ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139899.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139900.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To collate statistics, including drug susceptibility, of patients with bacteriologically confirmed tuberculosis in Australia during 1989–1992.Design:Collaborative project among the five Australian mycobacterial reference laboratories.Study population: 2509 Australian residents with bacteriologically confirmed tuberculosis.Outcome measures: Patient and specimen data, and drug susceptibility results recorded for isolates ofMycobacterium tuberculosisandMycobacterium bovis.Results:The annual incidence during 1989–1992 was about 3.6 per 100000. The male‐to‐female ratio was 1.4:1 and about half the patients were under 50. Older men had high rates of disease. Lymphatic disease was significantly more common in females; the converse was true for pulmonary and pleural disease. Resistance to at least one of the common antituberculosis drugs was detected in 14.4% of isolates, and usually involved streptomycin (7.6%) and isoniazid (8.4%). Fewer than 1% of isolates were resistant to isoniazid and rifampicin in combination.Conclusions:By international standards, Australia remains a “low‐incidence” country for tuberculosis, with a static annual incidence. Multiple drug resistance is uncommon and most patients should respond to the standard four‐drug regimen. Nevertheless, because clinical data confirm that the pool of infected persons is being supplemented through immigration, and that certain population subgroups have high rates of disease, it is essential that Australia maintain effective control programs.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139901.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objectives:To describe the first reported outbreak of Barmah Forest (BF) virus disease in the south‐west of Western Australia.Design:Case series correlated with results of arbovirus surveillance. All patients with clinically suspected Ross River (RR) virus infection were serologically tested for antibodies to BF and RR viruses. Home address and date of presentation of patients with serologically confirmed recent infection were recorded. Mosquitoes collected from the districts before and during the BF virus outbreak were identified to species level and tested for virus.Results:Twenty‐two cases of BF disease were reported from the region between August 1992 and March 1994. Most occurred in the Peel region in the spring and early summer of 1993. Eighteen isolates of BF virus were obtained from three different species of mosquito trapped between January and October 1993. Fifteen were from mosquitoes in the Peel region and a single isolate was from the Perth metropolitan area. No isolates were obtained from the region before 1993. RR virus was not isolated from mosquitoes trapped in the region during the BF virus outbreak.Conclusions:Most BF infections were acquired in the Peel region during spring and early summer of 1993.Aedes camptorhynchusmosquitoes were probably the main vectors. The lack of isolations from mosquitoes before 1993 suggests that the virus may have only recently been introduced (or reintroduced) to the region. It was transmitted under conditions that were apparently not conducive to transmission of RR virus.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139902.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To assess changes in survival and disability in liveborn extremely low birthweight infants (500–999g) in Western Australia, 1980–1987.Design:Cohort study comparing two periods, 1980–1983 (P1) and 1984–1987 (P2).Participants:All 586 liveborn extremely low birthweight infants in WA in 1980–1987 (266 in P1, 320 in P2).Main variables examined: Birthweight, place of birth, age at death, neurosensory examination findings and scores on the Griffiths Mental Development Scales or other standardised test results.Results:482/586 infants (82%) were born at King Edward Memorial Hospital (KEMH), a level III referral centre, and a further 4% were transferred there after birth. The proportion born at KEMH increased from 78% in P1 to 86% in P2. Survival increased from 35% to 43% overall. In those below 800 g birthweight, survival doubled from 14% to 29%. There was no change in the age at death for non‐survivors. Follow‐up information was known for 222 of the 229 survivors at median ages of 46 months (P1) and 43 months (P2). Disability rates in infants below 800 g birthweight remained static (P1, 26%; P2, 28%), but fell in those of 800–999 g birthweight from 24% to 13%. Overall, survival free of disability increased from 26% to 34%.Conclusion:Increased survival rates occurred without any increase in the rate or severity of disability in survivors.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139903.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To assess the use of patient‐held medication record cards and their acceptability to patients and doctors.Design:Prospective 12‐month study with data collection at baseline and on three subsequent occasions at four‐monthly intervals.Patients and setting: 187 patients with a mean age of 78.4 years (range, 60–101) were taking a mean of 5.8 medications each (range, 1–18). They lived on Sydney's lower north shore and were able to care for themselves.Main outcome measures: Availability of card on request, frequency of use, status of recorders and accuracy of records (checked by inspection of medications at home).Results:Most patients retained their cards, but the proportion who presented it to their doctor fell from 61% to 23% over the 12 months (P<0.0001), and the proportion with accurately recorded drug regimens ranged from 20% down to 16%. Of the 75 regimens written exclusively by general practitioners in the 12 months, only 19 (25%) were consistent with what the patients were actually taking.Conclusion:Medication record cards introduced into the doctor‐patient relationship by a “third‐party” are unlikely to result in better quality use of medicines.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139904.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To evaluate the uptake of hepatitis B vaccination by staff of a metropolitan district general hospital and associated community health service in order to determine if the existing vaccination program was adequate.Design, setting and participants: A cross‐sectional survey of all 1464 staff of a 304‐bed district general hospital and associated community health service, serving a population of approximately 240 000 people in a middle socioeconomic area of northern Sydney, by means of a self‐reported anonymous questionnaire.Results:The overall response rate was 56.4%, with 61.9% of high‐risk and 48.7% of low‐risk staff responding to the survey. The overall vaccination rate was 55.8%. Of high‐risk respondents, 70.7% had been or were in the process of being vaccinated, compared with 29.4% of low‐risk respondents. Of those already vaccinated, only 45.9% had subsequently been tested for antibody to hepatitis B surface antigen (anti‐HBs); 12% of this group did not know whether their response to the vaccine had been adequate and 18% reported being advised to have another anti‐HBs test later. Vaccination rates were higher in younger staff (68.7% of 20–29‐year‐olds) than in older staff (42.7% of 50–59‐year‐olds). There was no significant difference in vaccination rates between men (55.6%) and women (55.8%). Vaccination rates for doctors, dentists and nurses were 69%, 80% and 74.6%, respectively.Conclusion:The vaccination rate among high‐risk staff is suboptimal: more than half did not know whether their vaccination had induced a suitable level of antibodies; more than 10% had been vaccinated more than five years previously; and 5% had not completed the full course of three injections. High‐risk staff should be targeted in future vaccination programs.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139905.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To assess the causal prophylactic activity (activity against the pre‐erythrocytic liver stage) of a daily regimen of doxycycline combined with low dose primaquine against malaria in Australian Defence Force personnel deployed to Papua New Guinea (PNG).Participants and setting: A 53‐strong Australian Army engineer detachment deployed to the north coast of PNG for 42 days starting in July 1993.Interventions:The soldiers took doxycycline (100 mg) and primaquine (7.5 mg) daily, starting at least two days before they entered the endemic area and continuing for three days after their return to Australia. No primaquine eradication course was given at that time.Main outcome measures: The number of soldiers who developed malaria, plasma drug concentrations and drug side effects.Results:None of the 53 men developed malaria while in PNG. Three developed falciparum malaria two to three weeks after leaving the endemic area, although one of them had taken doxycycline alone because of glucose‐6‐phosphate dehydrogenase deficiency. Nine men developed vivax malaria between three and 40 weeks after leaving PNG, and three had relapses. Doxycycline was generally well tolerated, with only three of the men requiring a change of medication to mefloquine because of adverse gastrointestinal symptoms.Conclusions:Although doxycycline generally provides good protection against malaria infection, it cannot be relied on for causal prophylaxis, even when combined with low dose primaquine. Because the malaria infections occurred only after return to Australia, doxycycline appears to be effective in suppressing malaria while the drug is being taken. Intense, repeated exposure to malaria may require an extended period of chemoprophylaxis on return from an endemic area.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139906.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To determine the outcome of patients with subarachnoid haemorrhage and whether delays in their diagnosis and referral have been reduced over a 15‐year period.Design:A 15‐year retrospective study of patients admitted to a tertiary neurosurgical unit between 1977 and 1992.Setting:The Royal North Shore Hospital, Sydney.Patients:511 patients admitted with subarachnoid haemorrhage from ruptured intracranial aneurysms.Results:Of 486 patients with at least a six‐month follow‐up, 66% made a good recovery and 19% died. Outcome was significantly influenced by the neurological condition of the patient at admission (P<0.0001). There was no significant difference in the relative proportions of patients transferred late (three or more days after onset of symptoms) when those admitted before and after 1986 were compared.Conclusion:Delayed diagnosis and referral remain the major preventable problems in the management of patients with aneurysmal subarachnoid haemorrhage.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139907.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To determine the prevalence of markers of past hepatitis B infection among participants in Australian Rules football, to estimate the potential exposure of Australians to hepatitis B virus (HBV) in contact sport.Design and setting: A point prevalence survey for antibody to hepatitis B surface antigen (anti‐HBs) and core antigen (anti‐HBc), supported by a questionnaire used to determine the history of risk and exposure, in South Australian National Football League (SANFL) players supervised at club level by general practitioners and sports medicine specialists.Participants:Of 245 players from seven clubs, 49 were excluded from the study because they had been previously vaccinated. Of 196 eligible participants, 117 submitted blood samples and, of these, 85 returned questionnaires.Results:One player was positive for anti‐HBc (a prevalence rate of 0.85%). This individual and three anti‐HBc‐negative players were positive for anti‐HBs in the absence of a history of vaccination. We could not ascertain whether these additional three players had been previously infected, or vaccinated without this fact having been recorded on the questionnaires. No single behavioural factor correlated with positive anti‐HBs results.Conclusions:The prevalence of markers of past hepatitis B infection in SANFL football players was no different to that in blood donors of the same age group from the same city. There was no evidence for any additional HBV transmission due to participation in football over that in the blood donor population. Vaccination of footballers and people engaged in similar sports is of benefit in conferring protection on the individual, but would be unlikely to make a significant public health impact on community rates of HBV infection.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139908.x

出版商:Wiley    

年代:1995

数据来源: WILEY