ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139962.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139963.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139964.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To calculate the minimum prevalence of malnutrition among rural Aboriginal children under two years of age in the Top End of the Northern Territory (NT) using World Health Organization (WHO) criteria.Methods:We calculated weight‐for‐height and height‐for‐age Z‐scores (WHO‐endorsed references) for all children under two years who were admitted to hospital with diarrhoeal disease between May 1990 and April 1991. Weights recorded 48 hours after admission were used to allow for acute dehydration. Malnutrition was defined in terms of “wasting” and “stunting” when weight‐for‐height and height‐forage were more than two standard deviations below the median of the WHO reference population. The denominator population was calculated from NT Department of Health and Australian Bureau of Statistics data.Results:From an average population of no more than 480 children under two years, 34% were admitted to hospital at least once with diarrhoeal disease in the 12 months; 59% were malnourished (wasting alone, 36%; stunting alone, 10%; both, 13%). In the study period an estimated minimum of 20% of all Aboriginal children in the Top End were malnourished (wasted, 12%; stunted, 3%; both, 5%).Conclusions:The 20% prevalence of malnutrition is many times higher than would be expected statistically and higher than in many underdeveloped countries. International relief agencies regard a prevalence of wasting in children of more than 8% as a nutritional emergency. We urge that programs to alleviate the poor socioeconomic conditions, and mechanisms for early detection and intervention in childhood malnutrition, be offered to Aboriginal communities.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139965.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To describe women's experiences of pre‐pregnancy counselling and their knowledge of rubella immunity and folate intake.Design:A cross‐sectional sample of 121 public and 32 private patients at or less than 20 weeks' gestation attending their first antenatal appointment completed a self‐administered questionnaire.Main outcome measures: Awareness of the importance of rubella immunity and folate intake; and the proportion of women who discussed these with their general practitioner (GP) before pregnancy.Results:Rubella: 59% correctly identified the effect of rubella infection in pregnancy and 86% had been vaccinated. Women born in Australia, New Zealand or the United Kingdom were nearly 16 times more likely to have been vaccinated against rubella than those born elsewhere. Folate: 54% knew of the protective effect of folate, 30% correctly identified the timing of this effect, 72% correctly identified some of the sources of dietary folate, and 13% had increased their folate intake before pregnancy. In 49% of women their GP was aware of their intention to conceive, but rubella had not been discussed with the GP before 50% of these planned pregnancies, and in 80% the issue of folate had not been discussed. Private patients were more likely to have had their rubella immune status checked and to have increased their folate intake compared with public patients.Conclusions:Pre‐pregnancy counselling about rubella immunity and folate intake is underused in the primary prevention of birth defects. Given the high proportion of unplanned pregnancies, primary prevention strategies for birth defects must involve all women of child‐bearing age and not simply those planning a pregnancy.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139966.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objectives:To assess the place of bimanual pelvic examination as a routine procedure in healthy women.Methods:2623 healthy, asymptomatic volunteers (mean age, 51 years; range, 25–92 years) underwent pelvic examination as part of an ovarian cancer screening program. The presence of a bulky or fibroid uterus and adnexal abnormality was noted. Pelvic ultrasonography was used to investigate adnexal abnormalities and was also performed in all women with an elevated serum CA‐125 antigen level (>35 U/mL). Laparoscopy or laparotomy was performed as clinically indicated.Results:A bulky or fibroid uterus was detected in 12.9% of women. The prevalence of abnormal adnexal findings was 1.5%, with a positive predictive value for a subsequent diagnosis of benign adnexal abnormality of 22%. The specificity of vaginal examination for malignancy was 99.9%. No ovarian malignancies were identified at initial screening.Conclusions:This “routine” procedure is undertaken in the belief that it serves a screening purpose. The detection of benign uterine abnormality is of no clear benefit as progression to malignancy is rare. Bimanual pelvic examination is of questionable value as a screening strategy in view of the low incidence of ovarian cancer in healthy women, and the relatively high prevalence (1.5%) of relatively unimportant adnexal abnormalities.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139967.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To assess general practitioners' (GPs') perceptions of the effectiveness of screening for prostate and testicular cancers, and their self‐reported levels of screening for these conditions in the light of the conflicting advice available to GPs, and a lack of evidence to support testing for either of these cancers.Design:A questionnaire sent to all 101 GPs in the Division of General Practice, southern Tasmania.Results:There was an 82% response rate to the questionnaire. GPs had an accurate knowledge of the epidemiology of these cancers. Of 57 GPs who thought that digital rectal examination was an effective screening test for prostate cancer, 56 said they should screen asymptomatic patients but only 37 said they actually did screen. The corresponding results for prostate‐specific antigen screening were 45, 26 and 13, respectively. For testicular cancer screening, 59 GPs thought that clinical examination of the testes was an effective screening test, 55 said they should screen asymptomatic patients but only 21 said they actually did screen. Corresponding results for testicular self‐examination were 56, 57 and 21, respectively.Conclusions:Many GPs are uncertain about the tests available for screening for prostate and testicular cancers. Some think they should screen, but few do so consistently. Clear and precise evidence‐based guidelines for screening for these conditions are necessary.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139968.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objectives:To evaluate three strategies for preventing group B streptococcal neonatal sepsis in large teaching hospitals and to examine their cost effectiveness and cost benefit.Methods:A decision tree was constructed to determine the outcome of three prevention strategies: (1) Screen all pregnant women for group B streptococcus (GBS) at 28 weeks' gestation and give intrapartum chemoprophylaxis to all GBS carriers; (2) Screen all pregnant women, but give chemoprophylaxis selectively to those carriers with obstetric risk factors (i.e., premature labour, prolonged rupture of membranes and maternal sepsis); and (3) Do not screen but give intrapartum chemoprophylaxis for all women with obstetric risk factors. Australian data were used if available, and the cost benefit and cost effectiveness of each strategy compared with no screening at all were estimated.Results:All three strategies had a net cost benefit compared with no intervention at all. Strategy 1 could prevent 46%, Strategy 2 38% and Strategy 3 60%–80% of all early‐onset GBS sepsis.Conclusion:A substantial proportion of early‐onset GBS sepsis is preventable. Strategy 1, which is practical in some large teaching hospitals, prevents more sepsis at a lower cost per case prevented than Strategy 2. Strategy 3 theoretically could prevent more cases at a substantially lower cost than Strategies 1 or 2, but has not been evaluated clinically.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139969.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To determine the accuracy of information in popular magazines in Australia about drugs and environmental influences in pregnancy.Methods:All issues of the 14 highest‐circulation popular magazines likely to contain relevant articles were prospectively surveyed between November 1991 and October 1992. The accuracy of information about drugs and environmental influences in pregnancy was assessed after reference to evidence‐based scientific publications such as the Cochrane Database of Perinatal Trials.Results:Two hundred and ninety‐nine statements in 162 articles were rated as accurate (77.6%), misleading (16.7%), giving a false sense of security (3%) or anxiety‐provoking or inaccurate (2.7%).Conclusion:An accuracy rate of 77.6% may appear acceptable. However, the media, and popular magazines in particular, are an important source of health and lifestyle information. Misinformation may induce anxiety and lead to unnecessary or inappropriate changes to medication, diet and lifestyle. Any inaccuracy should be considered unacceptable.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139970.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Objective:To determine changes in the use of hormone replacement therapy (HRT) in South Australia between 1991 and 1993.Design and setting: Survey of women aged 40 years and over, as part of the 1991 and 1993 South Australian Health Omnibus Surveys (household interviews); 868 were interviewed in 1991 and 790 in 1993.Outcome measures: Rates of HRT use.Results:In 1993, 19.0% of women aged 40 years and over were taking HRT and 28.5% had ever taken it (currently or in the past). The highest rates were in the 50–54 years age group (46.2% current use and 57.8% ever use). Between 1991 and 1993 there was a 40% increase in the number of women taking HRT and a significant increase (P<0.01) in the median duration of therapy, from 38 to 54 months. There were also significant increases in rates of use by country women and Australian‐born women (P<0.01). Premarin and Provera remained the most commonly used products in 1993.Conclusion:Australian perimenopausal women are increasingly using HRT. This may reflect recent educational programs on the menopause for both health professionals and the public, and also an increasing number of choices of therapy.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb139971.x

出版商:Wiley    

年代:1995

数据来源: WILEY