who had died from a range of chronic conditions. All participants considered the timing and nature of the initial approach by the researchers to be appropriate. The experience for parents was reported to be enhanced by the sensitivity of the initial approach. The use of in-depth qualitative interviews promoted parent empowerment through determining both pace and content of interviews. Although the majority of parents primarily chose to participate for altruistic reasons, many described the research process as personally beneficial. CONCLUSION: Participating in research was viewed positively by these bereaved parents. Careful attention to the research process in terms of timing, approach and the interviewer's skills were key elements that underpinned a positive experience. The skilled utilisation of in-depth interviewing techniques was perceived to enhance ethical research practice.

Adult↗
PubMed2005

A survey of sexual and reproductive health in men with cystic fibrosis: new challenges for adolescent and adult services.

BACKGROUND: Improved survival dramatically alters the consequences of adult co-morbidities in men with cystic fibrosis (CF) such as male infertility. Few studies have systematically addressed the impact of sexual and reproductive health issues in these men or considered the implications for healthcare delivery. METHOD: A descriptive cohort study was undertaken using a sexual and reproductive health survey of men from a large adult CF centre, including men with lung transplantation. RESULTS: The mean (SD) age of the 94 men (response rate 75%) was 30.5 (7.6) years. 94% knew that men with CF had reduced fertility. Men first heard about infertility later than desired (p<0.001) and only 53% heard from their preferred source. Men who were told about infertility when older were more likely to be upset than those told earlier (p<0.01). 53% of men had undergone semen analysis: 68% of men who had not been tested wanted semen analysis. 73% believed semen analysis should occur before 18, but the youngest age of testing was 24 years. In adolescence, one in three men had assumed they did not need to use condoms and one in 10 had confused infertility with impotence. 66% of men wanted more information on reproductive options and 84% wanted children. Seventeen men were parents by natural conception (n = 1), micro-epididymal sperm aspiration (n = 6), donor sperm (n = 9), and through step children (n = 1). CONCLUSIONS: Men with CF desire more sexual and reproductive health information. Earlier discussion of sexual and reproductive health is indicated in paediatric settings, and semen analysis should be routinely offered. In adult services greater discussion of reproductive health options is indicated.

Adolescent↗
PubMed2004

Choosing to attend an asthma doctor: a qualitative study in adults attending emergency departments.

BACKGROUND: Asthma treatment guidelines currently recommend a 'therapeutic partnership' to achieve best care. It is frequently assumed that individuals presenting to emergency departments with asthma do not have a good doctor-patient relationship. We asked what is the nature of patients' relationships with their doctors in those presenting to hospital emergency departments for asthma care. METHODS: A qualitative study of all consenting individuals aged 18-70 years who presented to a hospital emergency department over 2 months was carried out. Sixty-two participants (19 male) engaged in in-depth interviews which were taped, transcribed and underwent thematic analysis. Questionnaire data were also collected and asthma severity determined. RESULTS: Nearly all patients (61/62) had a doctor whom they saw for their asthma. Patients made thoughtful choices on where they sought care according to their needs. Our findings identified that perceptions of doctors' competence, listening to patients and time constraints were important influences on doctor-patient relationships. Participants had strong expectations that their personal disease experience would be acknowledged by their doctors. CONCLUSION: This group of patients had doctors who cared for their asthma. The acceptability of medical care was determined as much by patient choice as by the quality of the doctor-patient relationship.

Adolescent↗
PubMed2003

The outcome of adolescent eating disorders: findings from the Victorian Adolescent Health Cohort Study.

The study aimed to ascertain the outcome of adolescent onset eating disorders in a representative cohort of females. The design was a seven wave cohort study conducted over 6 years. 982 female participants from a total sample of 2032 secondary school students initially aged 14-15 years at 44 schools in the state of Victoria Australia. Branched questionnaires (BET) were used for assessing symptoms of eating disorder. A partial syndrome was defined where a subject met two DSM-IV criteria for either anorexia or bulimia nervosa. The revised Clinical Interview Schedule (CIS-R) was used for assessing depression and anxiety, and self-report frequency of use and retrospective diaries for substance use. The mean point prevalence of eating disorders in females between 15-18 years at the partial syndrome level was 2.4 % (1.8-31). At follow-up at the age of 20 years the point prevalence was 3 % (1.9-4.1). In all 8.8 % reported an eating disorder across the six year study period. Eleven percent of those with eating disorder in the teens had persisting disorder at follow-up. In contrast, close to 50 % had high levels of depression and anxiety, a finding that was particularly marked for those with the partial syndrome of bulimia nervosa during the teens. The bulimia group tended to report a higher level of heavy alcohol use at follow-up. Eating disorders at the partial syndrome level are common in young women but most teenage syndromes are brief and self-limiting. The findings are consistent with the partial syndrome of bulimia nervosa being viewed as a variant of affective disorder with different associated behaviours at particular developmental points.

Adolescent↗
PubMed2003

Improving medical student performance in adolescent anti-smoking health promotion.

BACKGROUND: We developed a 1-hour teaching seminar for medical students on anti-smoking health promotion for adolescents. We report the development of the programme and a performance-based evaluation. AIM: To develop a seminar for medical students with the objective of improving medical student inquiry into smoking and the delivery of advice accordingly for adolescent patients in routine consultations. METHOD: The seminar was developed using principles of adult learning and delivered to a cohort of medical students (intervention group). Participants were Year 5 medical students in their paediatrics term. A comparison group of 58 medical students who did not receive the seminar was studied in the semester prior to the intervention. The primary outcome measure was a change in anti-smoking health promotion practice within an objective structured clinical examination (OSCE), where taking a smoking history and making links between smoking status and health were indicated in a 15-year-old simulated patient (SP) with poorly controlled asthma. This was part of the summative assessment in the paediatrics term. RESULTS: In the OSCE, 21 of 58 (36%) students in the comparison group asked the asthmatic SP about smoking, compared with 41 of 56 (73%) students in the intervention group (P = 0.0001). In all, 15 (26%) of the comparison group students addressed the patient's smoking, compared with 33 of the 56 (59%) intervention group students (P = 0.0004). CONCLUSION: A carefully designed seminar addressing adolescent smoking can increase the frequency of smoking inquiry and advice by medical students.

Adolescent↗
PubMed2003

Relation between measurements of cough severity.

BACKGROUND: In asthma, measurements of airway inflammation correlate poorly with clinical markers and airway hyperresponsiveness. While the relation between determinants of asthma severity is known, that for cough is unknown. We hypothesised that cough sensitivity changes relate to changes in cough scores and objectively measured cough frequency. AIMS: To examine the relation between commonly used outcome measurements of cough severity in children. METHODS: The concentration of capsaicin causing two and five or more coughs (C2 and C5 respectively), cough frequency objectively measured using an ambulatory cough meter, and parent and child recorded subjective cough scores were determined in 40 children with recurrent cough on two occasions. RESULTS: On occasion one, log cough frequency significantly correlated with parent and child recorded log cough score (r(s) = 0.32, p = 0.05; and r(s) = 0.32, p = 0.046 respectively) and significantly negatively correlated with log C2 (r(s)= -0.5, p = 0.005). Subjective cough scores did not relate to either C2 or C5. On occasion two, the relation between cough frequency and C2 and C5 measures was lost, but C2 had a weak but significant relation to parent recorded cough score (r(s) = -0.38, p = 0.047). When the changes in the log values were determined, C5 but not C2 significantly related to cough frequency. CONCLUSION: In children, measures of cough sensitivity have a weak relation with cough frequency. Subjective cough scores have a stronger and consistent relation with cough frequency. These cough severity indices measure different aspects of cough. The choice of indices depends on the reason for performing the measurement.

Adolescent↗
PubMed2003

Female sexual health care in cystic fibrosis.

Fifty five teenage girls with cystic fibrosis and their mothers were interviewed to assess the provision of sexual health information. Parents were the most common source of information for adolescents. The cystic fibrosis doctor was identified as the key resource for parents. Yet few parents had spoken to their doctor about these issues, and 96% requested more information. This information was wanted before puberty by mothers, and from puberty onwards by girls.

Adolescent↗
PubMed2003

Strategies to promote better outcomes in young people with chronic illnesses.

INTRODUCTION: This paper aims to provide an overview of chronic illness and disability in young people, focusing on the developmental needs of young people and the impact of chronic illness on adolescence. The emotional well-being of the young person with chronic illness is explored and strategies that promote better health outcomes for the young person through health, family and school settings are discussed. METHODS: Literature was searched using Medline from 1980 to 2002 using the keywords chronic illness, chronic disease, disability, psychological, social, outcomes and transition. Articles were also hand searched from retrieved articles. CONCLUSIONS: Young people with chronic illness have the same developmental needs as other adolescents. Traditional health care is focused on disease outcomes; however, young people do not necessarily share the same focus. Improving health outcomes for young people involves health professionals having an understanding of adolescent development and broadening the medical perspective to incorporate the developmental perspective. Building competence in young people with chronic illness, strengthening connectedness within the family, school and peer group and building the capacity of the health care team in different settings will provide opportunities to enhance resilience in young people with chronic illness. In doing so, their health outcomes will hopefully also be improved.

Adaptation, Psychological↗
PubMed2003

Adolescent chronic illness: a qualitative study of psychosocial adjustment.

INTRODUCTION: The purpose of this study was to investigate the psychosocial issues facing young people living with a chronic medical condition. MATERIALS AND METHODS: Subjects were young people with a range of medical conditions who were on a waiting list to participate in the Chronic Illness Peer Support programme at the Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia. Young people agreed to in-depth interviews which were taped and transcribed. Thematic analysis was undertaken by two researchers working independently. RESULTS: Thirty-five young people were interviewed. Thematic analysis revealed five broad themes: control (in control, under control, out of control); emotional reactions (happiness, frustration, anger, sadness, anxiety); acceptance (of illness, of others, of self); coping strategies, and; a search for meaning. The importance of social connections was emphasised. While illustrating the difficulties of managing a chronic medical condition during adolescence, a generally positive message emerges about these young people. CONCLUSIONS: Many young people with chronic illness appear relatively resilient in the face of the adjustment challenges presented by their illness. Interventions that allow a young person to explore meaning, build self-esteem, and acceptance through positive social connections are likely to improve adjustment outcomes in this group.

Adaptation, Psychological↗
PubMed2003

Adolescent admissions to a tertiary paediatric hospital: a dynamic pattern.

INTRODUCTION: Adolescent inpatient facilities emerged in Australia in the 1980s to cater for an increasing number of young people with chronic illness and disability. Yet, there is minimal published data on the number of young people admitted to hospital within these units, their unit of admission, length of stay or reason for admission. A 12-year audit of adolescents admitted to a tertiary hospital with a dedicated adolescent unit and adolescent medicine programme in Victoria, Australia, was conducted to review the pattern of hospitalisation in young people in order to provide data to assist healthcare policy and planning agendas. MATERIALS AND METHODS: Admissions to the Royal Children's Hospital in Victoria, Australia, of adolescents aged 10 years and above were reviewed over a 12-year period from 1990 to 2001. We identified the annual number of adolescents admitted, the proportion of adolescents admitted to the Adolescent Inpatient Unit (ward) and annual admissions under the Adolescent Medicine Unit (department). RESULTS: Adolescents now constitute nearly 30% of all admissions at this children's hospital. Over this period, admissions to the Adolescent Inpatient Unit have nearly doubled and annual admissions under the Adolescent Medicine Unit rose from 38 to 288. The majority of adolescents were admitted under specialty medical and surgical units. CONCLUSIONS: The knowledge that nearly one in three admissions to this tertiary children's hospital is over 10 years old should help promote the development of planning and policy agendas that better balance both health and developmental priorities in this age group.

Adolescent↗
PubMed2003

From recreation to creative expression: the essential features of an adolescent inpatient psychosocial support programme.

INTRODUCTION: Adolescent Inpatient Units are now an established component of leading tertiary children's hospitals in the developed world. While different methods have been used to provide psychosocial support in these settings, there is little recent literature about these programmes. We aimed to identify programme goals and to explore the features that are thought to underpin an effective programme. MATERIAL AND METHODS: A qualitative paradigm was used to identify the essential features of the psychosocial support programme within the adolescent inpatient unit, Royal Children's Hospital, by drawing on the practice wisdom of experts involved in the development of the psychosocial support programme since its inception over a decade ago. In-depth interviews were conducted that were analysed thematically following recording and transcription. RESULTS: Seven out of nine identified professionals were interviewed. These staff identified that while the psychosocial support programme had focussed on different activities since its inception, the goals of the program had been consistent overtime. The essential underpinning features were reported to be support for the programme and communication between multidisciplinary health professionals. When this was effective, the overarching role of the programme was reported to be the promotion of identity formation in adolescents. CONCLUSIONS: This small-scale qualitative investigation reveals that identity formation has consistently been the focus of the psychosocial support programme in our adolescent unit, despite the different ways the programme has been run over time. Findings about the importance of support and communication are essential knowledge for those considering the implementation of similar programmes.

Adolescent↗
PubMed2002

Multiple cavitating pulmonary nodules and clubbing in a 12-year-old girl.

We report on a 12-year-old girl with a prolonged history of cough and hemoptysis on three occasions. X-ray and computed tomography of the chest showed several cavitating lesions and mediastinal lymphadenopathy. Lung biopsy revealed nodular sclerosing Hodgkin's disease. Hodgkin's disease should be considered in the differential diagnosis of cavitating pulmonary lesions.

Child↗
PubMed2002

Telephone reminders improve adolescent clinic attendance: a randomized controlled trial.

OBJECTIVES: To measure the effect of telephone reminders on adolescent clinic attendance. METHODS: Clinic bookings of adolescents were randomly assigned to either a telephone reminder one day prior to their appointment, or a routine booking (no reminder). The setting was four general adolescent health clinics within a tertiary public adolescent health care service at the Centre for Adolescent Health. The main outcome measures were clinic non-attendance, reason for non-attendance, and satisfaction with the booking system. RESULTS: One hundred and seventy one adolescent appointments were studied. Of these, 51.5% were female, and 25% of bookings were for new, rather than review appointments. One hundred and one adolescents were randomly allocated to the reminder group, of whom 87% were contacted. The use of reminders (intention to treat analysis) significantly reduced the non-attendance rate from 20% to 8% (odds ratio 0.35; P = 0.03). Non-attendance was three times more likely for a new appointment than for review appointments. 'Forgetting' was the most common explanation given by patients (35%) who did not attend. Seventy-nine per cent of parents reported telephone reminders were helpful at prompting attendance. CONCLUSION: Telephone reminders greatly improved attendance at these adolescent clinics. The background non-attendance rate and the proportion of high-risk patients for non-attendance (new appointments in this setting) will determine whether reminders are more efficiently targeted at specific bookings than used routinely.

Adolescent↗
PubMed2002

Determinants of adherence in adults with cystic fibrosis.

Cystic fibrosis (CF) is now as much a disease of adults as of children and adolescents. An important focus of recent research has been the impact of the complex, expensive, and time consuming routine of self-care and medical treatment that is required by adults with CF to maintain health. A growing concern for medical and allied health teams is the issue of patient adherence to prescribed health management plans. A summary of the particular medical and treatment context of CF is followed by a review of adherence measurement issues and the determinants of adherence to treatment regimens in people with CF, primarily adults. Evidence for factors which influence adherence decisions of people with CF is examined. The medical and psychological aspects of this complex problem have not been adequately addressed because of difficulties with definition and measurement. Only a small proportion of the variance in adherence has been accounted for in the literature. New measurement technologies and new theoretical directions offer promise for a better understanding of this complex and important issue and may result in more effective intervention strategies to improve adherence.

Adult↗