ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140000.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140001.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140002.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140003.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To characterise blood donors with equivocal hepatitis C serological results and to develop an algorithm for their diagnosis and follow‐up.Design:Prospective case survey.Subjects and setting: 100 consecutive blood donors referred to the St Vincent's Hospital Liver Clinic, Victoria, with equivocal hepatitis C serological results (positive result for second generation Abbott Enzyme Immunoassay 2.0, but at least one negative result on supplemental testing by first generation Abbott neutralisation assay and Abbott Supplemental Assay for antibody to specific viral antigens).Outcome measures: Percutaneous risk factors for hepatitis C exposure, peak serum alanine aminotransferase (ALT) levels, results of alternative immunoassay (Monolisa) and polymerase chain reaction (PCR) to detect hepatitis C viraemia.Results:Thirty subjects had positive results for alternative immunoassay. A risk factor was identified for 32 subjects and was significantly associated (P<0.01) with positive results for alternative immunoassay (23/32) and PCR (11/32), abnormal ALT levels (7/32), and strong reactivity on initial immunoassay (23/32). Presence of antibodies to both structural and non‐structural antigens was also associated with risk factors and positive alternative immunoassay results.Conclusions:A definitive diagnosis was possible in 87% of subjects. A diagnosis of hepatitis C infection was based on positive alternative immunoassay results together with positive PCR results or presence of a risk factor. Hepatitis C was excluded for 60% of patients. The diagnosis for the remaining 13% remained indeterminate, indicating the need for a definitive diagnostic test for hepatitis C.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140004.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140005.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To assess the provision of accurate pre‐symptomatic genetic testing with DNA analysis and appropriate counselling for individuals and families known to be at high risk of developing familial adenomatous polyposis coli (FAP).Patients and methods: Thirty‐one families with clinically and pathologically documented FAP were ascertained from the Western Australian Polyposis Registry. DNA was collected from over 200 individuals in these families to establish their genetic risk status for FAP, either by direct mutation analysis, or by linkage analysis. Individuals undergoing DNA testing were given intensive psychosocial support and counselling.Results:In 19 families DNA‐based counselling could not be offered because either the adenomatous polyposis coli (APC) gene mutation could not be detected or there were insufficient family members for linkage analysis. Gene testing yielded mutations of the APC gene in 87 individuals from 12 families; by gene tracking (or linkage analysis) in three families and by mutation analysis in the remaining nine (four of which had only one affected individual). DNA results conformed with a definite clinicopathological diagnosis in 27 FAP patients and, of the remaining 60 high‐risk subjects tested, 14 had inherited the mutated APC gene.Conclusions:DNA analysis allowed accurate genetic counselling for 12 of 31 families affected by FAP, thus improving the medical and personal management in asymptomatic people who would otherwise be subjected to the uncertainty of long term surveillance and repeated colonic examinations. In future a superior biomolecular approach to gene mutation analysis, such as the protein truncation test, will facilitate management for most FAP individuals and families.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140006.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To determine perinatal autopsy rates and whether any maternal or obstetric factors affect consent for autopsy.Design:Ascertainment of perinatal autopsy rates between 1990 and 1993 for three categories of perinatal deaths: termination of pregnancy for antenatally diagnosed anomalies; fetal deaths and stillbirths; and neonatal and post‐neonatal deaths. A case‐control study matched deaths for which consent for autopsy was refused with the next death in the same category for which consent was given.Setting:A tertiary maternity hospital in South Australia.Results:The autopsy rate for pregnancies terminated for fetal abnormalities was 92.4% (171/185) and for intrauterine death was 87.7% (264/301); the rates in these two groups were higher for registrable births (gestation>20 weeks) than non‐registrable births. The overall autopsy rate in liveborn babies was 58.8% (80/136), the neonatal autopsy rate being 59.6% (68/114). No significant differences were found with regard to gestational age at birth, maternal gravidity and parity, employment, health insurance or marital status, or, among liveborn babies, postnatal age, between the autopsy and non‐autopsy groups.Conclusions:Perinatal autopsy rates are higher than rates in adults but are lower in registrable births than the recommended 75%. Consent for autopsy is the limiting factor. There is a need for a clearer definition of perinatal autopsies, and perinatal autopsy rates, to take into account non‐registrable deliveries.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140007.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objectives:To determine the effectiveness of measles vaccine during a measles outbreak, and to assess whether age at vaccination was a risk factor for measles vaccine failure.Design:A matched case‐control study.Setting:The five primary schools in western Sydney with the largest number of measles cases during the June to December 1993 outbreak.Subjects:Seventy‐nine children aged 5–9 years with an illness consistent with a clinical definition for measles. Two controls per case were selected from children in the same classroom.Main outcome measures: Estimated measles vaccine effectiveness by age of the child at vaccination and vaccination status: “unvaccinated”; “parental recall” (parents stated the child was vaccinated but no record could be found); and “record” (record including date of vaccination available).Results:The estimated vaccine effectiveness was 94% (95% confidence interval [CI], 83%–98%) in the “record” group, and 81% (95% CI, 46%–93%) in the “parental recall” group. Vaccine effectiveness did not differ significantly with age at vaccination (under 12 months of age 96% [64%–99%]; 12–14 months 95% [81%–99%]; and 15 months and over 93% [80%–98%]).Conclusion:Vaccination records should be used to calculate a vaccine's effectiveness as parental recall may not be sufficiently accurate. The high vaccine effectiveness in the “record” group (94%) makes it unlikely that low vaccine effectiveness was the cause of the outbreak. More effort is needed to increase vaccine coverage to at least 95% in all population subgroups.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140008.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objectives:To compare the estimated death rates associated with alcohol and tobacco use for Australian Aboriginals in Western Australia with those for non‐Aboriginals.Method:Deaths attributable to tobacco smoking and alcohol consumption were estimated for 1989–1991 with the aetiological fractions method, using data from the Health Department of Western Australia's mortality database.Results:Tobacco smoking was responsible for 15.4% of all deaths and 13.9% of Aboriginal deaths, and alcohol consumption for 5% and 9.2%, respectively. The age‐standardised death rates per 100000 person‐years for tobacco and alcohol were: Aboriginal males, 271 and 152; other males, 113 and 29; Aboriginal females, 118 and 56; and other females, 32 and 15. Of those who died as a result of tobacco use, 49% of Aboriginal males and 48% of Aboriginal females died before 55 years of age, compared with 11% and 10%, respectively, in non‐Aboriginal males. For alcohol‐related deaths, 62% of Aboriginal males and 70% of Aboriginal females died before 55 years of age, compared with 35% and 23%, respectively, in non‐Aboriginals.Conclusion:During 1989–1991 tobacco smoking and alcohol consumption were responsible for much higher death rates among Aboriginals than among non‐Aboriginals in Western Australia.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb140009.x

出版商:Wiley    

年代:1995

数据来源: WILEY