The improper use of pediculicides containing permethrin has led to the development of resistance. Thus, new alternatives for control are needed. Plant-derived insecticides are attractive alternatives to common chemical insecticides because most of them are environmentally friendly and non-toxic to mammals. The toxic activity of 23 monoterpenoids belonging to several chemical classes was tested against the eggs of permethrin-resistant head lice, Pediculus humanus capitis De Geer (Phthiraptera: Pediculidae). Significant differences in ovicidal action were observed among the tested substances. The most effective chemicals were hydrocarbons and ethers, followed by ketones, alcohols, phenols and esters. A linear relationship between egg mortality and knockdown time (KT(50)) on adults by the tested components revealed that most of the components were effective on both egg and adult stages. The monoterpenoids described herein are good candidates as effective pediculicides.

Infestation of the head louse Pediculus humanus var capitis DeGeer (Phthiraptera: Pediculidae) is an important public health problem in Australia, with up to a third of children infested in some primary schools. Insecticide resistance and inadequate attention to the application instructions of topical pediculicides are common reasons for treatment failure. This study evaluated six popular Australian over-the-counter products against head lice, primarily comprised of different botanical extracts, and compared them with permethrin 1%(Quellada) and a non-treatment control in order to assess their in vitro efficacy. We also assessed commonly used criteria for evaluating pediculicide efficacy in vitro. All tested products failed to demonstrate high levels of efficacy with the exception of Tea Tree Gel((R)), which outperformed 1% permethrin. Permethrin had a high level of efficacy, but using stringent criteria 18% of lice were not dead at 3 h, indicating some resistance to Quellada. Commonly used less stringent criteria were shown to overestimate mortality of head lice as a result of the protective phenomenon of stasis or sham death observed in exposed lice that may recover after some time. Using two different levels of stringency resulted in different rankings of efficacy for most products, with the exception of the first ranked product, Tea Tree Gel. Rankings of efficacy also varied over time, even within the different assessment criteria. Government regulatory agencies should require standard in vitro tests using stringent mortality criteria, with an observation period of >or= 6 h, to determine the efficacy of new pediculicides, and only products that cause a minimum mortality rate (e.g. 80%) in head lice collected from the target population should be licensed for sale.

ABSTRACT: BACKGROUND: Although stress is known to be a common occupational health issue in the veterinary profession, few studies have investigated its broad domains or the internal validity of the survey instrument used for assessment. METHODS: We analysed data from over 500 veterinarians in Queensland, Australia, who were surveyed during 2006-07. RESULTS: The most common causes of stress were reported to be long hours worked per day, not having enough holidays per year, not having enough rest breaks per day, the attitude of customers, lack of recognition from the public and not having enough time per patient. Age, gender and practice type were statistically associated with various aspects of work-related stress. Strong correlations were found between having too many patients per day and not having enough time per patient; between not having enough holidays and long working hours; and between not having enough rest breaks per day and long working hours. Factor analysis revealed four dimensions of stress comprising a mixture of career, professional and practice-related items. The internal validity of our stress questionnaire was shown to be high during statistical analysis. CONCLUSION: Overall, this study suggests that workplace stress is fairly common among Australian veterinarians and represents an issue that occupies several distinct areas within their professional life.

Chytridiomycosis, a disease that has caused amphibian population declines globally and elevated many species of anurans to endangered or threatened status, has recently been declared an internationally notifiable disease. Batrachochytrium dendrobatidis (Bd), the amphibian chytrid fungus causing this disease, has not been previously reported in Korea or on mainland Asia. Thirty-six frog specimens representing 7 species were collected from the wild in South Korea and examined for Bd using standard PCR. Bd was detected in 14 (38.8%) samples from 3 species (Bufo gargarizans, Hyla japonica, and Rana catesbiana). Skin sections from all 14 PCR-positive frogs were examined using 2 staining techniques: haematoxylin and eosin (H&E) and Bd immunoperoxidase (IPX). In histological sections, zoosporangia were found in 6 frogs, with lower sensitivity for H&E (21%) than for IPX (46%). Intensity of infection, based on histopathology, was low in all frogs. These results confirm that Bd is present in South Korea and, hence, on the Asian mainland. Studies are urgently required to determine the impact of chytridiomycosis on Korean amphibians, and to map the distribution of Bd in Korea and other Asian mainland countries.

Summary The presence of pathogens or predators in water may alter oviposition behaviour of gravid female Aedes aegypti mosquitoes. We evaluated the oviposition behaviour of A. aegypti in recipients containing larvivorous fish (Betta splendens and Poecilia reticulata). In four breeders, fish specimens were placed in 15 l of dechlorined water. Four control breeders only contained dechlorined water. Breeders with eucatex ovitraps and approximately 100 male and female mosquitoes were placed in wire netting cages. During a period of 7 weeks, eggs on the ovitraps were counted weekly. The median number of eggs laid in recipients with B. splendens (32.5/week) was lower than in those with P. reticulata (200.5/week) and the control group (186.5/week; P < 0.0001). The oviposition activity index (OAI) for P. reticulata did not show any considerable difference between posture in deposits with and without fish (-0005). Deposits with B. splendens showed a lower position than those used as controls (-0627). We conclude that B. splendens can be used to effectively prevent gravid A. aegypti females from laying eggs in large water containers.

BACKGROUND: Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. As part of a national survey, the present study was designed to evaluate Australian DMAT experience in relation to pre- and post-deployment health care. METHODS: Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 South East Asian Tsunami disaster. RESULTS: The response rate for this survey was estimated to be around 50%(59/118). Most of the personnel had deployed to the tsunami affected areas. The DMAT members were quite experienced with 53% of personnel in the 45-55 years age group (31/59). Seventy-six percent of the respondents were male (44/58). Only 42%(25/59) received a medical check prior to departure and only 15%(9/59) received a psychological assessment prior to deployment. Most respondents indicated that both medical and psychological screening of personnel would be desirable. Most DMAT personnel received some vaccinations (83%, 49/59) before departure and most felt that they were adequately immunised. While nearly all DMAT members participated in formal debriefing post-deployment (93%, 55/59), far less received psychological debriefing (44%, 26/59), or a medical examination upon return (10%, 6/59). Three respondents reported experiencing physical ill health resulting in time off work following their return. While only one reportedly experienced any adjustment problems post-deployment that needed time off work, 32%(19/59) found it somewhat difficult to return to work. There were multiple agencies involved in the post-deployment debriefing (formal and psychological) and medical examination process including Emergency Management Australia (EMA), Australian Government, State/Territory Health Departments, District Health services and others. CONCLUSIONS: This study of Australian DMAT members suggests that more emphasis should be placed on health of personnel prior to deployment with pre-deployment medical examinations and psychological assessment. Following the return home, and in addition to mission and psychological debriefing, there should be a post-deployment medical examination and ongoing support and follow-up of DMAT members. More research is needed to examine deployment health support issues.

BACKGROUND: Disaster medical assistance teams (DMATs) have responded to numerous international disasters in recent years. As part of a national survey, the present study was designed to evaluate Australian DMAT experience in relation to health and safety aspects of actual deployment. METHODS: Data were collected via an anonymous mailed survey distributed by State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the time of the 2004 South East Asian tsunami disaster. RESULTS: The response rate for this survey was 50%(59/118). Most of the personnel had deployed to the tsunami affected areas. The DMAT members were quite experienced with 53% of personnel in the 45-55 years age group (31/59) and a mean level of clinical experience of 21 years. 76% of the respondents were male (44/58). Once deployed, most felt that their basic health needs were adequately met. Almost all stated there were adequate shelter (95%, 56/59), adequate food (93%, 55/59) and adequate water (97%, 57/59). A clear majority, felt there were adequate toilet facilities (80%, 47/59), adequate shower facilities (64%, 37/59); adequate hand washing facilities (68%, 40/59) and adequate personal protective equipment (69%, 41/59). While most felt that there were adequate security briefings (73%, 43/59), fewer felt that security itself was adequate (64%, 38/59). 30%(18/59) felt that team members could not be easily identified. The optimum shift period was identified as 12h (66%, 39/59) or possibly 8h (22%, 13/59) with the optimum period of overseas deployment as 14-21 days (46%, 27/59). Missing essential items were just as likely to be related to personal comfort (28%) as clinical care (36%) or logistic support (36%). The most frequently nominated personal items recommended were: suitable clothes (49%, 29/59); toiletries (36%, 22/59); mobile phone (24%, 14/59); insect repellent (17%, 10/59) and a camera (14%, 8/59). The most common personal hardship reported during their deployment was being away from home/problems at home (24%, 14/59); however, most felt that their family was adequately informed of their whereabouts and health status (73%, 43/59). CONCLUSIONS: This study of Australian DMAT members suggests that, in the field, attention should be given to basics, such as adequate food, water, shelter and personal hygiene as well as appropriate clothing, sunscreen and vector protection. The inclusion of appropriate personal items can be assisted by provision of a minimum suggested personal equipment list, with local conditions and the nature of the deployment being taken into account. A personal survival kit should also be recommended. There should be medical and psychological support for team members themselves, including the provision of a dedicated team member medical cache. Concern for their own health and ability to communicate with family members at home are major issues for deployed team members and need to be addressed in mission planning. This should also recognise security issues, including briefings, evacuation plans and exit strategies. The team members concerns about adequate security and the risk profile of humanitarian intervention in natural disasters compared with complex humanitarian emergencies may help determine future deployment of civilian or defence based teams.

ABSTRACT: BACKGROUND: Needlestick and sharps injuries (NSI) represent an important occupational health issue in veterinary practice. Little is known about the distribution and correlates of NSI among Australian veterinarians. METHODS: A questionnaire-based NSI survey was mailed to 1094 veterinarians registered with the Veterinary Surgeons Board of Queensland during 2006. RESULTS: A total of 664 surveys were returned from 1038 eligible participants (response rate 64.0%) with 56.8% being male, around one-third in the >50 years age group and about half aged 31-50 years. Just over two-fifths were working in small animal practice only. Around three quarters (75.3%) reported suffering at least one NSI in the previous 12 months, while 58.9% reported suffering from at least one contaminated NSI during the previous 12 months, which crudely extrapolates to an exposure rate rates of 75.3 and 58.9 NSI per 100 person-years respectively. Risk factors for contaminated NSI were female gender, working in small or mixed animal practice, being less experienced, seeing more patients per week and working longer hours per week. The most common causative devices were syringes (63.7%), suture needles (50.6%) and scalpel blades (34.8%). CONCLUSION: The exposure rate of NSI is high for Queensland veterinarians and clearly remains a major occupational health problem. Current guidelines and strategies to reduce NSI in veterinary practice should be promoted, but appear to be adapted from human health care. Studies to understand why veterinarians have such high NSI rates are required to not only identify risk factors for NSI, but also to determine attitudes and beliefs about NSI. From these studies specific strategies for veterinarians can be designed and trialed to develop evidence-based guidelines and policies that are effective in decreasing the exposure rate of NSI in veterinary practice.

BACKGROUND: Although hand dermatitis (HD) represents a frequent occupational issue for many health professionals, little is known about the prevalence and distribution of HD among veterinarians, particularly in Australia. AIM: We utilized a previously validated questionnaire survey to examine a cross-section of veterinarians from Queensland, Australia, to determine the prevalence of HD and its associated factors. METHOD: We conducted a questionnaire-based survey of HD, which was mailed to 1094 veterinarians registered with the Veterinary Surgeons Board of Queensland during 2006 (64.0% response rate). RESULTS: The overall prevalence rate of HD during this study was 15.9%. HD prevalence was significantly higher in those with current allergic disease (P < 0.001), among female veterinarians (P < 0.001), and those reporting latex allergy in the past 12 months (P < 0.001). CONCLUSIONS: Overall, this study suggests that HD may be more prevalent among veterinarians in Queensland than among their counterparts studied elsewhere. Veterinary practices may need to consider making non-latex gloves available or avoiding latex products wherever possible, particularly for their female staff. The importance of HD to the veterinary profession is predicted to increase as females begin to make up a greater proportion of registered veterinarians as result of a demographic shift.

Several different plant extracts have been evaluated with respect to their antimicrobial effects against oral pathogens and for reduction of gingivitis. Given that a large number of these substances have been associated with significant side effects that contraindicate their long-term use, new compounds need to be tested. The aim of this study was to assess the short-term safety and efficacy of a Lippia sidoides ("alecrim pimenta")-based essential oil mouthrinse on gingival inflammation and bacterial plaque. Fifty-five patients were enrolled into a pilot, double-blinded, randomized, parallel-armed study. Patients were randomly assigned to undergo a 7-day treatment regimen with either the L. sidoides-based mouthrinse or 0.12% chlorhexidine mouthrinse. The results demonstrated decreased plaque index, gingival index and gingival bleeding index scores at 7 days, as compared to baseline. There was no statistically significance difference (p>0.05) between test and control groups for any of the clinical parameters assessed throughout the study. Adverse events were mild and transient. The findings of this study demonstrated that the L. sidoides-based mouthrinse was safe and efficacious in reducing bacterial plaque and gingival inflammation.

The head louse problem increases at all levels of the international societies due to activities or life conditions that lead to often hair contacts among people. Lice occur exclusively on humans. Thus, they avoid dropping down from a head and therefore accept even a bad smelling hair of new a host. Due to this behaviour, there are only a few products on the markets which dare to claim a repellency activity that protects humans from infestation with head lice. The present study shows that a combination of an extract of the seeds of the plant Vitex agnus castus (monk pepper) and the compound paramenthan-3,8-diol (which is also found in some plants, e.g. Eucalyptus) act synergistically and are able to protect human hair for at least 7 h from invasion of head lice (Pediculus humanus capitis). The recently developed product containing both compounds is named Licatack(R) Preventive Spray.

Head lice are an emerging social problem, not only in economically poor countries but also in practically all other societies. Several of the common anti-louse products have lost-at least in part-their efficacy due to increasing resistance of lice against insecticides such as permethrin or allethrin. Other compounds, like lindan, were redrawn or banned due to high toxicity. Some recently developed products are based on dimethicones or cyclomethicones and turned out to be easily inflammable. Other styled medicinal products are based on plant extracts-some were proven of high efficacy-others of ineffectivity. The present study investigated in in vitro tests the anti-head louse efficacy of 13 products, the contents of which are used worldwide: Aesculo(R)-Gel L, EtoPril(R), Goldgeist(R) Forte, InfectoPedicul(R), Jacutin(R) Pedicul Fluid, K.Laus(R), Liberalice(R), Licatack(R), Mosquito(R) Läuse-Shampoo, Nyda(R), Paranix(R), Picksan(R) Louse Stop, and Wash Away Louse(R). It turned out that several of them are easily inflammable, and therefore, they endanger users (InfectoPedicul(R), Paranix(R), EtoPril(R), Nyda(R), Goldgeist(R) Forte, and K.Laus(R), see Table 1). Others have to remain for many hours on the hair in order to reach efficacy (Table 4). During such long periods, highly dosed oils may become inhaled and thus may become dangerous for the user's lung epithelia by covering them. When incubating the lice for 3 or 10 min in vitro, only the following products killed all lice exposed to these products: InfectoPedicul(R), Paranix(R), Jacutin(R) Pedicul Fluid, Nyda(R), K.Laus(R), Picksan(R) Louse Stop, Licatack(R), and Wash Away Louse(R). When evaluating the possible dangers for the users, the last three products, especially, derived from plant extracts, are safe and highly effective at the same time. Furthermore, they had been tested dermatologically as "very good".

During the past decades, chemical control against the head louse Pediculus humanus capitis De Geer has been based in the application of products containing permethrin. The repetitive overuse of pediculicides has resulted in the development of high levels of resistance to one or more of these products worldwide. Essential oils obtained from aromatic plants like Eucalyptus are good and safe alternatives due to their low toxicity to mammals and easy biodegradability. In the present study, we reported the chemical composition of Eucalyptus dunnii and Eucalyptus gunni, and the fumigant activity of five Eucalyptus essential oils and their main compounds against permethrin-resistant head lice from Argentina. The most effective essential oils were Eucalyptus sideroxylon, Eucalyptus globulus ssp globulus, and Eucalyptus globulus ssp maidenii, with knockdown time 50%(KT(50)) values of 24.75, 27.73, and 31.39 min. A linear regression analysis between percentage of 1,8-Cineole and KT(50) values of the essential oils showed a significant correlation at a p < 0.01. Since Eucalyptus essential oils showed to be effective against head lice and are classified as safer compounds, they can be employed into pediculicide formulations.

Head lice are a common infection in school-age children worldwide. Several authorities in the US have recommended different treatments and school policies in order to control this disease. Recent concerns of emerging lice resistance worldwide raise the necessity to reassess the current recommendations. To perform a cost-effectiveness analysis (from the US caregiver perspective) of three head lice treatments commonly used in the US, permethrin 1%, malathion 0.5% and the lice comb, in order to evaluate the cost effectiveness of different treatments in the current era, and to explore the effect of different factors in this analysis. We used a decision-tree model to represent the costs and effectiveness of the different treatment strategies. A patient/caregiver perspective was applied, with a time horizon of 2 weeks. Probabilities of treatment success or failure of the three treatments were based on the literature. Effectiveness was measured as the successful eradication of head lice, and costs - including the costs of the treatment, the physician co-pay and the costs of days out of school - were calculated. One-way and multi-way analyses were performed using decision analysis software (Treeage Pro Healthcare 2008). Combing was dominated by permethrin 1%. The incremental cost-effectiveness ratio of malathion 0.5% versus permethrin 1% was $US161.75 per cure. For caregivers whose willingness to pay is <$US161.75 per cure, permethrin 1% is the most cost-effective option. For those with a willingness to pay of >/=$US161.75 per cure malathion 1% may offer the highest net monetary benefit. Twenty percent of the uncertainty in the model is due to variation in permethrin 1% resistance, and approximately 73% of the total variability of the model is attributed to the number of days the student has to be out of school because of the school's policy. Our study suggests that permethrin 1% was the most cost-effective treatment for those with a willingness to pay of <$US162 per cure. Sensitivity of lice to permethrin and the specific school head lice policy had major effects on the model. Thus, informing communities in a given geographical area about the degree of head lice resistance and sensitivity is necessary in order for the public to make a rational decision regarding treatment. Schools' head lice policies have a major effect on the cost of head lice treatments.

The efficacy of a 65% permethrin spot-on formulation (Defend EXspot, Schering-Plough Animal Health Corp., Union, NJ) against the dog louse, Trichodectes canis de Greer 1778, was studied. Fourteen dogs naturally infested with T. canis were evenly and randomly allocated to treatment with 65% permethrin administered at the label dose rate of 1 or 2 ml per dog or to an untreated control group. Louse counts were performed for each dog by gently back-combing the hair at six designated anatomic sites (head, tail, belly, each side, and an 8-cm strip the length of the body on the back), and lice were counted without removal on Days 0 (pretreatment), 7, 14, 21, and 28. Lice were eliminated from all dogs treated with the 65% permethrin spot-on within 7 days after treatment, and no subsequent reinfestations due to hatching of eggs were observed during the 28-day evaluation period. Untreated control dogs were subsequently treated with the 65% permethrin spot-on after the initial phase was completed and lice populations were evaluated as previously described. All lice were cleared from these dogs by Day 7, and there were no signs of reinfestation. No adverse reactions to treatment were noted during the study.

Objective: Studies compared spinosad creme rinse and permethrin lice treatment under "actual-use" conditions for pediculosis capitis (head lice). Subjects and Materials: Two phase-3, multicenter, randomized, evaluator/investigator-blinded studies compared 0.9% spinosad without nit-combing to 1% permethrin with combing (according to product instructions) in 1038 males and females aged >/=6 months. Spinosad-with-combing groups were included for descriptive, noninferential purposes only. Within 391 households, youngest members having >/=3 live lice were designated primary participants. All household members with lice received the same treatment. Participants administered product 1 to 2 times during the 21-day home-use period on the basis of complete lice eradication after a single use or the presence of lice requiring a second treatment. Scalp evaluations were performed at baseline, day 7, and day 14 (and day 21 for participants treated twice). The primary end point was the proportion of lice-free primary participants 14 days after last treatment. Results: A total of 84.6%(study 1) and 86.7%(study 2) of spinosad-treated participants were lice free versus 44.9% and 42.9% permethrin-treated participants (P <.001). Most spinosad-treated participants required 1 application, whereas most permethrin-treated participants required 2 applications. Few adverse events were reported, but those occurring were mild to moderate, including eye irritation (permethrin), ocular hyperemia, and application-site erythema/irritation (both medications). No laboratory measure changed significantly. Conclusions: Spinosad, which did not require nit combing, was significantly more effective than permethrin in 2 studies reflecting actual-use conditions, and most spinosad-treated participants required only 1 application. Spinosad is a more convenient and effective treatment for pediculosis capitis.

Malathion is an under-recognized and under-utilized therapy for head lice and scabies largely due to misperceptions about its safety profile. Specifically, its pure form as it exists in pharmaceutical preparations is non-toxic to humans in the low doses available. While labeled for ages six and up, recent studies showed no cholinesterase inhibition in head lice patients aged two-to-six treated with malathion. Flammability of malathion in isopropyl alcohol has reportedly resulted in human injury once in over one million prescriptions filled. Recent efficacy studies of malathion in United States (U.S.) head lice demonstrate efficacy rates of 97-98%. In the present era of permethrin and lindane resistance to head lice, malathion is a first-line option. For scabies, it is a reasonable alternative to permethrin 5% cream, especially when treatment of the scalp or hairy areas is desired.

Ectoparasites and epidermal parasitic skin diseases are a heterogeneous group of infections of the external layer of the skin. The most common forms world-wide are scabies, lice (Pediculosis capitis, corporis, vestimentorum and pubis), tungiasis and the hookworm-associated Larva migrans cutanea. The head louse is the most widespread parasite in children in Germany. The symptoms, apart from pruritis, eczematous skin eruptions and ictus reactions of the skin, are often unspecific and many differential diagnoses must be considered. Treatment of ectoparasites includes manual procedures, such as repeated cleansing and combing out of lice-infected hair and also local antiparasitic treatment with permethrin, pyrethrum extract, allethrin and dimeticon. Lindan which has been used for decades can no longer be used in medications after 2008 after a decision of the EU Commission. Failure of treatment of head lice can be a result of errors in the treatment which favor survival of the eggs, larvae or adults. This can be a result of too short reaction times and too economical use or unequal distribution of medications, excessive dilution due to wet hair or omitting repeated treatment stages. Additionally resistance of head lice to pyrethrum is a known phenomenon and has been reported in several countries.