Secondary prevention of osteoporosis in Australia: Analysis of government-dispensed prescription data

Background Osteoporosis is a common cause of disability and death in elderly men and women. Until 2007, Australian Government-subsidized use of oral bisphosphonates, raloxifene and calcitriol (1α,25-dihydroxycholecalciferol) was limited to secondary prevention (requiring x-ray evidence of previous low-trauma fracture). The cost to the Pharmaceutical Benefits Scheme was substantial (164 million Australian dollars in 2005/6). Objective To examine the dispensed prescriptions for oral bisphosphonates, raloxifene, calcitriol and two calcium products for the secondary prevention of osteoporosis (after previous low-trauma fracture) in the Australian population. Methods We analysed government data on prescriptions for oral bisphosphonates, raloxifene, calcitriol and two calcium products from 1995 to 2006, and by sex and age from 2002 to 2006. Prescription counts were converted to defined daily doses (DDD)/1000 population/day. This standardized drug utilization method used census population data, and adjusts for the effects of aging in the Australian population. Results Total bisphosphonate use increased 460% from 2.19 to 12.26 DDD/1000 population/day between June 2000 and June 2006. The proportion of total bisphosphonate use in June 2006 was 75.1% alendronate, 24.6% risedronate and 0.3% etidronate. Raloxifene use in June 2006 was 1.32 DDD/1000 population/day. The weekly forms of alendronate and risedronate, introduced in 2001 and 2003, respectively, were quickly adopted. Bisphosphonate use peaked at age 80–89 years in females and 85–94 years in males, with 3-fold higher use in females than in males. Conclusions Pharmaceutical intervention for osteoporosis in Australia is increasing with most use in the elderly, the population at greatest risk of fracture. However, fracture prevalence in this population is considerably higher than prescribing of effective anti-osteoporosis medications, representing a missed opportunity for the quality use of medicines.

Multi-centre research in Australia:analysis of a recent National Health and Medical Research Council-funded project

BACKGROUND AND OBJECTIVE: Human research ethics committees provide essential review of research projects to ensure the ethical conduct of human research. Several recent reports have highlighted a complex process for successful application for human research ethics committee approval, particularly for multi-centre studies. Limited resources are available for the execution of human clinical research in Australia and around the world.

METHODS: This report overviews the process of ethics approval for a National Health and Medical Research Council-funded multi-centre study in Australia, focussing on the time and resource implications of such applications in 2007 and 2008.

RESULTS: Applications were submitted to 16 hospital and two university human research ethics committees. The total time to gain final approval from each committee ranged between 13 and 77 days (median = 46 days); the entire process took 16 months to complete and the research officer's time was estimated to cost $A34 143.

CONCLUSIONS: Obstacles to timely human research ethics committee approval are reviewed, including recent, planned and potential initiatives that could improve the ethics approval of multi-centre research.

How is leflunomide prescribed and used in Australia? analysis of prescribing and adverse effect reporting

Purpose To evaluate the use of leflunomide in the Australian community since introduction in 2000. Trends in adverse drug reaction (ADR) reporting were also studied. Methods Annual Australian prescription and dispensing statistics were analysed. Drug utilisation was estimated as defined daily doses (DDD)/1000 inhabitants/day. ADR data from the Therapeutic Goods Administration's Adverse Drug Reactions Advisory Committee (ADRAC) national monitoring system were compared with the World Health Organisation (WHO) Vigibase records. Results Leflunomide use in Australia (dispensing data) increased from 0.2 in 2000 to 0.4 DDD/1000 inhabitants/day in 2002. The same overall pattern was observed in the 'authority to prescribe' data. From 2000-2002, prescribing of the starter pack (3 x 100 mg loading dose plus 30 x 20 mg tablets) declined (down 74%); likewise for the 20mg (30 tablets) pack. Gradual increases were noted for the 10 mg (30 tablets) pack (up 40%). Approximately 135 reports, detailing about 370 individual ADR, were generated annually. Gastro-intestinal disorders predominated, accounting for 24% of reactions reported to ADRAC. Skin and appendages disorders constituted 14% of reported reactions. Deaths in leflunomide users were attributed to a combination of haematological and gastro-intestinal complications, but it was not possible to ascertain other medication usage or contributing factors. Trends observed with the ADRAC reports were consistent with the WHO database. Conclusions Leflunomide was the first registered DMARD in Australia in over a decade and its use has increased within the community. The ADR reports might have contributed to Australian rheumatologists gradually abandoning loading patients with high doses of leflunomide in favour of starting therapy at lower doses. Copyright (c) 2006 John Wiley & Sons, Ltd.

A novel species of mastrevirus (family Geminiviridae) isolated from Digitaria didactyla grass from Australia.

Mastreviruses (family Geminiviridae) that infect monocotyledonous plants occur throughout the temperate and tropical regions of Asia, Africa, Europe and Australia. Despite the identification of a very diverse array of mastrevirus species whose members infect African monocots, few such species have been discovered in other parts of the world. For example, the sequence of only a single monocot-infecting mastrevirus, Chloris striate mosaic virus (CSMV), has been reported so far from Australia, even though earlier biological and serological studies suggested that other distinct mastreviruses were present. Here, we have obtained the complete nucleotide sequence of a virus from the grass Digitaria didactyla originating from Australia. Analysis of the sequence shows the virus to be a typical mastrevirus, with four open reading frames, two in each orientation, separated by two non-coding intergenic regions. Although it showed the highest levels of sequence identity to CSMV (68.7%), their sequences are sufficiently diverse for the virus to be considered a member of a new species in the genus Mastrevirus, based on the present species demarcation criteria. We propose that the name first used during the 1980s be used for this species, Digitaria didactyla striate mosaic virus (DDSMV).

Investigating early childhood teachers’ understandings of and practices in education for sustainability in Queensland: A Japan-Australia research collaboration

In a study undertaken in Queensland, Australia, analysis of a survey that included both qualitative and quantitative questions revealed that, like their Japanese counterparts, early childhood teachers do not have well-developed ideas and practices in education for sustainability (EfS). Instead, they mainly practise traditional nature-based activities, such as gardening or playing outdoors, and teaching about resource conservation through books, posters or fact sheets. Teachers’ understandings of nature education, environmental education, and education for sustainability seem to influence their educational practices. Deeper understandings about sustainability are necessary to extend beyond such traditional practices. Even though national curriculum frameworks and guidelines point to the importance of sustainability within early childhood curriculum, these appear to be insufficient in strengthening early childhood teachers’ ideas of sustainability and how to practise it effectively. We suggest that it would be beneficial for early childhood teachers, both preservice and inservice, to have professional development opportunities that build deeper understandings of sustainability and its implementation in their settings.

Honey proteins and their interaction with polyphenols

This project aimed to determine the protein prof i les and concent rat ion in honeys, ef fect of storage condi t ions on the protein content and the interact ion between proteins and polyphenols. Thi r teen honeys f rom di f ferent botanical or igins were analyzed for thei r protein prof i les using SDS-PAGE, protein concent rat ion and phenol ic content , using the Pierce Protein Assay and Fol in-Ciocal teau methods, respectively. Protein-polyphenol interact ions were analyzed by a combinat ion of the ext ract ion of honeys wi th solvents of di f ferent polar i t ies fol lowed by LCjMS analysis of the obtained f ract ions. Results demonst rated a di f ferent protein content in the tested honeys, wi th buckwheat honey possessing the highest protein concent rat ion. We have shown that the reduct ion of proteins dur ing honey storage was caused, partially, by the protein complexat ion wi th phenolics. The LCjMS analysis of the peak elut ing at retent ion t ime of 10 to 14 min demonst rated that these phenolics included f lavonoids such as Pinobanksin, Pinobanksin acetate, Apigenin, Kaemferol and Myricetin and also cinnamic acid.

Composition of stingless bee honey: Setting quality standards

Compositional data from 152 stingless bee (Meliponini) honey samples were compiled from studies since 1964, and evaluated to propose a quality standard for this product. Since stingless bee honey has a different composition than Apis mellifera honey, some physicochemical parameters are presented according to stingless bee species. The entomological origin of the honey was known for 17 species of Meliponini from Brazil, one from Costa Rica, six from Mexico, 27 from Panama, one from Surinam, two from Trinidad & Tobago, and seven from Venezuela, most from the genus Melipona. The results varied as follows: moisture (19.9-41.9g/100g), pH (3.15-4.66), free acidity (5.9-109.0meq/Kg), ash (0.01-1.18g/100g), diastase activity (0.9-23.0DN), electrical conductivity (0.49-8.77mS/cm), HMF (0.4-78.4mg/Kg), invertase activity (19.8-90.1IU), nitrogen (14.34-144.00mg/100g), reducing sugars (58.0-75.7g/100g) and sucrose (1.1-4.8g/100g). Moisture content of stingless bee honey is generally higher than the 20% maximum established for A. mellifera honey. Guidelines for further contributions would help make the physicochemical database of meliponine honey more objective, in order to use such data to set quality standards. Pollen analysis should be directed towards the recognition of unifloral honeys produced by stingless bees, in order to obtain standard products from botanical species. A honey quality control campaign directed to both stingless beekeepers and stingless bee honey hunters is needed, as is harmonization of analytical methods. © 2007 Asociación Interciencia.

The development of teacher assessment identity through participation in online moderation

Teachers’ professional conversations regarding the qualities evidenced in student work provide opportunities to develop a shared understanding of achievement standards. This research investigates social moderation conducted in a synchronous online mode as a specific form of professional conversation. The discussion considers the different factors that influenced these conversations which included the technologic medium of the meeting. The focus of the discussion is how participation in online moderation can support teachers to develop an assessment identity as one who works within a standards-based assessment system. Qualitative data were gathered from middle school teachers from different year levels, in different curriculum areas, in diverse geographic locations, and in a range of sociocultural contexts within Queensland, Australia. Analysis of the data through a sociocultural lens of becoming suggests that participation in online moderation, while challenging for teachers, can also provide opportunities to construct and to negotiate an identity as an assessor of student work.

Delineating the practice profile of advanced practice nursing : a cross-sectional survey using the modified strong model of advanced practice

AIMS: To test a model that delineates advanced practice nursing from the practice profile of other nursing roles and titles. BACKGROUND: There is extensive literature on advanced practice reporting the importance of this level of nursing to contemporary health service and patient outcomes. Literature also reports confusion and ambiguity associated with advanced practice nursing. Several countries have regulation and delineation for the nurse practitioner, but there is less clarity in definition and service focus of other advanced practice nursing roles. DESIGN: A statewide survey. METHODS: Using the modified Strong Model of Advanced Practice Role Delineation tool, a survey was conducted in 2009 with a random sample of registered nurses/midwives from government facilities in Queensland, Australia. Analysis of variance compared total and subscale scores across groups according to grade. Linear, stepwise multiple regression analysis examined factors influencing advanced practice nursing activities across all domains. RESULTS: There were important differences according to grade in mean scores for total activities in all domains of advanced practice nursing. Nurses working in advanced practice roles (excluding nurse practitioners) performed more activities across most advanced practice domains. Regression analysis indicated that working in clinical advanced practice nursing roles with higher levels of education were strong predictors of advanced practice activities overall. CONCLUSION: Essential and appropriate use of advanced practice nurses requires clarity in defining roles and practice levels. This research delineated nursing work according to grade and level of practice, further validating the tool for the Queensland context and providing operational information for assigning innovative nursing service.

Effectiveness of pilot car operations in reducing speeds in a long-term rural highway work zone

Pilot cars are used in one-lane two-way work zones to guide traffic and keep their speeds within posted limits. While many studies have examined the effectiveness of measures to reduce vehicle speeds in work zones, little is known about the reductions achievable through the use of pilot cars. This paper examines the effectiveness of a pilot car in reducing travel speeds in a rural highway work zone in Queensland, Australia. Analysis of speed data covering a period of five days showed that a pilot car reduced average speeds at the treatment location, but not downstream. The proportion of vehicles speeding through the activity area was also reduced, particularly those traveling at 10 km/h or more above the posted limit. Motorists were more likely to speed during the day, under a 40 kh/h limit, when traffic volumes were higher and when there were fewer vehicles in the traffic stream. Medium vehicles were less likely to speed in the presence of a pilot car than light vehicles. To maximize these benefits, it is necessary to ensure that the pilot car itself is not speeding.