Western Australian primary school teachers knowledge about childhood asthma and its management

A total of 164 primary school teachers from Perth, Western Australia anonymously completed a survey of their knowledge and attitudes about asthma. These teachers were active in assisting children with asthma management but most (91.5%) felt that they did not know enough about asthma. Attitudes toward children with asthma were positive; 97% agreed that such children should be encouraged to participate in sporting activities. Specific knowledge about asthma management and medications was, however, poor. This large sample of Western Australian teachers knew more than their European counterparts but asthma training is needed and should be targeted at improving knowledge of both regular and emergency treatments for asthma.

Cost-effectiveness analysis of humanitarian relief interventions: visceral leishmaniasis treatment in the Sudan

Spending by aid agencies on emergencies has quadrupled over the last decade, to over US$ 6 billion. To date, cost-effectiveness has seldom been considered in the prioritization and evaluation of emergency interventions. The sheer volume of resources spent on humanitarian aid and the chronicity of many humanitarian interventions call for more attention to be paid to the issue of 'value for money'. In this paper we present data from a major humanitarian crisis, an epidemic of visceral leishmaniasis (VL) in war-torn Sudan. The special circumstances provided us, in retrospect, with unusually accurate data on excess mortality, costs of the intervention and its effects, thus allowing us to express cost-effectiveness as the cost per Disability Adjusted Life Year (DALY) averted. The cost-effectiveness ratio, of US$ 18.40 per DALY (uncertainty range between US$ 13.53 and US$ 27.63), places the treatment of VL in Sudan among health interventions considered 'very flood value for money' (interventions of less than US$ 25 per DALY). We discuss the usefulness of this analysis to the internal management of the VL programme, the procurement of funds for the programme, and more generally, to priority setting in humanitarian relief interventions. We feel that in evaluations of emergency interventions attempts could be made more often to perform cost-effectiveness analyses, including the use of DALYs, provided that the outcomes of these analyses are seen in the broad context of the emergency situation and its consequences on the affected population. This paper provides a first contribution to what is hoped to become an international database of cost-effectiveness studies of health outcome such as the DALY.

Life-cycle preferences over consumption and health: when is cost-effectiveness analysis equivalent to cost-benefit analysis?

This paper studies life-cycle preferences over consumption and health status. We show that cost-effectiveness analysis is consistent with cost-benefit analysis if the Lifetime utility function is additive over time, multiplicative in the utility of consumption and the utility of health status, and if the utility of consumption is constant over time. We derive the conditions under which the lifetime utility function takes this form, both under expected utility theory and under rank-dependent utility theory, which is currently the most important nonexpected utility theory. If cost-effectiveness analysis is consistent with cost-benefit analysis, it is possible to derive tractable expressions for the willingness to pay for quality-adjusted life-years (QALYs). The willingness to pay for QALYs depends on wealth, remaining life expectancy, health status, and the possibilities for intertemporal substitution of consumption. (C) 1999 Elsevier Science B.V. All rights reserved.

The effectiveness of commercially available sports drinks

The purpose of this review is to evaluate the effectiveness of commercially available sports drinks by answering the questions: (i) will consuming a sports drink be beneficial to performance? and (ii) do different sports drinks vary in their effectiveness? To answer these questions we have considered the composition of commercially available sports drinks, examined the rationale for using them, and critically reviewed the vast number of studies that have investigated the effectiveness of sports drinks on performance. The focus is on the drinks that contain low carbohydrate concentrations (10%, which are intended for carbohydrate loading, Our conclusions are 3-fold. First, because of variations in drink composition and research design, much of the sports drinks research from the past cannot be applied direct Iv to the effectiveness of currently available sports drinks. Secondly, in studies where a practical protocol has been used along with a currently available sports beverage, there is evidence to suggest that consuming a sports drinks will improve performance compared with consuming a placebo beverage. Finally, there is little evidence that any one sports drink is superior to any of the other beverages on the market.

Transient evoked otoacoustic emissions in 6-year-old school children: a normative study

Great potential has recently been demonstrated for the application of transient evoked otoacoustic emissions (TEOAEs) in screening the hearing of school-aged children. The present study aimed to describe the range of TEOAE values obtained from a large cohort of 6-year-old children in school settings. Results indicated significant sex and ear asymmetry effects on signal-to-noise ratio, response, whole wave reproducibility, band reproducibility and noise levels. A prior history of ear infections was also shown to influence response level, whole wave reproducibility and band reproducibility. The sex, ear and history specific normative data tables derived may contribute to future improvements in the accuracy of hearing screening for 6-year-old school children.

Conversations on clinical supervision: benefits perceived by school counsellors

This Australian study describes the benefits of clinical supervision as perceived by school guidance officers who work in a large education authority. The participants were a random sample of guidance officers and senior guidance officers who agreed to participate in focus group interviews conducted via teleconference calls. The benefits of and reasons for clinical supervision graphically described by the participants raise questions about the cost of inadequate supervision to the individual counsellors themselves and to the profession as a whole. The findings become even more important when considered in light of the world of work of the 21st century.

Naltrexone in the treatment of male alcoholics - an effectiveness study in Singapore

Naltrexone has been demonstrated in western studies to be a useful pharmacological adjunct within treatment programmes for alcoholic patients. We report the first study of its efficacy and usefulness in an Asian region. This project was designed to allow naltrexone's performance to be assessed under routine clinical conditions but with patients selected on the basis of their being likely to comply. Following in-patient detoxification, 53 male alcohol-dependent patients admitted to the Alcohol Treatment Centre at Woodbridge Hospital, Singapore, were enrolled in a 12-week, placebo-controlled trial of naltrexone hydrochloride (50 mg/day). Subjects were randomized on a 2:1 basis, with 35 receiving naltrexone and 18 receiving placebo. Analyses identified that a higher percentage of naltrexone patients completed the study (40% vs. 22%). In the study non-completers, the dropout rate due to drinking relapse was also lower in the naltrexone group (9% vs. 43%). Of the 39 patients for whom drinking status over the trial could be ascertained, fewer naltrexone-treated patients drank (33% vs. 53%). Alcohol craving scores also showed a selective and distinct reduction in the naltrexone-treated group. Results suggest that naltrexone may be an effective and safe aid to treatment of alcohol dependent patients in Asian patients, for whom the aims are to reduce alcohol craving and drinking reinstatement, but where compliance is likely to be low.

The efficacy of a universal school-based program to prevent adolescent depression

Evaluated whether a universal school-based program, designed to prevent depression in adolescents, could be effectively implemented within the constraints of the school environment. Participants were 260 Year 9 secondary school students. Students completed measures of depressive symptoms and hopelessness and were then assigned to 1 of 3 groups: (a) Resourceful Adolescent Program Adolescents (RAP A), an 11-session school-based resilience building program, as part of the school curriculum; (b) Resourceful Adolescent Program-Family (RAP-F), the same program as in RAP A, but in which each student's parents were also invited to participate in a 3-session parent program; and (c) Adolescent Watch, a comparison group in which adolescents simply completed the measures. The program was implemented with a high recruitment (88%), low attrition rate (5.8%), and satisfactory adherence to program protocol. Adolescents in either of the RAP programs reported significantly lower levels of depressive symptomatology and hopelessness at post-intervention and 10-month follow-up, compared with those in the comparison group. Adolescents also reported high satisfaction with the program. The study provides evidence for the efficacy of a school-based universal program designed to prevent depression in adolescence.

Heterogeneity in inoculum potential and effectiveness of arbuscular mycorrhizal fungi

Arbuscular mycorrhizae are symbiotic associations among glomalean fungi and plant roots that often lead to enhanced water and nutrient uptake and plant growth. We describe experiments to test whether inoculum potential of arbuscular mycorrhizal (AM) fungal communities varies spatially within a broadleaf temperate forest, and also whether there is variability in the effectiveness of AM fungal communities in enhancing seedling growth. Inoculum potential of arbuscular mycorrhizal fungi in a temperate broad-leaved forest did not vary significantly among sites. Inoculum potential, measured as the extent to which the roots of red maple seedlings that had been germinated on sterile sand and then transplanted into the forest, were colonized by AM fungi, was similar in floodplain and higher elevation sites. It was as similar under ectomycorrhizal oaks as it was under red maples and other AM tree species. It was also similar among sites with deciduous understory shrubs with arbuscular mycorrhizae (spicebush, Lindera benzoin) and those with evergreen vegetation with ericoid mycorrhizae (mountain laurel, Kalmia latifolia). Where spicebush was the dominant understory shrub, inoculum potential was greater under gaps in the canopy than within the understory. Survivorship of transplanted red maple seedlings varied significantly over sites but was not strongly correlated with measures of inoculum potential. In a greenhouse growth experiment, arbuscular mycorrhizal fungal communities obtained from tree roots from the forest had different effects on plant growth. Seedlings inoculated with roots of red maple had twice the leaf area after 10 wk of growth compared to the AM community obtained from roots of southern red oaks. Thus, although there appears to be little heterogeneity in inoculum potential in the forest, there are differences in the effectiveness of different inocula. These effects have the potential to affect tree species diversity in forests by modifying patterns of seedling recruitment.