La survie implantaire suite à une réhabilitation par mise en charge immédiate d’une prothèse totale mandibulaire reliée à deux implants non jumelés : une étude pilote expérimentale

Problématique : Les connaissances théoriques et pratiques au sujet de la mise en charge immédiate d’implants non jumelés chez les édentés sont limitées. Objectifs : Cette étude avait pour but de : (1) déterminer le taux de survie implantaire de 2 implants non jumelés supportant une prothèse totale mandibulaire suite à une mise en charge immédiate, (2) évaluer les changements des niveaux osseux et de stabilité implantaire survenus sur ces 2 implants durant une période de 4 mois et les comparer à un implant témoin, et (3) décrire les complications cliniques associées à ce mode de mise en charge. Méthodologie : Chez 18 individus édentés (âge moyen de 62±7 ans), cette étude de phase I avec un design pré/post a évalué les résultats cliniques suivant la mise en charge immédiate (<48 heures) de 2 implants non jumelés par une prothèse totale mandibulaire. À l’aide de radiographies périapicales, de sondages osseux et d’analyses de la fréquence en résonnance, les niveaux osseux péri-implantaires (en mm) et les niveaux de stabilité implantairte (en ISQ) de ces 2 implants insérés dans la région parasymphysaire ont été évalués à la chirurgie (T0) et au suivi de 4 mois (T1). Un implant non submergé et sans mise en charge inséré dans la région de la symphyse mandibulaire a été utilisé comme témoin. Les données ont été analysées avec des modèles mixtes linéaires, la méthode de Tukey ajustée, l’analyse de variance de Friedman et des tests de rang signés de Wilcoxon. Résultats : De T0 à T1, 3 implants mis en charge immédiatement ont échoué chez 2 patients. Le taux de survie implantaire obtenu était donc de 91,7% (33/36) et, par patient, de 88,9% (16/18). Aucun implant témoin n’a échoué. Les changements osseux documentés radiologiquement et par sondage autour des implants mis en charge immédiatement étaient, respectivement, de -0,2 ± 0,3 mm et de -0,5 ± 0,6 mm. Les pertes d’os de support implantaire n’ont pas été démontrées statistiquement différentes entre les implants avec mise en charge immédiate et les témoins. Les niveaux moyens de stabilité implantaire ont augmenté de 5 ISQ indépendamment de la mise en charge. Les niveaux moyens d’ISQ n’ont pas été démontrés statistiquement différents entre les implants avec mise en charge immédiate et les témoins à T0 ou T1. Cinq des 18 patients n’ont expérimenté aucune complication clinique, alors que 9 en ont eu au moins deux. Hormis les échecs implantaires, aucune de ces complications n’a entraîné de changements au protocole. Conclusion : Les résultats à court terme suggèrent que : (1) le taux de survie implantaire suite au protocole immédiat est similaire à ceux rapportés lors d’un protocole de mise en charge conventionnel (2) les changements d’os de support implantaire et de stabilité ne sont pas différents comparativement à ceux d’un implant témoin, (3) un niveau élevé d’expérience clinique et chirurgicale est requis pour effectuer les procédures et pour gérer les complications associées. Ces résultats préliminaires devraient être confirmés dans une étude clinique de phase II.

Organic potatoes for processing

Drei Feldversuche auf zwei Standorten (DFH: 51°4, 9°4’, BEL: 52°2’, 8°08’) wurden in den Jahren 2002 bis 2004 durchgeführt, um den Einfluss der Vorfrucht, des Vorkeimens, der N- und K-Düngung und der Sorte auf Nährstoffverfügbarkeit, Gesamt- und sortierte Knollenerträge sowie die Qualität von Kartoffeln und deren Eignung für die industrielle Verarbeitung zu Pommes frites und Chips zu untersuchen. Bestimmt wurden die N- und K-Verfügbarkeit im Boden, die N- und K-Aufnahme von Kraut und Knollen, gesamte Frisch- und Trockenmasseerträge, sortierte Frischmasseerträge für die Verarbeitung, sowie die Gehalte der Knollen an Trockensubstanz und reduzierenden Zuckern. In einer sensorischen Prüfung wurden Qualitätsparameter von Pommes frites (Aussehen/Farbe, Textur und Geschmack/Geruch) bewertet, die gewichtet in einen Qualitätsindex eingingen. Die Qualität der Chips wurde maschinell durch den L-Wert (Helligkeit) des Produktes quantifiziert. Der Gehalt des Bodens an mineralisiertem Nitrat-Stickstoff hing von der Vorfrucht und dem Jahr ab. Nach Erbsen wurden zum Auflaufen der Kartoffeln in den Versuchsjahren 2003 und 2004 (187 und 132 kg NO3-N ha-1) die höchsten NO3-N-Werte in 0-60 cm Boden gemessen verglichen mit Kleegras (169 bzw. 108 kg NO3-N ha-1 oder Getreide (112 kg bzw. 97 kg NO3-N ha-1), obgleich die Differenz nicht in allen Fällen signifikant war. Entsprechend wurden nach Erbsen die höchsten Knollen-Frischmasseerträge (414 und 308 dt ha-1) geerntet. Dasselbe galt für die Trockenmasserträge, was belegt, dass der Trockensubstanzgehalt der Knollen bei verbesserter N-Versorgung nicht im selben Maße sinkt, wie der Frischmasseertrag steigt. Das Vorkeimen der Pflanzknollen führte zu einer rascheren phänologischen Entwicklung im Jugendstadium der Pflanze, beschleunigter Trockenmassebildung des Krautes und einer früheren Einlagerung von Assimilaten vom Kraut in die Knollen. Obwohl die positive Wirkung des Vorkeimens auf den Gesamtertrag bis Ende Juli (+ 26 in 2003 bzw. 34 dt ha-1 in 2004) im Jahr ohne Krautfäuleepidemie von den nicht vorgekeimten Varianten bis zur Endernte im September kompensiert wurde, konnte in diesem Jahr durch Vorkeimen dennoch ein erhöhter Ertragsanteil (+ 12%) der besonders nachgefragten Übergrößen (>50 mm für Pommes frites) erzielt werden. Die durchschnittliche Knollenmasse reagierte positiv auf Vorkeimen (+ 5,4 g), Sortenwahl (Sorte Agria) und ein erhöhtes N-Angebot (Leguminosenvorfrucht). Generell wurde deutlich, dass die Knollengesamterträge unter den Bedingungen des Ökologischen Landbaus (geringe bis mittlere Nährstoffversorgung, verkürzte Vegetationsdauer) sehr stark vom Anbaujahr abhängen. Die Ergebnisse belegen jedoch, dass organisch-mineralische N-K-Düngung den sortierten Ertrag an Knollen für die Verarbeitung signifikant erhöht: Höchste Gesamt- und sortierte Knollenfrischmasseerträge wurden nach kombinierter N (Horngrieß) und mineralischer K- (Kaliumsulfat) Gabe erzielt (348 dt ha-1 im Durchschnitt von 2002-2004). Im Gegensatz dazu kann eine Wirkung von Stallmist auf den Ertrag im Jahr der Ausbringung nicht unbedingt erwartet werden. Steigende Erträge nach Stallmistdüngung wurden lediglich in einem von drei Versuchsjahren (+58 dt ha-1) festgestellt und ließen sich eher auf eine K- als eine N-Wirkung zurückführen. Die Ergebnisse belegen, dass die Sortenwahl eine entscheidende Rolle spielt, wenn die Kartoffeln für die industrielle Verarbeitung zu den oben genannten Produkten angebaut werden. Insgesamt kann festgestellt werden, dass Kartoffelknollen aus ökologischen Anbauverfahren ausreichend hohe Trockensubstanzgehalte aufweisen, um für die Verarbeitung zu Pommes frites (>19%) geeignet zu sein und ohne dass dadurch die Konsistenz des Endproduktes gefährdet würde. Der Trockensubstanzgehalt der Referenzsorte für Chips, „Marlen“, unterschritt das in der Literatur geforderte Minimum für Chips von 23% lediglich, wenn die kombinierte Horngrieß-Kaliumsulfatdüngung zur Anwendung kam. Die Trockensubstanzgehalte der Knollen konnten durch Vorkeimen signifikant gesteigert werden und der Effekt war besonders groß (+1.2% absolut) in dem Jahr mit frühem Auftreten der Krautfäule (Phytophthora infestans), d.h. verkürzter Vegetationszeit. Die Knollen-Trockensubstanzgehalte waren in zwei von drei Experimenten nach Lagerung höher (+0.4 und 0.5% absolut) als noch zur Ernte. Sorten der sehr frühen und frühen Reifegruppe wiesen den größten relativen Anstieg der Gehalte an reduzierenden Zuckern (Glukose und Fruktose) während der Lagerung auf. Den mittelfrühen Sorten „Agria“ und „Marena“ hingegen kann aufgrund des von ihnen erreichten höchsten Qualitätsstandards (Pommes frites) zur Ernte eine sehr gute Eignung für die Bedingungen des Ökologischen Landbaus unterstellt werden. Die durchgehend beste Chipseignung wies die mittelfrühe Referenzsorte „Marlen“ auf. Insgesamt konnte nachgewiesen werden, dass durch gezielte Sortenwahl der Trockensubstanzgehalt und die Konzentration reduzierender Zucker, sowie die Qualität der Endprodukte (Pommes frites und Chips) gezielt beeinflusst werden kann. Im Gegensatz dazu haben acker- und pflanzenbauliche Maßnahmen wie Düngung, Wahl der Vorfrucht und Vorkeimen der Pflanzknollen einen eher geringen Einfluss. Dementsprechend sollte der Landwirt versuchen, durch die Wahl der Sorte den hohen Anforderungen der Industrie an die Rohware gerecht zu werden.

Comparing meta-analysis and ecological-longitudinal analysis in time-series studies: a case study of the effects of air pollution on mortality in three Spanish cities

The objective of this paper is to introduce a diVerent approach, called the ecological-longitudinal, to carrying out pooled analysis in time series ecological studies. Because it gives a larger number of data points and, hence, increases the statistical power of the analysis, this approach, unlike conventional ones, allows the complementation of aspects such as accommodation of random effect models, of lags, of interaction between pollutants and between pollutants and meteorological variables, that are hardly implemented in conventional approaches. Design—The approach is illustrated by providing quantitative estimates of the short-termeVects of air pollution on mortality in three Spanish cities, Barcelona,Valencia and Vigo, for the period 1992–1994. Because the dependent variable was a count, a Poisson generalised linear model was first specified. Several modelling issues are worth mentioning. Firstly, because the relations between mortality and explanatory variables were nonlinear, cubic splines were used for covariate control, leading to a generalised additive model, GAM. Secondly, the effects of the predictors on the response were allowed to occur with some lag. Thirdly, the residual autocorrelation, because of imperfect control, was controlled for by means of an autoregressive Poisson GAM. Finally, the longitudinal design demanded the consideration of the existence of individual heterogeneity, requiring the consideration of mixed models. Main results—The estimates of the relative risks obtained from the individual analyses varied across cities, particularly those associated with sulphur dioxide. The highest relative risks corresponded to black smoke in Valencia. These estimates were higher than those obtained from the ecological-longitudinal analysis. Relative risks estimated from this latter analysis were practically identical across cities, 1.00638 (95% confidence intervals 1.0002, 1.0011) for a black smoke increase of 10 μg/m3 and 1.00415 (95% CI 1.0001, 1.0007) for a increase of 10 μg/m3 of sulphur dioxide. Because the statistical power is higher than in the individual analysis more interactions were statistically significant,especially those among air pollutants and meteorological variables. Conclusions—Air pollutant levels were related to mortality in the three cities of the study, Barcelona, Valencia and Vigo. These results were consistent with similar studies in other cities, with other multicentric studies and coherent with both, previous individual, for each city, and multicentric studies for all three cities

The effects of different knowledge-dissemination interventions on the mastitis knowledge of Tanzanian smallholder dairy farmers

We developed three different knowledge-dissemination methods for educating Tanzanian smallholder farmers about mastitis in their dairy cattle. The effectiveness of these methods (and their combinations) was evaluated and quantified using a randomised controlled trial and multilevel statistical modelling. To our knowledge, this is the first study that has used such techniques to evaluate the effectiveness of different knowledge-dissemination interventions for adult learning in developing countries. Five different combinations of knowledge-dissemination method were compared: 'diagrammatic handout' ('HO'), 'village meeting' ('VM'), 'village meeting and video' ('VM + V), 'village meeting and diagrammatic handout' ('VM + HO') and 'village meeting, video and diagrammatic handout' ('VM + V + HO'). Smallholder dairy farmers were exposed to only one of these interventions, and the effectiveness of each was compared to a control ('C') group, who received no intervention. The mastitis knowledge of each farmer (n = 256) was evaluated by questionnaire both pre- and post-dissemination. Generalised linear mixed models were used to evaluate the effectiveness of the different interventions. The outcome variable considered was the probability of volunteering correct responses to mastitis questions post-dissemination, with 'village' and 'farmer' considered as random effects in the model. Results showed that all five interventions, 'HO' (odds ratio (OR) = 3.50, 95% confidence intervals (CI) = 3.10, 3.96), 'VM + V + HO' (OR = 3.34, 95% CI = 2.94, 3.78), 'VM + HO, (OR=3.28, 95% CI=2.90, 3.71), WM+V (OR=3.22, 95% CI=2.84, 3.64) and 'VM' (OR = 2.61, 95% CI = 2.31, 2.95), were significantly (p < 0.0001) more effective at disseminating mastitis knowledge than no intervention. In addition, the 'VM' method was less effective at disseminating mastitis knowledge than other interventions. Combinations of methods showed no advantage over the diagrammatic handout alone. Other explanatory variables with significant positive associations on mastitis knowledge included education to secondary school level or higher, and having previously learned about mastitis by reading pamphlets or attendance at an animal-health course. (c) 2005 Elsevier B.V. All rights reserved.

Evaluation of milk urea nitrogen as a diagnostic of protein feeding

An evaluation of milk urea nitrogen (MUN) as a diagnostic of protein feeding in dairy cows was performed using mean treatment data (n = 306) from 50 production trials conducted in Finland (n = 48) and Sweden (n = 2). Data were used to assess the effects of diet composition and certain animal characteristics on MUN and to derive relationships between MUN and the efficiency of N utilization for milk production and urinary N excretion. Relationships were developed using regression analysis based on either models of fixed factors or using mixed models that account for between-experiment variations. Dietary crude protein (CP) content was the best single predictor of MUN and accounted for proportionately 0.778 of total variance [ MUN (mg/dL) = -14.2 + 0.17 x dietary CP content (g/kg dry matter)]. The proportion of variation explained by this relationship increased to 0.952 when a mixed model including the random effects of study was used, but both the intercept and slope remained unchanged. Use of rumen degradable CP concentration in excess of predicted requirements, or the ratio of dietary CP to metabolizable energy as single predictors, did not explain more of the variation in MUN (R-2 = 0.767 or 0.778, respectively) than dietary CP content. Inclusion of other dietary factors with dietary CP content in bivariate models resulted in only marginally better predictions of MUN (R-2 = 0.785 to 0.804). Closer relationships existed between MUN and dietary factors when nutrients (CP to metabolizable energy) were expressed as concentrations in the diet, rather than absolute intakes. Furthermore, both MUN and MUN secretion (g/d) provided more accurate predictions of urinary N excretion (R-2 = 0.787 and 0.835, respectively) than measurements of the efficiency of N utilization for milk production (R-2 = 0.769). It is concluded that dietary CP content is the most important nutritional factor influencing MUN, and that measurements of MUN can be utilized as a diagnostic of protein feeding in the dairy cow and used to predict urinary N excretion.

Clinical predictors of response to cognitive-behavioural therapy in pediatric anxiety disorders: the Genes for Treatment (GXT) Study

Objective The Genes for Treatment study is an international, multisite collaboration exploring the role of genetic, demographic, and clinical predictors in response to cognitive-behavioral therapy (CBT) in pediatric anxiety disorders. The current article, the first from the study, examined demographic and clinical predictors of response to CBT. We hypothesized that the child’s gender, type of anxiety disorder, initial severity and comorbidity, and parents’ psychopathology would significantly predict outcome. Method A sample of 1,519 children 5 to 18 years of age with a primary anxiety diagnosis received CBT across 11 sites. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (posttreatment, 3-, 6-, and/or 12-month follow-up) and analyzed using linear and logistic mixed models. Separate analyses were conducted using data from posttreatment and follow-up assessments to explore the relative importance of predictors at these time points. Results Individuals with social anxiety disorder (SoAD) had significantly poorer outcomes (poorer response and lower rates of remission) than those with generalized anxiety disorder (GAD). Although individuals with specific phobia (SP) also had poorer outcomes than those with GAD at posttreatment, these differences were not maintained at follow-up. Both comorbid mood and externalizing disorders significantly predicted poorer outcomes at posttreatment and follow-up, whereas self-reported parental psychopathology had little effect on posttreatment outcomes but significantly predicted response (although not remission) at follow-up. Conclusion SoAD, nonanxiety comorbidity, and parental psychopathology were associated with poorer outcomes after CBT. The results highlight the need for enhanced treatments for children at risk for poorer outcomes.

Genome-wide association study of response to cognitive behavioural therapy in children with anxiety disorders

Background Anxiety disorders are common, and cognitive–behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent. Aims To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980). Method Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up. Results No variants passed a genome-wide significance threshold (P = 5×10−8) in either analysis. Four variants met criteria for suggestive significance (P<5×10−6) in association with response post-treatment, and three variants in the 6-month follow-up analysis. Conclusions This is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts.

The log-exponentiated Weibull regression model for interval-censored data

In interval-censored survival data, the event of interest is not observed exactly but is only known to occur within some time interval. Such data appear very frequently. In this paper, we are concerned only with parametric forms, and so a location-scale regression model based on the exponentiated Weibull distribution is proposed for modeling interval-censored data. We show that the proposed log-exponentiated Weibull regression model for interval-censored data represents a parametric family of models that include other regression models that are broadly used in lifetime data analysis. Assuming the use of interval-censored data, we employ a frequentist analysis, a jackknife estimator, a parametric bootstrap and a Bayesian analysis for the parameters of the proposed model. We derive the appropriate matrices for assessing local influences on the parameter estimates under different perturbation schemes and present some ways to assess global influences. Furthermore, for different parameter settings, sample sizes and censoring percentages, various simulations are performed; in addition, the empirical distribution of some modified residuals are displayed and compared with the standard normal distribution. These studies suggest that the residual analysis usually performed in normal linear regression models can be straightforwardly extended to a modified deviance residual in log-exponentiated Weibull regression models for interval-censored data. (C) 2009 Elsevier B.V. All rights reserved.

Prediction in Multilevel Logistic Regression

The purpose of this article is to present a new method to predict the response variable of an observation in a new cluster for a multilevel logistic regression. The central idea is based on the empirical best estimator for the random effect. Two estimation methods for multilevel model are compared: penalized quasi-likelihood and Gauss-Hermite quadrature. The performance measures for the prediction of the probability for a new cluster observation of the multilevel logistic model in comparison with the usual logistic model are examined through simulations and an application.

Local Influence Under Parameter Constraints

Calculations of local influence curvatures and leverage have been well developed when the parameters are unrestricted. In this article, we discuss the assessment of local influence and leverage under linear equality parameter constraints with extensions to inequality constraints. Using a penalized quadratic function we express the normal curvature of local influence for arbitrary perturbation schemes and the generalized leverage matrix in interpretable forms, which depend on restricted and unrestricted components. The results are quite general and can be applied in various statistical models. In particular, we derive the normal curvature under three useful perturbation schemes for generalized linear models. Four illustrative examples are analyzed by the methodology developed in the article.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Blood-nourishing and hard-softening capsule costs less in the management of osteoarthriticknee pain : A randomized controlled trial

The blood-nourishing and hard-softening (BNHS) capsule is a traditional Chinese formula used in the symptomatic treatment of inflammation and pain. We conducted this randomized controlled trial to compare the efficacy of BNHS with other commonly prescribed drugs. We recruited 120 patients from two teaching hospitals; 30 patients in each hospital were randomly assigned to receive BNHS. In one hospital, the 30 controls were given another traditional Chinese drug; whereas a Western medicine (chondroprotection drug/Viartril-s) was used as the control in the other hospital. Intervention was carried out over a period of 4 weeks. Primary outcome measures included self-reported pain level, and changes in stiffness and functional ability as measured by the Western Ontario McMaster Universities Osteoarthritis (WOMAC) index. Mixed models were used for statistical analysis. Substantial improvements in disease-specific symptoms were observed, after 4 weeks of treatment, in patients taking BNHS capsules. As assessed by the WOMAC index, pain level of the BNHS group decreased by 57% [95% confidence interval (CI) = 50, 63], stiffness by 63% (95% CI = 55, 71) and functional ability increased by 56% (95% CI = 50, 63). No significant differences were found in any of the outcome measures between the BNHS group and either of the comparison groups. No severe adverse effects were reported. However, this study lacked a placebo group; therefore, we conclude that BNHS appears to be as effective as commonly prescribed medicines for the relief of pain and dysfunction in knee osteoarthritis patients, but costs a lot less than other Western and herbal drugs in the study.

Area-level socioeconomic status and incidence of abnormal glucose metabolism : the Australian diabetes, obesity and lifestyle (AusDiab) study

OBJECTIVE--To examine the role of area-level socioeconomic status (SES) on the development of abnormal glucose metabolism (AGM) using national, population-based data.

RESEARCH DESIGN AND METHODS--The Australian Diabetes, Obesity and Lifestyle (AusDiab) study is a national, population-based, longitudinal study of adults aged [greater than or equal to] 25 years. A sample of 4,572 people provided complete baseline (1999 to 2000) and 5-year follow-up (2004 to 2005) data relevant for these analyses. Incident AGM was assessed using fasting plasma glucose and 2-h plasma glucose from oral glucose tolerance tests, and demographic, socioeconomic, and behavioral data were collected by interview and questionnaire. Area SES was defined using the Index of Relative Socioeconomic Disadvantage. Generalized linear mixed models were used to examine the relationship between area SES and incident AGM, with adjustment for covariates and correction for cluster design effects.

RESULTS--Area SES predicted the development of AGM, after adjustment for age, sex, and individual SES. People living in areas with the most disadvantage were significantly more likely to develop AGM, compared with those living in the least deprived areas (odds ratio 1.53; 95% CI 1.07-2.18). Health behaviors (in particular, physical activity) and central adiposity appeared to partially mediate this relationship.

CONCLUSIONS--Our findings suggest that characteristics of the physical, social, and economic aspects of local areas influence diabetes risk. Future research should focus on identifying the aspects of local environment that are associated with diabetes risk and how they might be modified.

Economic implications of obesity among people with atherothrombotic disease

Objective: The purpose of this study was to ascertain the impact of obesity on the cost of disease management in people with or at high risk of atherothrombotic disease from a governmental perspective using a bottom-up approach to cost estimation. In addition, the aim was also to explore the causes of any differences found.

Method: The health-care costs of obesity were estimated from 2819 participants recruited into the nationwide Australian REACH Registry with established atherothrombotic disease or at least three risk factors for atherothrombosis. Enrollment was in 2004, through primary care general practices. Information was collected on the use of cardiovascular drugs, hospitalizations and ambulatory care services. Bottom-up costing was undertaken by assigning unit costs to each health-care item, based on Australian Government-reimbursed figures 2006-2007. Linear-mixed models were used to estimate associations between direct medical costs and body mass index (BMI) categories.

Results: Annual pharmaceutical costs per person increased with increasing BMI category, even after adjusting for gender, age, living place, formal education, smoking status, hypertension and diabetes. Adjusted annual pharmaceutical costs of overweight and obese participants were higher (7 (P0.004) and 144 (0.001), respectively) than those of the normal weight participants. This was due to participants in higher BMI categories receiving more pharmaceuticals than normal weight participants. There was no significant change across the BMI categories in annual ambulatory care costs and annual hospital costs.

Conclusion: In these participants with or at high risk of atherothrombotic disease, annual pharmaceutical costs were greater in participants of higher BMI category, but there was not such a gradient in the annual hospital or ambulatory care costs. The greater cardiovascular pharmaceutical costs for participants of higher BMI categories remained even after adjusting for a range of demographic factors and comorbidities. Our results suggest that these costs are explained by the higher number of drugs used among people with atherothrombotic disease. Further investigation is needed to understand the reasons for this level of drug use.

Managing fire mosaics for small mammal conservation : a landscape perspective

1.Fire is a major driver of ecosystem structure and function worldwide. It is also widely used as a management tool to achieve conservation goals. A common objective is the maintenance of 'fire mosaics' comprising spatially heterogeneous patches of differing fire history. However, it is unclear what properties of fire mosaics most enhance conservation efforts. Here we focus on the spatial and temporal properties of fire-prone landscapes that influence the distribution of small mammals.

2.We surveyed small mammals in 28 landscapes (each 12·6km²) representing a range of fire histories in the Murray Mallee region (104 000km²) of semi-arid Australia. Generalised linear mixed models were used to examine the influence of five landscape properties on the capture rate of individual species and the species richness of native small mammals. We investigated the influence of the proportional extent of fire age-classes, the diversity of fire age-classes, the extent of the dominant vegetation type, rainfall history and biogeographic context.

3.Three of four study species were associated with the spatial extent of fire age-classes. Older vegetation was found to provide important habitat for native small mammals. Overall, however, rainfall history and biogeographic context were dominant influences: for example, the species richness of native mammals was positively associated with above-average rainfall. There was little evidence that the diversity of fire age-classes influenced either the capture rate of individual species or species richness.

4.Synthesis and applications. In fire-prone environments, habitat availability can change markedly over short time-scales. Sufficient habitat at a suitable seral stage within the landscape is a key requirement for species conservation. In mallee ecosystems, the retention of older vegetation is recommended to create more desirable fire mosaics for native small mammals. In addition to such spatial properties of mosaics that are amenable to manipulation, an understanding of how ecological processes affect the biota (such as variation in rainfall-driven productivity) is also essential for informed conservation management.