ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138469.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138470.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138471.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138472.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo investigate whether exposure to Murray River and allied water sources during a period of raised cyanobacterial cell counts was associated with gastrointestinal and dermatological symptoms.DesignA case‐control study selecting gastrointestinal and der‐matological cases and controls from subjects attending 21 general practitioners in eight Murray River towns. The association between the proportion of consultations for such symptoms and mean log cyanobacterial count was also examined.Subjects102 gastrointestinal cases, 86 dermatological cases and 132 controls.Main outcome measureThe relative odds of gastrointestinal and dermatological symptoms, respectively, as opposed to no such symptoms, according to water‐contact history during the week preceding the medical consultation.ResultsAfter adjusting for con‐current risk factors, subjects drinking chlorinated river water rather than rain water had a raised risk of gastrointestinal symptoms(P=0.008), and those using untreated river water for domestic purposes rather than rain water had a raised risk of gastrointestinal (P= 0.034) and of dermatological (P= 0.048) symptoms. The proportion of consultations for gastrointestinal and dermatological symptoms correlated on a weekly basis with the mean log cyanobacterial cell count, although statistical significance was not achieved for the correlation with dermatological consultations or for separate reaches of the river.ConclusionsThe raised risks of gastrointestinal and dermatological symptoms in those using Murray River water for drinking and other domestic purposes are consistent with causal relationships. However, the evidence for adverse health effects is, at best, only suggestive. Further research is indicated.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138473.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo assess the progress of 59 sexually abused children in the criminal justice system to see whether they testified, whether there were any effects on their self‐esteem or behaviour, whether it resulted in depression and what their parents' perceptions of the process were.DesignA prospective study of sexually abused children, with data from interviews with the parents and psychological testing of the children.ResultsThirty‐three cases were committed for trial or sentencing, resulting in 20 convictions. Twenty‐two children testified at the committal hearing and eight at trials. Although 55% of parents expressed dissatisfaction with the legal system, thinking it was stressful to their chil‐dren, a comparison of children who did not testify with those who did showed no significant differences on indices of depression, self‐esteem or behaviour. As most children were involved in court‐preparation programs and most mothers were supportive of their children, these may have been ameliorating factors.ConclusionsEven though the initial stressful effects of children appearing in court appear to be transient, there should be increased use of screens, closed‐circuit television and preparation‐for‐court pro‐grams to make court appearances less intimidating.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138474.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo assess the routine use of diagnostic laparoscopy and laparoscopic appendicectomy in women with a clinical diagnosis of acute appendicitis.MethodsWomen who presented with a clinical diagnosis of acute appendicitis between 1 January 1992 and 31 August 1993 were prospectively assessed and 107 underwent diagnostic laparoscopy.ResultsAppendicitis was confirmed in 63 women (59%) and no diagnosis could be made in seven (6%). An alternative diagnosis, most commonly a gynaecological disorder, was made in 37 women (35%). Twenty‐eight women with an alternative diagnosis (76%) did not require a laparotomy. Seventy‐three patients had a laparoscopic appendicectomy, with an 8% conversion rate to an open operation. The morbidity rate for laparoscopic procedures was 3%, the median inpatient stay was two days and the median time to return to normal activities was eight days.ConclusionsDiagnostic laparoscopy should be performed in women who present with a clinical diagnosis of acute appendicitis to confirm the diagnosis, reduce the rate of unnecessary appendicectomy and avoid an unnecessary laparotomy. When acute appendicitis is confirmed, appendicectomy may be performed laparoscopically.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138475.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo study delay in diagnosis, seizure control, seizure‐pro‐voking factors, suitable medications and drug side effects in patients with juvenile myoclonic epilepsy.DesignTelephone and personal interview of patients and review of their clinical notes.Participants and settingThirty‐six patients attending an epilepsy clinic at a tertiary referral hospital.ResultsThere was a substantial delay in the diagnosis of juvenile myoclonic epilepsy because the symptom of early‐morning myoclonus was not specifically sought. Sodium valproate is the drug of choice, producing absolute seizure control in 63% of cases (19/30). Most patients with poor seizure control had provoked seizures only, emphasising the importance of lifestyle in management. Half of the patients taking sodium valproate experienced side effects, such as weight gain. Lamotrigine is the most suitable alternative.ConclusionsJuvenile myoclonic epilepsy is a common, under‐recognised form of epilepsy which is best treated with sodium valproate. If side effects occur, lamotrigine should be used.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138476.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo assess the knowledge, attitudes and practices of general practitioners in New South Wales regarding the provision of emergency contraception.DesignRandomised group comparison of 100 rural and 100 urban general practitioners (GPs) by ques‐tionnaire.ResultsEighty‐four rural and 76 urban GPs responded. More rural GPs were knowledgeable about emergency contraception than urban GPs (95% v. 78%), and more women knew about it than men. More urban GPs frequently prescribed emergency contraception than rural GPs (26% v. 6%) and female GPs prescribed it more readily than male GPs (22% v. 12%). There was great variation in the regimens prescribed, especially among rural GPs. Twenty‐five per cent of urban GPs and 31% of rural GPs did not offer women information about emergency contraception, while 16% of both groups included such information in any discussion about contraceptive options, and 18% gave information only if requested by the woman. More than 60% of the GPs would provide information about emergency contraception as a backup to use of barrier methods.ConclusionsThe sex, attitude and knowledge of the GPs influence the likelihood of women being made aware of or being given emergency contraception in NSW. There is a need to further educate both the public and practitioners about emergency contraception.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138477.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo describe current mental health care practices of gen‐eral practitioners and to identify their educational priorities and training preferences.MethodSelf‐administered ques‐tionnaire to a stratified random sample of New South Wales general practitioners.Subjects721 full‐time general practitioners, of whom 534 (74%) responded.ResultsMental health problems recognised by general practitioners at least once per week were psychosomatic (93%), emotional (89%), addiction (79%), social/economic (71%) and family (69%). At least two‐thirds recognised sexual problems, sexual abuse and major psychiatric problems less frequently than once per week. Sixty‐four per cent of general practitioners reported that patients felt uncomfortable about being referred to psychiatrists; 53% that referral service waiting lists were too long; 51% that there were insufficient local mental health services; and 25% that communication difficulties between referring general practitioners and mental health specialists obstructed optimal care. Educational priorities were diagnostic and counselling skills, with particular emphasis on crisis, family, individual and marital counselling and strategies to prevent general practitioner burn‐out.ConclusionsGeneral practitioners are interested in improving their mental health counselling and diag‐nostic skills but barriers remain. Both structural and educational initiatives are essential to enhance the quality of mental health care in general practice.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb138478.x

出版商:Wiley    

年代:1995

数据来源: WILEY