ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126012.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Diagnosis of endothelial dysfunction in childhood offers an opportunity to prevent atherosclerosis

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126013.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

In asymptomatic women, age 65 could be the most rational choice

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126014.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Some medicines are lethal in suicidal hands; others are more forgiving

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126015.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo describe an epidemic of gonococcal conjunctivitis in central Australian Aboriginal children, the responsible phenotypes ofNeisseria gonorrkoeae,factors facilitating spread and treatment efficacy.DesignProspective study of patients with laboratory confirmed or clinical gonococcal conjunctivitis diagnosed from January to July 1991.SettingThe Alice Springs and Barldy Tablelands Health Districts of the Northern Territory, the Anangu Pitjantjatjara Lands of South Australia and the Ngaanyatjarra Homelands of Western Australia.MethodsCases were identified from surveillance data and laboratory notifications, and by active case finding. A community survey explored risk factors.Main outcome measuresAge‐specific attack rates, auxotype/ serovar characterisation of isolates, and clinical response to single dose treatment.ResultsWe identified 432 cases. The highest attack rate was in the 0‐4 year age group (86 per 1000), and the risk of conjunctivitis decreased with age. The odds ratio of secondary infection in household compared with community contacts was 14.5(P<0.002; 95% Cl, 1.8‐120.0). Disease was less common in children with clean faces and hands. The outbreak occurred after unseasonable rains and large community gatherings. Isolates were predominantly LA serovars, less common among central Australian serovars.ConclusionsThe trigger for non‐sexually transmitted gonococcal conjunctivitis epidemics remains obscure. Age is a significant risk factor and social and ecological factors may also contribute. Active case finding within affected households and treatment with a suitable penicillin is effective in stopping transmission.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126016.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo document the incidence, case fatality, clinical and demographic features of invasive pneumococcal disease in central Australia.DesignInvasive isolates from the regional central laboratory were prospectively recorded over five years and case notes retrospectively reviewed. Population denominators were calculated from national Census data from 1986 and 1991.ResultsThe population estimates for the region were 14 568 for Aboriginals and 28680 for non‐Aboriginals. There were 185 episodes of invasive pneumococcal disease over the five years, 162 (87.5%) in Abori‐ginals and 23 (12.5%), in non‐Aboriginals. The incidence in Aboriginal children under two years of age was 2052.7 per 100000 and for those 20‐59 years was 178.2 per 100000. The relative risk in Aboriginals compared with non‐Aboriginals was 10.8 (95% Cl, 5.6‐20.7;P<0.0001) for those aged 0‐4 years and 20.4 (95% Cl, 9.7‐42.5;P<0.0001) for those 15‐59 years. Forty‐one Aboriginal adults aged over 14 (62%) had at least one conventional risk factor for pneumococcal disease; alcohol abuse was present in 27 (41%). There were 13 Aboriginal deaths and the case fatality rose from 2% in those under four years to 40% for those over 59 years.ConclusionsCentral Australian Aboriginals have the highest incidence of invasive pneumococcal disease reported. The rate for children under two years is 59 to 80 times the rates for children in the United States and Sweden. These data have implications for improving vaccine use, health service delivery and environmental health in Aboriginal communities.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126016a.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo outline the maternal and perinatal features and outcome of patients referred to a tertiary referral obstetric hospital for management of their hypertension.Setting and patients205 consecutive public patients admitted for assessment of hypertension (either full admission or day‐stay) to King George V Hospital's Hypertension in Pregnancy Unit, between February 1993 and January 1994.DesignA prospective study in which patients were classified according to the Australasian Society for the Study of Hypertension in Pregnancy (ASSHP) Consensus Statement classification.ResultsOf the 205 patients, 25% did not meet the criteria for preeclampsia or chronic hypertension, 33% had mild pre‐eclampsia, 34% had severe pre‐eclampsia and the remainder had chronic hypertension. The mean gestation at delivery for those with mild pre‐eclampsia was 38.3 weeks and for severe preeclampsia 35.3 weeks. For the mild and severe groups respectively, the rate of elective delivery for raised blood pressure was 56% and 53%; for caesarean section, 17% and 61%; and for perinatal death, 2% and 4%. In the severe group, 49% had fetal problems and 25% required intravenous antihypertensives.ConclusionsThe multisystem nature of pre‐eclampsia makes comparison of management protocols difficult. Ongoing audit is needed of maternal and perinatal outcomes and features of disease in patients with hypertension in pregnancy under a universal classification. The ASSHP classification system successfully identifies patients who require more intensive management and intervention.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126018.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126019.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo examine the morbidity and mortality associated with self‐poisoning with different drug classes.DesignProspective cohort study with limited follow‐up. Retrospective analysis of coronial data.SettingPrimary and tertiary referral toxicology centre covering Newcastle and Lake Macquarie, Australia, 1987‐1992.ResultsThere were 1969 admissions after ingestion of 3724 substances (2424 prescription drugs and 1300 non‐prescription items). The coroner investigated 83 drug‐related deaths. Only 12 of these people presented to hospital and, for most of these, death was inevitable at presentation. The most frequently ingested substances were benzo‐diazepines, alcohol, paracetamol, antidepressants, neuroleptics and anticonvulsants. Since 1980, the percentage of self‐poisonings involving benzodiazepines has fallen, while it has risen for those involving antidepressants. Over 50% of deaths were due to tricyclic antidepressants or opioid analgesics.ConclusionsAs death usually occurs out of hospital, interventions to decrease mortality from selfpoisoning must focus on prevention, and targeting drugs that are frequently taken or frequently lethal in overdose. Consideration should be given to the use of antidepressants that are safer in overdose. The use of antidepressants, barbiturates or chloral hydrate as sedatives should be discouraged.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126020.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo compare prescription data for Australia with drugs ingested in self‐poisoning and suicide, to determine which drugs are over‐represented.DesignComparison of data on drugs taken in self‐poisoning admissions and suicides with Australian prescription drug dispensing data from the Drug Utilization Subcommittee (DUSC).SettingNewcastle and Lake Macquarie, Australia, 1989‐1992.SubjectsBetween July 1989 and June 1992, 1159 prescription drugs were taken in overdose. Eighty‐three drug‐related deaths were investigated by the coroner between 1987 and 1992. On 48 occasions a prescription drug was the primary cause of death.ResultsDrugs over‐represented in self‐poisoning (relative to Australian prescriptions) included not only those prescribed for psychiatric conditions (antidepressants, neuroleptics and lithium), but also benzo‐diazepines, barbiturates and other anticonvulsants. The highest odds ratios for death when adjusted for prescription numbers were for short‐acting barbiturates (523.7; 95% confidence interval [Cl], 207‐1322), chloral hydrate (58.1; 95% Cl, 18.1‐187), colchicine (27.9; 95% Cl, 3.8‐202), dextropropoxyphene (20.8; 95% Cl, 8.8‐48.9), tricyclic antidepressants (13.3; 95% Cl, 7.2‐24.5) and anticonvulsants (11.6; 95% Cl, 4.1‐32.2).ConclusionsShort‐acting barbiturates, chloral hydrate and dextropropoxyphene have little or no clinical advantage over alternatives and excessive toxicity in overdose. They should be removed from the market. The toxicity of anticonvulsants and colchicine should be con‐sidered when they are prescribed, and smaller amounts per prescription may be advisable for high risk patients using these and other toxic drugs.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126022.x

出版商:Wiley    

年代:1995

数据来源: WILEY