General practitioners' role in preventive medicine: scenario analysis using alcohol as a case study

The purpose of this analysis is threefold: first, to extract from the literature, current levels of GP detection of at-risk drinking by their patients, rates at which general practitioners (GPs) offer an intervention; and the effectiveness of these interventions; secondly, to develop a model based on this literature to be used in conjunction with scenario analysis; and thirdly, to consider the cost implications of current efforts and various scenarios. This study deals specifically with Australian general practice. A two-step procedure is used in the scenario analysis, which involves identifying opportunities for detection, intervention, effectiveness and assigning probabilities to outcomes. The results suggest that increasing rates of GP intervention achieves greatest benefit and return on resource use. For every 5% point increase in the rate of GP intervention, an additional 26 754 at-risk drinkers modify their drinking behaviour at a cost of $231.45 per patient. This compares with a cost per patient modifying drinking behaviour of $232.60 and $208.31 for every 5% point increase in the rates of detection and effectiveness, respectively. The knowledge, skill and attitude of practitioners toward drinking are significant, and they can be the prime motivators in persuading their patients to modify drinking behaviour.

A comparison of surface brightness profiles for ultracompact dwarfs and dwarf elliptical nuclei: implications for the “threshing” scenario

Using imaging from the Hubble Space Telescope, we derive surface brightness profiles for ultracompact dwarfs in the Fornax Cluster and for the nuclei of dwarf elliptical galaxies in the Virgo Cluster. Ultracompact dwarfs are more extended and have higher surface brightnesses than typical dwarf nuclei, while the luminosities, colors, and sizes of the nuclei are closer to those of Galactic globular clusters. This calls into question the production of ultracompact dwarfs via threshing, whereby the lower surface brightness envelope of a dwarf elliptical galaxy is removed by tidal processes, leaving behind a bare nucleus. Threshing may still be a viable model if the relatively bright Fornax ultracompact dwarfs considered here are descended from dwarf elliptical galaxies whose nuclei are at the upper end of their luminosity and size distributions.