ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121636.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121637.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121638.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121639.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo describe the incidence of the acquired immunodeficiency syndrome (AIDS) in Australia between 1982 and 1991.DesignState and Territory Health Departments notified new diagnoses of AIDS to the National AIDS Registry. Information reported for each case included sex, date of birth, date of AIDS diagnosis, presumed mode of exposure to the human immunodeficiency virus (HIV), and illness(es) on which the diagnosis of AIDS was based.ResultsTo the end of March 1992, 3160 cases of AIDS were reported as having been diagnosed between 1982 and the end of 1991. The cumulative incidence per head of population was about twice as high in New South Wales as in Australia as a whole. Over 97% of cases were in men, of whom 91% were adults or adolescents reporting homosexual contact. In women, 40% of cases were acquired through receipt of blood, blood products or tissue. The annual incidence of AIDS rose sharply until about 1988, but the annual rates of increase slowed in subsequent years. This trend was also apparent in cases acquired through sexual contact between men. In other exposure groups, numbers of cases were much smaller and trends less apparent. However, there was no indication of a similar levelling in AIDS incidence, except among blood transfusion recipients, in whom Incidence may be declining.ConclusionTransmission of HIV among people with AIDS in Australia has been overwhelmingly attributed to sexual contact between men. The annual incidence of cases attributed to sexual contact between men appears to be stabilising.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121640.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo describe the epidemiology of infection with the human immunodeficiency virus type 1 (HIV‐1) in Victoria from 1980 to 1991.DesignData on HIV‐1 infection in Victoria, obtained through routine laboratory‐based surveillance, were entered In a database. Missing information was sought by contacting the referring doctor where possible.SettingIn Victoria, the acquired immunodeficiency syndrome (AIDS) is notifiable to Health Department Victoria by diagnosing doctors, and laboratories are required to notify new diagnoses of HIV‐1 infection, without identifiers. All confirmatory testing for HIV‐1 has taken place at the State HIV Reference Laboratory at Fairfield Hospital.Main outcome measuresDiagnoses of HIV‐1 Infection, as confirmed at the State HIV Reference Laboratory by western blot Immunoassay, and notifications of AIDS to Health Department Victoria.ResultsOver six years the annual number of diagnoses of HIV‐1 infection in Victoria remained constant despite a substantial increase in the number of tests performed. To the end of 1991, 2679 people had been diagnosed with HIV‐1 infection, 686 of whom had developed AIDS. Information on exposure was available for 2379 (88.8%). Homosexual and bisexual men made up 75.5% (85.0% of those for whom exposure had been ascertained); 3.4% were female or heterosexual male injecting drug users; and 3.7% were heterosexuals with no history of injecting drug use. The latter two groups contributed 2.0% in 1985 to the proportion of all new diagnoses for which exposure was known, and 14.3% in 1991; for recipients of contaminated blood or blood products before 1985 this proportion fell from 12.4% to 1.0%. The cumulative incidence of HIV‐1 diagnoses was highest in the age group 25–29 years, and 20% of all HIV‐1 infected people were under 25 at the time of diagnosis. In 1991, 81 of the 311 people who had been diagnosed with HIV‐1 infection had had previous negative or indeterminate results of tests; half of these had acquired infection in the previous year.ConclusionMost HIV‐1 infections in Victoria have been acquired through male homosexual contact, with a small but increasing proportion of diagnoses occurring in heterosexuals. Laboratory‐based surveillance of voluntary testing, despite its limitations, has provided valuable information on the extent of the HIV‐1 epidemic in Victoria. Surveillance of all HIV‐1 test results and of seroconverters now supplements routine surveillance of HIV diagnoses and will ensure a more accurate picture of the epidemic in coming years.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121641.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine the prevalence of risk factors for human immunodeficiency virus (HIV) infection, and HIV‐1 seroprevalence, in surgical patients.DesignProspective study in which consenting patients completed a questionnaire on factors potentially related to a higher risk of HIV infection, and underwent an HIV‐1 antibody test.Patients and settingBoth elective and emergency surgical admissions between July and November 1990 at St Vincent's Hospital, Sydney.ResultsOf 1292 patients who were approached to participate, 27 had been previously diagnosed with HIV‐1 infection and, of the remaining 1265, eight (0.63%) refused to answer the questionnaire and undergo a blood test, and 12 (0.95%) refused the blood test only. HIV‐1 antibody testing was completed for 1171 study subjects. Twenty‐six of the 807 men who answered the questionnaire had been previously diagnosed with HIV‐1 infection. Of the remaining 781 male patients, 133 (17%) reported a history of homosexual contact, injecting drug use or blood transfusion, 132 (17%) had had a prior HIV‐1 antibody test and three were newly diagnosed with HIV‐1 infection as a result of the survey. Of 476 women who completed the questionnaire, one had been previously diagnosed with HIV‐1 infection, and of the remaining 475, 59 (12.4%) reported injecting drug use or a blood transfusion and 72 (15%) had had a prior HIV‐1 antibody test. No women were newly diagnosed with HIV‐1 infection. Of patients reporting specific factors, the proportion who had had a prior HIV‐1 antibody test varied from 62% for men reporting homosexual contact to 34% for recipients of a blood transfusion between 1980 and 1985.ConclusionAlthough an appreciable proportion of surgical patients admitted to St Vincent's Hospital reported factors associated with a higher risk of HIV infection, the prevalence of undiagnosed HIV‐1 infection is very low, particularly among patients reporting no such factors.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121642.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo compare between eras the early care of extremely low birthweight (birth‐weight<1000 g) infants born in non‐level‐III centres, that is, centres without a neonatal intensive care nursery, in Victoria, to identify changes associated with the improved quality of survival over time.Design and settingThe early care and outcome for infants of birthweight 500 to 999 g born in a non‐level‐III centre in Victoria were compared between two distinct eras, 1979–1980 and 1985–1987.Patients and outcomesMortality data to two years of age were available for all infants liveborn in non‐level‐III centres in the two eras (1979–1980, n = 106; 1985–1987, n = 129). In 1979–1980, 47 of 52 infants transferred to a level‐III centre were transported by the Newborn Emergency Transport Service (NETS); in 1985–1987, all 49 infants transferred were transported by NETS. Data concerning the immediate care after birth and during transport to a level‐III centre were available for all infants transferred by NETS. All survivors were assessed for sensorineural impairments and disabilities at two years of age, corrected for prematurity.ResultsIn both eras, 18 children born outside and transferred to a level‐III centre survived to two years of age. Survivors in both eras had almost identical mean birth‐weights and gestational ages. There were trends for more survivors to be referred by paediatricians — 1979–1980, 61%; 1985–1987, 83%; odds ratio (OR), 2.94; 95% confidence interval (CI), 0.7–12.4 — and for quicker referral times to NETS in 1985–1987 (1979–1980, median 34.5 minutes after birth; 1985–1987, median 21.5 minutes after birth; z = 1.91,P=0.056). It was possible only during 1985–1987 to monitor transcutaneous Po2during transport. Durations of transport were similar in both eras. However, only in 1985–1987 was it possible in survivors to reduce significantly the inspired oxygen concentration during transport (median reductions in inspired oxygen, 1979–1980 3.5%; 1985–1987 20%;P=0.028). Neurological impairment rates were substantially lower in survivors transported in the latter era (1979–1980 72% impaired; 1985–1987 22% impaired; OR 0.14, 95% CI 0.04–0.52). Of the neurological impairments, fewer had severe developmental delay alone (1979–1980 22%; 1985–1987 0%; OR 0.09, 95% CI 0.018–0.46), and the rate of blindness was lower, but the latter difference was not quite statistically significant (1979–1980 28%; 1985–1987 6%; OR 0.21, 95% CI 0.037–1.19). Over all, neurological disabilities were significantly reduced in the latter era (z = 2.93,P<0.005).ConclusionsMore active management of extremely low birthweight infants before transfer to a level‐III centre, including prompt referral and transcutaneous Po2monitoring during transport, may be important in improving the sensorineural outcome of survivors.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121643.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine the outcome in patients with acute overdose requiring admission to the Intensive Care Unit (ICU).DesignProspective survey of all overdose admissions to an ICU over a six‐year period ending January 1991.SettingTertiary referral adult teaching hospital.Patients732 consecutive patients with acute overdose.Outcomemeasures:Death rate, use and duration of mechanical ventilation, type of compound taken and compounds associated with a fatal outcome.ResultsThe 732 patients represented 13.8% of all admissions and 6% of the available ICU bed‐days. Comparison with all admissions to the Emergency Department for acute overdose over a 27‐month period ending April 1990 indicated that 22% of these patients were admitted to the ICU. Among the patients admitted to the ICU, tricyclic antidepressants, benzodiazepines and alcohol were the most frequently used compounds. More than one compound had been taken by 46.8% of the patients. Mechanical ventilation was required in 79.5% of the patients and 14 (2%) died.ConclusionsAcute overdose is a common cause of admission to the ICU but has a mortality rate of only 2%. In contrast to the overdoses taken by survivors, patients taking fatal overdoses are more likely to have taken a large dose of a single drug, or a non‐medicinal compound.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121644.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

The diagnosis of HIV infection is missed too often, with significant costs to patients and the community.Could it be HIV?gives practical advice about the detection of unsuspected HIV infection following clinical presentation. Each section is written for doctors by colleagues with extensive experience in HIV medicine; many illustrative case histories are drawn from their personal records. The chronology of HIV‐induced disease is a useful framework for interpreting the many possible clinical clues to HIV infection which, together with lifestyle clues, contribute to decision‐making about the rational use of HIV testing.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121645.x

出版商:Wiley    

年代:1993

数据来源: WILEY