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

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

Evolutionary distinctiveness and status of the endangered Lake Eacham rainbowfish (Melanotaenia eachamensis)

The Lake Eacham rainbowfish (Melanotaenia eachamensis) was declared extinct in the wild in the late 1980s after it disappeared from its only known locality, an isolated crater lake in northeast Queensland. Doubts have been raised about whether this taxon is distinct from surrounding populations of the eastern rainbowfish (Melanotaenia splendida splendida). We examined the evolutionary distinctiveness of M. eachamensis, obtained from captive stocks, relative to M. s. splendida through analysis of variation in mtDNA sequences, nuclear microsatellites, and morphometric characters Captive M. eachamensis had mtDNAs that were highly divergent from those in most populations of M. s. splendida. A broader geographic survey using RFLPs revealed some populations initially identified as M. s. splendida, that carried eachamensis mtDNA, whereas some others had mixtures of eachamensis and splendida mtDNA. The presence of eachamensis-like mtDNA in these populations could in principle be due to (1) sorting of ancestral polymorphisms, (2) introgression of M. eachamensis mtDNA into M. s. splendida, or (3) incorrect species boundaries, such that some populations currently assigned to M. s. splendida are M. eachamensis or are mixtures of the two species. These alternatives hypotheses were evaluated through comparisons of four nuclear microsatellite loci and morphometrics and meristics. In analyses of both data sets, populations of M. s. splendida with eachamensis mtDNA were more similar to captive M. eachamensis than to M. s. splendida with splendida mtDNA, supporting hypothesis 3. These results are significant for the management of M. eachamensis in several respects. First the combined molecular and morphological evidence indicates that M. eachamensis is a distinct species and a discrete evolutionarily significant unit worthy of conservation effort. Second it appears that the species boundary between M. eachamensis and M. s. splendida has been misdiagnosed such that there are extant populations on the Atherton Tableland as well as areas where both forms coexist. Accordingly we suggest that M. eachamensis be listed as vulnerable, rather than critical (or extinct in the wild). Third, the discovery of extant but genetically divergent populations of M. eachamensis on the Atherton Tableland broadens the options for future reintroductions to Lake Eacham.

Neuroleptic management of schizophrenia: A survey and commentary on Australian psychiatric practice

Objective: We seek to assess Australian psychiatrists' views and practices concerning provision of neuroleptic medication to patients with schizophrenia, and to determine whether such management strategies are likely to have changed over time and the extent to which they correspond to published treatment guidelines. Method: A sample of 139 psychiatrists based in three Australian capital cities was derived, with respondents completing a brief questionnaire by choosing from a limited-option answer set. Co-authors of this paper comment on the extent to which responses are in line with contemporary recommendations driven by experts or empirical studies. Results: Overall, survey findings indicate that there has been considerable change in clinical practice over the last decade and provide some estimate of the extent to which Australian management practices are congruent with contemporary recommendations. We identify a number of issues of concern (more in relation to dose levels of neuroleptic medication rather than treatment duration) revealed by survey data and make recommendations for addressing a number of practical clinical issues. Conclusions: As this report focuses on central issues involved in managing schizophrenia, and integrates a number of treatment guidelines, we suggest that it should be of assistance for practice review by clinicians.

Environmental poisoning: Presentation and management

Environmental poisoning is most commonly associated with chronic longterm exposure to toxins rather than to acute exposure. Such repeated exposure to sublethal doses of compounds and elements presents problems in risk assessment. This is primarily because the data are unavailable to describe relationships between dose and effect at lower levels of exposure to toxins. Bioavailability of toxins also presents a problem because the data on bioavailability are sparse and seldom as high as the default of 100% bioavailability commonly used in risk assessment. Examples are presented of two toxins: arsenic as an elemental anthropogenic and geologic poison and ciguatoxin, a polyether ladder compound, as a toxin produced naturally by dinoflagellates. Bioavailability drives the toxicity of arsenic from contaminated sites, whereas tissue accumulation drives the toxicity of ciguatoxin. Considerable benefit is derived from the harmonization of regulatory processes where there is linkage of health and environmental factors in the derivation of credible risk assessment.

The management of elderly patients with femoral fractures - A randomised controlled trial of early intervention versus standard care

Objective: To determine the effect of an early intervention program in an acute care setting on the length of stay in hospital of elderly patients with proximal femoral fractures. Setting: Acute orthopaedic ward of a large teaching hospital. Design and Participants: A randomised controlled trial comparing 38 intervention patients with 33 Standard Care patients. Intervention: Early surgery, minimal narcotic analgesia, intense daily therapy and close monitoring of patient needs via a multidisciplinary approach versus routine hospital management. Main outcome measures: Length of stay (LOS); deaths; level of independent functioning. Results: Mean LOS was shorter in the Intervention group than in the Standard Care group (21 days v. 32.5 days; P<0.01). After adjusting for other factors that could affect LOS (e.g. age, sex, pre-trauma functional levels, pre-trauma comorbidity and postsurgical complications), the Intervention program was significantly predictive of shorter LOS (P=0.01). The Intervention group did not experience greater numbers of deaths, deterioration in function or need for social support than the Standard Care group. Conclusion: This early intervention program in an acute care setting results in significantly shorter length of hospital stay for elderly patients with femoral fractures.