Pesticide leaching through sandy and loamy fields - long-term lessons learnt from the Danish Pesticide Leaching Assessment Programme.

The European Union authorization procedure for pesticides includes an assessment of the leaching risk posed by pesticides and their degradation products (DP) with the aim of avoiding any unacceptable influence on groundwater. Twelve-year's results of the Danish Pesticide Leaching Assessment Programme reveal shortcomings to the procedure by having assessed leaching into groundwater of 43 pesticides applied in accordance with current regulations on agricultural fields, and 47 of their DP. Three types of leaching scenario were not fully captured by the procedure: long-term leaching of DP of pesticides applied on potato crops cultivated in sand, leaching of strongly sorbing pesticides after autumn application on loam, and leaching of various pesticides and their DP following early summer application on loam. Rapid preferential transport that bypasses the retardation of the plow layer primarily in autumn, but also during early summer, seems to dominate leaching in a number of those scenarios.

Sampling of herbicides in streams during flood events.

In stream water xenobiotics usually occur as pulses in connection with floods caused by surface run-off and tile drainage following precipitation events. In streams located in small agricultural catchments we monitored herbicide concentrations during flood events by applying an intensive sampling programme of ½ h intervals for 7 h. In contrast to grab sampling under non-flood conditions, clearly elevated concentrations were recorded during the floods, and pulses varying in occurrence, duration and concentration were recorded. Pulses of recently applied herbicides were the most prominent, but also agricultural herbicides used in previous seasons caused pulses in the streams. Asynchronism of chemographs may be related to the characteristics of the compounds as well as their transport pathways and transformation in compartments between the source and the point of sampling in the stream. Thus, the occurrence of chemographs is difficult to predict, which ought to be taken into account when designing a sampling strategy. Even though the chemographs of herbicides and their transformation products (glyphosate and aminomethylphosphonic acid (AMPA) as well as terbuthylazine and desethylterbuthylazine) seem to be synchronous, their occurrence may still be difficult to predict. It is evident that grab sampling under non-flood conditions yields insufficient information on the dynamics of occurrence of herbicides in stream water, both with respect to environmental effects and the calculation of the load to a recipient. In conclusion, the design of a sampling strategy regarding herbicides in stream waters should adequately consider the aim of the investigation.

Predicting phosphorus losses with the PLEASE model on a local scale in Denmark and the Netherlands.

To reduce losses from agricultural soils to surface water, mitigation options have to be implemented as a local scale. For a cost-effective implementation of these measures, an instrument to identify critical areas for P leaching is indispensable. In many countries, P-index methods are used to identify areas as risk for P losses to surface water. In flat areas, where losses by leaching are dominant, these methods have their limitations because leaching is often not described in detail, PLEASE, is a simple mechanistic model designed to stimulate P Losses by leaching at the field scale using a limited amount of local field data. In this study, PLEASE, was applied to 17 lowland sites in Denmark and 14 lowland sites in the Netherlands. Results show that the simple model simulated measured fluxes and concentrations in water from pipe drains, suction cups, and groundwater quite well. The modeling efficiency ranged from 0.92 for modeling total-P fluxes to 0.36 fr modeling concentrations in groundwater. Poor results were obtained for heavy clay soils and eutrophic peat soils, where fluxes and concentration were strongly underestimated by the model. The poot performance for the heavy clay soil can be explained by the transport of P through macropores to the drain pipes and the underestimation of overland flow on this heavy-textured soil. In the eutrophic peat soils, fluxes were underestimated due to the release of P from deep soil layers.

Australian physiotherapy student intake is increasing and attrition remains lower than the university average: a demographic study.

QUESTIONS: Have student numbers (ie, intake and attrition) changed since the introduction of graduate entry-level physiotherapy courses in Australian universities? What is the impact of any changes in student numbers on university funding? What is the impact of any changes in student numbers on the workforce? Have student characteristics (ie, gender, country of origin, background) changed? DESIGN: Demographic study of 2003 graduates, 2004 student intake, and estimated 2007 student intake. PARTICIPANTS: Eleven Schools of Physiotherapy in Australia. RESULTS: In 2003, 836 new physiotherapists graduated, and in 2004, 1108 students commenced with the percentage of graduate-entry Masters and international students increasing. Compared to the overall average 25% attrition rate of students from university, the rate for physiotherapy students was less than 5%; the funding formula thus underestimates physiotherapy student numbers across the years of the courses. While it remains the case that in undergraduate and graduate-entry programs most physiotherapy students are female, a greater proportion of males are entering graduate-entry Masters programs than undergraduate courses. International student numbers are increasing in line with trends across the sector, but representation of Aboriginal and Torres Strait Islander students in physiotherapy courses was lower than within universities generally. CONCLUSIONS: The marked overall increase in student numbers and greater retention rate in the graduate entry-level courses puts physiotherapy at a disadvantage in relation to Department of Education, Science and Training student funding. While the substantial increase in new physiotherapists may serve to ease workforce demands in the short term, significant pressure on physiotherapy academics and clinical educators was evident.

Reducing nitrogen loading of inland and marine waters--evaluation of Danish policy measures to reduce nitrogen loss from farmland.

An evaluation in December 2003 of the Danish National Action Plan for the Aquatic Environment II showed that nitrogen leaching from farmland had declined to almost half the amount of that in 1989. This can be ascribed to successful implementation of several measures, the most efficient of which were related to the use of fertilizers: lowered nitrogen standards for crops, increased nitrogen utilization in manure and catch crops. Although the objectives of the plan were almost met and measurements have shown a similar, but not percentually as high a decrease in nitrogen concentrations in both inland and coastal waters, the ecological impact in estuaries and coastal areas is not yet satisfactorily significant. As a consequence, a new National Action Plan for the Aquatic Environment III, including both nitrogen and phosphorus reduction from farming, was agreed to in April 2004. To ensure that good ecological status can be achieved in water bodies according to the requirements of the European Union Water Framework Directive, the national measures will be combined with additional measures for individual river basins.

The costs and benefits of physiotherapy as first-line treatment for female stress urinary incontinence.

OBJECTIVE: To evaluate the costs and benefits of physiotherapy for stress urinary incontinence (SUI) in Australia. METHODS: We evaluated the costs and benefits of physiotherapy for the treatment of SUI using outcome data from a prospective multicentre observational study conducted in 1999/2000. Women presenting with SUI to physiotherapists trained in continence management in 35 centres across Australia were recruited into the study. The outcomes of treatment were assessed using subjective, objective and quality-of-life measures at the conclusion of treatment and with 12-month follow-up. The number of treatments in an average episode of care was calculated and adverse events were recorded. RESULTS: Of the 274 consenting subjects, 208 completed an episode of physiotherapy care consisting of a median (IQ range) of five (4-6) visits. The estimated average costs for an episode of ambulatory physiotherapy treatment were dollar 302.40. Based on 'intention to treat' principles, 64% of women were objectively cured. There was a clinically and statistically significant improvement (p < 0.05) in all outcomes after treatment and these were maintained at one-year follow-up. No adverse events were reported. CONCLUSIONS AND IMPLICATIONS: Specialised ambulatory physiotherapy for SUI in Australia is a low-cost, low-risk and effective treatment. These results provide evidence to support international recommendations that physiotherapy should be routinely implemented as first-line treatment before consideration of surgery. This information has important economic implications for planning future health services.

'Micro' public health--the reality.

The first paper in this series itemised the research undertaken to discover the unexpressed needs of the village population. Community Participatory Appraisal methodology ensured that local people had the opportunity to express their opinions and health needs. Interviews were analysed and data offered to a focus group for ratification. This information was then used to create a questionnaire. The World Health Organization Quality of Life questionnaire (brief form) and Antonovsky's 'Orientation to Life' questionnaire were added to ensure as many aspects affecting the health of the population were covered. The questionnaire indicated the importance for planning purposes. The role of health visitors has recently returned to the broader remit outlined in 1977 by the Council for the Education of Health Visitors and framed in the four principles of health visiting. In the 1980s the medical model of health visiting prevailed and individual health promotion dominated. During the 1990s this expanded to encompass 'family public health' looking at the impact of a variety of attributes, for example; poverty, relationships, lifestyle and community. Now government is urging health visitors to work with populations; to determine health needs and collaborate with agencies to effect changes. Implementation of the research findings, detailed in this, the second paper, records the steps taken to accomplish 'micro' population public health and the success of this new way of working. Health visitors need to equip themselves with a variety of new ways of working, including community development, in order to maximise the health of their population.

Lay perceptions of health and health needs.

The accurate identification of need is imperative to maximise population health gains and target health inequalities. Social capital, expressed in social, psychological, economic and contextual factors, acts as a buffer in communities. The aim of this study was to determine the unexpressed health needs of a population. A needs analysis was undertaken, using Community Participatory Appraisal methodology, to determine the lay perspective in a rural village. Semi-structured face-to-face interviews with 11 adults were conducted followed by a focus group of seven adults. A questionnaire was developed and posted to 350 adults randomly selected within stratified categories from the general practice surgery list. The predominant feature of the interviews and focus group was that the divided nature of the village impinged on social cohesion and the health of the population. Of the questionnaire results 63% reported good health. Other findings were the lower educational achievement and life expectations in the social housing area, and the level of psychological distress among males, particularly in the 18 to 25 age group. Information on health needs can be determined from the lay perspective. To target a population for public health initiatives, it is important to gather data pertinent to the specific community. The study demonstrated that knowledge is held by individuals that can be used to inform direction of travel and more accurate service provision. This paper is the first of two; the first reports the research and the second describes the implementation of some of the results of the study.

Physiotherapy for female stress urinary incontinence: a multicentre observational study.

BACKGROUND: No previous data are available on the effectiveness of physiotherapy management of urinary stress incontinence with relevance to the Australian health system. AIMS: To evaluate Australian ambulatory physiotherapy management of stress urinary incontinence. METHODS: Observational multicentre clinical study of physiotherapy management of female stress urinary incontinence between February 1999 and October 2000, with 1-year follow-up. Outcome measures were a stress test and a 7-day diary of incontinent episodes (pretreatment and at every visit) and a condition-specific quality of life (QoL) questionnaire (pre- and post-treatment). Subjects were followed-up 1 year after treatment by questionnaire with a 7-day diary, QoL questionnaire, and assessment of subjective outcome, subjective cure, satisfaction and need for surgery. RESULTS: Of the 274 consenting subjects, 208 completed an episode of physiotherapy care consisting of a median (IQ range) of five (four to six) visits. At the end of the episode, 84% were cured and 9% improved on stress testing, whilst 53% were cured and 25% improved according to the 7-day diary. Mean volume of urine loss on stress testing reduced from 2.4 (2.5) mL to 0.1(0.4) mL after treatment. There was a significant improvement in all QoL domains. Median (interquartile range) incontinent episodes per week were reduced from five (three to 11) to zero (zero to two) (P < 0.05) after treatment and to one (zero to four) at 1 year (P < 0.05). At 1 year, approximately 80% of respondents had positive outcomes on all outcome measures. CONCLUSIONS: Physiotherapy management in Australian clinical settings is an effective treatment option for women with stress urinary incontinence.

Leaching of glyphosate and amino-methylphosphonic acid from Danish agricultural field sites.

Pesticide leaching is an important process with respect to contamination risk to the aquatic environment. The risk of leaching was thus evaluated for glyphosate (N-phosphonomethyl-glycine) and its degradation product AMPA (amino-methylphosphonic acid) under field conditions at one sandy and two loamy sites. Over a 2-yr period, tile-drainage water, ground water, and soil water were sampled and analyzed for pesticides. At a sandy site, the strong soil sorption capacity and lack of macropores seemed to prevent leaching of both glyphosate and AMPA. At one loamy site, which received low precipitation with little intensity, the residence time within the root zone seemed sufficient to prevent leaching of glyphosate, probably due to degradation and sorption. Minor leaching of AMPA was observed at this site, although the concentration was generally low, being on the order of 0.05 microg L(-1) or less. At another loamy site, however, glyphosate and AMPA leached from the root zone into the tile drains (1 m below ground surface [BGS]) in average concentrations exceeding 0.1 microg L(-1), which is the EU threshold value for drinking water. The leaching of glyphosate was mainly governed by pronounced macropore flow occurring within the first months after application. AMPA was frequently detected more than 1.5 yr after application, thus indicating a minor release and limited degradation capacity within the soil. Leaching has so far been confined to the depth of the tile drains, and the pesticides have rarely been detected in monitoring screens located at lower depths. This study suggests that as both glyphosate and AMPA can leach through structured soils, they thereby pose a potential risk to the aquatic environment.

Ethics in human subjects research: do incentives matter?

There is considerable confusion regarding the ethical appropriateness of using incentives in research with human subjects. Previous work on determining whether incentives are unethical considers them as a form of undue influence or coercive offer. We understand the ethical issue of undue influence as an issue, not of coercion, but of corruption of judgment. By doing so we find that, for the most part, the use of incentives to recruit and retain research subjects is innocuous. But there are some instances where it is not. Specifically, incentives become problematic when conjoined with the following factors, singly or in combination with one another: where the subject is in a dependency relationship with the researcher, where the risks are particularly high, where the research is degrading, where the participant will only consent if the incentive is relatively large because the participant's aversion to the study is strong, and where the aversion is a principled one. The factors we have identified and the kinds of judgments they require differ substantially from those considered crucial in most previous discussions of the ethics of employing incentives in research with human subjects.

Expanded paper towel test: an objective test of urine loss for stress incontinence.

AIM: To investigate the repeatability of a short stress test of coughing and jumping (the expanded Paper Towel Test (PTT)) to quantify urine loss in stress incontinent adult women. MATERIALS AND METHODS: In the laboratory, the reliability of two methods of measuring the size of the wet area, produced by a typical volume of water titrated onto paper towel was investigated and some absorbency properties of the brand of towel used were quantified. Thirty one women performed a provocative coughing and jumping test on consecutive days using a "perineal pad" of paper towel. The repeatability coefficient was calculated. RESULTS: The provocative test was repeatable to within 2.8 ml of urine loss, but with the exclusion of one anomalous result, the repeatability improved to lie within 1 ml. The coefficient of variation (CV) for the between-method differences (computer scanning and graph paper) was 1.27%. A volume of 1 ml of water produced a wet area of 25.7 cm2. The range of measurable areas corresponded to volumes of 0.005-8 ml. Standardization of method is required because the size of the wet area differed by manufacturer of paper towel (P < 0.01, two products compared) and with time elapsed since titration (P < 0.01). CONCLUSIONS: The "expanded PTT" is a simple tool for quantification of urine loss (0.005-8 ml) in women to 72 years with stress incontinence. With a suggested modification, it should prove reliable for detection of between-visit differences of 1 ml. The reliability of the test is dependent upon the use of standard protocol and paper towel with known volume-area ratio. To improve clinical diagnosis, it can also be used with any brand of paper towel to confirm the sign of stress incontinence on exertion.