ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01460.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01461.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:In February 1993,11 cases of hepatitis A virus (HAV) were identified in permanent residents of a centre for young people with developmental disabilities.Aims:To define the extent of the outbreak in the centre, to determine the seroprevalence of hepatitis A antibodies (anti‐HAV) in permanent residents, and to ascertain risk factors for serological evidence of HAV infection.Methods:A cross‐sectional serological survey of 270 permanent residents, aged eight to 40 years, in a centre for people with developmental disabilities, was conducted in western Sydney. Using a radioimmunoassay technique, sera were tested for anti‐HAV (IgM and total antibody). We used logistic regression to determine risk factors for presence of anti‐HAV.Results:Blood samples were collected from 259 permanent residents (96%). Serological testing revealed anti‐HAV in 128 residents tested (49%). Presence of anti‐HAV was associated with living in specific residential units, and with residents' age and length of stay at the centre, but was not associated with reported behavioural factors.Conclusions:More than half of the residents of the centre were susceptible to HAV infection. Behavioural characteristics of the residents and their close contact with each other make HAV transmission difficult to control. HAV vaccine should be promoted in communities at risk, such as those with developmental disabilities. (Aust NZ J Med 1994; 2

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01462.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractAim: To determine the incidence of second malignant neoplasms in patients treated for Hodgkin's disease.Methods: The records were reviewed of all patients receiving primary treatment for Hodgkin's disease at the Oncology Service, Christchurch Hospital from 1969 to 1992. Second malignant neoplasms presenting at least six months after the diagnosis of Hodgkin's disease were noted and the cumulative risk estimated.Results: Twenty‐two second malignant neoplasms developed in 20 of the 209 patients. The risk was 5.6 ± 3.8% (CI) at five years, 11.4 ± 6.2% at ten years, and 21.7 ± 11.2% at 15 years and continued to increase thereafter. Thirteen patients have died of their second malignancy, including two of a third malignancy, while four have been followed for less than one year. Three leukaemias (CML, 1; acute non lymphocytic leukaemia, 2), three lymphomas and 16 solid tumours developed. The risk was greater after six or more cycles of MOPP‐like chemotherapy and after radiation doses exceeding 30 Gray. The risk was less after laparotomy and splenectomy (p =0.0205).Conclusions: In view of the significant risk of a second neoplasm in survivors of Hodgkin's disease follow up should continue beyond ten years, after which time second malignancies were more likely than recurrence. Efforts should continue to minimise the carcinogenicity of therapy while preserving efficacy. (Aust NZ J Med 1994; 24: 36

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01463.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:Bacterial infection is a major cause of morbidity and mortality in neutropenic patients.Aims:(1) To review patterns and trends in bacterial infections in three cohorts of febrile neutropenic patients managed by a single unit over a seven year period. (2) To relate any changes to the use of central venous (Hickman's) catheters and high‐dose cytosine arabinoside chemotherapy.Methods:Retrospective review of the results of initial bacteriological work‐up performed on 344 episodes of febrile neutropenia. The three cohorts were 1986–87 (n= 102), 1989–90 (n= 92) and 1991–92 (n= 150).Results: (1)The ratio of gram‐negative to gram‐positive bacteraemias fell from 1.36 in the first cohort to 1.05 in the second and 0.40 in the third (p= 0.03). There was a fall in both percentage and number of gram‐negative isolates coupled with a rise in the frequency of gram‐positive isolates. (2) Coincidentally there was a rise in the frequency of positive cultures from Hickman catheter entry wounds and an increasing frequency of simultaneous isolation of the same organism from the catheter entry site and the blood. The types of organisms isolated from catheter entry wounds showed a trend towards fewer gram‐negative and more gram‐positive. (3) A relationship was observed between the use of high‐dose cytosine arabinoside chemotherapy and the incidence of bacteraemia (p= 0.025) but not with the change in types of organisms.Conclusions:Over seven years we have documented a major change in the types of infections, particularly bacteraemias, seen in febrile neutropenic patients. In our institution the more widespread use of intravenous catheters and high‐dose cytosine arabinoside chemotherapy have been identified as two possible contributing factors. (Aust NZ

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01464.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:Aged Care Assessment Teams (ACATs) have been established throughout Australia during the past seven years. Early studies of their effect have concentrated on their impact on the rate of institutionalisation of disabled elderly, the clinical characteristics of referred cases and the relationship between disability and recommended care plan.Aims:The aim of this study was to explore the relationship between age, clinical features and social characteristics of AC AT subjects with outcomes at 12 months after assessment.Methods:The examination of an arbitrary sample of persons referred to ACATs over a year by one generalist geriatrician with follow‐up of all cases by the three ACATs associated with the study was carried out. All analyses were performed on raw data presented as categorical variables in the form of contingency tables.Results:The sample included 324 subjects who suffered from 2030 clinical problems with a mean of 6.5 per person aged 75 or over and 5.5 for those under 75. Cardiovascular and neurological disease were the commonest source of problems. Study of accommodation outcome at 12 months, for those subjects who survived this period revealed that, in the older group, over 60% of subjects with neurological disease were resident in nursing homes while the majority of all other groups remained in the community, as did two‐thirds of those aged under 75. Admission to a nursing home was independent of social support for older subjects with neurological disease, but it played a significant role in those with cardiopulmonary or musculoskeletal disease.Conclusions:The study demonstrates that for one‐year survivors there is an increased likelihood of admission to a nursing home of people aged 75 or over with neurological disease, while those under 75 were more likely to remain at home. The association was independent of whether spouse, family or friends were living with the subject. (Aust NZ J Med 1994; 24: 378

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01465.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Usual ‘Yes/No’ definitions of a family history of heart disease do not allow for ‘Don't know’ responses. In some families, misclassification of family history may result if these are not considered.Aims: To study the accuracy of family history reporting and the impact of ‘Don't know’ responses.Methods:We compared reported family history of coronary heart disease (CHD) and cancer among 360 deceased relatives of 59 probands with ‘gold standard’ diagnoses recorded on official death certificates.Results:For first degree relatives, sensitivity of reporting was 81% for CHD, 86% for any heart disease and 60% for cancer, while for second degree relatives, sensitivity was 73%, 69% and 90%, respectively. When ‘Don't know’ responses were classified as ‘No’, sensitivity in first degree relatives was not affected, but in second degree relatives, it fell to 49%, 41% and 60%, respectively. Specificities were unchanged. These data show that in families where information beyond first degree relatives is considered, failing to account for ‘Don't know’ responses is likely to lead to misclassification of family history of CHD. (Aust

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01466.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Diabetic nephropathy is now the commonest single cause of end‐stage renal failure (ESRF) in New Zealand.Aims: To investigate differences in the natural history of established nephropathy in Type 1 and 2 diabetes.Methods: Retrospective analysis of the rate of progression to ESRF in 17 subjects with Type 1 diabetes (predominantly European) compared to 29 subjects with Type 2 diabetes (all Polynesian). The rate of decline of renal function was determined from serial creatinine measurements (median 5, range 3–8) during progression of chronic renal failure to end stage. Glomerular filtration rate (GFR) was estimated from creatinine measurements using the Cockcroft Gault equation, and the regression slope of these measurements against time was used to determine rate of change of renal function.Results: GFR fell significantly more rapidly in the group with Type 2 diabetes than in those with Type 1 diabetes: median 1.7 (interquartile range 1.2 to 2.3) mL min‐1month‐1vs 1.1 (interquartile range 0.4 to 1.5) mL min‐1month‐1,p =0.017. During the study period the mean reduction in diastolic blood pressure in subjects with Type 1 diabetes (15 mmHg) was greater than that in the Type 2 subjects (8 mmHg), but the stage at which antihypertensives were commenced was similar in the two groups. Glycaemic control was worse in the subjects with Type 1 diabetes(p<0.005). The differences in blood pressure control were not significant on analysis of covariance which indicated that ethnicity was the major determinant of the different rates of decline of GFR between the groups. We conclude that in subjects with diabetic nephropathy the rate of progression to ESRF is more rapid in Polynesians with Type 2 diabetes than in Europeans with Type 1 diabetes. This could contribute to the apparent excess of Type 2 diabetic subjects of Polynesian origin on renal replacement programmes in New Zealand. (Aust NZ J Med 1994; 2

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01467.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:Patients with chronic obstructive airways disease and asthma are at special risk of developing osteoporosis. Previous research has indicated that adrenal androgen levels in postmenopausal women are suppressed by short term high dose inhaled corticosteroids. Such an effect, if sustained, may be a causative factor for long term bone loss. We tested the hypothesis that postmenopausal women receiving ≥1 mg/day inhaled beclomethasone dipropionate, long term, have suppressed dehydroepiandrosterone sulphate levels when compared to postmenopausal controls.Methods:As part of a larger study, we studied 36 postmenopausal subjects, recruited from regional pharmacies and a hospital chest clinic, who had been receiving treatment for asthma. Subjects were selected if they were receiving ≥1 mg/day inhaled beclomethasone dipropionate(n= 27) or receiving no beclomethasone dipropionate (n= 9). The two groups were compared for dehydroepiandrosterone sulphate levels, age and potential confounders.Results:Mean dehydroepiandrosterone sulphate levels were 35% lower in the high dose beclomethasone dipropionate group than the control group (p<0.01).Conclusions:This is the first report of suppression of dehydroepiandrosterone sulphate in postmenopausal women receiving long term inhaled beclomethasone dipropionate. Further research is needed to clarify whether or not there is any associated clinically important adverse effect on bone density. (Aust NZ J Med 1994; 24: 396

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01468.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01469.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY