ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127631.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Are governmental regulations disadvantaging patients?

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127591.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Antenatal drug therapy shows promise in preventing genital and psychosexual ambiguity

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127592.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The trans fatty acid debate has lost sight of the real problem – saturated fats

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127593.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectivesTo examine recent changes in the cardiovascular risk factor profile of Australian adults and to compare these with trends in mortality.DesignQuestionnaire and examination data collected from multicentre cross‐sectional surveys conducted in 1980, 1983 and 1989.Subjects19315 randomly selected respondents aged 25‐64 years living in the six State capital cities.ResultsDuring the 1980s, average blood pressure levels declined in all age groups and for both men and women. The prevalence of hypertension decreased and it appeared to be more effectively managed. Total cholesterol levels decreased significantly in younger men and older women but lipid results showed no overall favourable trend. Weight for height increased in all ages, strongly suggesting increased body fatness. In women, the odds of being overweight or obese increased by 58%, and in men by 23%. The prevalence of smoking declined significantly in men and women. Cessation of smoking and decreased uptake both contributed to the decline in men, while smoking cessation was more important in women. Consumption of alcohol declined significantly in both sexes. Adding salt to food became less common, as did eating the fat on meat. Walking for recreation or exercise and other forms of less vigorous exercise became more popular, while the prevalence of aerobic exercise and vigorous exercise remained unchanged.ConclusionsReductions in cigarette smoking and blood pressure are likely to have contributed to the falls that have been noted in cardiovascular mortality rate. Changes in dietary behaviour were consistent with health education messages. The trend towards greater body fatness may retard the benefits of favourable trends in other cardiovascular risk factors, morbidity and mortality and requires greater attention.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127594.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo compare two interventions for reducing dietary fat intake in first degree relatives of recent heart attack victims.DesignA randomised controlled trial comparing a low cost mail‐out advice program; referral to a general practitioner (GP); and no intervention (control group).ParticipantsAdult children or siblings, aged less than 70 years, of survivors of definite or suspected heart attack who had been admitted to hospitals in the Lower Hunter Region of New South Wales.Main outcome measuresDietary fat intake (evaluated with a validated short questionnaire) and measurement of blood cholesterol levels at six months.ResultsOf the 342 relatives who participated (36% of those invited), 109, 120 and 113, respectively, were randomly assigned to receive a mail‐out intervention, advice from their GP or to be part of a control group. The six‐month follow‐up questionnaire was completed by only 59% of those in the mail‐out intervention group compared with 71% of the GP group and 77% of the control group. Younger participants, cigarette smokers and children (compared with siblings) were less likely to return a follow‐up questionnaire. The mail‐out group showed a statistically significant 20% reduction in self‐reported dietary fat intake, but this was not seen in either the GP group or the controls. The low response rate meant the study had insufficient power to detect hypothesised changes in blood cholesterol.ConclusionBecause of the poor response rate and possible biases from a differential response to follow‐up, we conclude that this low intensity intervention for relatives of people with recent heart attack produces only a modest improvement in reported dietary fat intake. Alternative strategies may be more effective in reducing the risk of heart disease.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127595.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo assess and compare quality of life of patients six months after an acute myocardial infarction treated with one of two thrombolytic agents, streptokinase (SK) or recombinant tissue plasminogen activator (tPA).DesignA cohort study of consecutive patients randomly allocated to thrombolytic therapy and treated in hospitals participating in the Australian arm of the International tPA/SK Mortality Trial (AUS‐TASK).Patients and setting776 patients with acute myocardial infarction were asked to complete questionnaires at their follow‐up clinic visit six months after the infarct.Main outcome measuresTwo measures were used: (i) the York Health Measurement Questionnaire, which measures activities and distress and provides basic descriptors of quality of life; and (ii) a time trade‐off question about the number of years a person would be willing to give up in exchange for returning to full health.ResultsThe quality of life of the 714 respondents (92%) was generally high, with a mean index of 0.98. The five main areas causing distress were: lack of energy; breathlessness; anxiety; difficulty sleeping; and pain. In the time trade‐off question, the mean number of years res‐pondents were willing to forgo, out of 15 years, was 0.87 years; while 76% did not think it worthwhile to forgo any time. The 8% of patients who declined to answer the questionnaire were in significantly poorer health (New York Heart Association classification, P=0.01; and Karnofsky index,P<0.001). There were no significant differences in quality of life or time trade‐off answers between patients allocated to streptokinase or tPA (P=0.96 and 0.73, respectively).ConclusionsQuality of life six months after myocardial infarction is generally high, and most patients are able to return to normal activities. However, it is significantly impaired in a small group of patients, mainly those with a subsequent stroke or re‐infarction. There was no significant difference in quality of life between those treated with tPA and those with streptokinase.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127596.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo assess coronary risk factors and management 6‐12 months after coronary artery bypass grafting.DesignPatient survey by questionnaire after discharge from hospital in 1994 and comparison with similar surveys from 1990 and 1986.Setting and patientsOne hundred and ninety‐four patients undergoing coronary artery bypass grafting at one hospital campus between 1 March 1993 and 31 August 1993. Replies to questionnaires were received from 175 patients (90%); we had clinical and biochemical data for 166‐175 patients (86%‐90%).ResultsThe proportion with hypercholesterolaemia (serum cholesterol levels>6.5mmol/L) declined from 60% in 1986 to 9% in 1994. Those with diastolic hypertension (>95 mmHg) declined from 23% to 3%. The proportion of current smokers remained low at 6%. The proportion overweight had increased from 32% in 1986 to 47% in 1994. The proportion taking lipid‐regulating drugs increased from 2% in 1986 to 37% in 1994.ConclusionCoronary risk factors after coronary artery bypass grafting appear to be better managed in 1994 than in earlier years, but there may still be a need for improvement in lipid disorders and weight.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127597.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo evaluate attitudes and knowledge about infectious disease notification and the self‐reported notifying practices of general practitioners in New South Wales before and after the introduction of thePublic Health Act 1991(NSW).DesignA survey of a random sample of general practitioners in NSW before and after the introduction of the Act.ResultsThe percentage of doctors who considered notification to be very important increased (57% “before” v. 67% “after”;P=0.02), as did the percentage who believed that notification usually leads to preventive action (41% v. 54%; P = 0.04). There was no increase in self‐reported notification (50% v. 54% who reported notifying cases of notifiable diseases “always, or almost always”; P = 0.42).ConclusionsNotification of infectious disease by doctors remains suboptimal, but may improve over time as the impact of the new Act is felt. Feedback to doctors showing that preventive action is taken as a result of their notifications may be the most effective way to improve notification practices.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127598.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo review the outcome of endoluminal repair of abdominal aortic aneurysm.PatientsTwelve patients with abdominal aortic aneurysms (mean diameter, 5 cm; range, 4.4‐7.8 cm) were selected according to strict criteria relating to the morphology of the aneurysm and iliac arteries. The aneurysms all had a proximal neck between the renal arteries and the aneurysm and a distal neck between the aneurysm and the bifurcation of the aorta. The iliac arteries were not tortuous and were 8 mm or greater in diameter.InterventionThe aneurysm was repaired with a graft stent device introduced into the aorta via a sheath in the femoral artery.ResultsSuccessful endoluminal repair was achieved in 10 of 12 patients (83%). The two patients in whom the endoluminal repair was abandoned were treated by standard open repair. All patients have since had an aortogram and duplex ultrasound examination to confirm exclusion of the aneurysm from the general circulation (mean period of follow‐up, seven months). There have been no deaths.ConclusionAbdominal aortic aneurysms conforming to strict morphological criteria can be treated safely and successfully by this minimally invasive endoluminal method.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127599.x

出版商:Wiley    

年代:1994

数据来源: WILEY