ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121687.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121688.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121689.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo determine trends in prevalence of neural tube defects in Australia over the past decade; to investigate the impact of terminations of pregnancy on the birth prevalence of neural tube defects; and to provide a baseline against which to evaluate the potential effects of preventive public health measures.Data sourcesTwo population‐based registries in Victoria and Western Australia and a statewide survey from Tasmania.Design and methodA cohort study. Data on the numbers and the prevalence proportions of neural tube defects from three States — Western Australia, Victoria and Tasmania — were compared by Poisson regression.ResultsThe prevalence proportions for all neural tube defects for all three States remained level over the study period 1980–1989. Terminations of pregnancy for all neural tube defects increased significantly over the decade in all three States. By 1989, 39.9% of all neural tube defects were ascertained as terminations before 20 weeks’ gestation, while 10 years previously only 2.9% were. The percentage of cases of anencephaly ascertained as terminations of pregnancy increased from 4.8% in 1980 to 58.6% in 1989. Corresponding figures for spina bifida were 1.4% (1980) and 26.9% (1989), and for encephalocele 0% (1980) and 12.5% (1989). This increase in terminations was associated with a decrease per year in the birth prevalence proportion for anencephaly of 7.0%, for spina bifida of 4%, and for encephalocele of 11.0%, and a reduction in the risk of a birth with a neural tube defect in 1989 of 47% compared with the risk in 1980.ConclusionComplete ascertainment of all terminations for neural tube defects as well as births with neural tube defects is necessary to provide reliable baseline data on the prevalence of neural tube defects. Such data are essential in evaluating primary preventive measures such as the effect of an increase in folic acid intake by women of child‐bearing age.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121690.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo describe the epidemiology of HIV infection based on notifications of HIV infection in Aboriginal and Torres Strait Islander people in Queensland and to review their implications for Aboriginal and Torres Strait Islander communities.DesignDescriptive study of data obtained through HIV notifications to the AIDS Medical Unit, Specialised Health Services, Queensland Health from 1 July 1985 to 31 August 1991.SubjectsAboriginal and Torres Strait Islander people of Queensland.Main outcome measuresCenters for Disease Control (CDC) classification of HIV infection, as at 31 August 1991.ResultsTwenty‐nine individuals identified as Aboriginal or Torres Strait Islander were notified as positive for HIV antibodies in the period 1 July 1985 to 31 August 1991. Of those diagnosed, three were female and 26 male. At 31 August 1991, only 10 were asymptomatic (CDC Group II, III), eight were symptomatic (AIDS‐related complex) and 11 were diagnosed as having AIDS. Seven of those with a diagnosis of AIDS had died by the end of the study period. By comparison, 1158 non‐Aboriginal or Torres Strait Islander people were notified for the same time period. Of these, 48 were female, 1105 were male and five were transsexual. In the non‐Aboriginal and Torres Strait Islander group, 633 were asymptomatic and 297 were diagnosed with AIDS. By the end of the study period, 228 had died.ConclusionsThe data show an estimated prevalence of diagnosed HIV infection in Aboriginal and Torres Strait Islander people in Queensland comparable with the rest of the population. Cases are distributed throughout the State, though some clustering is evident. There has been a stable pattern of notifications over the past five years. The proportion of asymptomatic (CDC groups II, III) HIV‐positive Aboriginal and Torres Strait Islander clients was significantly lower than for the non‐Aboriginal and Torres Strait Islander group. These data have implications in terms of projections of total cases, diagnosed and undiagnosed, and relative access to the advantages attending early diagnosis.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121691.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine the prevalence ofGiardia duodenalisand other intestinal parasites in children, dogs and cats from Aboriginal communities in the west Kimberley region of Western Australia.Design: A four‐year parasitological survey of faecal specimens from humans and faecal and intestinal specimens from dogs and cats.Setting: Local hospital servicing Aboriginal communities surveyed in this study and the Veterinary School, Murdoch University.Population: Children (under 14 years) and adults, as well as dogs and cats, from five Aboriginal communities.Results: G. duodenaliswas the most prevalent parasite in children and adults (32.1% in children,n= 361; 12.5% in adults,n= 24). Human infections withHymenolepis nana(20.5%) andEntamoeba coli(13.0%) were also common.Ancylostoma duodenale(1.3%),Pentatrichomonas hominis(1.0%),Chilomastix mesnili(0.52%),Entamoeba hartmanni(0.52%),Sarcocystissp. (0.52%),Trichuris trichiura(0.26%),Enterobius vermicularis(0.26%),Strongyloides stercoralis(0.26%) andIsospora belli(0.26%) were present at low rates. Dogs were most commonly infected withAncylostoma caninum(51.1%) andG. duodenalis(17.0%). Cats were found to have a high prevalence ofAncylostoma tubaeforme(18.2%),Toxoplasma gondii(18.2%),Isospora felis(15.1%) andSpirometra erinacei(15.1%).Conclusions: This study has shown that children from Aboriginal communities in the west Kimberley region of Western Australia, particularly in the age group one to five years, are commonly infected with intestinal parasites. The dogs and cats in these communities are also infected. The high prevalence rates ofGiardiaand other enteric parasites in this survey are indicative of poor living conditions and low levels of hygiene. In addition, the high prevalence of hookworm andGiardiainfection in dogs and hookworm andToxoplasmainfection in cats is of potential zoonotic significance for humans in these communities.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121692.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo report the prevalence and distribution of infections with the parasitic nematodeStrongyloides stercoralisin the Aboriginal and Torres Strait Islander communities of Queensland.Design: A 20‐year retrospective survey of computerised data and selected files from the former Aboriginal Health Programme (AHP) of the State Health Department of Queensland, based on cases diagnosed by the microscopic examination of preserved faecal specimens. Findings were compared with figures published in annual reports.Study population: Children under 15 years of age from 122 Aboriginal and Torres Strait Islander communities.Results: Numbers of specimens examined varied widely according to time and place, as did detected infection rates. In 32 145 faecal samples examined by AHP microscopists during 1972–1991 the overall infection prevalence was 1.97%.Strongyloideslarvae were found in only 52 of 122 communities. The parasite was absent from many small, southern inland communities, and the prevalence of infection increased in northern regions with summer wet seasons. On average, it was highest in Doomadgee (12%), where a peak prevalence of 27.5% (92/334 children examined) was detected in a wet season survey. Some infections resolved spontaneously, while others persisted for more than four years. At Gununa (Mornington Island), the prevalence fell from 26.2% to below 7% after thiabendazole treatment of most infected children, and remained at this level for at least four years. Single stool examinations by experienced microscopists may have failed to diagnose at least 26% of Infected cases. The records give no indication of the clinical impact of strongyloidiasis.Conclusions: Strongyloidiasis is well established in many Aboriginal communities of north‐eastern Australia. Children appear to be the major reservoirs of infection; the prevalence in adults is probably much lower. Failing improvements in community sanitation and hygiene, it may be possible to reduce significantly, if not eradicate, the infection by selectively treating diagnosed children with thiabendazole.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121693.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Donna B Mak and Judith A Y StratonObjective: To describe the operation of the Fitzroy Valley Pap Smear Register, a population‐based call and recall system for cervical screening for Aboriginal women, and the prevalence of cervical abnormalities in the women screened.Design: Descriptive study.Setting: An Aboriginal community in the far north‐west of Western Australia.Participants: Aboriginal women aged 15 to 69 years, living in the Fitzroy Valley, Kimberley region.Main outcome measures: Proportion of eligible women on the Register; age distribution of women screened; prevalence of squamous cell abnormalities.Results: In December 1990, there were 507 Aboriginal women on the Register, being 86.9% of the Aboriginal women in the Fitzroy Valley aged 15–69 years. During 1990, 53.6% of the target population were screened; 369 Pap smears were taken from 312 Aboriginal women. Seventy‐six (24.3%) had never previously been screened. Considering only the first smear for each woman in the study period, 10.6% showed minor abnormalities, and 1.6% (95% confidence interval [CI], 0.2%–3.0%) had cervical intraepithelial neoplasia (CIN I, II or III); 2.6% had smears showing definite evidence of human papillomavirus (HPV) infection. For 15–19 year olds the prevalence of CIN was 4.7% (95% CI, 1.0%–13.3%).Conclusions: The study shows how an inexpensive call and recall system can ensure good coverage of cervical screening in a group of women who would otherwise be under‐screened. The overall prevalence of CIN in Aboriginal women in the Fitzroy Valley was lower than the figure for all Victorian women (3.6% — data from the Victorian Cytology Service). Although the numbers are small, the relatively high prevalence of CIN in young women is of some concern, and emphasises the importance of regular screening in this group.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121694.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo assess the effect of dexfenfluramine on weight loss, diabetic control and blood lipids in type II diabetics over a three‐month period.Design, setting and patients: Forty overweight patients in the Diabetic Clinic, Fremantle Hospital, were studied in a double‐blind, placebo‐controlled trial with a run‐in period of one month followed by three months on either dexfenfluramine or placebo.Main outcome measures: Changes in body weight, and fasting plasma glucose, glycosylated haemoglobin, plasma cholesterol and triglyceride levels.Main results: The median change in weight was ‐3.8 kg in the treatment group (Df) and +0.3 kg in the placebo group (PI) (P= 0.006). The median changes in fasting plasma glucose levels were ‐1.0 mmol/L (Df) and +0.6 mmol/L (PI)P=0.010). The median changes in glycosylated haemoglobin levels were ‐1.4% (Df) and +0.2% (PI) (P= 0.002). The median changes in triglyceride levels were ‐0.3 mmol/L (Df) and +0.2 mmol/L (PI) (P= 0.017). Cholesterol level did not change significantly.Conclusion: Dexfenfluramine is effective in achieving weight loss and also improved diabetic control in obese type II diabetics over a three‐month period.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121695.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo assess some of the employment experiences of people with diabetes mellitus and to compare their experiences with those of a non‐diabetic sibling control group.Design: A questionnaire about employment experiences was administered to diabetic subjects aged 16–39 years, and an abbreviated questionnaire was administered to their eligible siblings.Setting: The Illawarra area of New South Wales.Participants: The names of diabetic subjects were obtained from the Illawarra diabetes register.Results: Interviews were conducted with 184 of 226 (81.4%) eligible diabetic subjects and with 70 eligible siblings. There were no significant differences between the diabetic subjects and their siblings with respect to educational achievements and rates of employment. Siblings reported a mean of 2.6 days sickness absenteeism in the year prior to the survey. Diabetics were absent from work for a mean of 4.5 days for reasons not related to their diabetes and for a mean of 2.6 days for diabetic causes. Within the diabetic group, 50% felt that having diabetes would make it more difficult to find another job, 33.7% felt that diabetes would influence their search for alternative employment and 19.6% felt that at some stage they had been refused employment because of their diabetes. Fifteen per cent of diabetics were aware of an example of discrimination and 24.2% of diabetics in employment had at some stage tried to hide their diagnosis from their employer.Conclusions: Diabetics do not appear disadvantaged compared with their siblings with respect to employment participation but are more likely to be absent from work due to sickness. However, many diabetic subjects had experienced a job refusal, had tried to hide their diagnosis from employers, were aware of examples of discrimination and were very negative about future employment prospects.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121696.x

出版商:Wiley    

年代:1993

数据来源: WILEY