Evaluating Australia's National Medicines Policy using geographical mapping

Background: There has been a proliferation of quality use of medicines activities in Australia since the 1990s. However, knowledge of the nature and extent of these activities was lacking. A mechanism was required to map the activities to enable their coordination. Aims: To develop a geographical mapping facility as an evaluative tool to assist the planning and implementation of Australia's policy on the quality use of medicines. Methods: A web-based database incorporating geographical mapping software was developed. Quality use of medicines projects implemented across the country was identified from project listings funded by the Quality Use of Medicines Evaluation Program, the National Health and Medical Research Council, Mental Health Strategy, Rural Health Support, Education and Training Program, the Healthy Seniors Initiative, the General Practice Evaluation Program and the Drug Utilisation Evaluation Network. In addition, projects were identified through direct mail to persons working in the field. Results: The Quality Use of Medicines Mapping Project (QUMMP) was developed, providing a Web-based database that can be continuously updated. This database showed the distribution of quality use of medicines activities by: (i) geographical region, (ii) project type, (iii) target group, (iv) stakeholder involvement, (v) funding body and (vi) evaluation method. At September 2001, the database included 901 projects. Sixty-two per cent of projects had been conducted in Australian capital cities, where approximately 63% of the population reside. Distribution of projects varied between States. In Western Australia and Queensland, 36 and 73 projects had been conducted, respectively, representing approximately two projects per 100 000 people. By comparison, in South Australia and Tasmania approximately seven projects per 100 000 people were recorded, with six per 100 000 people in Victoria and three per 100 000 people in New South Wales. Rural and remote areas of the country had more limited project activity. Conclusions: The mapping of projects by geographical location enabled easy identification of high and low activity areas. Analysis of the types of projects undertaken in each region enabled identification of target groups that had not been involved or services that had not yet been developed. This served as a powerful tool for policy planning and implementation and will be used to support the continued implementation of Australia's policy on the quality use of medicines.

A review of the flower characteristics of Geraldton waxflower and factors influencing their abscission from harvested stems

Geraldton waxflower (Chamelaucium uncinatum Schauer) is Australia's most economically important cut-flower export. Its small, attractive flowers make it particularly suitable as a filler in floral arrangements. However, postharvest bud and flower abscission is a major problem during transport, handling and marketing. Abscission may be caused by wound-induced endogenous ethylene production brought about by flower tissue infection with fungal pathogens such as Botrytis cinerea. Botany and postharvest characteristics are discussed in relation to flower abscission and how resultant postharvest losses may be minimised.

Crisis, change, and institutions in forest management: the Wet Tropics of northeastern Australia

This paper tests the four-phase heuristic model of change in resource management regimes developed by Gunderson et al. (1995. In: Barriers and Bridges to the Renewal of Ecosystems and Institutions. Columbia University Press, New York, pp. 489-533) by applying it to a case analysis of rainforest management in northeastern Australia. The model suggests that resource management regimes change in four phases: (i) crisis caused by external factors, (ii) a search for alternative management solutions, (iii) creation of a new management regime, and (iv) bureaucratic implementation of the new arrangements. The history of human use arid management of the tropical forests of this region is described and applied to this model. The ensuing analysis demonstrates that: (i) resource management tends to be characterized by a series of distinct eras; (ii) changes to management regimes are precipitated by crisis; and (iii) change is externally generated. The paper concludes by arguing that this theoretical perspective oil institutional change in resource management systems has wider utility. (C) 2002 Elsevier Science Ltd. All rights reserved.

Survival of conidia of sorghum ergot (caused by Claviceps africana) on panicles, seed and soil in Australia

Macroconidia of the sorghum ergot pathogen, Claviceps africana Frederickson, Mantle & de Milliano, survived in dried honeydew on soil for 13-14 weeks in a glasshouse at ambient temperatures, but for less than half that time on seed stored in a shadehouse over summer. Those on seeds stored at 4degreesC, however, survived for over a year (58-62 weeks). During summer, conidia on ergot-infected panicles buried in soil, or on the soil surface, survived for 7.5-12 weeks, whereas over winter the survival times were 4 weeks and 19-27 weeks, respectively. Macroconidia on infected panicles held above the soil surface survived for >38 weeks (8 calendar months) over winter, suggesting that they may play a role in the perennation of C. africana in Australia.

Factors influencing the germination of macroconidia and secondary conidia of Claviceps africana

The influences of temperature, time, and moisture on the germination of macroconidia and secondary conidia of Australian isolates of Claviceps africana were studied in vitro. The optimum temperature for germination of both macroconidia and secondary conidia of C. africana was 20degreesC. Although germination of macroconidia ceased near 31degreesC, approximately 30% of secondary conidia germinated at 37degreesC after 48 and 72 h of incubation. Sorghum flower extract agar stimulated macroconidium and secondary conidium germination, irrespective of temperature. Germination of macroconidia and secondary conidia on water agar started after 4 h of incubation at 20degreesC, reaching a maximum after 16-24 h and 14 h, respectively. Maximum germination of both macroconidia and secondary conidia was at greater than or equal to-5 bars at 20degreesC. Germination of secondary conidia ceased at -35 bars, whereas macroconidia germinated at water potentials as low as -55 bars at 20degreesC.

Genotypic variation in proanthocyanidin status in the Leucaena genus

The proanthocyanidin (PA) status of 116 accessions from the Leucaena genus representing 21 species, 6 subspecies, 3 varieties and 4 interspecific hybrids was evaluated under uniform environmental and experimental conditions at Redland Bay, Queensland, Australia in October 1997. The PA content of lyophilized youngest fully expanded leaves was measured spectrophotometrically by the butanol/HCl assay referenced to L. leucocephala ssp. glabrata standard PA and expressed as L. leucocephala ssp. glabrata PA equivalents (LLPAE). Considerable interspecific variation in PA concentration existed within the genus, ranging from 0-339 g LLPAE/kg dry matter (DM). Taxa including L. confertiflora, L. cuspidata, L. esculenta and L. greggii contained very high (> 180 g LLPAE/kg DM) PA concentrations. Similarly, many agronomically superior accessions from L. diversifolia, L. pallida and L. trichandra contained extremely high (up to 250 g LLPAE/kg DM) PA concentrations, although these taxa exhibited wide intraspecific variation in PA content offering the potential to select accessions with lower (120-160 g LLPAE/kg DM) PA content. Commercial cultivars of L. leucocephala ssp. glabrata, known to produce forage of superior quality, contained low amounts of PA (33-39 g LLPAE/kg DM). Artificial interspecific hybrids had PA contents intermediate to those of both parents, Lesser-known taxa. including L. collinsii, L. lanceolata, L. lempirana, L. macrophylla, L. magnifica, L. multicapitula, L. salvadorensis and L. trichodes, contained undetectable to low (0-36 g LLPAE/kg DM) quantities of PA and have potential as parents to breed interspecific hybrids of low PA status and superior forage quality. Extractable PA was the dominant PA component, accounting for 91% of total PA within the genus. Regression analysis of accession ranks from different experiments compared to these results indicated that genetic regulation of Leucaena spp. PA content was consistent (P < 0.01) under different edapho-climatic environments. The distribution of PA within the Leucaena genus did not concur with the predictions of various evolutionary and phylogenetic plant defence theories.

Behaviour of caregivers to protect their infants from exposure to the sun in Queensland, Australia.

Exposure to the sun by infants has been demonstrated to increase the risk of the development of melanoma and other skin cancers later in life. A cohort of 508 women who delivered healthy Caucasian babies were followed up at 1 year to determine their knowledge, attitudes and practices regarding sun protection towards themselves and their child. In addition, the 1-year-old infants were assessed by a trained nurse for the number of nevi they had on their skin. Results indicate caregivers reported a high level of sun-protection practices towards their child, with 93% of the caregivers reporting usually or always placing the child in the shade when going outside. Further, 81% of the caregivers reported usually or always placing a hat on the child, while 64% reported usually or always applying sunscreen to the child's exposed skin. Interestingly, only 61% of the caregivers reported that they stayed in the shade to reduce sun exposure and only 42% wore a hat when out in the sun. Mother's own personal sun-protection methods predicted the method of sun protection that she would most likely use for the child. While children appear to be reasonably protected from the sun, they are influenced by their mother's own behaviors.

Screening for vulnerability to abuse among older women: Women's health Australia study

The validity of a brief self-report screening measure for elder abuse was examined on a nationally representative sample of more than 12,000 older women it? the baseline survey of the Australian Longitudinal Study on Women's Health. The screening instrument was a modification Of the Hwalek-Sengstock Elder Abuse Screening Test. Construct validity was examined using factor analysis and correlation with a wide range of sociodemographic, psychological. and health-related variables. Four factors, each of three items, were identified representing the following domains: Vulnerability, Dependence, Dejection, and Coercion. The Vulnerability and Coercion factors had the highest face validity for abuse and demonstrated moderate to good construct validity. The six items comprising these factors may provide a simple screening tool for elder abuse The identified correlates of abuse indicators have the potential to enhance policy development, screening, intervention, and carer support programs.

The spread of Angiostrongylus cantonensis in Australia

Until the recent establishment of Angiostrongylus cantonensis in North America. Australia was the only developed region endemic for this parasite. Almost 50 years ago the life cycle was elucidated there, in the city of Brisbane, and the first human infections probably occurred in 1959. From the 1970s, increasing numbers of autochthonous infections have been reported along the central east coast of the continent (southeast Queensland and northern New South Wales), involving humans, rats, dogs, horses, flying foxes and marsupials. Ten years ago, the parasite was discovered in Sydney, almost 1,000 km to the south, in dogs. In that city, it has since been diagnosed as a cause of neurological disease in increasing numbers of dogs, flying foxes, marsupials and zoo primates. Presumably, these infections resulted from the ingestion of snails or slugs, and it seems that virtually all species of native and exotic terrestrial molluscs can serve as intermediate hosts. It is not known how the parasite was introduced to this continent, or how it has spread over such an extensive territory, although eventually its range could encompass the entire east coast, and potentially other regions. It is also not known if the almost identical, native species, A. mackerrasae, is able to infect people (or other non-rodent hosts). All worms recovered to date, from one fatal human case, and from many animal infections, have been confirmed as A. cantonensis.

Sensitivity and specificity of pooled faecal culture and serology as flock-screening tests for detection of ovine paratuberculosis in Australia

The flock-level sensitivity of pooled faecal culture and serological testing using AGID for the detection of ovine Johne's disease-infected flocks were estimated using non-gold-standard methods. The two tests were compared in an extensive field trial in 296 flocks in New South Wales during 1998. In each flock, a sample of sheep was selected and tested for ovine Johne's disease using both the AGID and pooled faecal culture. The flock-specificity of pooled faecal culture also was estimated from results of surveillance and market-assurance testing in New South Wales. The overall flock-sensitivity of pooled faecal culture was 92% (95% CI: 82.4 and 97.4%) compared to 61% (50.5 and 70.9%) for serology (assuming that both tests were 100% specific). In low-prevalence flocks (estimated prevalence

Assault-related admissions to hospital in Central Australia

Objective: To determine the number of assault-related admissions to hospital in the Central Australia region of the Northern Territory over a six-year period. Design and setting: Retrospective analysis of all patients admitted to Alice Springs Hospital (ASH) and Tennant Creek Hospital (TCH) from July 1995 to June 2001, where the primary cause of injury was assault. Main outcome measures: Frequency of assault-related admission to hospital; demographic characteristics of the victims. Results: in the six years, there were 2449 assault-related admissions to ASH and 545 to TCH. Adults aged 25-34 years were most frequently hospitalised for assault, in a proportion greater than their proportion in the NT population, Females represented 59.7% of people admitted to ASH and 54.7% to TCH, greater than their proportion in the NT population. Aboriginals comprised 95.2% of ASH and 89.0% of TCH admissions, and were admitted in a significantly greater proportion than their proportion in the NT population (P < 0.001). The age-adjusted hospital admission rate resulting from assault has increased (P = 0.002) at an average rate of 1.6 (SE, 0.2) per 10 000 people per year. The proportion of assault-related admissions associated with alcohol has also increased significantly (P < 0.001). Conclusion: The frequency of assault-related admissions to hospital, especially among the Aboriginal population, suggests that this major public health issue is escalating.