International education services: challenges for Australia

Australian universities face a challenging task of servicing an increasingly diverse international student community in the globally competitive education market. The pressure on universities to successfully negotiate the cultural diversity and improvement in service quality will continue to increase with the global expansion of the international student market. Market forecasts indicate an increase in the number of students seeking higher education overseas by 2025 to 7.2 million. The attractiveness of the international education market in the form of both pecuniary and non pecuniary benefits will continue to create a highly competitive environment for Australia requiring Australian higher education institutions to pursue well planned strategies to maintain a globally competitive position.

Student satisfaction is a key strategic variable in maintaining such a competitive position with long term benefits arising from student loyalty, positive word of mouth (WOM) communication and image of the study destinations and to meet the challenges of increasing global competition, rising student expectations of quality, service and value for money.

This paper, based on the expectancy-disconfirmation paradigm, and using logistic regression, ANOVA and chi square testing, investigates factors that influence international postgraduate students from four Asian countries studying in Australia and concludes with strategic implications for universities

Exploring the relationship between customer loyalty to the service worker and customer citizenship behaviors to the service organization

This paper conceptualizes the positive relationship between customer loyalty to the service worker (personal loyalty) and customer citizenship behaviors to the service organization including: positive word of mouth; suggestions for improvements; customer participation in activities; benevolent acts of service facilitation; customer policing; customer flexibility; customer voice and displays of relationship affiliation.

Seasonal and diet comparisons of the diets of four dominant fish species within the main channel and flood-zone of a small intermittently open estuary in south-eastern Australia

The diets of four highly-abundant, dominant fish species within the Surrey River, a small intermittently open estuary in south-east Australia, were examined from specimens collected between July 2004 and June 2005. These four, similar-sized species (Atherinosoma microstoma, Galaxias maculatus, Philypnodon grandiceps and Pseudogobius olorum) have limited ability to spatially segregate along the length of the estuary owing to its small size relative to other estuarine habitats. All four species fed on a variety of prey items including crustaceans, insects and detritus. Despite this parity, the four species were demonstrated to occupy differing dietary niches that were concluded to be responsible for reducing interspecific feeding competition. Seasonal variations in the diets were observed for A. microstoma and Philypnodon grandiceps, with these species also exhibiting contrasting diel feeding behaviours. The closure of the estuary mouth led to the flooding of its margins, resulting in an increase in the size of the estuary and providing alternative food resources for the fish to exploit. It appears the inundation of the flood-zone facilitated further significant divergence in the diets of the fish and is likely to be of high ecological value to the estuary.

Customer citizenship behaviours : towards the development of a typology

Eight types of customer citizenship behaviours were extracted from the existing marketing literature, and the more developed organisational citizenship behaviour literature. These included: positive word of mouth behaviour; suggestions for service improvements; participation in organisation events/activities; benevolent acts of service facilitation; policing of other customers; flexibility; voice and displays of relationship affiliation. Although citizenship behaviours such as positive word-ofmouth and voice have established empirical measures, the other types of customer citizenship behaviours do not. The objective of this study, therefore, was to source, adapt and derive measures for each of the eight identified citizenship behaviours. Using exploratory and confirmatory factor analysis, these measures were validated across three service contexts.

Hunting the unobservables for optimal social security a general equilibrium approach

We study the optimal size of a pay-as-you-go social security program for an economy composed of both permanent-income and hand-to-mouth consumers. While previous work on this topic is framed within a two-period partial equilibrium setup, we study this issue in a life-cycle general equilibrium model. Because this type of welfare analysis depends critically on unobservable preference parameters, we methodically consider all parameterizations of the unobservables that are both feasible and reasonable—all parameterizations that can mimic key features of macro data (feasible) while still being consistent with micro evidence and convention (reasonable). The baseline model predicts that the optimal tax rate is between 6 percent and 15 percent of wage income.

Community water fluoridation : is it still worthwhile

Community Water Fluoridation (CWF) is the adjustment of fluoride concentration in community drinking water to a level that confers optimal protection from dental caries (Truman et al 2002). It is supported by many authorities as the single most effective public health measure for reducing dental caries (DHS 2007). It has consistently been shown to be effective in reducing the prevalence and severity of dental caries in populations following its introduction (NHMRC 1999). The most dramatic reductions (50-60%) were demonstrated in the earlier studies although more recent research has still shown reductions of between 30 and 50% (Truman et al 2002). Despite the strong scientific evidence for its beneficial effects and safety the issue of the appropriateness of CWF is often the focus of public debate. Proponents argue that it reduces dental caries. is safe and cost effective. and that it provides significant benefits to all social classes (Slade et al 1995: Slade et a 1996: Spencer et al 1996). Opponents question its efficacy and safety and argue that its addition to community water supplies is unethical mass medication (Colquhoun 1990: Diesendorf 1986: Diesendorf et al 1997).

More recently, however, there have been important questions raised regarding the continuing benefit of CWF over and above that produced by the widespread use of other sources of fluoride (toothpaste. mouth rinses. varnish and other professionally applied fluorides). Generally, dental caries has declined steeply in the last thirty years and many have observed that dental caries has also reduced in parts of Australia and other countries where there has never been CWF or where it has ceased. It has been suggested that because of the current low population levels of dental caries and the increase in alternate sources of fluoride, CWF no longer offers the benefits it may have in the past. Given this notion, together with the concerns of a minority subgroup of the population regarding the safety of CWF, it is valuable to examine current evidence to answer the question: Is there still a role for CWF in Australia?

This paper will firstly examine the history of water fluoridation and its mechanisms of action. Secondly. trends in dental decay experience over the last three decades with particular emphasis on social and geographical inequities in Australia will be described. We also review the current state of scientific evidence for the benefits of CWF including the contribution it makes to the reduction of oral health inequalities. In light of this we will provide a response to the question posed above.

Presence of fish on the shallow flooded margins of a small intermittently open estuary in South Eastern Australia under variable flooding regimes

Shallow water habitats within estuarine systems are believed to be important areas for small fish. While a wide variety of shallow habitats have been studied, the land that becomes inundated by the damming effect after the closure of intermittently open mouths has previously been overlooked. Fish were sampled monthly from both the main channel and flood zone of an intermittently open estuary between July 2004 and June 2005 using minifyke nets during the day and at night. A total of 7,787 fish were collected during the study representing 13 species and 11 families. Philypnodon grandiceps was the most abundant species and, together with Atherinosoma microstoma, Pseudogobius olorum, and Galaxias maculatus, made up 94% of the total catch. Inundation of the flood zone occurred in two discrete forms associated with mouth condition, which consisted of sporadic flooding while the mouth was open, to long-term flooding for 6 months after its closure. Large numbers of fish were captured on the flood zone, which included nine species; however, A. microstoma dominated the catch. A distinct shift in the flood zone fish assemblage occurred between the two mouth conditions, which is likely associated with changes in hydro-period and food availability of the flood zone and physico-chemical parameters in the main channel. There was no longitudinal variation in the fish assemblage in both the main channel and flood zone; similarly, the diel period was found to have little effect on the fish assemblage. The total catch per unit effort did not vary across seasons and suggests that fish abundance within the estuary is stable throughout the year. Unlike other estuarine systems where shallow water fish assemblages may be structured by variations in tide and elevation within the Surrey, freshwater inflow and, more importantly, mouth condition appear to have the greatest influence in composition of the shallow water flood zone fish assemblage of intermittently open estuaries.

Do mass media campaigns capture and describe the experience of stroke symptoms?

Introduction: In 2006, the National Stroke Foundation of Australia launched the FAST (Face, Arm, Speech)/ Signs of Stroke (SOS) (5 symptom categories) campaigns designed to improve public awareness of stroke symptoms and the sense of urgency to present to hospital. However, there is little published review of how well such campaigns capture and describe the experience of stroke. This study aims to examine the awareness, content and language of the FAST/SOS campaigns by those experiencing stroke symptoms.
Methods: Interviews were conducted with either the stroke patient or a witness (incapacitated patients) whilst an inpatient at Box Hill or Maroondah Hospitals between August 2006 through April 2008. They were asked to describe awareness of campaigns, symptoms experienced (recorded verbatim and coded into campaign symptom categories) and to evaluate the descriptions of “Signs of Stroke” against their own experience (exact, somewhat, or not at all).
Results: Of 239 eligible stroke cases, 167 (70%) were interviewed (100 patients and 67 witnesses). Few (n= 20, 12%) were aware of the FAST campaign and only 16% recalled all three symptoms. Most recalled that it was “something” to do with the face, however facial droop (n=6) was less commonly experienced compared to speech impairments (n=16) and arm drift (n=13). FAST symptoms detected 84% (patients 77% and witnesses 94%) and SOS symptoms 100% of stroke patients. Patients not describing a FAST symptom (n=27) described: arm or hand numbness; hand incoordination; leg impairments; vision disturbances; or collapse. Approximately, half of patients and witnesses thought the SOS descriptions of the most commonly detected symptoms (arm/leg/face weakness or paralysis or numbness and speech impairments) exactly described the experience. Common language used to describe symptoms were: incoordination of hands or limbs; sudden difficulty walking; drooped/dropped face or mouth; slurred or loss of speech; pins and needles or tingling.
Conclusion: Both campaigns identified symptoms most commonly detected in those experiencing and reacting to symptoms. Both campaigns could portray symptoms more realistically using common descriptors without impacting on the simplicity of the messages

Invertebrate larval dynamics in seasonally closed estuaries

Estuarine benthic assemblages are often numerically dominated by polychaetes. The limits of these populations are determined by larval, and probably to a lesser extent adult movement. A previous study (Newton 1996), indicated that planktonic polychaete larvae were very abundant over the summer months in the Hopkins River; however, the identification and source of these larvae was not known. Defining the extent of a population, and therefore the likelihood of that population recovering following a perturbation, is crucial for effective estuarine management. This study investigated both the likely source of the larvae, (i.e. estuarine or marine) and the extent of larval dispersal within and between estuaries by addressing the following questions: Which taxa produced the planktonic larvae? Are these taxa resident estuarine species? Are the larvae of different taxa evenly distributed within the estuary or do physicochemical parameters or other factors influence their abundance? Are the same larvae found in other estuaries along the coast? and Is there exchange of these larval taxa with the marine environment and other estuaries? Larvae were identified and described by culturing commonly occurring planktonic larvae until adult characteristics appeared. The spionids, Carazziella victoriensis and Prionospio Tatura, numerically dominated the plankton in the Hopkins and the spionid, Orthoprionospio cirriformia was recorded from the Hopkins, Curdies and Gellibrand estuaries. Two spionids, Carazziella sp. and Polydora sp. were identified from tidal waters. Mouth status and physicochemical conditions (salinity, temperature and dissolved oxygen) were monitored in each estuary. Whereas the Merri and Gellibrand estuaries were predominantly stratified over the sampling period, the Curdies was more often well mixed and the Hopkins varied from well mixed to stratified. The duration of mouth opening and hence the opportunity for larval exchange also varied in each estuary. The Merri River was closed for 13.5% of days over the study period, the Gellibrand River for 18.4%, the Hopkins River for 49% and the Curdies River for 71.0%. The distributions of larvae at spatial scales of metres, 100s of metres and kilometres were investigated within a single estuary. While the same larvae, C. victoriensis, P. Tatura and bivalve larvae, were found along the length of the Hopkins estuary the abundances varied at different spatial scales suggesting different processes were influencing the distribution of P. Tatura larvae, and C. victoriensis and bivalve larvae. The distribution of larvae between several estuaries was investigated by monitoring meroplankton at two sites at the mouth of each of the four estuaries approximately monthly (except for winter months). Different meroplanktonic assemblages were found to distinguish each estuary. Further, C. victoriensis and P. Tatura larvae were only recorded in the Hopkins but larvae of the spionid, Orthoprionopio cirriformia were detected in the Hopkins, Curdies and Gellibrand estuaries. The extent of larval exchange with other estuaries and the marine environment was determined by monitoring tidal waters. Settlement trays were also deployed to determine if larvae were moving into estuaries and settling but not recruiting. P. tatura larvae were not detected in the tidal waters of any estuary and while C. victoriensis and O. cirriformia were found in both flood and ebb tides there was no evidence of movement of theses taxa to other estuaries. Larvae of the spionids, Carazziella sp. and Polydora sp., were found in tidal waters of each estuary but were rarely detected in the plankton within the estuaries. Neither species was found as an adult in background cores from any estuary, nor with the exception of a few individuals in the Merri, were they detected in settlement trays in any estuary. I conclude that the source of the larvae of C. victoriensis, P. Tatura and O. cirriformia is estuarine and while C. victoriensis, and O. cirriformia move in and outh of the source estuary in tidal waters there was no evidence for movement to other estuaries. The spionids, Carazziella sp. and Polydora sp were considered to be marine and while they moved in and out of estuaries in tidal waters they did not usually settle in the estuaries. The results of this study are a crucial first step in the development of ecological models to better understand dispersal in seasonally closed estuaries that are typical of southern Australia. This study emphasises the unique physicochemical characteristics and biological assemblages within these estuaries and the need for estuarine management to reflect these differences.

Ecology of epifaunal caridean shrimps in the Hopkins River estuary, and the role of estuaries in the life history of the atyid "Paratya Australiensis" Kemp, 1917 in south-eastern Australia

This study examined the factors affecting the distribution and abundance of epifaunal caridean shrimps in seagrass meadows of the Hopkins River estuary in south-western Victoria, Australia, and investigated the life history patterns of the freshwater Parana australiensis, found for the first time in estuaries. Adult and sub-adult shrimps were surveyed in seagrass meadows along the estuary over two years, and their planktonic larvae were surveyed in adjacent waters. Three species were collected. The marine Palaemon serenus occurred only near the mouth, summer to autumn, in high salinities. The marine/estuarine Macrobrachium intermedium occurred throughout the estuary. Adults were most abundant in late autumn, and least abundant in summer (unlike trends reported in marine meadows). Densities were higher and less variable in downstream meadows. P. australiensis occurred in the upper estuary all year, most abundantly in spring, due to migration from the river after peak discharge. Ovigerous females dominated, while males, showing less migration into the estuary, dominated above estuarine influence. Adults disappeared from the estuary in summer as salinity rose. Breeding period for P. australiensis was briefer in the estuary (September-December) than upstream (July-April). M. intermedium began breeding later in the upper estuary (November/December-March) than in the lower estuary (October-March), probably reflecting a physiological response to lower salinity, rather than an interaction with P. australiensis. No ovigerous P. serenus were found in the estuary. Larvae of P. australiensis and M intermedium occurred abundantly throughout the estuary, but P. serenus larvae did not. P. australiensis was an early coloniser to the plankton after peak discharge (November-December). Larvae concentrated in the deep saline layer at the head of the intruding salt wedge, thus probably maintaining longitudinal position. Diurnal vertical migrations were evident within the salt wedge, and in a deep pool above tidal influence. M. intermedium larvae occurred October-May in the lower estuary and November-April in the upper estuary, peaking in abundance one to two months after P. australiensis. They were associated with low surface flows and surface salinities greater than 10, over an anoxic deeper layer. All three species exhibited extended development of euryhaline larvae in the laboratory. Tolerances and optimal salinities of larvae of the three species reflected their distributions. M. intermedium was the most euryhaline species. P. australiensis larvae were tolerant of higher salinities than juveniles of adults: capable of developing in salinity of at least 15. Most P. australiensis juveniles recruited to the estuary November-December, after which numbers declined dramatically. After settlement, most recruits probably migrated upstream out of the estuary. Two cohorts of M. intermedium recruited to the estuary from larvae in summer (December and February), but some juveniles also migrated from adjacent coastal waters. Post-larval migration was at least as important a determinant of abundance as direct recruitment from estuarine, planktonic larvae in all three species. Distributions among seagrass meadows along the estuary were determined primarily by physico-chemical patterns driven by hydrological changes. Seasonal variations in salinity and temperature were strongly associated with seasonal variations in shrimp abundance. Salinity tolerances of adults of the three species reflected their distribution patterns. Biotic interactions were more important in determining distributions within meadows. P. australiensis, when abundant, were associated with seagrass biomass. M. intermedium were also, but when seagrass was sparsest and least extensive. The two species apparently partitioned the seagrass meadow according to depth in early summer. Laboratory experiments suggested P. australiensis was displaced from deeper water by M. intermedium. Preference for vegetative complexity and competition for position within meadows suggest the underlying importance of predation in regulating shrimp populations. A survey of south-eastern Australian estuaries found P. australiensis larvae abundant in all stable, open, well-developed, salt-wedge estuaries where adults were abundant. Adults were most abundant in low salinities among submerged leafy macrophytes. Reproductive traits of P. australiensis were compared in estuarine and fresh reaches of three rivers. Early in the breeding season, egg size was smaller, and (size-specific) egg number larger in estuaries than upstream. A trade-off between egg size and egg number resulted in no difference in total (size-specific) reproductive investment between locations. Reproductive investment tended to decrease at some locations over the breeding season, and this decrease was a result of decreased egg size in most cases. The decrease in reproductive investment probably reflected reduced food availability for the adult, while the reduced egg size was probably a response to improved conditions for larval development. In the Hopkins River, larger egg size at upstream sites was reflected in larger early stage larvae. Later stage larvae were larger in the estuary, suggesting more favourable conditions for larval development. Allozyme electrophoresis showed the P. australiensis populations in each of the three rivers to be distinct. Allozyme frequencies were not different within the Hopkins River, but upstream and estuarine locations in the Curdies and Gellibrand were different. Although some variation in reproductive traits within catchments may have been due to genotypic differences, trade-offs between egg size and number, and decreases in egg size over summer were probably due to plastic responses to environmental cues. It is proposed P. australiensis inhabits and reproduces in both estuarine and freshwater environments by plastic response to environmental conditions. Recruitment to estuaries is dependent on the presence of suitable adult, littoral habitat, and a stable salt wedge for larval retention. Estuaries are important recruitment sites for P. australiensis, potentially allowing an extra brood each year before riverine recruitment. Estuarine broods could constitute a large part of the total fecundity of P. australiensis females. Euryhaline larvae and estuarine recruitment of P. australiensis suggest marine transport of larvae between estuaries as a possible dispersal mechanism for Paratya species.

Population dynamics of the infaunal bivalve, Soletellina alba

The population dynamics of the infaunal bivalve Soletellina alba was investigated at three sites situated within close proximity to the mouth of the Hopkins River estuary. The initial study design was planned to examine the importance of winter flooding to the persistence of this bivalve mollusc within the Hopkins estuary, since mass mortalities have been observed during previous years coincident with periods of winter flooding. Unfortunately, the climatic conditions experienced during this study were atypical compared to the long-term average, so detailed sampling was limited to two, unanticipated, non-flood years rather than two, highly anticipated, flood years. This hampered my ability to conduct complete tests of the importance of winter flooding. Patterns of river discharge and the frequency and duration of mouth opening and closing differed greatly from that expected. Unexpectedly, periods of mouth closure were not always associated with periods of minimal river discharge; low salinities were another unexpected result during an extended period of mouth closure during 1998. As expected, salinities varied considerably with increasing water depth when the estuary mouth was open. Mouth closure lead to salinities becoming more uniform between water depths but hypoxic and anoxic conditions became evident via stratification in the water column at 1 m below the Australian Height Datum (AHD). Other than trends associated with increased water depth, significant variation was not evident between measurements of salinity taken from three sites within close proximity of the estuary mouth (approximately 500 m), or during changes in tide. The most pertinent anomaly was the absence of winter flooding. The distribution and abundance of juvenile and adult S. alba was variable across all Dates, Sites and Channel elevations (i.e. water depths) sampled during this study. An experimental test comparing the recruitment of juveniles at different channel elevations and in sediments of varying particle size was conducted during an exceptionally successful period of recruitment during 1999. The results of these tests showed that recruitment was greatest at the shallowest channel elevation used, and there was little evidence that sediment particle size influenced recruitment. In contrast to 1999, recruitment during 1997 or 1998 was extremely poor. Growth rates were monitored using tagged individuals held in caged and uncaged plots, which revealed that growth was highly variable among individuals, but not between Sites. These tests also revealed that growth was negligible during the colder, winter months, and that the fastest growing individuals were capable of growing 0.2 mm/day. Mixed results were obtained for tests of potential cage artifacts and the influence of handling. Caging and differing amounts of handling did not appear to influence growth, but there was evidence that cages and handling influenced bivalve condition and number of mortalities. These direct tests appeared to be the most appropriate method for determining growth rates of this species, since attempts to analyse length-frequency data were made difficult by the apparent convergence of cohorts, and shell aging is difficult due to the thin, fragile nature of the shell. As expected, mass mortalities were observed during the flood of 1996, but not during the two non-flood years of 1997 and 1998. There were, however, some considerable declines in abundances at some channel elevations during the two non-flood years. However, these declines were attributable to the complete disappearance of individuals, rather than the sudden presence of numerous, recently dead individuals that typify observed declines during winter flooding. The complete disappearance of individuals suggest that S. alba may be capable of post-settlement emigration, or that they were consumed by an unknown predator. Salinity tolerance tests showed that bivalves exposed to low salinities (≤6 ppt), exhibited poorer condition and took longer to re-burrow into sediments than those exposed to greater salinities (≥14 ppt), while death of bivalves exposed to salinities ≤1 ppt occurred after 8 days of exposure. These tests provide evidence that low salinities are probably the principal cause of mass mortalities during winter flooding, although the interaction between salinity, temperature and turbidity also deserve consideration. The results of this study indicate that certain aspects of winter flooding, especially salinity, are responsible for the mass mortalities of S. alba rather than the result of a short-lived life history. I hypothesise that the survival of very young juveniles (between 0.5 and 1 mm shell length) and rapid growth rates are important features of the life history of S. alba that explain its successful persistence within the Hopkins River estuary. The rapid rates of growth suggest that it may be possible for juveniles that survive winter flooding to grow, reach sexual maturity, and reproduce before the onset of the next flood event. Unfortunately, the increased survivorship of juveniles during periods of winter flooding was not demonstrated by this study because of the absence of winter flooding and also relatively poor recruitment. It is highly likely that this species is capable of completing it entire life cycle within the estuary since the absence of other nearby populations, together with periods of mouth closure, are likely to greatly limit the potential contribution made by larvae entering from the surrounding marine environment. This study has added considerably to our knowledge of how infauna cope with life in the intermittently closing estuaries that typify semi-arid coastlines in the Southern Hemisphere.

The trophic effect of dietary fibre is not associated with a change in total crypt number in the distal colon of rats

Soluble fibres, such as guar gum, promote and wheat bran or methylcellulose protect from chemically induced colon carcinogenesis, relative to the effect of a fibre-free diet in rats. Mechanisms are poorly understood. Whereas all fibres are trophic to the colonic epithelium, the heterogeneity of effects on carcinogenesis may reflect different effects on the total number of crypts and, therefore, the size of the stem cell population. This study aimed to assess this hypothesis. Sprague–Dawley rats were fed one of fibre-free diets with or without 10% wheat bran, methylcellulose or guar gum for 4 weeks. The distal colons were stained with methylene blue and quantified for the number and density of crypts using an image analysis system. Epithelial proliferative kinetics was measured stathmokinetically. Methodology for quantifying crypts was valid and reproducible. Rats fed a fibre-free diet had atrophic distal colon, as shown by a decrease in crypt column height and a lower mitotic index. Fibre supplementation prevented the atrophy and was associated with crypt mouth areas that were 30–60% larger than those in the fibre-free group (P < 0.001, ANOVA), with the methylcellulose group being the largest (1.16 µm2). The crypt density of the fibre-free group was 16–19% greater than those in fibre fed groups (P + 0.006), due to the smaller size of the crypts. However, there was no difference in the total number of crypts across the four dietary groups (P > 0.1). Distal colons in all of the dietary groups contained ~105 crypts. In conclusion, although variation in the amount or type of dietary fibre exerts heterogeneous effects on the growth of the colonic epithelium and on colon carcinogenesis, the total number of crypts in the distal colon remains constant. It is, therefore, unlikely that fibres influence carcinogenic events by altering the size of the stem cell population.

Fish use of flooded margins of an intermittently open estuary

Fish communities in the shallow flooded margins of an intermittently open estuary were examined over an 18 month period. A distinct shift in the fish assemblage occurred when the mouth of the estuary closed and was associated with changes in the hydro-period, food availability and physico-chemical changes in the main channel.

Utilizing and adapting leisure constraints models to enhance 'short-break' vacations : case study of Melbourne, Australia

Short-break tourism is likely to continue as a popular vacation for time-, income- and special interest conscious tourists. With the competition for visitors, destinations need to consider the constraints and facilitators associated with tourist decision-making for short-break vacations. This study presents the application of a leisure model toward better explaining such vacation choices. This study found key constraints, such as time and awareness, inhibited visitors from visiting attractions. The importance and influence of word-of-mouth recommendations plays a key role in gaining the attention of future visitors.

Olanzapine / fluoxetine combination for treatment resistant depression : efficacy and clinical utility

Antidepressant monotherapy is a first-line treatment for depression; however, not all sufferers will adequately respond to treatment. When treating a patient with treatment-resistant depression, the clinician needs to consider all factors which may contribute to an inadequate response to an antidepressant. These include accuracy of diagnosis and medication adherence, as well as the patient’s personality, lifestyle, life events and social circumstances. If it is determined that treatment resistance is due to failure of efficacy of antidepressant monotherapy, then an augmentation strategy using an atypical antipsychotic may be considered. Treatment using olanzapine/fluoxetine combination (OFC) is one of many options. Four randomized, acute-phase trials have suggested OFC is useful for reducing Montgomery–Åsberg Depression Rating Scale scores after inadequate response to antidepressant monotherapy. OFC has been useful at doses of olanzapine/fluoxetine 6/25, 6/50, 12/25 and 12/50 mg/day, with 1/5 mg/day suggested to be an ineffective dose. Treatment with OFC has been associated with some side effects, including weight gain and the metabolic syndrome, somnolence, dry mouth, increased appetite and headache. Treatment decisions therefore need to be made to balance the risks and benefits.