Factors associated with ownership and use of written asthma action plans in North-West Melbourne.

PURPOSE: Written asthma action plans (WAAPs) have become a core component of asthma management in Australia. We investigated ownership, utilisation and factors associated with ownership of asthma action plans by caregivers. METHODS: 443/776 (57%) caregivers of children aged 2-14 years with asthma were identified from 32 GP clinics as part of a randomised controlled trial (RCT), and completed self-administered questionnaires. RESULTS: Only 29% of participants owned a WAAP, while 13% possessed verbal instructions, and 56% had no plan. An asthma action plan for children, which was developed by a general practitioner (GP) was more likely to comprise verbal instructions (p = 0.001), while action plans developed by paediatricians were more likely to be written (p < 0.001). Just over one half of caregivers (59%) reported discussing their child's action plan the last time they visited their doctor for asthma. Factors associated with WAAP ownership included nights waking (p = 0.013), self reported severity (p = 0.001), and days lost from school (p = 0.037). Children who had seen a GP in the last 3 months for asthma, or who had been to the Emergency Department (ED) or hospital were more likely to possess a WAAP (p < 0.001). Caregivers who were less satisfied with their child's asthma control were more likely to own a WAAP (p = 0.037). Caregivers with any action plan found it useful and 82% reported using their action plan for management of an acute attack. However, caregivers with a WAAP were more likely to adhere to the plan for an acute attack compared to caregivers with verbal instructions (OR = 4.5, p < 0.05). Caregivers with a WAAP were more knowledgeable about asthma (p = 0.002), better able to recognise the difference between preventer and reliever medications (p = 0.01), and better able to recognise an asthma attack (p = 0.006). CONCLUSIONS: Ownership of WAAPs in this group was still too low. Importantly, caregivers with written instructions were more knowledgeable about asthma and more likely to report following the action plan during an asthma attack.

Gamma dose measurement in a water phantom irradiated with the BNCT facility at THOR.

It has been proposed that a LiF thermoluminescence dosemeter (TLD) is used as a gamma dosemeter in a water phantom irradiated with the BNCT facility at THOR. Based on the TLD neutron sensitivity and neutron fluxes in the water phantom, which were simulated by the MCNP code, TLD-700 was chosen as a gamma dosemeter in this report. For the correction of the neutron influence on TLD-700, the thermal neutron sensitivity to TLD-700 was investigated with MCNP simulation and the thermal neutron flux was measured with gold foils using the cadmium difference technique. The correction to the neutron influence on the TLD was established on the TLD thermal neutron sensitivity. the thermal neutron flux, and the conversion factor from energy deposition in the TLD to the TLD response. By comparing the experimental data with the thermal neutron influence correction, these data are in very good agreement with the MCNP predictions.

Australian general practice and the meeting of needs for mental health care.

BACKGROUND: This report, drawing on a national epidemiological survey conducted in 1997, examines the role of Australian medical general practitioners (GPs) in responding to needs for mental health care. METHODS: We analysed data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB). The NSMHWB employed clustered probability sampling of all Australian adults, and 10,641 participants were interviewed. The field questionnaire included modules of the Composite International Diagnostic Interview, and instruments assessing disability, service utilisation and perceived needs for care. RESULTS: Eighty-four percent of people with a mental disorder consulted a GP in the year prior to survey, but only 29% consulted in relation to a mental health problem. GP services were seen as more responsive to needs for medication, counselling and information than needs for social interventions and skills training. People with perceived needs for counselling were more likely to consult with other providers, either as alternative or additional consultations to those with a GP. Counselling needs were reported as less well met when people saw a GP alone than when consulting other service providers. CONCLUSIONS: Many people with mental health problems attend primary medical care practitioners without presenting these problems to their physicians. When they do present, perceived needs for medication are rated as well met, but there is substantial unmet perceived need for interventions in social and occupational domains. Perceived needs for counselling are less well met where the GP is the sole provider. To close these identified gaps calls for improvements in primary care physicians' skills and effective collaborative models with other providers.

Expression and regulation of a molecular marker, SPR1, in multistep bronchial carcinogenesis.

A small proline-rich protein, SPR1, is overexpressed in squamous metaplasia of bronchial epithelium. We studied the expression and regulation of SPR1 in a series of human bronchial epithelial cell lines representing a model of multistep bronchial carcinogenesis. These cell lines included a primary culture of tracheobronchial epithelial cells (HTBE), a papilloma virus-transformed tracheobronchial epithelial cell line (HBE1), a cell line selected from HBE1 by a tobacco carcinogen and a phorbol ester (HBE1-C), a simian virus-transformed bronchial epithelial cell line (BEAS-2B), and a lung carcinoma cell line (H460). Different tumorigenic potentials of these cell lines were indicated by graded levels of telomerase activity. Concomitant with squamous transformation, there was an increase in SPR1 expression in HTBE, HBE1, and HBE1-C that was reversible by vitamin A. With progression of tumorigenicity, there was a marked reduction in SPR1 expression in BEAS-2B and a total loss of expression in H460. In these latter cell lines representing advanced malignant transformation, there was a loss of up- and downregulation, respectively, by the phorbol ester and vitamin A. Transfection study with chimeric constructs of the SPR1 promoter and a reporter gene showed that the dysregulation of SPR1 expression in malignant transformation was a result of perturbation of the basal and enhancer elements of the first 162 nucleotides in the 5'-flanking promoter region of the SPR1 gene. These findings suggest an association of transcriptional dysregulation of the SPR1 gene with multistep bronchial carcinogenesis.

Depression in general practice.

Depression is the most common, serious psychological disability presenting to general practitioners. Its prevalence varies from 0.6 to 36% of GP encounters depending on the method of diagnosis. Apart from methodological differences, some of this variability relates to barriers in the diagnostic process. These include 'doctor barriers' both personal and professional, 'consultation barriers', and real or perceived 'patient barriers'. Education and training of GPs to recognise and manage depression in all its guises is only one way of overcoming these barriers. Other ways include raising community awareness through public health campaigns and raising patient and doctor awareness by screening for depression in the course of seemingly unrelated consultations in 'at risk patients'. As 95% of depression is capable of being managed in general practice, GPs will need to be more active in this field to reduce the considerable burden of morbidity and mortality attributed to this condition.

The effect of a computer-generated patient-held medical record summary and/or a written personal health record on patients' attitudes, knowledge and behaviour concerning health promotion.

OBJECTIVE: The aim of the study was to examine the effect of a computer-generated patient-held medical record summary (CHR) and/or a written personal health record (PHR) on patients' attitudes, knowledge and behaviour concerning health promotion. METHOD: It was conducted in five general practices in Oxfordshire. Patients aged 25-65 years in each practice were randomly assigned to receive either a CHR plus PHR, CHR only, PHR only, or no personal record. Patients were recruited by mail (one practice) or opportunistically by nurses (four practices). Health checks were carried out using the randomly assigned record, which the patient retained. Attitudes to patient-held records, and pre- and post-intervention knowledge and behaviour concerning health promotion, were assessed using questionnaires. Only those who responded to 'before' and 'after' questionnaires were included in the analysis. RESULTS: A sample of 261 patients was obtained from mail recruitment and 103 from opportunistic nurse recruitment. Patients receiving a CHR as part of mail recruitment were significantly more likely to attend for a health check (P = 0.016). Those receiving both PHR and CHR were more likely to keep (P = 0.014) and use (P = 0.029) the record. Those receiving PHR as part of the package improved their knowledge of health promotion and became more aware of and more likely to change their life-style (P = 0.022). CONCLUSIONS: The effectiveness of a computer-generated patient-held health summary and an explanatory booklet together is greater than either separately in changing patients' knowledge attitudes and behaviour concerning health promotion.