ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137815.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137816.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137817.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137818.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo present and analyse the results of eight years of experience (1983‐1990) in breast tumour receptor analysis.DesignAll female primary breast tumour samples received (4683) were analysed for seasonal variation, patient age, relative risk index, oestrogen receptor (ER) and progesterone receptor (PR) status, ER and PR status as a function of age, ER and PR levels as a function of age, and ER and PR levels as a function of month of analysis.SettingThe assays were done at the Medical Research Centre, Prince Henry's Hospital, Melbourne, as a non‐profit service to surgeons, oncologists and pathologists.Results and conclusionsThe numbers of samples referred for assay increased progressively each year, from 473 in 1983 to 1097 in 1990, but the receptor status (ER±, PR±) appeared not to vary from year to year. ER+PR+ tumours were the most common in all age groups, steadily increasing from between 50% and 60% in premenopausal women to 70% or more in those aged over 80. In postmenopausal women, levels of ER in ER+ tumours were three times those in premenopausal women; PR levels in PR+ tumours, however, were bimodal, with higher levels in the age groups 35‐49 and 70‐89 years than in women aged 50‐69 years. No significant seasonal variation was seen, and the overall patterns of receptor status are similar to those seen in Northern hemisphere studies.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137819.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137820.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo describe Australian‐born women's experience of symptoms during the natural menopause transition and the relative contribution of menopausal and health status, social factors and lifestyle behaviours.DesignA community based cross‐sectional survey by telephone interview was carried out on a randomly derived sample of Melbourne women.ParticipantsThe participants were 2000 Australian‐born women, aged between 45 and 55 years.Outcome measuresA list of 22 symptoms was used. Explanatory variables were: sociodemographic variables; menopausal and health status; lifestyle behaviours; attitudes to ageing and to menopause.ResultsA 70% response rate was achieved for eligible women who could be contacted during the study. Premenopausal women were the least symptomatic and perimenopausal women the most symptomatic. Factor analysis found seven common factors from the 22 symptoms studied. Menopausal status based on menstrual history was significantly related to two groups of symptoms: vasomotor symptoms, which increased through the menopausal transition; and general somatic symptoms which were more frequent in the perimenopause. Analysis of variance of factor scores found fewer symptoms with increasing years of education, better self‐rated health, the use of fewer non‐prescription medications, the absence of chronic health conditions, a low level of interpersonal stress, the absence of premenstrual complaints, not currently smoking, exercise at least once a week, and positive attitudes to ageing and menopause.ConclusionsMany factors unrelated to hormonal changes contributed to the symptoms. Longitudinal investigation is needed to determine the relative importance of hormonal, psychosocial and lifestyle variables in the aetiology of mid‐life symptoms.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137821.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo describe the epidemiology of infection with hepatitis C virus (HCV) among injecting drug users (IDUs) in Victoria.Design and subjectsSubjects were current IDUs from a wide spectrum of age, sex and social background, enrolled in a prospective study of injecting drug use. They were contacted by peer workers through their social networks and through community agencies and prisons, and were regularly followed for interview and blood collection in the field. Sera were tested for presence of antibody to HCV (anti‐HCV), for the presence of HCV RNA directly in serum, and for measures of liver function. The results were correlated with demographic variables.SettingRural and metropolitan Victoria.Main outcome measuresPresence of anti‐HCV and demonstration of HCV RNA.ResultsTwo‐thirds (68%, 206/303) of the current cohort of IDUs were seropositive for HCV, risk being particularly associated with duration of injecting, and independently for men with opiate use and prison history, and for women with a history of methadone therapy. HCV RNA was detected in 48% (76/160) by polymerase chain reaction (PCR); 61% (74/122) of these subjects were HCV seropositive and 5% (2/38) seronegative. Of 32 HCV seronegative subjects followed for a mean period of 291 days, five seroconverted to HCV, an incidence of 20 infections per 100 person‐years. Those who seroconverted were older, more likely to be male, had been injecting longer, more often reported opiate use, and were more likely to be based in the country. Serum liver enzyme levels were higher and more likely to be abnormal in HCV seropositive than seronegative subjects, and were highest in those seropositive subjects in whom HCV RNA was detected.ConclusionsThis population of IDUs has a very high rate of exposure to HCV, related to duration of injecting and independently to opiate use and prison history, perhaps reflecting increased risk in particular social networks. There is evidence of high rates of carriage of HCV, of continuing transmission of HCV, and of ongoing liver disease among these IDUs. If these IDUs are at all representative of all IDUs in Australia, we estimate that 80 000 current and former IDUs may be at risk of chronic liver disease from HCV, and that 8000‐10 000 new infections may be occurring each year. Two subjects who were seronegative had HCV RNA detectable in sera. These data have important implications for screening programs and document the need for further measures to prevent spread of blood‐borne viruses including HIV among IDUs.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137822.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo examine the use of upper gastrointestinal endoscopy in people 65 years of age and over in New South Wales, and compare its use between geographic areas, sex and age groups. Also, to investigate the relationship between endoscopy use and peptic ulcer mortality.DesignA retrospective review of upper gastrointestinal tract (GIT) endoscopy hospital separation data for NSW from 1986 to 1989‐1990 and peptic ulcer mortality data from 1979 to 1989.Main outcome measuresRates per 1000 population aged 65 years and over were calculated for upper GIT endoscopy for each of the four‐year age groups and by sex. Peptic ulcer and other digestive system disease rates for endoscopy patients were determined. Correlations between hospital standardised separation rates for endoscopy and standardised mortality rates for gastric cancer and peptic ulcers were calculated. Age and sex standardised death rates were calculated for each year between 1979 and 1989, and changes in death rates over time were determined by regression analysis.ResultsThe rate of endoscopies increased significantly (P<0.001) over the period 1986 to 1989‐1990, with the highest rate and greatest increase occurring in patients aged 70 years and over. Men had significantly higher endoscopy rates than women (P<0.001). Geographic variations in the use of endoscopy were found and were not explained by geographic differences in the proportion of peptic ulcers diagnosed, deaths from peptic ulcers or malignant neoplasms. Despite the increase in endoscopies performed, there was no corresponding significant increase in the rate of peptic ulcers detected. Between 1979 and 1989 peptic ulcer mortality rates for women over 74 years of age increased significantly (P<0.05); the rate for men did not change.ConclusionMany endoscopies are performed in people aged 65 years and over in NSW and there has been a substantial increase in endoscopy rates in recent years. While the increase in upper GIT endoscopy may have resulted in a number of health benefits, it does not appear to have resulted In a reduction in peptic ulcer related mortality.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137823.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo set up and evaluate a pilot scheme integrating salaried community health centre staff and fee‐for‐service medical practitioner services (CHAMPS).DesignPreliminary interviews with both groups established the aims, logistics and financial arrangements of the project. The community health centre provided staff and the general practitioners provided premises and administrative services. Follow‐up interviews evaluated the scheme and made recommendations.SettingA New South Wales country town, population 24 000, with 25 general practitioners and 23 community health centre professionals.ResultsSix general practitioners and 23 community health professionals determined the aims to be: improved access for patients to community health services; improved liaison between the two groups of providers; and a broadening of services offered at general practice locations. Two dietitians and three mental health workers were rostered for half a day per week in four general practices for six months. The dietitians continued after the project finished, but the mental health workers did not. The five community health staff, five of the general practitioners originally interviewed and six other general practitioner participants cited the major benefits as increased communication between providers and improved access for patients, and the major difficulties as lack of appropriate equipment and organisational logistics.ConclusionsThe providers believe that the project succeeded in improving access to community health services and liaison between professionals. For future projects they recommended better communication, firmer role delineation and better planning for space and equipment.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137824.x

出版商:Wiley    

年代:1993

数据来源: WILEY