Review: insights gained from modelling high-grade glioma in the mouse.

High-grade gliomas (HGGs) are devastating primary brain tumours with poor outcomes. Advances towards effective treatments require improved understanding of pathogenesis and relevant model systems for preclinical testing. Mouse models for HGG provide physiologically relevant experimental systems for analysis of HGG pathogenesis. There are advantages and disadvantages to the different methodologies used to generate such models, including implantation, genetic engineering or somatic gene transfer approaches. This review highlights how mouse models have provided insights into the contribution of specific mutations to tumour initiation, progression and phenotype, the influence of tumour micro-environment, and the analysis of cell types that can give rise to glioma. HGGs are a heterogeneous group of tumours, and the complexity of diverse mutations within common signalling pathways as well as the developmental and cell-type context of transformation contributes to the overall diversity of glioma phenotype. Enhanced understanding of the mutations and cell types giving rise to HGG, along with the ability to design increasingly complex mouse models that more closely simulate the process of human gliomagenesis will continue to provide improved experimental systems for dissecting mechanisms of disease pathogenesis and for preclinical testing.

Rural residents' utilisation of health and visiting specialist health services.

INTRODUCTION AND OBJECTIVES: The purpose of the study was to identify the demographic and health service characteristics impacting on rural residents' utilisation of health and visiting specialist services in Western Australia. METHOD: Focus group discussions were held with an age-stratified, randomly selected group of forty-eight residents in four rural Western Australian towns between May and June 2000. RESULTS: Discussions revealed a preference to use local health services for basic care and to travel for the treatment of major or severe illnesses. The focus group participants supported visiting specialist services, indicating a willingness to use them for consultations, diagnostic and minor procedures. Utilisation of visiting services was conditional on the provision of information on specialist reputation, service outcomes, integration of the service into local facilities, and recommendation by the local general practitioner. CONCLUSION: Numerous factors influence the service-seeking behaviour of rural patients. These factors need to be recognised and considered in the design and promotion of resident and visiting specialist services if the migration for health care is to be rationalised.

Costs of accessing surgical specialists by rural and remote residents.

INTRODUCTION: Access to surgical specialist services by rural and remote residents in Australia is limited. Little information is available on the cost to rural residents of accessing specialist treatment. The aim of the present study was to define the personal costs incurred by country patients in Western Australia when accessing specialist surgical services in a rural or metropolitan setting. METHODS: A random sample of 50 patients who attended a visiting rural surgical service between December 1998 and February 1999 inclusive was recruited. In a structured telephone interview patients were asked 40 non-clinical questions relating to their recent specialist consultation. The cost of accessing these services was determined from time lost from work, distance and travel expenses. The same formula was then applied to estimate the cost of attending a base metropolitan hospital. The need for an accompanying person was determined from a subset of 16 patients who had transferred to metropolitan specialist consultation in the previous 12 months. Average waiting list times for consultations and common surgical procedures for the visiting service were compared with those for a metropolitan-based service. RESULTS: An estimated saving of AU$1,077 was made per specialist consultation when accessing a local rather than a metropolitan service. Savings were observed in travel time, distance travelled, lost income, provision of an escort and waiting time. CONCLUSION: The present study shows that the personal costs and difficulties incurred by rural and remote residents when accessing specialist treatment can be reduced if a visiting specialist service is available.

A specific activity questionnaire to measure the functional capacity of cardiac patients.

Exercise testing is often performed in persons with cardiac disease to measure their functional capacity. Physical activity questionnaires assessing functional capacity have been used a low-cost and convenient alternative to exercise testing, but have not been well validated against measured oxygen consumption in a cardiac population. This study assesses the ability of a simple, 13-item activity questionnaire, known as the Specific Activity Questionnaire (SAQ), to measure functional capacity prospectively in a large sample of cardiac patients. Ninety-seven consecutive cardiac outpatients (85 men and 12 women aged 59 +/- 10 years [mean +/- SD]) completed the SAQ before an elective symptom-limited treadmill test. Subjects returned within 10 days to repeat the treadmill test, following the same protocol, with the additional measurement of peak oxygen consumption, VO2 (ml x kg(-1)min(-1)), using open circuit spirometry. The SAQ score was significantly related to measured peak VO2(r=0.57, p<0.001). Stepwise multiple linear regression analysis found that the addition of patient age, height, and body weight to SAQ score improved the measurement of peak VO2, accounting for 51% of the sample variance (R=0.71, p<0.001). Peak VO2 was obtained from the following regression formula: [formula: see text]. Thus SAQ, a simple 13-item self-administered activity questionnaire, is able to provide a moderately good measure of functional capacity in cardiac patients and may be useful tool in studies of the cardiac population when formal exercise testing is impractical or uneconomical.