Guidelines for the treatment of postmenopausal osteoporosis for general practitioners

BACKGROUND: Osteoporosis Australia has been committed to the education of general practitioners and the community with a series of updated guidelines on the management of osteoporosis. Since the last series was published in Australian Family Physician (August 2000), there have been further advances in our understanding of the treatments involved in both prevention of bone loss and the management of established osteoporosis. OBJECTIVE: This article represents updated guidelines for the treatment of postmenopausal osteoporosis to assist GPs identify those women at risk and to review current treatment strategies. DISCUSSION: Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonates, raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone replacement therapy has mixed risks and benefits that requires individual patient counselling.

Who does not gain weight? Prevalence and predictors of weight maintenance in young women

OBJECTIVE: To investigate the prevalence and predictors of weight maintenance over time in a large sample of young Australian women. DESIGN: This population study examined baseline and 4y follow-up data from the cohort of young women participating in the Australian Longitudinal Study on Women's Health. SUBJECTS: A total of 8726 young women aged 18 - 23y at baseline. MEASURES: Height, weight and body mass index (BMI); physical activity; time spent sitting; selected eating behaviours (eg dieting, disordered eating, takeaway food consumption); cigarette smoking, alcohol consumption; parity; and socio-demographic characteristics. RESULTS: Only 44% of the women reported their BMI at follow-up to be within 5% of their baseline BMI (maintainers); 41% had gained weight and 15% had lost weight. Weight maintainers were more likely to be in managerial or professional occupations; to have never married; to be currently studying; and not to be mothers. Controlling for sociodemographic factors, weight maintainers were more likely to be in a healthy weight range at baseline, and to report that they spent less time sitting, and consumed less takeaway food, than women who gained weight. CONCLUSIONS: Fewer than half the young women in this community sample maintained their weight over this 4y period in their early twenties. Findings of widespread weight gain, particularly among those already overweight, suggest that early adulthood, which is a time of significant life changes for many women, may be an important time for implementing strategies to promote maintenance of healthy weight. Strategies which encourage decreased sitting time and less takeaway food consumption may be effective for encouraging weight maintenance at this life stage.

The effects of status on subgroup relations

Two experiments were conducted to assess the impact of status differentials on subgroup attitudes and behaviours. In Experiment 1, 73 maths-science students were led to believe they had higher or lower status than humanities students. They then performed a non-interactive decision-making task during which they were categorized exclusively as a university student (superordinate condition), or as a university student and maths-science student simultaneously (subgroups condition). Experiment 2 (N = 98) differed from Experiment I in that perceptions of relative subgroup status were measured rather than manipulated. Consistent with social identity theory, subgroup members tended to categorize themselves more at the superordinate (university) level the lower status they considered their subgroup to be. In Experiment 2, a series of interactions also emerged, showing that status and inter-subgroup bias were positively related when the participants had been categorized exclusively at the superordinate level. When superordinate and subgroup identities were activated simultaneously, perceptions of status had no effect on levels of bias. The results were interpreted in terms of participants' needs for identity enhancement and identity distinctiveness.

Communicating vegetation management science to land managers and other stakeholders

Science communication. including extension services. plays a key role in achieving sustainable native vegetation management. One of the pivotal aspects of the debate on sustainable vegetation management is the scientific information underpinning policy-making. In recent years. extension services have Shifted their focus from top-down technology transfer to bottom-up participation and empowerment. I here has also been a broadening of communication strategies to recognise the range of stakeholders involved in native vegetation management and to encompass environmental concerns. This paper examines the differences between government approaches to extension services to deliver policy and the need for effective communication to address broader science issues that underpin native vegetation management. The importance of knowing the learning styles of the stakeholders involved in native vegetation management is discussed at a time of increasing reliance on mass communication for information exchange and the importance of personal communication to achieve on-ground sustainable management. Critical factors for effective science-management communication are identified Such as: (i) undertaking scientific studies (research) with community involvement, acceptance and agreed understanding of project objectives (ii) realistic community consultation periods: (iii) matching communication channels with stakeholder needs; (iv) combining scientific with local knowledge in in holistic (biophysical and social) approach to understanding in issued and (v) regional partnerships. These communication factors are considered to be essential to implementing on-ground natural resource management strategics and actions, including those concerned with native vegetation management.

An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland

Objective: To evaluate the pilot phase of a tobacco brief intervention program in three Indigenous health care settings in rural and remote north Queensland. Methods: A combination of in-depth interviews with health staff and managers and focus groups with health staff and consumers. Results: The tobacco brief intervention initiative resulted in changes in clinical practice among health care workers in all three sites. Although health workers had reported routinely raising the issue of smoking in a variety of settings prior to the intervention, the training provided them with an additional opportunity to become more aware of new approaches to smoking cessation. Indigenous health workers in particular reported that their own attempts to give up smoking following the training had given them confidence and empathy in offering smoking cessation advice. However, the study found no evidence that anybody had actually given up smoking at six months following the intervention. Integration of brief intervention into routine clinical practice was constrained by organisational, interpersonal and other factors in the broader socio-environmental context. Conclusions/implications: While modest health gains may be possible through brief intervention, the potential effectiveness in Indigenous settings will be limited in the absence of broader strategies aimed at tackling community-identified health priorities such as alcohol misuse, violence, employment and education. Tobacco and other forms of lifestyle brief. intervention need to be part of multi-level health strategies. Training in tobacco brief intervention should address both the Indigenous context and the needs of Indigenous health care workers.

How well do general practitioners deliver palliative care? A systematic review

General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.

Dinoflagellate symbiosis: strategies and adaptations for the aquisition and fixation of inorganic carbon

Dinoflagellates exist in symbiosis with a number of marine invertebrates including giant clams, which are the largest of these symbiotic organisms. The dinoflagellates (Symbiodinium sp.) live intercellularly within tubules in the mantle of the host clam. The transport of inorganic carbon (Ci) from seawater to Symbiodinium (=zooxanthellae) is an essential function of hosts that derive the majority of their respiratory energy from the photosynthate exported by the zooxanthellae. Immunolocalisation studies show that the host has adapted its physiology to acquire, rather than remove CO2, from the haemolymph and clam tissues. Two carbonic anhydrase (CA) isoforms (32 and 70 kDa) play an essential part in this process. These have been localised to the mantle and gill tissues where they catalyse the interconversion of HCO3- to CO2, which then diffuses into the host tissues. The zooxanthellae exhibit a number of strategies to maximise Ci acquisition and utilisation. This is necessary as they express a form II Rubisco that has poor discrimination between CO2 and O-2. Evidence is presented for a carbon concentrating mechanism (CCM) to overcome. this disadvantage. The CCM incorporates the presence of a light-activated CA activity, a capacity to take up both HCO3- and CO2, an ability to accumulate an elevated concentration of Ci within the algal cell, and localisation of Rubisco to the pyrenoid. These algae also express both external and intracellular CAs, with the intracellular isoforms being localised to the thylakoid lumen and pyrenoid. These results have been incorporated into a model that explains the transport of Ci from seawater through the clam to the zooxanthellae.

Risk and protective factors for depressive symptomatology among a community sample of adolescents and young adults

Objectives: The study explores the risk and protective factors for current depressive symptomatology in a large community sample of 15-to-24-year-olds. Methods: The study was designed as a cross-sectional household survey, which used telephone recruitment followed by an anonymous self-report postal questionnaire. The final sample included 3,082 adolescents and young adults from Queensland, Australia. Results: The vast majority of measured risk and protective factors were associated with current depressive symptomatology. Key risk factors included high levels of neuroticism, perceived problems with parents, sexual abuse, relationship breakups, educational failure and sexual identity conflict. A different profile of protective factors was evident for each of these high-risk groups. Of particular note was the importance of well-developed intrapersonal skills as protective for both males and females. The significance of social connectedness as a protective factor for the males overall and across a range of high-risk groups was a central finding. Conclusions and implications: The implications of these findings in relation to a range of mental health promotion and mental illness prevention and early intervention initiatives are discussed. Supported initiatives include parenting programs that consider the realities of modern families, increasing community awareness of the impact on young people of the breakdown of their intimate relationships, initiatives in educational settings and workplaces to increase tolerance of gay/lesbian and bisexual lifestyles and the enhancement of social connectedness.

Community-acquired Klebsiella pneumoniae bacteremia: Global differences in clinical patterns

We initiated a worldwide collaborative study, including 455 episodes of bacteremia, to elucidate the clinical patterns of Klebsiella pneumoniae. Historically, community-acquired pneumonia has been consistently associated with K. pneumoniae. Only four cases of community-acquired bacteremic K. pneumoniae pneumonia were seen in the 2-year study period in the United States, Argentina, Europe, or Australia; none were in alcoholics. In contrast, 53 cases of bacteremic K. pneumoniae pneumonia were observed in South Africa and Taiwan, where an association with alcoholism persisted (p=0.007). Twenty-five cases of a distinctive syndrome consisting of K. pneumoniae bacteremia in conjunction with community-acquired liver abscess, meningitis, or endophthalmitis were observed. A distinctive form of K. pneumoniae infection, often causing liver abscess, was identified, almost exclusively in Taiwan.