ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101304.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101305.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101306.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101307.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To study the incidence of H1N1 influenza from 1977 to 1988 in unvaccinated volunteers and the effects of continuing minor antigenic change (antigenic drift) in the virus.Design:Prospective study by a group of general practitioners, backed up by virological findings.Participants:Mainly patients of the general practitioner group, also some doctors and members of staff. There were 287 participants during 1977–1981, and 207 at the end of 1988.Intervention:Any participant deemed to be “at risk” was encouraged to be vaccinated and to withdraw from the study.Background:In 1957, H1N1 subtype influenza had been displaced by H2N2 (Asian) subtype. In 1968, H2N2 was displaced by H3N2 (Hong Kong) subtype. During 1977, H1N1 influenza unexpectedly reappeared in Asia, and spread widely. The resurgent strain, designated A/USSR/90/77(H1N1), caused world pandemics, attacking (almost exclusively) persons who had been born since the 1950–1951 northern winter and causing negligible mortality. It did not displace the current H3N2 strain, and strains of both subtypes have continued to emerge independently.Hypothesis:Antigens of A/USSR resembled closely those of the 1950–1951 H1N1 strain, which apparently was rendered antigenically inert between 1951 and 1976 (possibly frozen) and was reactivated during 1977. Antigenic drift was then resumed.Main outcome measure:The A/USSR/90/77 strain and its close successor, A/Brazil/11/78, attacked mainly the young, whose previous exposure to H1N1 antigens had been minimal or zero. Mortality during the A/USSR pandemics was negligible because death from influenza in people aged less than 30 years is rare. Would continuing antigenic drift ultimately widen the H1N1 spectrum of attack?Result:During the epidemic of 1988, A/Taiwan/1/86(H1N1) attacked a wider range of age groups than had A/USSR or A/Brazil.Conclusion:Assuming that H1N1 viruses continue to undergo further antigenic drift, an ever widening age spectrum of H1N1 attack may be expected.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101308.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:A previously unreported source of injuries to children, the exercise bicycle, is identified and the associated injuries and their treatment are described.Design:A retrospective review of clinical records and the records of the Victorian injury Surveillance System.Setting:The Plastic Surgery Unit of the Royal Children's Hospital, Parkville, Victoria.Patients:Seventeen children with finger injuries from exercise bicycles presented to the Emergency Department of the hospital and one presented to one of us (K L M) at his private practice. Sixteen of the 18 children were under five years of age; 10 were less than two years of age. Five times as many boys as girls were injured.Interventions:Fourteen children required surgical treatment of their injuries.Results:Four children had superficial injuries not in need of surgical repair. Eleven children had single digit injuries — five had injuries that were repaired by suture; five had complete avulsion of the tip of the digit that required flap graft repair; and one child underwent amputation of the index finger. Three boys had multiple digit injuries, each one requiring the amputation of a digit and repair of other digits. Two of these boys underwent replantation of a digit; only one replantation was successful.Conclusions:The most dangerous parts of the exercise bike were the wheel, the chain and the sprocketwheel. Design modifications and education of parents about the risks for children playing near exercise bikes are warranted.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101309.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101310.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To compare the effects of single doses of oral levodopa, subcutaneous apomorphine and sublingual apomorphine.Design:Single‐blind placebo‐controlled comparative study.Setting:Subjects were admitted as day patients to the neurology ward.Patients:Five patients with idiopathic Parkinson's disease and “end of dose deterioration” entered and completed the study.Interventions:Patients were given domperidone (20 mg by mouth three times a day) to prevent nausea and apomorphine (1–3 mg by subcutaneous injection), apomorphine in glycerol (10–30 mg sublingually) or their usual levodopa regimen.Main outcome measures:Efficacy, time to onset of effect and duration of effect of oral levodopa, subcutaneous apomorphine and sublingual apomorphine. Tremor amplitude and timed pegboard and gait tasks were used as objective indices of clinical state.Results:Maximal efficacy of the three treatments was comparable (P= 0.28–0.99). Mean latency to onset of effect of both formulations of apomorphine was less than that of levodopa (P= 0.022–0.048) but so was the duration of effect (P= 0.044–0.049).Conclusions:Sublingual apomorphine may be a convenient means of rapidly terminating “off” periods associated with long term levodopa therapy.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101311.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To investigate the content of general practitioners' referral letters to the Accident and Emergency (A&E) Department of a large regional hospital.Method:Two hundred and fourteen consecutive identifiable letters from general practitioners presented by patients over a four week period were reviewed. The accuracy and content of the letters was measured by the presence of 10 key items, and checked against the A&E notes when necessary. A further nine items were examined to discover whether the context of the referral had any influence on letter content.Results:Information that was relatively poorly represented in the letters included social and personal background details, vital signs, regional examination findings, a management plan, and investigation results. The presence in the letter of a management plan or a clear presenting problem was found to be significantly associated with appropriate referrals.Conclusions:Poor referral letters may reflect a professional distance between the general practitioner and A&E staff that is stretched by the anonymity of the relationship, increasing A&E specialisation, or lack of feedback to the general practitioner. Specific information standards for A&E referrals should be developed to ease contact and to establish criteria for referral.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101312.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To investigate the pathways by which the human immunodeficiency virus (HIV) is entering populations of injecting drug users (IDUs) in Victoria.Design:A retrospective case‐control study comparing the prevalence of self reported risk behaviour in HIV‐infected and uninfected Victorian IDUs.Setting:Subjects were recruited by trained peer outreach workers from their personal networks, community agencies and Fairfield Hospital outpatients, and by a research worker from the major metropolitan prison.Participants:People who had been resident in Victoria for the past 12 months and had injected an illicit drug more than once in the previous three years were eligible to participate. Sixty‐two such people (28 HIV‐infected, 34 not infected) were included in the study.Main outcome measures:The two main hypothesised portals of entry were from the non‐IDU homosexual population in Victoria, and from HIV‐infected IDUs elsewhere.Results:Male homosexual contact was the most consistent risk factor identified by this study (odds ratio [OR], 6.2; 95% confidence interval [CI], 1.7–23.8). Having lived in or visited Sydney before 1986 was also associated with being infected with HIV (OR, 13.2; 95% CI, 1.5–603), and this was associated with homosexuality. Infected IDUs reported more sharing of injecting equipment than controls (OR, 9.0; 95% CI, 1.5–92.5), particularly with sexual partners; when this was the case, they were more likely to always use the injecting equipment after their partner (61% of cases, 0% of controls; OR, ≥4.1;P= 0.0006).Conclusion:Men who have a history of both homosexual contact and injecting drug use represent the group of IDUs at highest risk of HIV infection in Victoria. Although heterosexual and homosexual IDUs may have limited contact only, a larger epidemic of HIV infection in heterosexual IDUs could spread from homosexual IDUs through the sharing of injecting equipment.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb101313.x

出版商:Wiley    

年代:1991

数据来源: WILEY