A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral -126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar - almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was f52.85 for those in urban areas and f59.93 per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was f47.13 for urban patients and f48.77 for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.

Promotion of motoneuron survival and branching in rapsyn-deficient mice

Inhibition of programmed cell death of motoneurons during embryonic development requires the presence of their target muscle and coincides with the initial stages of synaptogenesis. To evaluate the role of synapse formation on motoneuron survival during embryonic development, we counted the number of motoneurons in rapsyn-deficient mice. RaDsyn is a 43 kDa protein needed for the formation of postsynaptic specialisations at vertebrate neuromuscular synapses. Here we show that the rapsyn-deficient mice have a significant increase in the number of motoneurons in the brachial lateral motor column during the period of naturally occurring programmed cell death compared to their wild-type littermates. In addition, we observed an increase in intramuscular axonal branching in the rapsyn-deficient diaphragms compared to their wild-type littermates at embryonic day 18.5. These results suggest that deficits in the formation of the postsynaptic specialisation at the neuromuscular synapse, brought about by the absence of rapsyn, are sufficient to induce increases in both axonal branching and the survival of the innervating motoneuron. Moreover, these results support the idea that skeletal muscle activity through effective synaptic transmission and intramuscular axonal branching are major mechanisms that regulate motoneuron survival during development. (C) 2001 Wiley-Liss, Inc.

Ethephon promotion of crop abscission for unshaken and mechanically shaken macadamia

Promotion of fruit abscission in macadamia, Macadamia integrifolia (Proteaceae), has potential to reduce costs associated with prolonged harvesting of late-abscising cultivars. Effects of ethephon [(2-chloroethyl) phosphonic acid] on fruit removal force and crop abscission were monitored at 3 stages of the harvest season on both unshaken and mechanically shaken trees of the late-abscising macadamia cultivar A16. Ethephon application, tree shaking, or a combination of the 2 methods, accelerated crop removal from the tree at all stages during harvest. Early harvest before natural abscission resulted in little or no difference in nut-in-shell and kernel weight, kernel recovery and kernel oil content. Delaying ethephon application or tree shaking until commencement of natural abscission resulted in greater crop removal. Fruit removal force declined naturally towards 1 kgf at this stage, and was further reduced by ethephon application. The most effective approach for harvest acceleration was to reduce fruit removal force, before tree shaking, by spraying trees with ethephon.

Differences in physical activity between black and white girls living in rural and urban areas

This study examined the relationship of race and rural/urban setting to physical, behavioral, psychosocial, and environmental factors associated with physical activity. Subjects included 1,668 eighth-grade girls from 31 middle schools: 933 from urban settings, and 735 from rural settings. Forty-six percent of urban girls and 59% of rural girls were Black. One-way and two-way ANOVAs with school as a covariate were used to analyze the data. Results indicated that most differences were associated with race rather than setting. Black girls were less active than White girls, reporting significantly fewer 30-minute blocks of both vigorous and moderate-to-vigorous physical activity. Black girls also spent more time watching television, and had higher BMIs and greater prevalence of overweight than White girls. However, enjoyment of physical education and family involvement in physical activity were greater among Black girls titan White girls. Rural White girls and urban Black girls had more favorable attitudes toward physical activity. Access to sports equipment, perceived safety of neighborhood, and physical activity self-efficacy were higher in White girls than Black girls.

A clinical audit of the prescribing of celecoxib and rofecoxib in Australian rural general practice

Aims The new cyclooxygenase-2 (COX-2) selective inhibitors, celecoxib (Celebrex®) and rofecoxib (Vioxx®), have been widely prescribed since their launch. No reviews currently appear in the literature of prescribing patterns in Australia. This paper describes a self-audit of the clinical use of selective COX-2 inhibitor therapy undertaken with rural general practitioners (GPs) in Australia. Methods A structured audit form was developed and distributed to interested GPs. The form was self-administered and focused on issues about COX-2 inhibitors and the types of patients who were receiving them, e.g. indications, patient demographics, risk factors and drug interactions. Results A total of 627 patients were recruited (569 celecoxib and 58 rofecoxib). A range of doses was prescribed. Osteoarthritis was the most common indication (68.1%). Risk factors known for the nonselective nonsteroidal anti-inflammatory drugs were identified in 65.1% of patients, with the most common being advanced age, hypertension and previous peptic ulcer disease. Potential drug interactions were common. A variety of reasons for initiation of therapy was identified; these included perceived increased efficacy, safety and failure of other treatment. Conclusions These results show that COX-2 inhibitors are being prescribed for patients with multiple risk factors that may place the patient at increased risk of adverse drug reactions to a COX-2 inhibitor. The perception of improved safety and efficacy was common and is of concern. Limitations of the study include the reliance on self-reporting.

Remitting behaviour of Nepalese rural-to-urban migrants: Implications for theory and policy

This article uses data for Nepal to test contemporary hypotheses about the remitting behaviour and associated motives of rural-to-urban migrants and to consider the likely impact of such remittances on rural development. Possibilities for inheritance, degree of family attachment, likelihood of eventual return to place of origin and family investment in the education of the migrants are found to be significant influences on levels of remittances by Nepalese migrants. However, in Nepal, remittances do not seem to result in long-term capital investment in rural areas and so may not promote long-term development of these areas.

Rural lines of flight: Telecommunications and post-metro dreaming

Information and communications technologies hold a prominent place in the cultural imagination of many people living outside the Australian metropolis, especially recent émigrés. A vision of a wired pastoral conjures up the possibilities of city work, connections and pleasures accompanying the flight to the country. Such aspirations have given a twist to one of the great topos of Australian post-invasion communications history, communications ameliorating the perceived isolation in the bush. This article examines important changes to rural telecommunications in the 1990s coinciding with post-metro dreaming and digital convergence, namely the rise of local telecommunications. Neo-Foucauldian accounts of citizenship hold some promise for explaining the criss-cross of tangled lines of flight in regional communications in the twenty-first century: emergent subjectivities, utopian digital modes of becoming, new politics of infrastructure, reconfigured relationships among state, market and citizen.