Breast fine needle aspiration cytology: a review of current practice in Australasia.

AIMS: To investigate breast fine needle aspiration (FNA) cytology in Australasia, in terms of laboratory demographics, specimens received and quality control (QC). METHODS: A questionnaire was sent to all laboratories enrolled in the FNA module of the Royal College of Pathologists of Australasia Cytopathology Quality Assurance Program (QAP), requesting information about specimens received in a 3-month period in 2001 and in 2008. RESULTS: Responses were received from 81/180 laboratories in 2001 and from 94/200 in 2008. The mean number of cases per 3 months was 137 in 2001 and 141 in 2008 and for the 42 laboratories responding on both occasions, the mean number of cases declined from 191 to 149 (P=0.001). The mean percentage of malignant cases was 11.7% in 2001 and 10.5% in 2008 and the mean percentages of unsatisfactory rates were 21.7% and 25.2%, respectively; 43.2% of laboratories in 2001 and 40.4% in 2008 reported fewer than 50 cases for the 3-month period. The unsatisfactory rate was inversely proportional to the number of cases received. Most QC (69.1% in 2001, 71.3% in 2008) was carried out by correlation with any later histology. With no histology available, 35.8% of laboratories in 2001 and 48.9% in 2008 did no further follow-up. Follow-up of all diagnostic categories increased from 30.9% in 2001 to 44% in 2008. CONCLUSIONS: Breast FNA cytology is still actively undertaken in Australasia, but numbers have declined. Unsatisfactory rates have reached the Australian recommended upper limit and are inversely proportional to the total number of cases received. Overall QC measures are unchanged and consideration of a review of breast FNA guidelines is suggested.

Cross-pollination of nontransgenic corn ears with transgenic Bt corn: efficacy against lepidopteran pests and implications for resistance management.

The efficacy of nontransgenic sweet corn, Zea mays L., hybrids cross-pollinated by Bacillus thuringiensis (Bt) sweet corn hybrids expressing Cry1Ab toxin was evaluated in both field and laboratory studies in Minnesota in 2000. Non-Bt and Bt hybrids (maternal plants) were cross-pollinated with pollen from both non-Bt and Bt hybrids (paternal plants) to create four crosses. Subsequent crosses were evaluated for efficacy in the field against European corn borer, Ostrinia nubilalis (Hübner), and corn earworm, Helicoverpa zea (Boddie), and in laboratory bioassays against O. nubilalis. Field studies indicated that crosses with maternal Bt plants led to low levels of survival for both O. nubilalis and H. zea compared with the non-Bt x non-Bt cross. However, the cross between non-Bt ears and Bt pollen led to survival rates of 43 and 63% for O. nubilalis and H. zea larvae, respectively. This intermediate level of survival also was reflected in the number of kernels damaged. Laboratory bioassays for O. nubilalis, further confirmed field results with larval survival on kernels from the cross between non-Bt ears and Bt pollen reaching 60% compared with non-Bt crossed with non-Bt. These results suggest that non-Bt refuge plants, when planted in proximity to Bt plants, and cross-pollinated, can result in sublethal exposure of O. nubilalis and H. zea larvae to Bt and may undermine the high-dose/refuge resistance management strategy for corn hybrids expressing Cry1Ab.

Blood transfusion for caesarean delivery complicated by placenta praevia.

AIM: This study was undertaken to determine if the need for red cell blood transfusion in placenta praevia could be predicted. METHODS: Data from a retrospective observational study of 246 obstetric patients, with placenta praevia, from 1999 to 2005 were analysed to generate a model to predict requirement for transfusion. RESULTS: Seventy-one patients were transfused. Independent risk factors for transfusion were gestational age at delivery of 32-35 weeks [odds ratio (OR): 2.6; 95% confidence interval (CI): 1.1-6.4] and caesarean combined with hysterectomy (OR: 29.4; 95% CI: 5.9-145.9; P < 0.001). No independent risk of transfusion was associated with maternal age, race, parity, smoking status, type of anaesthesia, caesarean combined with arterial balloon occlusion, grade of placenta, accreta and previous uterine surgery. CONCLUSIONS: Gestational age at delivery and type of surgery required are predictors of transfusion during caesarean for placenta praevia. Arterial balloon occlusion does not appear to increase transfusion risk and may be considered as one of the techniques in management.

Service quality for Type 2 diabetes in Australia: the patient perspective.

AIMS: To assess the service quality of care as perceived by people with Type 2 diabetes mellitus. METHODS: A cross-sectional survey using a self-administered questionnaire was carried out among members of Diabetes Australia-Queensland with Type 2 diabetes. For 12 aspects of service quality derived from a literature review and focus group research, patients scored the relative importance of the aspects and their perception of quality of received care. A measure of service quality was derived by combining the relative importance and actual performance. RESULTS: A total of 603 people with Type 2 diabetes participated. Of the 12 aspects of care, communication, availability of support group, safety and prevention had the highest scores for importance; support group and basic amenities had the highest average performance values; but the highest service quality values were for support group, basic amenities, dignity and confidentiality. Younger participants had lower service quality scores (P = 0.001) and participants with good control of their diabetes had higher scores (P < 0.001). Compared with the reference population, our sample had 8.7% fewer people under 65 years old. CONCLUSIONS: From the perspective of people with Type 2 diabetes, there is a notable gap between their expectations and what they have actually received in most aspects of provided care. In addition, overall service quality and six aspects of service quality (choice of care provider, accessibility, prevention, continuity, timeliness and safety) were identified to be of inadequate quality. Hence, this study demonstrates a significant opportunity to improve quality of healthcare services.

Do case conferences between general practitioners and specialist palliative care services improve quality of life? A randomised controlled trial (ISRCTN 52269003).

Australian palliative care is delivered by general practitioners (GPs) and specialist palliative care teams. Patient outcomes should improve if they work in formal partnership. We conducted a multi-centred randomised controlled trial of specialist- GP case conferences, with the GP participating by teleconference, or usual care and communication methods. Primary outcome measure was global Quality of Life (QoL) scores at 3 weeks from intervention. Secondary measures included subscale QoL scores and carer burden. Two a priori intention-to-treat analyses were conducted using recruitment, and time of death, as fixed time points. There was no difference between groups in the magnitude of change in global QoL measures from baseline to any time point up to 9 weeks post-case conference, or at any time before death. The case conference group showed better maintenance of some physical and mental health measures of QoL in the 35 days before death. Case conferences may improve clinical relationships and care plans at referral, which are not implemented until severe symptoms develop. Case conferences between GPs and specialist palliative care services may be warranted for palliative care patients.

Caries experience in preschool children referred for specialist dental care in hospital.

BACKGROUND: Increasing numbers of preschool children are being referred for specialist dental management in a paediatric hospital. Most cases have severe early childhood caries and require comprehensive management under general anaesthesia. The present study investigated risk factors for disease presence at initial consultation. METHODS: A convenience sample of 125 children under four years of age from the north Brisbane region were examined and caries experience recorded using dmft and dmfs indices. A self-administered questionnaire obtained information regarding social, demographic, birth, neonatal, infant feeding and dental health behaviour variables. The data were analysed using the chi-square and one-way analysis of variance procedures. RESULTS: Ninety-four per cent of referred children had severe ECC with mean dmft of 10.5 +/- 3.8 and mean dmfs of 27.1 +/- 15.1. Prevalence of severe ECC was significantly higher in children allowed a sweetened liquid in the infant feeding bottle (99 per cent) and allowed to sip from an infant feeding bottle during the day (100 per cent). Mean dmfs was significantly higher in children allowed to sleep with a bottle (28.7) and sip from a bottle during the day (29.9), children from a non-Caucasian background (31.8), those children that commenced regular toothbrushing between 6 to 12 months of age (28.1), had no current parental supervision of daily tooth-brushing (34.2) and had not taken daily fluoride supplements (27.8), vitamin supplements (27.8) or prescription medicine previously (27.6). CONCLUSIONS: The behavioural determinants for severe early childhood caries presence in hospital-referred children were similar to those identified in the regional preschool population.

Fetal development and gestational changes in Bos taurus and Bos indicus genotypes in the tropics.

Weights of the gravid uterus and fetus as well as the fetal measurements were determined at slaughter for 107 Bos taurus cows grazed on improved pastures and for 70 Bos indicus cows grazed on native pastures in northern Australia. The stage of gestation was assessed from palpation per rectum in early-to-mid gestation and at slaughter and from fetal development characteristics at slaughter. The age and breed of the cow and the sex of the fetus did not significantly affect any of the uterine components or fetal measurements. Growth curves had dominant, positive linear components but negative quadratic ones, which improved the fit, particularly for the later stages of gestation. Uterine components and fetal measurements were highly correlated (0.94 to 0.99). For Bos taurus cows, there were higher estimates at birth for weights of the gravid uterus and the fetus, but estimates for other fetal measurements were similar to those for Bos indicus cows. Major fetal growth occurred during the third trimester, with the length of the foreleg tending to change relatively slowly and the head width quite fast during the first trimester. Correction factors for cow liveweight to adjust to commonality for non-pregnancy were 5, 7, 10, 14, 20, 29, 43 and 65 kg for Bos taurus and 2, 4, 6, 10, 15, 23, 35 and 51 kg for Bos indicus at 2 to 9 months of gestation.

Predictors of demand for emergency prehospital care: an Australian study.

INTRODUCTION: Determining the predictors of demand for emergency prehospital care can assist ambulance services in undertaking policy and planning activities. HYPOTHESIS: Demand for prehospital care can be explained by demographic, health status, and economic determinants. METHODS: The study used a cross-sectional design to investigate the association of demographic, health status, and insurance factors with the use of prehospital, ambulance care. Core data items including age, gender, marital status, country of origin, triage score, diagnosis, time of presentation, method of arrival, and patient disposition were collected for every patient who presented at the Emergency Department of the study hospital over a four-month period. Ambulance usage was analysed using Poisson regression. RESULTS: For the 10,229 patients surveyed, only a small number were triaged as having the highest level of urgent medical need (0.8%), but the majority of these used prehospital emergency medical care (90.2%). Predictors of ambulance use included age > 65 years (Prevalence Ratio [PR] = 2.92; 95% confidence interval [CI]: 2.35-3.63), being married or in a de-facto relationship (PR = 0.69; 95% CI: 0.60-0.79) or divorced, separated, or widowed (PR = 0.83; 95% CI: 0.70-0.98), triage score level 1 or 2 (PR = 1.95; 95% CI: 1.68-2.28), or triage score level 3 (PR = 1.54; 95% CI: 1.38-1.72), diagnosis involving either mental (PR = 4.29; 95% CI: 1.84-10.01), nervous (PR = 2.74; 95% CI: 1.19-6.31) or trauma (PR = 2.33; 95% CI: 1.03-5.27) conditions, and insurance status (PR = 1.54; 95% CI: 1.40-1.71). Ethnicity, gender, and time of day were not associated with usage. CONCLUSION: Demand for ambulance services can be predicted by a number of demographic, medical status, and insurance variables. Age and triage levels are key influences on demand for ambulance services. Ambulance insurance status provides an economic incentive to use ambulance services regardless of the urgency of the medical condition.

Dental caries experience of preschool children from the North Brisbane region.

BACKGROUND: To report the dental caries experience of preschool children within the north Brisbane region and to investigate the association between selected social and demographic variables and disease presence. METHODS: A cross-sectional sample of 2515 children aged four to six years was examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) and percentage caries free indices. A self-administered questionnaire obtained information regarding selected social and demographic variables. The data were analysed using the chi-square and one way analysis of variance procedures at the 5 per cent level of significance. RESULTS: Overall, 1668 (66.3 per cent) children were disease free at the examination and mean dmft was 1.4+/-2.77 and dmfs was 2.28+/-6.00. Dental caries occurred more frequently and severely in children from non-Caucasian background (p<0.000), family language other than English (p=0.001) and lower socio-economic status (p<0.000). CONCLUSIONS: Significant associations between child ethnicity, language spoken at home, socio-economic status and caries presence have been identified. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Social and behavioural determinants of early childhood caries.

BACKGROUND: To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region. METHODS: A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self-administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance. RESULTS: The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income dollars 20,000-dollars 35,000 (OR=1.7, CI=1.3, 2.3) and annual family income less than dollars 20,000 (OR=2.1, CI=1.5, 2.8). CONCLUSIONS: A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Toxicity of Crotalaria Goreensis for chickens.

Ground Crotalaria goreensis seed fed to day-old cockerel chickens at 3 different rates in a commercial ration of chick starter mash depressed growth rates. Moist faeces were common. Lesions consistently found included ulceration of the proximal large intestine and a dark grey discolouration of the glandular portion of the proventriculus. C. goreensis should be excluded from all poultry rations.

Oedema disease in chickens caused by Mexican poppy (Argemone mexicana) seed.

Ground Mexican poppy (Argemone mexicana) seed produced growth depression, oedema and death when fed at 1% and 3% of a basal ration to day-old, layer strain, cockerel chickens. The mortality rate was increased by raising the sodium chloride content of the basal ration from 0.18% to 1.68%. Clinical signs consisted of subcutaneous oedema, a high pitched chirp and terminal gasping. Hydropericardium, oedema of the lungs, and subcutaneous oedema of the thorax, abdomen, wings, neck and throat were the major lesions. Foci of calcificaton were present in the ventricular myocardium of some chickens fed 3% A. mexicana.

Evaluation of oral iron galactan as a method of iron supplementation for intensively housed sucking piglets.

Iron supplementation of piglets with oral galactan given as a single dose within 24 hours of birth was evaluated in a series of on farm trials. The growth rate of piglets receiving this treatment was faster than that of piglets receiving single injections of iron dextran or iron galactan at 3 days of age, or ferrous sulphate crystals orally at weekly intervals. Mean values for red cell parameters of oral iron galactan supplemented piglets at 2 to 4 weeks of age were lower than those of injected piglets but there was no clinical evidence of anaemia in any of the piglets.

Pre slaughter handling of cattle: the availability of water during the lairage period.

A comparison was made of the effect of providing or denying water to steers during the last 20 h before slaughter on carcase weight, bruising, muscle pH, and during the dressing process on the numbers of rumens from which ingesta was split and the number of heads and tongues condemned because of contamination with ingesta. All cattle were offered water from arrival at the abattoir until the start of the treatment period. In one experiment the steers were rested for 24 or 48 h after a 120 km journey before being slaughtered, while in a second experiment they rested for 66 h after a 725 km journey. Giving steers access to water until they were slaughtered did not affect adversely carcase weight, bruise score, muscle pH or the incidence of ingesta spillage from rumens. The number of condemned heads and tongues was not consistently related to the availability of water. In the absence of any adverse effects it is recommended that cattle be provided with water during the lairage period.

Numerical taxonomy of proteolytic psychrotrophs from Queensland raw milks.

Eighty-seven proteolytic psychrotrophic micro-organisms were isolated from 11 bulk milk supplies of two Queensland factories from different climatic regions, before and after storage at 4 degrees C for 7 d. These isolates together with 15 reference strains formed the basis of a numerical taxonomic study involving 81 attributes. All but six isolates were pseudomonads. The strains clustered into nine groups, of which one group consisted of four yeasts. One group, containing 39 isolates, was designated as Pseudomonas fluorescens biovar 1; three groups, containing 27 isolates, as Ps. fluorescens biovar 5; and one group, containing 10 isolates, as Ps. putida biovar A. This study showed that the proteolytic psychrotrophic microflora of the 11 milks supplying the two factories was substantially different and that the proteolytic flora of 7 d refrigerated milk could not be estimated by examining the flora before storage.

Reliability of computer image analysis of pigmented skin lesions of Australian adolescents.

BACKGROUND: The diagnosis of melanomas at an early stage is associated with improved survival, so the recognition of changes in pigmented skin lesions over time is important. We have developed a computer imaging system with the aim of assisting clinicians in differentiating early melanomas from benign pigmented skin lesions. The objective of this study was to investigate the system's reliability over time in measuring diagnostic characteristics of pigmented skin lesions, including their color, size, shape, and distinctness of boundary. METHODS: We captured video images of 5 lesions, all larger than 2 mm in greatest dimension, on each of 66 Australian adolescents on 2 occasions approximately 1 month apart. Features extracted by computer image analysis included area, perimeter, and regularity of outline of the lesions, the mean and standard deviation of reflectance at red, green, and blue wavelengths, and the mean and standard deviation of the gradients of red, green, and blue reflectance at the lesion boundary. RESULTS: All measurements showed moderate to high reliability (intraclass correlation coefficients 0.66-0.94), except for the standard deviations of the color gradients, whose reliability improved to moderate levels (0.68-0.71) when the mean of 5 lesions was considered. For most outcomes, reasonable within subject reliability was achieved when five lesions per subject were measured. CONCLUSIONS: These results, in combination with previous work demonstrating the reasonable ability of this computer imaging system to discriminate between malignant melanomas and other pigmented lesions, indicates that the system has the potential to become a useful tool for clinicians in following people with pigmented lesions over time to detect early malignant changes.