The pollen season dynamics and the relationship among some season parameters (start, end, annual total, season phases) in Kraków, Poland, 1991-2008.

The dynamics of 15 taxa pollen seasons in Kraków, in 1991-2008 was monitored using a Burkard volumetric spore trap of the Hirst design. The highest daily pollen concentrations were achieved in the first half of May, and they were caused mainly by Betula and Pinus pollen. The second period of the high concentrations took place from the middle of July to the end of August (mainly Urtica pollen). Tree pollen seasons were shorter (18-24 days) in comparison with the most herbaceous pollen seasons (73-89 days), except at Artemisia and Ambrosia seasons (30 and 24 days, respectively). The season phases (percentyles) of the spring and late-summer taxa were the most variable in the consecutive years. The highest annual sums were noted for Urtica, Poaceae (herbaceous pollen seasons) and for Betula, Pinus, Alnus (tree pollen seasons), and the highest variability of annual totals was stated for Urtica, Populus, Fraxinus and the lowest for Ambrosia, Corylus, Poaceae. For the plants that pollinate in the middle of the pollen season (Quercus, Pinus and Rumex), the date of the season start seems not to be related to the season end, while for late pollen seasons, especially for Ambrosia and Artemisia, the statistically negative correlation between the start and the end season dates was found. Additionally, for the most studied taxa, the increase in annual pollen totals was observed. The presented results could be useful for the allergological practice and general botanical knowledge.

Attracting psychiatrists to a rural area - 10 years on.

CONTEXT: In rural areas across Australia the recruitment and retention of adequate numbers of medical specialists, including psychiatrists, has been a long outstanding problem. Latrobe Regional Hospital (LRH) has not been exempt. Latrobe Regional Hospital provides public mental health services to a population of over 220 000 across the rural Gippsland region, with little or no access to local private psychiatrists. The equivalent of 11 full time psychiatrists are employed, the majority of whom are international medical graduates (IMGs). ISSUE: Latrobe Regional Hospital reached a major crisis in 1994, with only one psychiatrist and a large number of vacancies. This led to a focus on the recruitment and retention of psychiatrists in order to improve this essential element of the workforce. In 2006 an internal review of psychiatrist recruitment and retention over the past 10 years was undertaken to gain a better understanding of approaches that worked, those that could be improved and those that required further development and implementation. Elements of the review included aggregation of data from employment records, documented changes to the medical structure, level of professional support provided and the LRH educational program for psychiatrist IMGs. Individual interviews were also undertaken with psychiatrists who have been or are now employed by LRH. LESSONS LEARNED: Between 1994 and 2006 the number of full time equivalent psychiatrists employed by LRH increased from one to 11. Retention rates also improved from an average of 18 months to 4 years. The key elements of this success are seen as: a focus on building individual rapport with new psychiatrists at the time of their recruitment; an extensive and multifaceted orientation program, taking into account cultural background; working to meet individual and family needs, both professionally and within the wider context; a sectorised medical staff structure with both community and inpatient elements; the provision of ongoing educational support with a specific focus on preparing for Royal Australian & New Zealand College of Psychiatrists' fellowship exams. A number of additional issues were also identified that had the potential to further increase psychiatrists' work satisfaction and longer term employment. These included an increased focus on cultural adaptation and professional supervision, as well as additional linkages to city based psychiatrists and services.

Differential distribution of G-protein beta-subunits in brain: an immunocytochemical analysis.

Heterotrimeric G proteins play central roles in signal transduction of neurons and other cells. The variety of their alpha-, beta-, and gamma-subunits allows numerous combinations thereby confering specificity to receptor-G-protein-effector interactions. Using antisera against individual G-protein beta-subunits we here present a regional and subcellular distribution of Gbeta1, Gbeta2, and Gbeta5 in rat brain. Immunocytochemical specificity of the subtype-specific antisera is revealed in Sf9 cells infected with various G-protein beta-subunits. Since Gbeta-subunits together with a G-protein gamma-subunit affect signal cascades we include a distribution of the neuron-specific Ggamma2- and Ggamma3-subunits in selected brain areas. Gbeta1, Gbeta2, and Gbeta5 are preferentially distributed in the neuropil of hippocampus, cerebellum and spinal cord. Gbeta2 is highly concentrated in the mossy fibres of dentate gyrus neurons ending in the stratum lucidum of hippocampal CA3-area. High amounts of Gbeta2 also occur in interneurons innervating spinal cord alpha-motoneurons. Gbeta5 is differentially distributed in all brain areas studied. It is found in the pyramidal cells of hippocampal CA1-CA3 as well as in the granule cell layer of dentate gyrus and in some interneurons. In the spinal cord Gbeta5 in contrast to Gbeta2 concentrates around alpha-motoneurons. In cultivated mouse hippocampal and hypothalamic neurons Gbeta2 and Gbeta5 are found in different subcellular compartments. Whereas Gbeta5 is restricted to the perikarya, Gbeta2 is also found in processes and synaptic contacts where it partially colocalizes with the synaptic vesicle protein synaptobrevin. An antiserum recognizing Ggamma2 and Ggamma3 reveals that these subunits are less expressed in hippocampus and cerebellum. Presumably this antiserum specifically recognizes Ggamma2 and Ggamma3 in combinations with certain G alphas and/or Gbetas. The widespread but regionally and cellularly rather different distribution of Gbeta- and Ggamma2/3-subunits suggests that region-specific combinations of G-protein subunits mediate signal transduction in the central nervous system. The different subcellular distribution of Gbeta-subunits in cultivated neurons reflects that observed in tissue where Gbeta5 and Gbeta2 associate preferentially with the perikarya and the neuropil, respectively, and suggests an additional association of Gbeta2 with secretory vesicles.

Oxitropium bromide. Dose-response and time-response study of a new anticholinergic bronchodilator drug.

The efficacy and side effects of oxitropium bromide, a new anticholinergic bronchodilator drug, were tested in a double-blind placebo-control study. Twenty-four men, aged 58 to 72 years, with chronic partially reversible obstruction of the airways were used as subjects. Three doses of oxitropium were tested (100 micrograms, 200 micrograms, and 300 micrograms) to determine the optimum dose by metered-dose inhaler. A comparison was also made between oxitropium, fenoterol (400 micrograms), and a combination of oxitropium (200 micrograms) and fenoterol (400 micrograms). Fenoterol produced a greater degree of maximal bronchodilatation than each of the three doses of oxitropium, and its effect was more rapid in onset (30 vs 120 minutes to peak effect); however, the duration of action of oxitropium was greater than that of fenoterol (ie, the forced expiratory volume in one second [FEV1] remained within 5 percent of peak FEV1 for three hours, compared to one hour). Oxitropium in the 100 micrograms dose was inferior to 200 micrograms and 300 micrograms in subjective efficacy scores, peak percent change in FEV1, forced vital capacity, (FVC), mean forced expiratory flow over the middle half of the FVC, and duration of action; there was no difference between 200 micrograms and 300 micrograms. The oxitropium-fenoterol combination had a rapid onset of action, and a greater peak effect was achieved than for oxitropium alone. The main unwanted effect was a mildly unpleasant taste. Anticholinergic effects were not seen in this group of elderly men. Oxitropium bromide therefore is an effective bronchodilator with slow onset but prolonged activity and few side effects when used in patients with moderately severe obstruction of the airways. An appropriate dose appears to be 200 micrograms. Addition of oxitropium to fenoterol appears to offer even greater efficacy.

Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket-targeting alginate-antacid (Gaviscon Double Action) - a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease.

BACKGROUND: The alginate-antacid, Gaviscon Double Action (Gaviscon DA; Reckitt Benckiser, Slough, UK) suppresses reflux after meals by creating a gel-like barrier that caps and displaces the acid pocket distal to the oesophago-gastric junction. The effect of Gaviscon DA on reflux and dyspepsia symptoms has not yet been demonstrated with a modern trial design. AIM: A pilot study to assess the efficacy and safety of Gaviscon DA compared with matched placebo for decreasing upper gastrointestinal symptoms in symptomatic gastro-oesophageal reflux disease (GERD) patients. METHODS: A randomised, double-blind, parallel group study was performed in 110 patients with symptoms of GERD. Patients received Gaviscon DA or placebo tablets for 7 consecutive days. The primary endpoint compared the change in overall Reflux Disease Questionnaire (RDQ) symptom score (combined heartburn/regurgitation/dyspepsia). Secondary endpoints assessed individual dimensions, GERD dimension (heartburn and regurgitation) and overall treatment evaluation (OTE). RESULTS: There was a greater decrease in overall RDQ symptom score in the Gaviscon DA group compared with the placebo group (Least Squares Mean difference -0.55; P = 0.0033), and for each of the dimensions independently. Patients in the Gaviscon DA group evaluated their overall treatment response higher than patients in the placebo group [mean (standard deviation) OTE 4.1 (2.44) vs. 1.9 (3.34); P = 0.0005]. No differences in the incidence of adverse events were observed between treatment groups. CONCLUSIONS: Gaviscon DA decreases reflux and dyspeptic symptoms in GERD patients compared with matched placebo and has a favourable benefit-risk balance. Larger scale clinical investigations of medications targeting the acid pocket are warranted. (EudraCT, 2012-002188-84).

Anxiety is more common in children with asthma.

OBJECTIVE: There are a variety of reasons why there may be an association between asthma and anxiety in children. Research into the relation between asthma and anxiety has been limited by the sole use of parent-reported or self-reported asthma symptoms to define asthma status. The objective of this study was to determine if children with physician-defined asthma are more likely to suffer anxiety than children without asthma. DESIGN: A population-based, cross-sectional assessment, of self-reported anxiety symptoms. SETTING AND PARTICIPANTS: Children aged 5-13 years from Barwon region of Victoria, Australia. Asthma status was determined by review with a paediatrician. Controls were a sample of children without asthma symptoms (matched for age, gender and school). OUTCOME MEASURE: The Spence Children's Anxiety Scale (SCAS) written questionnaire. The authors compared the mean SCAS score, and the proportion of children with an SCAS score in the clinical range, between the groups. RESULTS: Questionnaires were issued to 205 children with asthma (158 returned, response rate 77%), and 410 controls (319 returned, response rate 78%). The SCAS scores were higher in asthmatics than controls (p<0.001); and were more likely to be in the clinical range (OR=2.5, 95% CI 1.1 to 5.8, p=0.036). There was no evidence that these associations could be explained by known confounding factors. CONCLUSIONS: Children with asthma are substantially more likely to suffer anxiety than children without asthma. Future studies are required to determine the sequence of events that leads to this comorbidity, and to test strategies to prevent and treat anxiety among children with asthma.

Pulmonary candidiasis in cystic fibrosis.

A child with cystic fibrosis and asthma developed pulmonary candidiasis. Predisposing factors in this patient were prolonged antibiotic therapy, high-dose corticosteroids, and intravenous catherisation. A diagnosis was made by lung puncture and confirmed by rapid response to 5-fluorocytosine.

Effects of inhaled oxitropium and fenoterol, alone and in combination, in chronic airflow obstruction.

Twenty-four elderly male patients with moderate-to-severe chronic airway obstruction took part in a double-blind, placebo-controlled, randomized dose-response and response-duration comparison of a new inhaled anticholinergic bronchodilator oxitropium bromide and the inhaled beta-agonist bronchodilator fenoterol hydrobromide. On 6 separate days lung function changes and side effects were monitored for 8 h after either placebo, oxitropium 100, 200 and 300 micrograms, fenoterol 400 micrograms, or oxitropium 200 micrograms plus fenoterol 400 micrograms. Fenoterol alone and in combination with oxitropium produced a rapid peak effect (mean delta FEV1 = 41.6 and 39.5%, respectively at 30 min). Oxitropium alone had a slow onset of action (peak delta FEV1 seen at 120 min: 100 micrograms = 22.7%, 200 micrograms = 29.9%, 300 micrograms = 28.2%). However, mean FEV1 remained within 5% of peak for 60 min after fenoterol, but for 180 min after each dose of oxitropium and after fenoterol plus oxitropium. No differences between oxitropium 200 and 300 micrograms were seen; however, these doses produced more prolonged bronchodilatation than did oxitropium 100 micrograms. The fenoterol-plus-oxitropium combination produced even more prolonged bronchodilatation. The only side effect, seen with each inhaler was a mildly unpleasant taste. No anticholinergic effects were seen. We conclude that oxitropium is an effective bronchodilator with slow onset but prolonged duration of action. In combination with fenoterol it produced both rapid and prolonged bronchodilatation in patients with chronic airflow obstruction.

Meningitis and septicaemia in a child caused by non-typable Haemophilus influenzae biotype III.

Since vaccination against Haemophilus influenzae type b (Hib) became widespread, other strains of H. influenzae have become more common than Hib as causes of disease in vaccinated children. A four-month-old, appropriately vaccinated infant presented with meningitis and septicaemia caused by H. influenzae biotype III. To our knowledge, this is the first reported case of meningitis caused by this biotype, which is not detectable by Hib antigen tests.

The management of congenital tricuspid incompetence.

2 examples of severe tricuspid incompetence presenting in the newborn period are described. Both recovered with medical treatment alone, with subsequent decrease in tricuspid incompetence. Postnatal course is attributed to normal decrease in pulmonary vascular resistance. Some infants may be at considerable risk until this decrease occurs.

A 12-month profile of community paediatric consultations in the Barwon region.

OBJECTIVE: To determine the profile of all consultations carried out in paediatricians offices in the Barwon region over a 12-month period. METHODOLOGY: The age, sex, category, diagnosis, and outcome of all non-hospital-based paediatric consultations carried out in the Barwon region were documented prospectively on a day by day basis. Relevant demographic data and information on Barwon children treated elsewhere were also collected. The frequency of different categories of illness, systems involved and groups of diagnoses was determined. RESULTS: A total of 14,711 consultations was carried out in the region with 10% of the childhood population having contact with the paediatricians during the year; 3135 new patients or problems were seen with 34.8% of all consultations involving behavioural problems and 76% of these relating to ADHD. The most frequent medical diagnostic group was CNS/disability being 16% of all consultations. At least 50% of the medical consultations involved chronic illness. CONCLUSIONS: Behavioural difficulty, chronic disability, and learning problems represent a significant part of the workload of community-based general paediatricians. Appropriate exposure during paediatric training should be given to these issues along with more sophisticated training in the medical, social and psychological complications of chronic illness and its effect on clients and families.

The evolving role of community-based general paediatricians: the Barwon experience.

OBJECTIVE: To detail the acute and chronic paediatric service and community-orientated activities and responsibilities of community-based general paediatricians. METHODOLOGY: Data were collected over the 12 months July 1996 to June 1997 relevant to (i) acute neonatology and paediatrics, (ii) the different community paediatric service organizations with which the paediatricians were involved, and (iii) the quantification of the amount of time spent in non-consulting paediatric work. RESULTS: Findings revealed decreasing hospital admissions, infrequent severe neonatal resuscitation requirements, extensive involvement in community organizations and a great deal of time spent in non-consulting paediatric work. CONCLUSIONS: Ongoing training and upgrading in acute paediatric diagnostic and procedural skills, rationalization of resuscitation expertise, training in management and administrative skills and models of care for the chronically ill should become part of the training of community-based general paediatricians.