ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93918.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93919.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93920.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93921.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To ascertain factors associated with having a test for human immunodeficiency virus (HIV)' antibody.Design:All attenders at a sexually transmitted diseases (STD) clinic who were at risk of HIV infection and had not been tested previously were included in the study and classified as requesting a test or being offered a test.Setting:The study was conducted at a central city STD clinic.Participants:Of all patients in 1990, 1835 men and 849 women were excluded because of previous HIV tests and 259 men and 120 women were not tested because of their low risk, leaving a target population of 2249 men and 1153 women.Main outcomes:Among men tested the results in 1.2% (9/771) of those requesting a test and in 0.6% (7/1177) of those not requesting a test were positive. There were no positive results among the women tested.Results:Among men, accepting testing was related to intravenous drug use (odds ratio [OR] = 3.49), not having a steady partner (OR = 1.40), and having an STD (OR = 0.57) or a history of STD (OR = 0.67). Among women, accepting testing was related to not having a steady partner (OR = 1.73), being an STD contact (OR = 0.43), having vaginal discharge and/or dysuria (OR = 0.51), and having a history of STD (OR = 0.61), and was unrelated to having an STD. In both men and women accepting testing was unrelated to having multiple sex partners.Conclusions:The findings are consistent with a failure to associate the risk of HIV infection with risks associated with other STDs. This has implications for health education programs as well as approaches to testing by doctors. Those requesting a test accounted for only 56% (9/16) of infections detected.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93922.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To report the first “domino‐donor” operation performed in Australia; review the results of the first five combined procedures at the Alfred Hospital; and discuss the advantages of the procedure and its place in transplantation.Patients and outcome:The first domino‐donor was a 25‐year‐old man with cystic fibrosis and pulmonary hypertension, receiving a heart‐lung transplant, whose heart was transplanted into a 20‐year‐old woman with end‐stage cardiomyopathy. The cardiac recipient's initial course was satisfactory, but at eight months she developed severe rejection, with failure of the donor heart, and required retransplantation. Subsequently four further combined procedures were performed. All 10 patients are alive and well. Four patients have had cytomegalovirus infection but without major complications. Improved function of the donor right ventricle has been observed when the ventricle is working against a lower resistance.Conclusions:Four advantages of the domino procedure are evident: an increased pool of donor allografts; the use of a heart with an hypertrophied (“prepared”) right ventricle; absence of the adverse effects of brain‐death in the live donor; and improved ability to match the donor and recipient before the operation.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93923.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To assess the effectiveness of a child abuse surveillance and intervention program in protecting infants at risk.Design and setting:A retrospective review of all children discussed by the Suspected Child Abuse and Neglect Team of the Mater Misericordiae Children's Hospital, South Brisbane, over the five year period January 1986 to December 1990.Patients:A total of 2126 children were discussed by the team; 375 were infants (less than 12 months of age) at the time of the initial discussion. Nine infants died suddenly and these nine deaths were examined in detail.Results:All deaths were considered initially to be due to sudden infant death syndrome (SIDS), but autopsy findings in six suggested death was not accidental and in the other three significant doubt was raised by the history. Identifying risk factors for non‐accidental injury were clearly present in all cases; however, there were major problems with notification to the appropriate authorities. Even in cases where appropriate identification and notification occurred planned interventions by multiple agencies failed to prevent death of these infants.Conclusions:There is a growing awareness of child abuse as a significant cause of morbidity and mortality in developed countries, but intervention is fraught with multiple difficulties and prevention programs are few. Recommendations are offered for improvement in recognition and notification of incipient child abuse as well as appropriate interventions to prevent infant deaths. Inappropriate death recording procedures may result in some sudden deaths being recorded as SIDS when in fact they are caused by child abuse.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93924.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To assess the palliative care needs and the results of treatment of patients with terminal cancer admitted to a general teaching hospital.Design, setting, patients:A retrospective analysis of 110 consecutive patients with terminal cancer admitted to the Austin Hospital.Main outcome measures:The occurrence and relief of pain, the use of allied health services and the place of death.Main results:Pain was the most common symptom and was satisfactorily improved in only two‐thirds of the patients. Allied health services were used sporadically and appeared to be underused. Psychological problems were documented in very few patients. Only seven patients died at home, the remainder dying in hospital (82) or in a hospice (21).Conclusions:One‐third of patients with terminal cancer in a general teaching hospital received inadequate pain relief; the reasons for this included lack of medical expertise in the use of analgesics for chronic cancer pain and the frequent use of analgesia given only “as required”. The underuse of allied health services, the infrequent documentation of psychological issues and the observation that only a small proportion of patients were able to die outside hospital all underline the need for a coordinated multidisciplinary approach to the management of patients with terminal cancer.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93925.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To find out whether trends in rates of non‐fatal myocardial infarction (Ml) parallel trends in rates of coronary death.Design:A population‐based observational study involving continuous surveillance of all suspected heart attacks or coronary deaths from 1985 to 1989.Study population:Residents of the Hunter Region of New South Wales aged under 70 years.Main outcome measures:Rates of non‐fatal definite or possible Ml or fatal Ml or coronary death, as defined by the diagnostic criteria of the WHO MONICA Project.Results:For men, mortality rates declined by an average of 16.2 per 100 000 per year (95% confidence interval [CI]: ‐23.8, ‐8.7); rates of non‐fatal definite Ml declined by 16.2 per 100 000 (95% CI: ‐27.8, ‐4.6); rates of non‐fatal possible Ml increased initially and then stabilised. For women smaller changes occurred in the same directions.Conclusion:In this population trends in rates for non‐fatal definite Ml paralleled the declines in mortality rates. Rates for less severe non‐fatal possible Ml did not follow this pattern, perhaps reflecting increased medical attention to chest pain.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93926.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93927.x

出版商:Wiley    

年代:1991

数据来源: WILEY