Xerostomia: a common adverse effect of drugs and radiation

Reproduced with permission from Australian PrescriberThe document attached has been archived with permission from the publisher/copyright holder.Xerostomia is the subjective sensation of dry mouth. Many drugs, especially those with anticholinergic effects, can cause xerostomia, particularly in the elderly. Another major cause is radiotherapy to the head and neck damaging the salivary glands. Newer techniques to target radiotherapy and protective drugs, such as amifostine, could decrease the incidence of xerostomia.Treatment is based on either stimulating the flow of remaining salivary tissue with lollies or sialogogues such as pilocarpine, or wetting the mucosa with water or artificial saliva containing glycerine or compounds such as carboxymethylcellulose. Patients need regular dental examinations because of the effect of xerostomia on intra-oral health.Ian N Olve

Message on a bottle: are alcohol warning labels about cancer appropriate?

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background Although most Australians are unaware of the risk, there is strong evidence for a direct link between alcohol consumption and many types of cancer. Warning labels on alcohol products have been proposed as a cost-effective strategy to inform the community of this health risk. We aimed to identify how Australians might respond to such an approach. Methods We conducted a national online survey canvassing responses to four separate cancer warning messages on labels. The graphically presented messages were informed by qualitative data from a series of focus groups among self-identified ‘light-to-moderate’ drinkers. For each label, participants were asked their level of agreement with impact statements about raising awareness, prompting conversation, influencing drinking behaviour and educating others about cancer risk. We analysed responses according to demographic and other factors, including self-reported drinking behaviour (using the 3-item Alcohol Use Disorder Test – AUDIT-C – scores). Results Approximately 1600 participants completed the survey, which was open to all Australian adults over a period of 1 month in 2014. Overall, the labels were well received, with the majority (>70 %) agreeing all labels could raise awareness and prompt conversations about the cancer risk associated with alcohol. Around 50 % or less agreed that the labels could influence drinking behaviour, but larger proportions agreed that the labels would prompt them to discuss the issue with family and friends. Although sex, AUDIT-C score and age were significantly associated with agreement on bivariate analysis, multivariate analyses demonstrated that being inclined to act upon warning label recommendations in general was the most important predictor of agreement with all of the impact statements. Having a low AUDIT-C score also predicted agreement that the labels might prompt behaviour change in friends. Conclusions The findings suggest that providing detailed warnings about cancer risk on alcohol products is a viable means of increasing public awareness of the health risks associated with alcohol consumption. Further research is needed to explore the ability of such warnings to influence behavioural intentions and actual drinking behaviour

Variational Principles for Natural Divergence-free Tensors in Metric Field Theories

Let $T^{ab}=T^{ba}=0$ be a system of differential equations for the components of a metric tensor on $R^m$. Suppose that $T^{ab}$ transforms tensorially under the action of the diffeomorphism group on metrics and that the covariant divergence of $T^{ab}$ vanishes. We then prove that $T^{ab}$ is the Euler-Lagrange expression some Lagrangian density provided that $T^{ab}$ is of third order. Our result extends the classical works of Cartan, Weyl, Vermeil, Lovelock, and Takens on identifying field equations for the metric tensor with the symmetries and conservation laws of the Einstein equations

Message on a bottle: are alcohol warning labels about cancer appropriate?

Background Although most Australians are unaware of the risk, there is strong evidence for a direct link between alcohol consumption and many types of cancer. Warning labels on alcohol products have been proposed as a cost-effective strategy to inform the community of this health risk. We aimed to identify how Australians might respond to such an approach. Methods We conducted a national online survey canvassing responses to four separate cancer warning messages on labels. The graphically presented messages were informed by qualitative data from a series of focus groups among self-identified ‘light-to-moderate’ drinkers. For each label, participants were asked their level of agreement with impact statements about raising awareness, prompting conversation, influencing drinking behaviour and educating others about cancer risk. We analysed responses according to demographic and other factors, including self-reported drinking behaviour (using the 3-item Alcohol Use Disorder Test – AUDIT-C – scores). Results Approximately 1600 participants completed the survey, which was open to all Australian adults over a period of 1 month in 2014. Overall, the labels were well received, with the majority (>70 %) agreeing all labels could raise awareness and prompt conversations about the cancer risk associated with alcohol. Around 50 % or less agreed that the labels could influence drinking behaviour, but larger proportions agreed that the labels would prompt them to discuss the issue with family and friends. Although sex, AUDIT-C score and age were significantly associated with agreement on bivariate analysis, multivariate analyses demonstrated that being inclined to act upon warning label recommendations in general was the most important predictor of agreement with all of the impact statements. Having a low AUDIT-C score also predicted agreement that the labels might prompt behaviour change in friends. Conclusions The findings suggest that providing detailed warnings about cancer risk on alcohol products is a viable means of increasing public awareness of the health risks associated with alcohol consumption. Further research is needed to explore the ability of such warnings to influence behavioural intentions and actual drinking behaviour

Taking the Pulse: perceptions of crime trends and community safety and support for crime control methods in the Canadian Prairies

The present study analyzed crime survey data extracted from the 2012 Saskatchewan Taking the Pulse survey on a sample of 1,700 adult Saskatchewan residents. The focus was on examining perceptions of crime trends, perceived effectiveness of various methods for controlling crime, and their sociodemographic correlates. The majority of survey respondents perceived crime in general to be on the rise (37%) or to have not changed at all (48%) over the last three years. Individuals who perceived crime to have decreased were significantly more likely to support alternatives to punishment as effective methods for reducing crime, while individuals who perceived crime to be on the rise were twice as likely to support the use of punitive methods. Perceptions of community safety were unrelated to preference for one crime reduction method over another. Education level was inversely related to crime trend perceptions (r = -.14) and preference for punitive methods to reduce crime (r = -.20). Finally, the results of logistic regression indicated higher levels of education, higher income, and perceptions of crime decreasing were all uniquely associated with a preference for alternatives to punishment in reducing crime. In these analyses, younger age was predictive of a preference for alternatives in reducing youth crime, while urban residential setting was associated with a preference for alternatives to punishment in reducing crime in general

How Australian general practitioners engage in discussions about alcohol with their patients: a cross-sectional study

Objective: This study aimed to investigate factors that inhibit and facilitate discussion about alcohol between general practitioners (GPs) and patients. Design: Data analysis from a cross-sectional survey. Setting and participants: 894 GP delegates of a national health seminar series held in five capital cities of Australia in 2014. Main outcome measures: Likelihood of routine alcohol enquiry; self-assessed confidence in assessing and managing alcohol issues in primary healthcare. Results: Most GPs (87%) reported that they were likely to routinely ask patients about their alcohol consumption and had sufficient skills to manage alcohol issues (74%). Potential barriers to enquiring about alcohol included perceptions that patients are not always honest about alcohol intake (84%) and communication difficulties (44%). ‘I usually ask about alcohol’ was ranked by 36% as the number one presentation likely to prompt alcohol discussion. Altered liver function test results followed by suspected clinical depression were most frequently ranked in the top three presentations. Suspicious or frequent injuries, frequent requests for sickness certificates and long-term unemployment were ranked in the top three presentations by 20% or less. Confidence in managing alcohol issues independently predicted likelihood to ‘routinely ask’ about alcohol consumption. Lack of time emerged as the single most important barrier to routinely asking about alcohol. Lack of time was predicted by perceptions of competing health issues in patients, fear of eliciting negative responses and lower confidence in ability to manage alcohol-related issues. Conclusions: Improving GPs' confidence and ability to identify, assess and manage at-risk drinking through relevant education may facilitate greater uptake of alcohol-related enquiries in general practice settings. Routine establishment of brief alcohol assessments might improve confidence in managing alcohol issues, reduce the time burden in risk assessment, decrease potential stigma associated with raising alcohol issues and reduce the potential for negative responses from patients

Classification of Generalized Symmetries for the Vacuum Einstein Equations

A generalized symmetry of a system of differential equations is an infinitesimal transformation depending locally upon the fields and their derivatives which carries solutions to solutions. We classify all generalized symmetries of the vacuum Einstein equations in four spacetime dimensions. To begin, we analyze symmetries that can be built from the metric, curvature, and covariant derivatives of the curvature to any order; these are called natural symmetries and are globally defined on any spacetime manifold. We next classify first-order generalized symmetries, that is, symmetries that depend on the metric and its first derivatives. Finally, using results from the classification of natural symmetries, we reduce the classification of all higher-order generalized symmetries to the first-order case. In each case we find that the generalized symmetries are infinitesimal generalized diffeomorphisms and constant metric scalings. There are no non-trivial conservation laws associated with these symmetries. A novel feature of our analysis is the use of a fundamental set of spinorial coordinates on the infinite jet space of Ricci-flat metrics, which are derived from Penrose's ``exact set of fields'' for the vacuum equations.Comment: 57 pages, plain Te