Exploring the impact of particulate matter on mortality in coastal Mediterranean environments.

Air pollution is one of the most important problems the world is facing nowadays, adversely affecting public health and causing millions of deaths every year. Particulate matter is a criteria pollutant that has been linked to increased morbidity, as well as all-cause and cause-specific mortality. However, this association remains under-investigated in smaller-size cities in the Eastern Mediterranean, which are also frequently affected by heat waves and dust storms. This study explores the impact of particulate matter with an aerodynamic diameter ≤ 10 µm (PM10) and ≤ 2.5 µm (PM2.5) on mortality (all-cause, cardiovascular, respiratory) in two coastal cities in the Eastern Mediterranean; Thessaloniki, Greece and Limassol, Cyprus. Generalized additive Poisson models were used to explore overall and gender-specific associations, controlling for long- and short-term patterns, day of week and the effect of weather variables. Moreover, the effect of different lags, season, co-pollutants and dust storms on primary associations was investigated. A 10 µg/m3 increase in PM2.5 resulted in 1.10 % (95 % CI: -0.13, 2.34) increase in cardiovascular mortality in Thessaloniki, and in 3.07 % (95 % CI: -0.90, 7.20) increase in all-cause mortality in Limassol on the same day. Additionally, significant positive associations were observed between PM2.5 as well as PM10 and mortality at different lags up to seven days. Interestingly, an association with dust storms was observed only in Thessaloniki, having a protective effect, while the gender-specific analysis revealed significant associations only for the males in both cities. The outcome of this study highlights the need of city- or county-specific public health interventions to address the impact of climate, population lifestyle behaviour and other socioeconomic factors that affect the exposure to air pollution and other synergistic effects that alter the effect of PM on population health.

Involuntary psychiatric admission in Cyprus: A descriptive correlational study.

INTRODUCTION: Studies on the clinical and socio-demographic characteristics of those involuntarily admitted to psychiatric settings could help professionals and researchers to develop effective, targeted interventions, alternative to compulsory psychiatric care. AIM: The association between socio-demographic and clinical characteristics in adults under involuntary hospitalization for psychiatric treatment in the Republic of Cyprus was assessed. METHOD: This was a descriptive, cross-sectional and correlational study. Data collection was achieved (December 2016 to February 2018) via a census sampling method. Socio-demographic and clinical data of individuals involuntarily admitted to the reference psychiatric hospital of Cyprus with psychotic symptomatology were recorded. RESULTS: The sample encompassed 144 females and 262 males. The most frequent diagnosis was schizophrenia or a relevant psychotic disorder (72.9%). The most frequent cause of admission was "Disorganized behaviour" along with non-adherence to pharmacotherapy (53.7%). Approximately 42.8% of the participants confirmed positive substance use history, which was more frequently reported in males than in females (88.5% vs. 11.5%, respectively, p < 0.001). Additionally, males were more frequently admitted due to Disorganized behaviour with substance use compared to females (31.3% vs. 4.9%, respectively, p < 0.001), while females were more frequently admitted due to d"Disorganized behaviour with non-adherence to pharmacotherapy (70.1% vs. 44.7%, respectively, p < 0.001). Also, males were more frequently involuntarily hospitalized due to suicidal/self-harming behaviour compared to females (12.2% vs. 5.6%, respectively, p = 0.031). CONCLUSION: Gender differences were noted in relation to clinical characteristics of the participants, highlighting the need for gender-specific interventions to decrease compulsory psychiatric care, including enhancement of adherence to therapy.

Social gradient in health-related quality of life among urban middle-age residents in Limassol, Cyprus: research article.

BACKGROUND: Social inequalities in health threaten social cohesion and their investigation is an important research field. Monitoring the health of the population is necessary to identify health needs, design programs focused in people's needs and to evaluate the effectiveness of health policies. METHODS: A cross-sectional survey using primary data was applied. The study investigated the size and the extent of social inequalities in quality of life and health behaviours in Limassol, Cyprus. Data collection was done door-to-door in the form of survey interviews. The sample consisted of 450 residents aged 45-64 across 45 randomly selected neighbourhoods, that met the selection criteria. The tools used were: Demographic questionnaire, SF 36 Questionnaire, IPAQ- International Physical Activity Questionnaire short form. RESULTS: The social gradient appears in all social indicators. Physical dimension of health has a strong relationship between health-related quality of life with the education index. Specifically, the range is 12 points for males and 14 points for females (p for interaction = 0.16). Profession systematically appears to have a stronger relationship with men than with women, and is present in both physical and mental dimensions. The range is 13 points for men and 10 points for women (p for interaction = 0.31). CONCLUSIONS: It seems that young highly educated males, employed full time, earning high income and engaging in mild physical activity, have significantly higher level of health-related life quality, compared to other middle age adult groups, living in Limassol. This finding is in agreement with other studies that show correlations between gender and the patterns of risk factors.

Prevalence of asthma and respiratory symptoms in 15-17 year-old Greek-Cypriots by proximity of their community of residence to power plants: Cyprus 2006-07.

OBJECTIVES: Numerous studies have reported adverse effects of traffic pollution on respiratory health. Exposure to power plants emissions has not been as comprehensively studied. The prevalence of asthma and respiratory symptoms was investigated among 15-17 year-olds in communities in the vicinity of power plants in Cyprus in relation to the rest of the island. STUDY DESIGN: Cross-sectional study METHODS: Based on responses of 5817 participants to the ISAAC questionnaire, study outcomes were: active asthma (i.e. report of asthma and current symptoms), inactive asthma and respiratory symptoms without a diagnosis. Associations in terms of the distance of the participants' community to any of the three power plants were investigated in logistic models before and after adjusting for known confounders. RESULTS: At 7.4% (95% CI: 4.5, 11.3), the prevalence of active asthma in communities at 5 km of power plants appeared elevated but reduced to national levels of 5% at longer distances. Adjusted odds ratio for active asthma was 1.83 (95% CI: 1.04, 3.24) in the 5 km zone compared to 30 km away. No clear pattern was observed for inactive asthma while the odds ratio of respiratory symptoms in the absence of diagnosis was 0.76 (95% CI: 0.58, 1.01) in the affected communities. CONCLUSIONS: Higher prevalence of active asthma was observed in the vicinity of power plants, with no evidence of a distance-response relationship. With less than 5% of this age-group residing in close proximity to power plants, this corresponds to a small fraction of active asthma attributable to power plant emissions.

Single mothers' self-assessment of health: a systematic exploration of the literature.

AIM: This study aimed to explore single mothers' self-assessed level of health status compared to partnered mothers and the relevant factors associated with it. BACKGROUND: The number of single-mother families is increasing worldwide. A large body of international research reveals that single mothers experience poorer physical and mental health than their married counterparts. An important contributory factor for this health disparity appears to be socio-economic disadvantage. METHODS: A systematic search of the literature was conducted using the keywords 'lone' or 'single' and 'mother*' or 'parent*' or 'family structure' in combination with 'health'. EMBASE, CINAHL, COCHRANE and PUBMED databases were searched for quantitative research studies published in the past decade. RESULTS: Eleven quantitative research articles with self-assessment of health status in single mothers were identified. Single mothers report lower levels of health status compared to partnered mothers. These inequalities appear to be associated with financial hardship and lack of social support. Both these factors increase single mothers' susceptibility to stress and illness. CONCLUSION: Despite the study limitations (e.g. results based mainly on secondary data from household surveys), it provides evidence that single motherhood places women in an adverse social position that is associated with prolonged stress mainly due to unemployment, economic hardship and social exclusion, which affects negatively their health status. These findings can be seen as a challenge for health professionals, especially those working in the community sector and policy makers too, to establish supportive measures for this vulnerable group focused on socio-economic factors.

Low serum high-density lipoprotein cholesterol in childhood is associated with adolescent asthma.

BACKGROUND: Whilst emerging evidence from animal and cell experiments has shown high-density lipoprotein cholesterol to have anti-inflammatory effects consistent with a protective role in asthma, human studies investigating the relationship of high-density lipoprotein cholesterol with asthma have produced conflicting results. OBJECTIVE: To examine the association between serum lipids among Cypriot children aged 11-12 years and prevalence of asthma at age 15-17 years. METHODS: In 3982 children, we assessed serum lipids, body mass index and maximal oxygen consumption at baseline (2001-2003) and explored associations with respiratory health at follow-up (2007) using multiple logistic regression models. RESULTS: Lower levels of high-density lipoprotein cholesterol at age 11-12 years were found in subjects who reported ever asthma (58.2 vs. 60.0 mg/dL, P = 0.005) and active asthma (57.5 vs. 59.9 mg/dL, P = 0.010) in adolescence, in comparison with their respective reference groups. Total cholesterol, low-density lipoprotein and triglycerides had no association with any of the asthma outcomes. In contrast, with estimated odds ratios of 1.89 (95% CI 1.19-3.00) and 1.89 (95% CI 1.02-3.53), ever asthma and active asthma respectively appeared particularly pronounced among those who at baseline had high-density lipoprotein cholesterol <40 mg/dL, even after adjusting for potential confounders including body mass index and maximal oxygen consumption. CONCLUSIONS & CLINICAL RELEVANCE: Low-serum high-density lipoprotein cholesterol in childhood is associated with an increased risk for asthma in adolescence, suggesting a potential role of this lipoprotein in the pathogenesis of paediatric asthma.

The effect of prolonged endurance exercise upon blood pressure regulation during a postexercise orthostatic challenge.

OBJECTIVE: To investigate the regulation of blood pressure in response to an orthostatic challenge in athletes running a marathon. METHODS: 10 experienced male runners (mean (SD) age 29 (4) years) were tested on the day prior to the 2004 London Marathon, and again immediately postrace (race time 210 (36) min). In addition, 6 of the subjects were retested 24 h postrace. During each examination, beat-to-beat systolic arterial blood pressure (SBP) and heart rate (HR) were measured, and stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were estimated via arterial transmural pressure waveforms during 3 min in a supine position and then during 3 min of upright, unsupported standing. Data were averaged over 20 s epochs, and the final 20 s of each posture were compared prerace and postrace via repeated measures 2-way ANOVA. RESULTS: Prerace SBP in standing increased only moderately when compared with supine values (2 (9) mm Hg, NS). This was accompanied by an increase in HR (13 (7) beats/min, p<0.05), as well as a decrease in SV (16 (9) ml, p<0.05). However, there was little change in CO (-0.13 (0.97) litres/min, NS) or TPR (0.047 (0.280) medical units (MU), NS). Postrace SBP significantly decreased from supine to standing (-15 (20) mm Hg, p<0.05). The change in SBP was accompanied by an increase in HR (19 (6) beats/min, p<0.05) and a reduction in SV (26 (14) ml, p<0.05) and CO (-1.02 (1.39) litres/min, p = 0.05). Postrace there was no change in TPR (0.366 (0.607) MU, NS) upon standing. The orthostatic adjustments in SBP, HR and CO were greater than at prerace (p<0.05). The postrace orthostatic challenge resulted in only one subject experiencing presyncopal symptoms. At 24 h postrace, cardiovascular responses to an orthostatic challenge mirrored those at prerace. CONCLUSIONS: Following prolonged exercise, a fall in systolic blood pressure during orthostasis results from an inadequately compensated decrease in SV and resultant CO during standing.

Training induced changes in maximum heart rate.

The present study aimed to examine maximum heart rate (HRmax) in elite athletes. 130 (68 male, 23.2 +/- 4.8 years, 62 female, 21.0 +/- 5.1 years) endurance trained athletes, 40 (24 male, 24.0 +/- 5.6 years, 16 female, 22.8 +/- 4.6 years) anaerobically trained athletes, and 95 (39 male, 24.8 +/- 4.8 years, 56 female, 23.0 +/- 4.8 years) sedentary participants entered the study. All participants undertook a standard ramp protocol to volitional exhaustion to establish HRmax. Significant differences in HRmax were identified due to mode of exercise (p < 0.001) and gender (p = 0.001). The mean HRmax for the three modes of exercise were; aerobic 190.3 (SEE = 0.66), anaerobic 190.1 (SEE = 1.12) and sedentary 194.8 (SEE = 0.73) beats . min (-1) estimated at the average age of 23.1 years. The slope parameter for age varied between genders, the beta slope for females being significantly more negative than male subjects (- 1.1 beats . min (-1) . year (-1) vs. - 0.55 beats . min (-1) . year (-1), respectively). The predictive HRmax equation for male athletes was HRmax = 202 - 0.55 x age, and for female athletes it was HRmax = 216 - 1.09 x age. HRmax is similar between aerobically and anaerobically trained athletes. HRmax is significantly lower in athletes compared with age matched sedentary counterparts. The mechanisms underlying the lower HRmax remain to be elucidated.

Childhood diet and insulin-like growth factors in adulthood: 65-year follow-up of the Boyd Orr Cohort.

OBJECTIVE: High levels of insulin-like growth factor-I (IGF-I) are associated with an increased cancer risk and reduce risk of diabetes and coronary heart disease. We investigated associations of diet in childhood, in particular energy intake, with the IGF system in adulthood to determine if IGF-I - disease associations could be linked to early nutrition. DESIGN: Retrospective cohort study. SETTING: Sixteen survey centres in England and Scotland that originally participated in the Carnegie (Boyd Orr) Survey of Diet and Health in Pre-War Britain, 1937-1939. SUBJECTS: Seven hundred and twenty-eight participants (679 with complete data) in the Boyd Orr cohort. METHODS: Participants were originally surveyed between 1937 and 1939 (at median age 5.8 years; inter-quartile range: 2.9-9.6) and were followed up for 65 years. Dietary exposure in childhood was assessed from 7-day household food inventories. Outcomes are expressed as regression coefficients for the change in IGF per standard deviation increased childhood nutrient or food intake, as derived from levels of household consumption. RESULTS: In fully-adjusted models, energy-rich family diets in childhood were not associated with IGF-I (regression coefficient: 0.9 ng/ml; 95% confidence interval (CI): -1.8, 3.7), IGF-II, IGF binding proteins (IGFBP)-2 or IGFBP-3 in adulthood. IGF-I was associated inversely with childhood family-diets high in milk (-2.5 ng/ml; -5.1, 0.1; P=0.05) and positively with vegetable-rich diets (3.5 ng/ml; 0.9, 6.1; P=0.009). IGF-I was not associated with family diets rich in protein, carbohydrates, fats, calcium, meat or fruit. IGF-II, IGFBP-2 and IGFBP-3 were not related to childhood family diet. CONCLUSIONS: This study suggests that energy-rich family diets in childhood do not program the IGF system in adulthood. As childhood diet was based on household consumption, however, measurement error may obscure individual-level diet-IGF associations. The associations of milk- and vegetable-rich family diets in childhood with IGF-I could be chance findings, but nevertheless are consistent with recent publications and warrant further investigation.

Cardiovascular autonomic control in endurance-trained and sedentary young women.

This study aimed to investigate whether endurance-trained (ET) female athletes demonstrate differences in cardiovascular autonomic control compared with sedentary controls. Eighteen healthy eumenorrhoeic subjects, nine trained (22.4 +/- 3 years) and nine sedentary (21.0 +/- 1 years), volunteered for the study. Heart rate variability (HRV) and cardiovagal baroreflex sensitivity (BRS) measures were adopted to assess cardiac autonomic control. HRV was recorded for 30 min under both controlled (0.25 Hz) and spontaneous breathing conditions. Cardiovagal BRS was assessed using the Valsalva manoeuvre. Analysis of the HRV showed a longer R-R interval (1089 +/- 114 ms versus 865 +/- 100 ms; P<0.001) in the trained subject but only in the spontaneous breathing condition. Conversely, athletes exhibited higher normalized low frequency (LFnu, 44.2 +/- 8.5% versus 29.5 +/- 6.8%; P<0.001) and lower normalized high frequency (HFnu, 55.8 +/- 8.5% versus 69.9 +/- 7.7%; P<0.01) only during the controlled breathing condition, consequently the LF/HF ratio was also higher in the trained group in the same condition (0.83 +/- 0.3 versus 0.47 +/- 0.1, P<0.01). BRS was significantly lower in the ET group (7.95 +/- 4.0 ms mmHg(-1) versus 13.00 +/- 4.4 ms mmHg(-1), P<0.05). Further studies are necessary to elucidate the potential role of training and altered hormonal profile in the genesis of the observed differences in cardiovascular autonomic control between highly trained and sedentary control female subjects.

Errors associated with milk cell counting.

The accuracy of somatic cell counts in milk samples was investigated in four studies. First, the counts recorded by one milk buyer in one supply over six months ranged from 105,000 to 401,000 cells/ml with no apparent changes in the volume of milk consigned or the level of mastitis in the herd that would explain this wide range. Secondly, the counts in daily samples from one bulk milk supply for 28 days ranged from 84,000 to 282,000 cells/ml, again with no apparent changes in the performance of the herd to explain the wide range. Thirdly, the replicated counts recorded for one sample by three separate laboratories agreed closely; however, when a sample with a high cell count was interspersed then two of the three laboratories reported high cell counts suggestive of 'carry-over' in excess of the 2 per cent 'allowable' Finally, cell count data from three separate laboratories on samples from 21 cows for 33 days revealed problems with the misidentification of samples on the farm in 1 per cent of the samples, and misidentification and mishandling of 1 to 2.6 per cent of the samples in the laboratories. All three laboratories differentiated samples from cows with subclinical and clinical mastitis, but the mean cell count of the uninfected cows varied between the laboratories with one of them recording statistically significantly higher counts over the period.

Whole blood and mononuclear cell glutathione response to dietary whey protein supplementation in sedentary and trained male human subjects.

Sedentary male subjects (n=9) on a controlled diet were fed two doses (0.8 or 1.6 g/kg body mass) of a whey protein isolate (WPI), in addition to an isocaloric placebo; blood samples were drawn over a 4-h period and glutathione concentration determined. There was no effect of the supplementation at either level over the 4-h sampling period. The effects of a WPI supplemented diet on glutathione concentrations in whole blood as well as peripheral mononuclear cell populations were also investigated over a 6-week period in male subjects (n=18) involved in arduous aerobic training; blood was collected prior to and following a 40 km simulated cycling trial. The aerobic training period resulted in significantly lower glutathione concentrations in whole blood, an effect that was mitigated by WPI supplementation. A significant increase in mononuclear cell glutathione was also observed in subjects receiving the WPI supplement following the 40 km simulated cycling trial.

Tenoxicam 20 mg or 40 mg after thoracotomy: a prospective, randomized, double-blind, placebo-controlled study.

Forty-five adults undergoing thoracotomy were randomized to receive placebo, tenoxicam 20 mg or tenoxicam 40 mg IV during chest wall closure. All patients received intraoperative fentanyl and intercostal blocks followed by morphine by patient-controlled analgesia. Patient numbers 13 to 45 also received thoracic epidural analgesia by continuous infusion of bupivacaine 0.125%, patient numbers 25 to 45 having fentanyl 2 microg/ml added to the epidural infusion. Efficacy parameters and adverse reactions were assessed over the first 24 hours postoperatively. On a 100 mm visual analogue scale, mean (SD) pain at rest (adjusted area under curve for hours 1 to 24) was 25.8 (12.5), 17.4 (14.8) and 16.5 (13.3) mm for groups receiving placebo, 20 mg and 40 mg tenoxicam, respectively (ANOVA: P<0.05). There were no significant differences between study groups postoperatively in pain on coughing, opioid consumption, blood gas measurements, nausea, vomiting, sedation, blood loss, haemoglobin or serum creatinine. One patient in each tenoxicam group reported epigastric pain, rated moderate. These data support the inclusion of tenoxicam 20 mg IV in the management of pain at rest for patients undergoing thoracotomy, but do not show additional benefit for a higher dose.

Socioeconomic inequality and meningococcal disease.

Incidence of meningococcal disease was associated with socioeconomic deprivation across a rural English region. In young children the incidence was twice as high in the most deprived compared with the least deprived electoral wards. By addressing social inequalities the incidence of this serious infection could be reduced.

Secular trends in antidepressant prescribing in the UK, 1975-1998.

BACKGROUND: We have examined secular trends in age- and sex-specific prescribing of antidepressants to determine whether these mirror changes in other population measures of mental health. METHOD: An analysis was carried out of age- and sex-specific rates of antidepressant prescribing by a representative sample or panel of UK general practitioners (GPs) in the period 1975-1998. RESULTS: The number of antidepressant prescriptions issued increased more than twofold in the period 1975-1998 and, in 1998, a total of 23.4 million antidepressant prescriptions were issued by GPs in the United Kingdom. Rates of antidepressant prescribing increased markedly in all age and sex groups with as much as a threefold increase in the older age groups. With the exception of 12-19-year-olds, these increases have been more marked in males, although absolute levels of prescribing are still at least two times higher in females. CONCLUSIONS: Antidepressant prescribing has increased in all age and sex groups. This indicates either that there have been changes in the presentation, recognition and management of depression in general practice or that the prevalence of depression has increased, or a combination of these two phenomena. The higher prescribing rate in females is in keeping with evidence from psychiatric morbidity surveys suggesting that women experience higher levels of psychiatric morbidity than men. Decreases in the ratio of female to male prescribing, however, support other data indicating that, relative to females, the mental health of young males has declined in recent years. Changes in patterns of help-seeking may also contribute to the observed trends.

Method availability and the prevention of suicide--a re-analysis of secular trends in England and Wales 1950-1975.

BACKGROUND: In England and Wales in the 1960s there were marked declines in suicide rates. These reductions were partly attributable to the detoxification of the domestic gas supplies; however, their extent varied by age and gender, with the most striking effects seen in older men. The objective of this study was to investigate method-specific trends in suicide between 1950 and 1975 to elucidate possible explanations for the patterns seen in different demographic groups. METHODS: An analysis of age-standardised method-specific suicide rates for England and Wales between 1950 and 1975 was carried out using routinely available mortality and population statistics. RESULTS: As has previously been shown, there were marked reductions in suicides by gassing in men and women of all ages between 1960 and 1975. In women and younger men, the effects of these reductions on overall suicide rates were partially offset by rises in drug overdose deaths (method substitution), but there were no immediate increases in the use of other suicide methods. In contrast, in older men, reductions in suicide by gassing were accompanied by only a slight increase in overdose suicides as well as reductions in rates of suicide using all other methods. The modest rise in overdose fatalities in older men occurred despite the fact that they were more often prescribed barbiturates and tricyclic antidepressants than younger men. CONCLUSIONS: Accessibility to and the lethality of particular methods of suicide may have profound effects on overall suicide rates. Such effects appear to depend upon the popularity of the method and the extent to which alternative methods that are acceptable to the individual are available. Social and psychological interpretations of fluctuations in suicide rates should only be made after assessing the possible contribution to these of changes in method availability and lethality.

A prospective randomized clinical assessment of a new pigtail central venous catheter in comparison with standard alternatives.

The Cook Pigtail central venous catheter (CVC) has been designed to diminish the risk of vascular perforation and consequent cardiac tamponade. With the participation of 12 consultant anaesthetists and 19 registrars, adults undergoing elective surgery were randomized to receive either a Pigtail (n = 101) or their consultant anaesthetists' "standard" CVC (n = 102). Median ease of insertion was rated 8 for Pigtail CVCs and 9 for standards (10 being best; P = 0.001). Arrhythmias occurred during 16 standard and 33 Pigtail central venous catheter insertions (P < 0.006). No significant difference was found in insertion time or radiographically assessed tip depth for standard and Pigtail central venous catheters. A perforated right atrium of uncertain cause occurred in a patient who received an Arrow triple-lumen central venous catheter. Participating consultant anaesthetists preferred their "standard" central venous catheter for routine use, but five indicated that they would select a Cook Pigtail where long-term use was planned because of in vitro evidence of its greater safety.

Phylogeny of Melaleuca, Callistemon, and Related Genera of the Beaufortia Suballiance (Myrtaceae) Based on 5S and ITS-1 Spacer Regions of nrDNA.

A phylogenetic analysis of genera within the informal suballiance Beaufortia (family Myrtaceae), largely endemic to Australia and New Caledonia, is presented based on separate and combined data sets for 5S and ITS-1 spacer regions of nuclear ribosomal DNA. The two sets were not in conflict but the 5S data set was more informative. Data were analysed using conventional parsimony, jackknife parsimony, and three-item parsimony analyses. Three-item analysis gave more resolved trees than conventional parsimony analysis. The Beaufortia suballiance includes two major clades, with all Australian representatives of Callistemon (shown to be monophyletic) and most Australian representatives of Melaleuca forming one of these. The sister clade comprises a well-defined group of endemic New Caledonian taxa (classified as Callistemon and Melaleuca), some Australian species of Melaleuca, a clade including the Western Australia/Northern Territory genera Beaufortia, Lamarchea, and Regelia, and a clade including the south-west Western Australian genera Calothamnus, Eremaea, Conothamnus, and Phymatocarpus. All molecular analyses sup port the monophyly of Conothamnus and of Regelia, genera for which a number of species were included. Three-item analysis of the combined data set supports the monophyly of Beaufortia. The findings have implications for both taxonomy and biogeography.