ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126111.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Doctors, educators, administrators and patients must commit to health care decisions based on valid scientific research

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126112.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Careful surveillance shows the extent to which our prevention efforts have been successful

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126113.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Better training of general practitioners in psychiatry would improve prescribing

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126114.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Be not the first by whom the new are tried, nor yet the last to lay the old aside —Alexander Pope

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126115.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo improve the quality of surveillance data for HIV in Victoria by following up all cases with an unknown exposure category; and to determine whether those with no exposure category included cases of transmission other than via the conventionally recognised routes.MethodsThe Victorian HIV database records data on all people diagnosed with HIV in Victoria, including information on route of exposure to the virus. We identified all HIV diagnoses to which no exposure category had been attributed and, with the permission of the State Minister for Health, obtained access to namecoded testing records. Exposure categories, where possible, were obtained directly from these records. Otherwise, cases were checked against the namecoded AIDS database and, if necessary, an intensive process of call‐back to laboratories, diagnosing doctors and HIV treatment centres was undertaken.ResultsThe database initially contained records for 289 people with unknown exposure categories (9.1% of Victorian people with HIV infection). We identified exposure categories for 155 of these people.ConclusionsExposure categories for those cases previously without data were similar to those for cases where exposure category was known. No instances of HIV transmission by previously unrecognised means were detected.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126116.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo determine the pattern of use of psychotropic drugs in Sydney nursing homes.DesignSurvey of data from medical records of residents and interviews with residents and staff.SettingCentral Sydney Health Area, June to December 1993.Participants: All residents of 46 of the 47 nursing homes in the western sector of the health area.Main outcome measuresPsychotropic drugs used regularly or as required. Degree of cognitive impairment and depression rated on interview with residents, using Mini‐Mental State Examination and Geriatric Depression Scale. Behavioural disturbances reported by staff.Results: Most residents (58.9%) were taking one or more psychotropic drugs regularly and another 7% were prescribed these drugs as required. Neuroleptics were taken regularly by 27.4% and as required by a further 1.4% (at least one dose in the previous four weeks), but doses were equivalent to more than 100 mg/day of chlorpromazine for only 8.8%. Neuroleptics were more likely to be given to residents with greater cognitive impairment and more disturbed behaviour. Other psychotropic drugs in regular use were: benzodiazepines (32.3%); hypnotics (26.6%); antidepressants (15.6%); and anxiolytics (8.6%). At least half of antidepressant doses were subtherapeutic. Of 874 residents who responded to a depression questionnaire, 30% scored as significantly depressed; one‐third of these were taking antidepressants.ConclusionsThe percentage of residents in Central Sydney nursing homes who were taking neuroleptics, hypnotics or anxiolytics is among the highest reported from geriatric institutions around the world. Prescribing practices in Australian nursing homes need to be reviewed.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126117.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo evaluate the risk of post‐transfusion and postoperative non‐A non‐B hepatitis in Australia immediately before the introduction of screening for hepatitis C.DesignRetrospective testing of blood samples from a prospective study of cardiac surgery patients. Samples were taken from transfusion recipients and non‐transfused controls at regular intervals for 12 months after surgery during 1987‐1989. For all donor, recipient and control samples, alanine aminotransferase (ALT) levels were measured and tests for antibody to hepatitis B (anti‐HBc, anti‐HBs) and, when available, to hepatitis C (anti‐HCV) were performed.SettingCardiac surgery units.ParticipantsParticipants were included if they lived in the metropolitan area, and had not had a transfusion in the past year.Main outcome measuresPost‐transfusion hepatitis (two consecutive samples showing raised ALT levels,>90IU/L with no other known cause); hepatitis C infection and carriage (antibody to hepatitis C).ResultsPost‐transfusion hepatitis occurred in 1.1% of 736 recipients of blood not screened for hepatitis C (i.e., two cases per 1000 unscreened units given). No hepatitis occurred in 514 controls. Seven of the eight patients with post‐transfusion hepatitis seroconverted to hepatitis C virus infection. Seven of the 26 anti‐HCV‐positive donations transmitted hepatitis C, six of these were positive by recombinant immunoblot assay (RIBA) (one by second generation testing only) and one was RIBA indeterminate. Nineteen were RIBA non‐reactive; one transmitted hepatitis but the recipient did not develop anti‐HCV, although hepatitis C RNA was detected in the donation. Serum ALT was raised in four of the six infective donations.ConclusionsHepatitis C virus infection accounted for almost all cases of non‐A non‐B post‐transfusion hepatitis. First generation anti‐HCV tests detected about 85% of infective donations. Surrogate testing of donations by ALT or anti‐HBc offers no additional advantage.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126118.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo determine whether there has been an increase in the proportion of small (<1 cm in size) and localised breast cancers in women aged 50‐69 (the group actively recruited to mammographie screening) compared with women aged 40—49.DesignCases of invasive breast cancer in women aged 40—69 notified to the NSW Central Cancer Registry in 1986, 1989 and 1992 were included. Tumour sizes were determined from histopathology reports.ResultsA higher percentage of breast cancers were under 1 cm in size in 1992 (10%) than in 1986 and 1989 (7%). The increase in the percentage of small breast cancers was statistically significant in women aged 50‐69 (X2 for linear trend, 7.9; P= 0.005) but not in those aged 40‐49 (x2 for linear trend, 2.5; P=0.12). Slightly more than half the breast cancers (53%) in 1992 were localised to the breast, representing an increase from 49% in both 1986 and 1989. This increase was also statistically significant in women aged 50‐69 (x2 for linear trend, 3.9; P= 0.05) but not in those aged 40‐49 (x2 for linear trend, 1.4; P=0.24).ConclusionsBreast cancers in 1986, 1989 and 1992 showed a moderately strong shift to smaller tumours and localised disease in women aged 50‐69. As women of this age group were targeted by mammographie screening, the widespread availability of mammography may explain this shift.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126119.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo evaluate the success of strategies —including replacing petrol with aviation gasoline (avgas) in the fuel supply, and employment and skills‐training programs targeting young people —in reducing petrol sniffing at Maningrida, an isolated Aboriginal community in northern Australia.MethodsA follow‐up study of 13 Aboriginals who were non‐sniffers, 15 who were ex‐sniffers and 27 who were petrol sniffers in 1992 was conducted by questionnaire in 1994, 20 months after intervention strategies were commenced; 11 non‐sniffers, 11 ex‐sniffers and 18 petrol sniffers, respectively, participated.Main outcome measuresPetrol‐sniffing status, changes in employment status, blood lead levels of the participants, and community crime statistics.ResultsAfter intervention strategies in Maningrida, petrol sniffing ceased, with related crime falling markedly. Employment increased significantly among petrol sniffers, from 7% to 63% (x2= 11.53; df= 1;P<0.001). Only two petrol sniffers were reported to have continued petrol sniffing elsewhere. Apart from one of these individuals, who had recently returned to Maningrida, blood lead levels fell significantly in those with a history of petrol sniffing, indicating they had not continued to sniff avgas, which contains lead additives (0.8 g/L).ConclusionsWhile avgas introduction was a key element in eliminating petrol sniffing, its apparent lack of success as a single intervention elsewhere indicates the importance of widespread community resolve against petrol sniffing and the development of coordinated employment strategies in successfully eliminating the practice and reducing associated social disruption.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb126120.x

出版商:Wiley    

年代:1995

数据来源: WILEY