ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137997.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137998.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137999.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb138000.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb138001.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo estimate the impact of smoking on the incidence of coronary heart disease in Australia. Data collected for the WHO MONICA Project were used.DesignCombined data from a community‐based register of all suspected coronary events and a survey of risk factor prevalence in a random sample of the same population.Setting and participantsAll residents of the Hunter Region of New South Wales aged 35‐69 years who had a first acute myocardial infarction or fatal heart attack (without a history of coronary heart disease) between 1 January 1986 and 31 December 1990.Main outcome measuresAcute myocardial infarction or coronary death, as defined by the WHO MONICA Project.ResultsMen who are current smokers are 2.9 times (95% CI, 2.7‐3.1) more likely than non‐smokers to have a first myocardial infarction or fatal heart attack, and for women the equivalent figure is 3.5 times (95% CI, 3.2‐3.8), after adjusting for age. Current male smokers with a history of hypertension are 4.5 times more likely to have a coronary event (7.9 times in women) than are non‐smokers without a history of hypertension. The age‐adjusted excess rate was 566 per 100 000 per year in men and 373 per 100 000 per year in women. Smoking is a stronger predictor of coronary heart disease incidence than a history of hypertension (relative risk [RR] = 1.6 for men and 1.9 for women) or a known history of hypercholesterolaemia (RR not significantly different from 1).ConclusionsCigarette smoking plays a more important role in the causation of a first myocardial infarction or fatal heart attack and appears to have more influence on the incidence of coronary heart disease in Australia than hypertension.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb138002.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo explore immune function in patients with chronic post‐traumatic stress disorder (PTSD).DesignA case‐control study using the standardised Cell‐mediated Immunity (CMI) Multitest.ParticipantsCases were 25 Vietnam combat veterans undergoing treatment for clinically diagnosed PTSD. Controls had no diagnosed psychiatric disorders: 28 were civilians and 20 were servicemen who had had South‐east Asian postings but no combat experience.Main outcome measuresThe sum score, the number of reactions and the compound scores from the CMI Multitest were assessed as a measure of immune function.ResultsPsychometric tests distinguished between cases and controls at a highly significant level (P<0.001). Veterans with PTSD had enhanced cell‐mediated immunity compared with civilians (P= 0.008) and servicemen (P= 0.02).ConclusionPTSD in combat veterans is associated with enhanced cell‐mediated immune responsiveness. This could have wide implications for psychiatry and general medicine. (Med J Aust 1993; 159: 513‐516)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb138003.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo provide estimates of the numbers of New South Wales children in Family Day Care who may be exposed to environmental tobacco smoke while attending day care; to describe existing smoking policies; and to analyse these policies with the aim of providing guidelines for smoking policy in Family Day Care.SettingAll 109 Family Day Care schemes in NSW.MethodScheme coordinators were sent a questionnaire regarding the proportion of carers who smoked while caring for children; the nature, enforcement and experience of smoking policies; and barriers to implementation of a no‐smoking policy.ResultsA mean of 10% of Family Day Care caregivers were reported to smoke while caring for children (range, 0–60%). An estimated 2045 children were potentially exposed to environmental tobacco smoke in the 86 schemes which provided this information. Thirty‐five per cent of schemes had formal no‐smoking policies. A range of advantages, disadvantages and perceived practical and legal barriers to implementation of a no‐smoking policy in Family Day Care were described. Forty‐four per cent of schemes with no‐smoking policies reported no implementation problems.ConclusionsThere is considerable potential for exposure of children to environmental tobacco smoke in Family Day Care homes. There is legal support for Family Day Care caregivers not to expose children under their care to environmental tobacco smoke. A formal (and enforced) no‐smoking policy should exist in every Family Day Care scheme, and a “top‐down” directive is most likely to be successful. The issue of other smokers in the caregiver's household needs to be specifically addressed in any such directive. (Med J Aust 1993; 159: 518‐522)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb138004.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo assess the adequacy of management of Sydney women with Papanicolaou (Pap) smears showing cervical intraepithelial neoplasia (CIN) grades two and three.DesignA prospective descriptive study of patient management.MethodAll 206 general practitioners (GPs) who sent Pap smears which were reported as CIN 2 or CIN 3 to three Sydney laboratories between January and June 1990 were included in the sample. The GPs were contacted and management details for the women collected. The adequacy of management was evaluated by comparing it with management guidelines constructed for the study. Management steps were: notification of results, referral for colposcopy, biopsy, treatment and follow‐up. The number of women reaching each step, expressed as a proportion of those women who should have reached that step according to the management guidelines, was calculated. The points where management was inadequate were established and the reasons explored.ResultsAll GPs provided management information about their patients. Ninety‐nine per cent of women (95% confidence intervals [CI], 98%‐100%) were informed of their Pap smear result and 94% (CI, 90%‐97%) of the total sample subsequently underwent colposcopy. Ninety‐three per cent (CI, 88%‐97%) of the 160 women definitely requiring histological diagnosis had this and 98% (CI, 94%‐100%) of the 140 women definitely needing treatment were treated. Following treatment (or equivalent if not indicated) 80% of women (CI, 74%‐86%) were known to have had a follow‐up Pap smear but only 31% (CI, 24‐38%) of women needing follow‐up colposcopy were known to have had it. At the time of the study (on average, 17 months after the index Pap smear) only 60% (CI, 54%‐67%) of women were still being followed up.ConclusionsVirtually all women with the more severe cytological abnormalities are being referred by their GPs for further investigation and treatment. However, follow‐up after treatment is often inadequate. The responsibility for this follow‐up needs to be clarified, as well as communication about it between women, their GPs and gynaecologists. A cytology registry could increase the proportion of Sydney women known to be receiving follow‐up. (Med J Aust 1993; 159: 523‐528)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb138005.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo determine the pattern of emergence of post‐traumatic stress disorder (PTSD) among motor vehicle accident victims and to examine the influence of PTSD on subsequent levels of disability.DesignA longitudinal study of motor vehicle accident victims one month and 18 months after the accident.SubjectsTwenty‐four motor vehicle accident victims admitted by the trauma team at the Royal Adelaide Hospital. A 52% response rate was achieved.Main outcome measuresPosttraumatic stress disorder as diagnosed by the Diagnostic Interview Schedule and disability as measured with the Sickness Impact Profile.ResultsEighteen months after their accidents, six of the 24 subjects had clinically significant PTSD and one was considered borderline. None had been previously diagnosed or treated. The group with PTSD had higher scores on all measures of psychological distress one month after the accident and were more likely to use immature psychological defences. There was no association between physical outcome (measured with the modified Glasgow Outcome Scale) at six months and subsequent diagnosis of PTSD. However, the group with PTSD had higher levels of disability on assessment with the Sickness Impact Profile, particularly in the domain of social functioning. The results suggest PTSD was associated with work‐related dysfunction equal to that associated with severe physical handicap.ConclusionThe data from this pilot study suggest that PTSD after motor vehicle accidents is an important cause of disability, which may also become the focus for damages in litigation. Thus, there is a need for further investigation of the early patterns of distress and to design preventive programs for victims of road accidents. (Med J Aust 1993; 159: 529‐534)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb138006.x

出版商:Wiley    

年代:1993

数据来源: WILEY