ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124587.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Midwives and obstetricians — separate roles but a collaborative effort

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124588.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Is it a recognisable disease entity with a unique pathophysiology, or a ragbag of non‐specific symptoms with many causes?

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124589.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Accepted theories about raised intraocular pressure may not be valid

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124590.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Levodopa is still the mainstay of treatment, but new surgical strategies offer hope where drug therapy has failed

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124591.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo compare continuity of care from a midwife team with routine care from a variety of doctors and midwives.DesignA stratified, randomised controlled trial.Participants and setting814 women attending the antenatal clinic of a tertiary referral, university hospital.InterventionWomen were randomly allocated to team care from a team of six midwives, or routine care from a variety of doctors and midwives.Main outcome measuresAntenatal, intrapartum and neonatal events; maternal satisfaction; and cost of treatment.Results405 women were randomly allocated to team care and 409 to routine care; they delivered 385 and 386 babies, respectively. Team care women were more likely to attend antenatal classes (OR, 1.73; 95% Cl, 1.23‐2.42); less likely to use pethidine during labour (OR, 0.32; 95% Cl, 0.22‐0.46); and more likely to labour and deliver without intervention (OR, 1.73; 95% Cl, 1.28‐2.34). Babies of team care mothers received less neonatal resuscitation (OR, 0.59; 95% Cl, 0.41‐0.86), although there was no difference in Apgar scores at five minutes (OR, 0.86; 95% Cl, 0.29‐2.57). The stillbirth and neonatal death rate was the same for both groups of mothers with a singleton pregnancy (three deaths), but there were three deaths (birthweights of 600 g, 660 g, 1340 g) in twin pregnancies in the group receiving team care. Team care was rated better than routine care for all measures of maternal satisfaction. Team care meant a cost reduction of 4.5%.ConclusionContinuity of care provided by a small team of midwives resulted in a more satisfying birth experience at less cost than routine care and fewer adverse maternal and neonatal outcomes. Although a much larger study would be required to provide adequate power to detect rare outcomes, our study found that continuity of care by a midwife team was as safe as routine care.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124592.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo determine whether serum levels of chlorinated hydrocarbons are elevated in patients with chronic fatigue syndrome.MethodsChlorinated hydrocarbon levels were measured in 22 patients with chronic fatigue syndrome (CFS) (as defined by the Centers for Disease Control [CDC]); in 17 patients with CFS symptoms whose history of exposure to toxic chemicals excluded them from the research definition of CFS; and in 34 non‐CFS control subjects matched for age and sex.ResultsDDE (l,l‐dichloro‐2,2‐6i.s (p‐chlorophenyl) ethene) was detected in all serum samples at levels over 0.4 ppb. The incidence of hexachlorobenzene (HCB) contamination (>2.0 ppb) was 45% in the CFS group, compared with 21% in the non‐CFS control group (P<0.05). The CFS group had a significantly higher total organochlorine level (15.9 ppb; SEM, 4.4) than the control group (6.3 ppb; SEM, 1.1; P<0.05). The toxic exposure group also had a higher mean organochlorine level (13.6 ppb; SEM, 6.2) than the control group, but the difference was not statistically significant. DDE and HCB comprised more than 90% of the total organochlorines measured in each of the groups.ConclusionThe results suggest that recalcitrant organochlorines may have an aetiological role in CFS. There were no significant differences in serum organochlorine concentrations between CFS patients and chronic fatigue patients with a history of toxic chemical exposure. Therefore, exclusion of patients from the CDC research definition of CFS on the basis of a reported history of known exposure to toxic chemicals is not valid. The role of low‐level organochlorine bioaccumulation in the development of CFS symptoms requires further investigation.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124593.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124594.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo determine the frequency of heterozygous carriers of the Tay‐Sachs disease gene in an asymptomatic Ashkenazi Jewish population and to compare the acceptability of different community testing strategies.DesignPilot survey of carrier rates and community attitudes.SettingSydney, February 1993 to November 1994.Participants147 self‐or medically referred people of Ashkenazi Jewish origin were tested. Jewish religious, medical and community organisations and leaders were consulted.OutcomesPrevalence ofHEXAmutations, client and community preference for different testing and reporting strategies.ResultsFrequency of heterozygous carriers was 1 in 18, with a relative frequency of the three major allelic variants similar to that in overseas studies. Most subjects were medically referred and preferred individual reporting of their carrier status. Community representatives had serious reservations about this strategy and few orthodox Jews participated in the study. An alternative strategy was developed for future testing.ConclusionsFrequency of heterozygous carriers of the Tay‐Sachs disease gene was higher than found among Ashkenazi Jews in other countries, possibly because of ascertainment bias. A testing strategy with medical referral and individual reporting of carrier status may not be appropriate for all the community at risk and a modified strategy is necessary.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124595.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo survey early‐onset neonatal infections in Australian and New Zealand neonatal units and to compare the incidence of group B streptococcal (GBS) sepsis among Aboriginal and non‐Aboriginal babies.DesignSecond year of an ongoing longitudinal, prospective study.SettingNine Australian units and one New Zealand unit with level 3 neonatal care and one Australian unit with level 2 care, between October 1992 and September 1993 inclusive.Outcome measuresEpisodes of early‐onset sepsis (within 48 hours of birth), causative organisms, mortality, birthweight and gestational age.SubjectsBabies in the neonatal units with early‐onset systemic sepsis, either born in attached maternity hospitals or referred.ResultsIn the Australian units there were 100 episodes of early‐onset sepsis (incidence among babies born in attached maternity hospitals of 2.9 per 1000 live births). GBS was the commonest infecting agent (70% of cases) and caused all 12 cases of early‐onset meningitis. The mortality from early‐onset sepsis was 10%. The incidence of GBS sepsis was 1.7 per 1000 live births in non‐Aboriginal babies and 5.2 per 1000 in Aboriginal babies (odds ratio, 3.1; 95% confidence interval, 1.4‐6.6).ConclusionsEarly‐onset GBS sepsis is more than three times as common in Aboriginal babies delivered in hospital than in non‐Aboriginal babies. Four of seven Australian maternity hospitals surveyed had no firm policy for reducing the incidence of early‐onset GBS sepsis. All should urgently consider such a policy.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124596.x

出版商:Wiley    

年代:1995

数据来源: WILEY