Costs of illness due to endemic cholera.

Economic analyses of cholera immunization programmes require estimates of the costs of cholera. The Diseases of the Most Impoverished programme measured the public, provider, and patient costs of culture-confirmed cholera in four study sites with endemic cholera using a combination of hospital- and community-based studies. Families with culture-proven cases were surveyed at home 7 and 14 days after confirmation of illness. Public costs were measured at local health facilities using a micro-costing methodology. Hospital-based studies found that the costs of severe cholera were US$32 and US$47 in Matlab and Beira. Community-based studies in North Jakarta and Kolkata found that cholera cases cost between US$28 and US$206, depending on hospitalization. Patients' cost of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively. This burden on families is not captured by studies that adopt a provider perspective.

Phase III trial of gemcitabine plus docetaxel versus capecitabine plus docetaxel with planned crossover to the alternate single agent in metastatic breast cancer.

BACKGROUND: Safety and efficacy of gemcitabine plus docetaxel (GD) and capecitabine plus docetaxel (CD) were compared in patients with metastatic breast cancer, where the alternate crossover monotherapy (GD→C or CD→G) was predetermined. PATIENTS AND METHODS: Patients were randomly assigned to 3-week cycles of either gemcitabine 1000 mg/m(2) on days 1 and 8 plus docetaxel 75 mg/m(2) on day 1 or capecitabine 1000 mg/m(2) twice daily on days 1-14 plus docetaxel 75 mg/m(2) day 1. Upon progression, patients received crossover monotherapy. Primary end point was time to progression (TtP). Secondary end points evaluated overall response rate (ORR), overall survival (OS), and adverse events (AEs). RESULTS: Despite over-accrual of 475 patients, the trial matured with only 324 of 385 planned TtP events due to patient discontinuations. Human epidermal growth factor receptor 2 status was not captured in this study. More CD patients (28%) discontinued due to AEs than GD patients (18.0%, P = 0.009). TtP [hazard ratio (HR) = 1.101, 95% confidence interval (CI) 0.885-1.370, P = 0.387] and OS (HR = 1.031, 95% CI 0.830-1.280, P = 0.785) were not significantly different comparing GD and CD. ORR was not statistically different (P = 0.239) comparing GD (72 of 207, 34.8%) and CD (78 of 191, 40.8%). TtP, OS, and ORR were not significantly different comparing crossover groups. GD caused greater fatigue, hepatotoxicity, neutropenia, and thrombocytopenia but not febrile neutropenia; CD caused more hand-foot syndrome, gastrointestinal toxicity, and mucositis. CONCLUSIONS: GD and CD produced similar efficacy and toxicity profiles consistent with prior clinical experience.

Risk indicators of caries experience among young adults.

BACKGROUND: Significant gains have been documented on the oral health of Australian children. However, the question remains as to whether improvements have extended to the oral health of young adults. This study aimed to determine the risk indicators associated with oral health status in young adults aged 20-25 years. METHODS: A random sample of young adults was selected from the South Australian electoral roll. Telephone interviews were conducted for 1261 young adults. These provided socio-demographic, health behaviour and dental visiting data. Dental examinations were carried out on 644 subjects by three calibrated examiners in clinical settings. RESULTS: The mean number of tooth surfaces affected by dental caries (DMFS) was 6.05 with the presence of untreated cavitated decayed surfaces (DS) evident in 28.6 per cent. In regression models the risk indicators associated with DS were being on government benefits, unemployed, usually visiting for a problem rather than a check, visiting a public clinic, drinking 5+ acidic drinks per day and being a current smoker. Risk indicators for higher DMFS scores were usually visiting for a problem, visiting a public clinic, being on government benefits and having made a dental visit in the previous 2 years. CONCLUSIONS: Socio-demographic factors, dental visiting patterns and general health behaviours are risk indicators for caries in young adults.

Dental fear in Australia: who's afraid of the dentist?

BACKGROUND: This study aimed to describe both the prevalence of dental fear in Australia and to explore the relationship between dental fear and a number of demographic, socio-economic, oral health, insurance and service usage variables. METHODS: A telephone interview survey of a random sample of 7312 Australian residents, aged five years and over, from all states and territories. RESULTS: The prevalence of high dental fear in the entire sample was 16.1 per cent. A higher percentage of females than males reported high fear (HF). Adults aged 40-64 years old had the highest prevalence of high dental fear with those adults aged 80+ years old having the least. There were also differences between low fear (LF) and HF groups in relation to socioeconomic status (SES), with people from higher SES groups generally having less fear. People with HF were more likely to be dentate, have more missing teeth, be covered by dental insurance and have a longer time since their last visit to a dentist. CONCLUSIONS: This study found a high prevalence of dental fear within a contemporary Australian population with numerous differences between individuals with HF and LF in terms of socioeconomic, socio-demographic and self-reported oral health status characteristics.

Pamidronate reduces skeletal morbidity in women with advanced breast cancer and lytic bone lesions: a randomized, placebo-controlled trial. Protocol 18 Aredia Breast Cancer Study Group.

PURPOSE: To assess whether pamidronate can reduce the frequency of skeletal morbidity in women with lytic bone metastases from breast cancer treated with hormone therapy. PATIENTS AND METHODS: Three hundred seventy-two women with breast cancer who had at least one lytic bone lesion and who were receiving hormonal therapy were randomized to receive 90 mg of pamidronate or placebo as a 2-hour intravenous infusion given in double-blind fashion every 4 weeks for 24 cycles. Patients were evaluated for skeletal complications: pathologic fractures, spinal cord compression, irradiation of or surgery on bone, or hypercalcemia. The skeletal morbidity rate (the ratio of the number of skeletal complications to the time on trial) was the primary efficacy variable. Bone pain, use of analgesics, quality of life, performance status, bone tumor response, and biochemical parameters were also evaluated. RESULTS: One hundred eighty-two patients who received pamidronate and 189 who received placebo were assessable. The skeletal morbidity rate was significantly reduced at 12, 18, and 24 cycles in patients treated with 90 mg of pamidronate (P = .028, .023, and .008, respectively). At 24 cycles, the proportion of patients having had any skeletal complication was 56% in the pamidronate group and 67% in the placebo group (P = .027). The time to the first skeletal complication was longer for patients receiving pamidronate than for those given placebo (P = .049). There was no statistical difference in survival or in objective bone response rate. Pamidronate was well tolerated. CONCLUSION: Treatment with 90 mg of pamidronate as a 2-hour intravenous infusion every 4 weeks in addition to hormonal therapy significantly reduces skeletal morbidity from osteolytic metastases.

The effect of lifetime fluoridation exposure on dental caries experience of younger rural adults.

BACKGROUND: The aim of this study was to confirm whether the level of lifetime fluoridation exposure is associated with lower dental caries experience in younger adults (15-46 years). METHODS: Data of the cohort born between 1960 and 1990 residing outside Australia's capital cities from the 2004-2006 Australian National Survey of Adult Oral Health were analysed. Residential history questionnaires were used to determine the percentage of each person's lifetime exposure to fluoridated water (<50%/50+%). Examiners recorded decayed, missing and filled permanent teeth (DMFT). Socio-demographic variables, periodontal risk factors, and access to dental care were included in multivariable least-squares regression models. RESULTS: In bivariate analysis, the higher level of fluoridation category had significantly lower DMFT (mean 6.01 [SE=0.62]) than the lower level of fluoridation group (9.14 [SE=0.73] p<0.01) and lower numbers of filled teeth (4.08 [SE=0.43], 7.06 [SE=0.62], p<0.01). In multivariate analysis, the higher number of full-time equivalent dentists per 100,000 people was associated with a lower mean number of missing teeth (regression coefficient estimate=-1.75, p=0.03), and the higher level of water fluoridation with a lower mean DMFT (-2.45, p<0.01) and mean number of filled teeth (-2.52, p<0.01). CONCLUSIONS: The higher level of lifetime fluoridation exposure was associated with substantially lower caries experience in younger rural adults, largely due to a lower number of filled teeth.

Simultaneous adjuvant radiation therapy and chemotherapy in high-risk breast cancer--toxicity and dose modification: a Transtasman Radiation Oncology Group Multi-Institution study.

PURPOSE: To establish the toxicity profile of simultaneously administered postoperative radiation therapy and CMF chemotherapy as a prelude to a randomized controlled study addressing the sequencing of the two modalities. METHODS AND MATERIALS: One hundred and thirty eight breast cancer patients at high risk of locoregional, as well as systemic relapse, who were referred to three centers in Australia and New Zealand were treated with postoperative radiation therapy and chemotherapy simultaneously. Acute toxicity and dose modifications in these patients were compared with 83 patients treated over the same time frame with chemotherapy alone. In a separate study the long-term radiation and surgical effects in 24 patients treated simultaneously with radiation therapy and chemotherapy at Newcastle (Australia) following conservative surgery were compared with 23 matched patients treated at Newcastle with radiation therapy alone. RESULTS: Myelotoxicity was increased in patients treated simultaneously with radiation therapy and chemotherapy. The effect was not great, but may have contributed to chemotherapy dose reductions. Lymphopenia was observed to be the largest factor in total white cell depressions caused by the simultaneous administration of radiation therapy. Postsurgical appearances were found to so dominate long-term treatment effects on the treated breast that the effect of radiation therapy dose and additional chemotherapy was difficult to detect. CONCLUSION: Studies addressing the sequencing of radiation therapy and chemotherapy will necessarily be large because adverse effects from administering the two modalities simultaneously are not great. The present study has endorsed the importance in future studies of stratification according to the extent and type of surgery and adherence to a single strict policy of chemotherapy dose modification.

Neural tube defects and the 13q deletion syndrome: evidence for a critical region in 13q33-34.

Neural tube defects (NTD) are common findings in the 13q deletion syndrome, but the relationship between the 13q- syndrome and NTDs is poorly understood. We present a child with a 13q deletion and lumbosacral myelomeningocele. This was a boy with microcephaly, telecanthus, minor facial anomalies, and ambiguous genitalia. Cytogenetic and fluorescence in situ hybridization analysis showed a de novo 46,XY,del(13)(q33.2-->qter) with no visible translocation. By using microsatellite markers, the deletion breakpoint was mapped to a 350-kb region between D13S274 and D13S1311 and was paternal in origin. An analysis of 13q deletions with NTDs, including the present case, suggests that a deletion in 13q33-34 is sufficient to cause an NTD. The deletions associated with NTDs are distal to and nonoverlapping with the previously defined critical region in 13q32 for the major malformation syndrome [Brown et al., 1999: Am J Hum Genet 57: 859-866]. Our analysis also suggests that one or more genes in 13q33-34 produces NTDs by haploinsufficiency.

Mitotic effect of autologous blood injection and diode laser bleb revision on rabbit filtration blebs.

OBJECTIVE: To investigate the effect of intrableb autologous blood injection and diode laser bleb revision on cellular proliferation in filtration blebs of rabbits. METHODS: Bilateral filtration surgery with mitomycin was performed on 19 white 2.5- to 3-kg New Zealand rabbits. Autologous blood injection (n = 9) or diode laser bleb revision (n = 10) was performed on blebs of right eyes (intervention eyes) on day 14 after filtration surgery. The blebs of the left eyes served as controls. Cellular proliferation was assessed by in vivo incorporation of 5-bromo-2'-deoxyuridine (BrdU), after BrdU, 10 mg/kg, was injected via the ear vein on days 15, 16, and 18. The rabbits were euthanized on day 21. Conjunctival sections were stained with hematoxylin-eosin for total cell counts and with anti-BrdU antibody for counts of proliferating cells. The BrdU labeling index was calculated by dividing the mean proliferating cell count by the mean total cell count. RESULTS: The BrdU labeling index was significantly increased in the blood-injected eyes as compared with the control eyes (P = .03). The BrdU labeling index was increased in the diode laser-revised eyes as compared with the control eyes, approaching significance (P = .06). Intraocular pressure increased significantly in the eyes that underwent bleb interventions in both groups from baseline and compared with the control eyes. CONCLUSIONS: Intrableb autologous blood injection and diode laser bleb revision stimulate cellular proliferation in the rabbit filtration bleb, which may contribute to the rise in intraocular pressure observed clinically after these interventions.

The effect of a brief education program on glaucoma patients.

PURPOSE: To assess our patients' knowledge of glaucoma and to measure the effect of a brief education program on their understanding of glaucoma. METHODS: Patients attending glaucoma clinics at a university and a Veterans' Affairs hospital were randomized into two groups: "exposed" and "unexposed" to a simple education program of a video and brochures. Glaucoma knowledge was assessed twice by an oral questionnaire, at 2 weeks and 6 months after randomization plus or minus education. RESULTS: Younger patients and those with more years of formal schooling knew more about glaucoma. Two weeks after the education program, the exposed group performed significantly better than did the unexposed group. Analysis of the results showed benefit from both brochures and video. This effect of education was not seen at retesting 6 months later. CONCLUSION: Older patients and those with less formal education know less about glaucoma. A brief, simple education program can significantly improve levels of knowledge about glaucoma, even in a relatively well-informed population. However, patient education must be repeated to maintain a useful effect.

Pelvic radiotherapy with concurrent 5-fluorouracil modulated by leucovorin for rectal cancer: a phase II study.

Combined modality treatment for cancer of the rectum has been shown to reduce recurrences and improve overall survival. We wished to find out if we could safely give concurrent radiotherapy and 5-fluorouracil (5-FU) modulated by leucovorin (LV) in 3 settings: pre-operatively, adjuvantly and in recurrent disease. A total of 39 patients were treated, 11 preoperatively, 17 adjuvantly and 11 with recurrent disease. There were 26 males and 13 females with a median age of 64 years. The median radiotherapy (RT) dose was 45 Gy/25 fractions/1.8 Gy per fraction (range 25-63 Gy). Chemotherapy consisted of LV 80 mg/m2 i.v. infusion over 1.5 hours followed by 5-FU 400 mg/m2 i.v. bolus, both given once a week. The median number of cycles was 8 (range 3-12). Diarrhoea was the main toxicity, and was encountered in 30 patients (77%): grade 1 in 3 (8%), grade 2 in 12 (30%), grade 3 in 11 (28%), and grade 4 in 4 (10%). This required 18 (46%) patients to have modifications to their RT (20% had breaks and 26% ceased at doses < 45 Gy). Nine patients (23%) had modifications in the chemotherapy (10% had breaks and 13% received < 6 cycles). Encouraging responses were seen in the preoperative setting. Concurrent RT and 5-FU/LV, as given in this schedule, results in an unacceptable incidence of diarrhoea, limiting both the total dose of RT and chemotherapy that can be delivered, particularly in patients who have had previous surgery.

Caries experience among children in fluoridated Townsville and unfluoridated Brisbane.

Fluoridation of community water supplies constitutes the main public health strategy for prevention of dental caries in Australia. In recent years questions have been raised about the effectiveness of water fluoridation. The aim of this paper was to examine differences in caries experience of children aged 5 to 12 years who were lifetime residents either of Brisbane (the unfluoridated Queensland capital) or Townsville (fluoridated since 1965). Children from each city were sampled from patients of the school dental service. Dental therapists and dentists from the school dental service recorded data describing dental caries experience and parents were asked to complete a questionnaire about their children's residential history and exposure to other fluorides. Of the 18,348 children sampled, 10,195 (55.6 per cent) provided completed questionnaires, and 4588 were lifetime residents of their respective cities. Caries rates were significantly lower (P < 0.01) among children in Townsville than in Brisbane, both in the deciduous dentition (according to age 32 to 55 per cent fewer tooth surfaces affected) and permanent dentition (20 to 65 per cent fewer tooth surfaces affected). Significantly lower rates in Townsville persisted (P < 0.01) in multivariate analyses that controlled for oral hygiene practices, exposure to fluoride supplements and household income. Water fluoridation appears to provide a substantial public health benefit for children in Townsville.

The Australian public's perception of mercury risk from dental restorations.

The debate about mercury and dental amalgam has been one of the longest running in dentistry, and shows no signs of abating. This study aimed to investigate perceptions about mercury in dental fillings among a representative sample of the Australian public. A random sub-sample of participants in a national dental telephone interview survey completed a follow-up postal questionnaire which included four items on dental mercury. The postal survey response rate was 85.2%. Concern about mercury in dental fillings was expressed by 37.5%, while 16.2% reported having requested fillings that do not contain mercury. Avoidance of dental care because of concern about mercury in fillings was reported by 5.8%, but only 4.7% reported having had fillings replaced because they contained mercury. The data indicate that there is a substantial degree of concern about mercury and dental amalgam among the Australian public, but that the dental behavioural and treatment-pattern consequences of that concern are infrequent.

Influence of exposure to fluoridated water on socioeconomic inequalities in children's caries experience.

This study aimed to evaluate inequalities in children's dental caries experience among socioeconomic status (SES) groups and to investigate effects of exposure to fluoride in water on those inequalities. Cross-sectional data were obtained from 6704 Queensland children aged 5-12 years and 6814 South Australian children aged 5-15 years. School dental therapists and dentists recorded dmfs and DMFS data. A questionnaire to parents sought information about household SES and each child's lifetime exposure to fluoridated drinking water. SES fluoride exposure and multiplicative interactions between the two were used as explanatory variables in least squares models in which dmfs and DMFs were dependent variables. Additive interactions were evaluated by calculating the excess rate of disease. In both states, children from low SES groups (categorized by household income or parental education) had higher mean dmfs and DMFS values than children from high SES groups (P < 0.01). Independent effects of income and education remained significant (P < 0.01) after controlling for exposure to fluoride in drinking water. In Queensland, there was a significant multiplicative interaction whereby SES inequalities were lower among children exposed to fluoride: dmfs ratios between low- and high-income groups ranged among ages from 1.54 to 3.56 for children with no exposure to fluoride and from 0.84 to 2.07 for children with lifetime exposure to fluoride. Multiplicative interactions were not statistically significant in South Australia or when DMFS was the dependent variable. However, additive interactions were consistent and most pronounced for deciduous teeth in both States. Absolute differences in caries experience between low and high SES children were greater among non-exposed groups due to the higher underlying levels of caries experience of children with no exposure to fluoride in water.

Patient mobility in Australian dentistry.

Data on the mobility of dental patients are scarce. The aim of this study was to investigate movement among dentists of a representative sample of the Australian public. A postal questionnaire was completed by a random subsample of 1,010 participants in the 1995 National Dental Telephone Interview Survey. The response rate was 85.2 per cent. Approximately one-third of the 885 dentate respondents reported attending a different dentist to that attended two years previously; this was substantially higher (over half) among those whose last visit was not in the private sector. Most (81.8 per cent) of those who had changed dentist had done so for reasons which were beyond the immediate control of the dental profession, but 15.2 per cent had changed because they were unhappy with the care provided by the previous dentist, and 3.0 per cent had changed because the previous dentist was too expensive. Perceived freedom to change dentist was greater among individuals who used the private sector, spoke English in the home, and who were not holders of health cards. The findings of this study indicate that the Australian public manifests a moderate degree of movement among dental providers, and that such movement is greater among users of public-sector dental services.

Associations between exposure to fluoridated drinking water and dental caries experience among children in two Australian states.

OBJECTIVES: This study assessed associations between exposure to fluoride in water and dental caries experience among children in two Australian states. METHODS: Cross-sectional data were obtained from 9,690 South Australian children aged 5-15 years and 10,195 Queensland children aged 5-12 years. School dental service practitioners recorded DMFS and dmfs data. A questionnaire to parents gained information about residential history that was used to calculate children's percent of lifetime exposed to fluoridated water. RESULTS: Greater exposure to fluoride in water was associated with lower dmfs and DMFS in both states (P < .01), although in South Australia the effect for DMFS was statistically significant only after controlling for extent of unknown fluoridation exposure and for fluoride supplements. Caries-fluoridation associations were stronger for dmfs compared with DMFS and for Queensland (5% of population fluoridated) compared with South Australia (70% of population fluoridated). Effects for DMFS persisted after controlling for socioeconomic factors. CONCLUSIONS: Fluoridation was associated with lower caries experience. The weaker association with DMFS in South Australia may be due to less caries and more fissure sealants in that state, and is consistent with a "diffusion" effect, whereby a high proportion of the population exposed to fluoridation diminishes differences among exposure groups.

Use of human recombinant erythropoietin and prednisone for treatment of myelodysplastic syndrome with erythroid predominance in a dog.

A 7-year-old German Shepherd dog was referred for evaluation of severe nonregenerative anemia (PCV, 10%; reticulocyte fraction, 0.2%). Cytologic examination of a bone marrow aspirate indicated erythroid predominance and dyserythropoiesis, and a diagnosis of myelodysplastic syndrome (MDS) with erythroid predominance was made. The dog was given a single blood transfusion and was treated with prednisone and recombinant human erythropoietin (EPO). Eight weeks later, anemia had resolved. The dog remained clinically normal 30 months after treatment, with a PCV of 45%. Results suggest that EPO may be useful in the treatment of dogs with MDS with erythroid predominance or erythroleukemia. Additional studies are required to confirm the benefit of EPO to manage MDS-associated anemia in dogs.

Dental anxiety among Australians.

This study aimed to estimate the prevalence of dental anxiety and examine its associations among a representative sample of Australians aged 18 and over. A random sub-sample of participants in a national dental telephone interview survey completed a follow-up postal questionnaire (response rate 85.2 per cent) which included Corah's Dental Anxiety Scale (DAS). The prevalence of dental anxiety (defined by a DAS score of 13 or more) in the sample was 14.9 per cent, with overall severity represented by the mean score of 9.04 (sd, 3.45). The prevalence and severity of dental anxiety were greater among women than men, and in the 35-44 age group. High-anxiety individuals reported more deferring of dental care, and more frequently reported an episodic dental visiting pattern. Although there were no differences in dental anxiety by self-reported dental status, individuals who reported impact from their oral conditions had higher dental anxiety. These associations with social impacts and deferment of care indicate that dental anxiety may be an important dental public health problem in Australia.

Evaluation of MDA instant working level meters.

The U.S. Bureau of Mines and the Mine Safety and Health Administration have evaluated, for accuracy and reliability, a commercially available Instant Working Level Meter (IWLM) used by the mining industry to measure short-lived 222Rn-progeny concentrations. Six evaluation parameters were determined experimentally. These included two alpha and two beta detector efficiencies for the short-lived 222Rn progeny and two internal conversion factors. The experimental procedure detailing the evaluation technique is described in the paper. The measuring accuracy of 13 instruments is as follows: average inherent uncertainty (at least 68% confidence interval) is +/- 18%; for counting statistics and rounding at 0.10 WL (2.1 microJ m-3), coefficients of variation range from +/- 15% at low gamma flux backgrounds to +/- 50% at gamma flux backgrounds of 0.39 microC kg-1 h-1 (1.5 mR h-1). All parameters were derived theoretically and measured experimentally. All tests were conducted at a sample flow rate of 2.5 L min-1. A sample air flow rate of 7.5 L min-1 can lower the counting statistics to more acceptable levels at 0.1 WL (2.1 microJ m-3).

Access to dental care by young South Australian adults.

BACKGROUND: Despite reported concern over the dental care of young adults little research has been done on their use of dental services in Australia. The aim of this study was to investigate the patterns of dental utilization of young South Australian adults aged 20-24 years. METHODS: A random sample of 2300 young adults was selected from the electoral roll. Partial or complete addresses and possible phone numbers were obtained for 1921 persons. Telephone interviews were conducted for 1261 subjects to obtain information on socio-demographics, health behaviour and dental visiting (response rate 65.6 per cent). RESULTS: One third of young adults (34 per cent) had not made a dental visit in the previous two years and 38 per cent usually visited for a problem rather than a check-up. Making a dental visit in the last two years was significantly associated with a number of socio-demographic variables including age and gender, with holders of private dental insurance and those who have not avoided care because of cost having higher odds of making a visit and males and government concession card holders having lower odds of visiting. Usual reason for visiting a dentist for a problem was significantly associated with no private dental insurance, holding a government concession card, no tertiary education and avoiding care because of cost. CONCLUSIONS: This study suggests that demographic and economic factors influenced use of dental services and reason for visiting of young South Australian adults.