ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01617.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01618.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01619.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01620.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Three cases of haemolytic‐uraemic syndrome in the Hunter area were reported in February 1995. An investigation was initiated to identify any verocytotoxicEscherichia coliin clinical samples that could be associated with the development of the disease.Escherichia coliO6:H‐ and O2:H7 were isolated from Case 1. No organisms were identified for Case 2, and Case 3 samples yieldedCampylobacter jejuni. In addition, efforts were made to trace sources of any such pathogens in food samples or in the environment generally. Shiga‐like toxins were found in meat products sampled from butchers' shops patronised by the families of the three cases. However, it was not found possible to match stool samples with samples of food from sources used by the families of the children. Environmental factors seemed likely to have played a significant role in the development of haemolytic‐uraemic syndrome in Case 3. It is suggested that the incidence of the disease may be reduced by increasing the frequency of testing of meat products for Shiga‐like toxins I and II and through educational and research

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01621.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:A retrospective, population‐based study of patients hospitalised with the haemolytic‐uraemic syndrome in Western Australia from 1980 to 1994 was undertaken to describe the epidemiology of the disease in this state. We identified 41 patients. Episodes were commonest in children under five years of age (63.4 per cent) and were more frequent in females (58.5 per cent) than in males; only one Aboriginal patient was detected. More than 90 per cent of episodes had a gastrointestinal prodrome lasting from one to 22 days; in 47.6 per cent of these episodes patients had bloody diarrhoea. The average hospital stay was 26 days, and 63.4 per cent of patients required dialysis (mean 10 days). More than 20 per cent of patients developed chronic renal failure, 9.7 per cent died, two patients developed hypertension and one child became epileptic; three of the 10 patients over 16 years of age (30 per cent) died. The haemolytic‐uraemic syndrome is potentially fatal, affects mostly young children, and is usually preceded by a gastrointestinal illness. Episodes can occur in common‐source outbreaks but, with the exceptions of related cases in families, that appears not to have been so in Western Australia since 1980. There is a need for increased awareness of the haemolytic‐uraemic syndrome to enhance prospects for earlier detection and better clinical outcomes. Improved public health surveillance is also needed to reduce the risks of the syndrome in the

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01622.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Two genes associated with a high breast cancer risk (BRCA1andBRCA2) have been discovered recently from study of large breast‐cancer‐dense kindreds. It is problematic to make inferences from these atypical families to the general population. Nevertheless, it appears that about 1 to 2 per cent of all breast cancer may be due to rare deleterious mutations inBRCA1orBRCA2. The majority of breast cancer families with fewer than four cases are likely to have cancers not attributable to these genes. There may be more common mutations in other genes (such asATM, HRAS1) that confer a moderate risk of breast cancer, and may account for 5 to 15 per cent of cases. At this early stage of cancer genetics, the risks associated with particular mutations are not known, there are no proven and acceptable strategies for women with an inherited susceptibility to ameliorate risk or improve prognosis, and risk estimates appropriate for Australian women with a family history of breast cancer are not established, although data from the United States may overestimate risk. Information is needed from population‐based studies, such as the Australian Breast Cancer Family Study (Hopper et al.Breast1994; 3: 79–86), but 100 per cent mutation detection in large cancer genes is difficult and expensive. Development of a systematic, research‐oriented, evidence‐based approach to genetic testing in Australia is recommended. Australia could lead the world in having common protocols used in breast cancer clinics across the country, linked to a national research consortium a

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01623.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Area‐based needs‐assessment methods tend to reinforce the status quo in service or program delivery rather than challenge it. Data collection easily becomes routine and self‐justifying. To rid ourselves of ritualistic methods of data collection, we must turn attention to the process of change that should result from it. That is, we must think in advance of the types of decisions that must made about service delivery and the nature of the change process itself. There are two routes to this end, depending on how change is conceptualised. If one adopts a conflict model of change, then felt need or, more crudely, what consumers or groups and communities want becomes the primary focus. This would place consumers in the chief role within an action‐oriented advocacy process. Alternatively, if a more functionalist model of change is adopted, then the focus of activity is on the information needs of managers and the type of data they require to justify a resource shift. Typically these data are not about ‘needs’ but marginal health gains and costs. In either event, the data collection procedures should be far more specific and directed than the existing broad‐brush procedures that presently serve only a limited purpose and effectively dilute or detract from both agendas for change. There are several possible pathways to resolve some of these issues, in particular, using hypothetical results to foresee if or how change could result from any proposed data collec

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01624.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The primary aim of this study was to identify the licence status of those involved in incidents of nonfatal firearm‐related misuse and to determine the involvement of legal firearms in such incidents. Firearm‐related attempted suicides were excluded. The study also sought to identify the types of firearms most likely to be misused. Over a three‐month period in early 1994, all nonfatal firearm‐related incidents reported in any New Zealand newspaper were identified by a commercial clipping bureau. Data pertaining to the licence status and the legality of the firearm involved in these incidents were obtained from the police who completed a standardised questionnaire under the Official Information Act (1982). Over the study period, 78 incidents yielded information on 97 perpetrators and 100 firearms. Of the 97 perpetrators, 66 per cent were unlicensed, 20 per cent were licensed, the licence status of 8 per cent of the perpetrators was unknown and the remaining 7 per cent were using air guns, and therefore a licence was not required. Half of the perpetrators involved in domestic disputes were licensed. Of the 100 firearms, 44 per cent were classified as ‘legal firearms’ and 56 per cent were classified as ‘illegal firearms’. These findings suggest that strategies aimed at reducing or preventing injury due to firearm misuse must focus on both licensed and unlicensed individuals and both legal and i

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01625.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Nonparticipants in epidemiological studies may differ in important respects from participants but the magnitude of this potential bias is rarely quantified. This study estimates the effect of nonparticipation on estimates of mental health problems following stillbirth, neonatal death or sudden infant death syndrome. Of 805 families approached, 512 (64 per cent) were recruited, of whom 77 per cent of mothers and 71 per cent of fathers completed four study interviews. Younger, unmarried, unemployed parents without private health insurance were less often recruited, and even if recruited, were less likely to complete the interview. By evaluating several possible scenarios, we estimated that had mothers lost to follow‐up remained in the study, anxiety rates would have varied by no more than ε4 per cent. Relative risks associated with bereaved‐control comparisons would have differed little from the observed estimate of 2.33. Estimating the effects of initial nonresponse is more difficult but the adoption of a worst‐case scenario produced a relative risk of 3.47. Despite systematic nonparticipation suggestive of social disadvantage, attrition‐related bias may have had only a modest effect on anxiety and depression rate estimates. However, this may not be the case when sample loss is high, when associations between attrition and outcome are strong, and when attrition‐related behaviour differs across compari

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01626.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY