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Biomedical subjects

A Bauman

Publications and source records attributed to A Bauman.

At least 73 records · Page 4Linked to original sources
PubMed1998

Is there equity in emergency medical care? Waiting times and walk-outs in South Western Sydney hospital emergency departments.

This study explores the association between selected socioeconomic characteristics of emergency patients with waiting times in emergency departments and walk-outs (those who did not wait for treatment) in South Western Sydney Area Health Service hospital emergency departments. Bivariate and multivariate analyses indicated that waiting times to see a doctor and walk-out rates varied by age, sex, country of birth, insurance status, socioeconomic status, severity of patient illness and day of arrival. Patients who were female, from a non-English-speaking background, self-referred, uninsured and those from lower socioeconomic status showed significantly longer waiting times than others. Patients who left emergency departments without treatment showed higher waiting times from arrival to triage than other groups. This applied across socioeconomic categories. These findings indicate that prolonged waiting times for triage, which occur at the busiest periods, may be one of the main indicators for patients leaving emergency departments without treatment. The study also demonstrates variability in waiting times, which could possibly be partly addressed by more standardised triage policies, but may be influenced by other non-clinical factors, which require further investigation.

Adolescent↗
PubMed1998

A longitudinal study of smoking in year 7 and 8 students speaking English or a language other than English at home in Sydney, Australia.

OBJECTIVE: To compare the rates and predictors of smoking uptake between adolescents speaking English and those speaking a language other than English (LOTE) at home. DESIGN: A cross-sectional survey of year 7 and 8 students (aged 12 and 13 years) was conducted in 1994 and repeated 12 months later. A cohort of students was identified with respondents at baseline matched at follow up. chi 2 and logistic regression were used for analysis. SETTING: 38 schools in southern, east, and northern Sydney, Australia. SUBJECTS: Year 7 and 8 students in the schools were included and examined on two occasions, with complete data for 5947 (80%) students at baseline and 6177 (98%) students at a 12-month follow up. Records were able to be matched perfectly for 3513 respondents (59%). MAIN OUTCOME MEASURES: Smoking rates and predictors of smoking uptake among students speaking English or a LOTE at home. RESULTS: At baseline, 6.1% of students surveyed were smokers. Twelve months later, 15.8% of student surveyed were smokers. There were significantly lower smoking rates among students speaking a LOTE at home compared with those speaking English at home at baseline and at 12 months. Using matched data, for students speaking English at home, five variables were significant predictors of smoking uptake: thinking it acceptable to smoke, perceived benefits of smoking, and having a brother, sister, or close friend who smokes. For students speaking a LOTE, the only predictor was the smoking status of close friends. CONCLUSIONS: Despite the higher smoking prevalence among men with a non-English-speaking background, and the reported strong association between fathers' smoking status and smoking onset of their children, adolescents speaking a LOTE at home were significantly less likely to be smokers than their English-speaking counterparts. Thus, there would seem to be a delay of smoking onset among students speaking a LOTE at home. The smoking rates among respondents speaking a LOTE at home in this study are lower than those obtained from the studies conducted in Europe and the United States. Effective smoking prevention interventions need to be implemented at an early stage of adolescence.

Adolescent↗
PubMed1997

Risk of unanticipated intraoperative events in patients assessed at a preanaesthetic clinic.

PURPOSE: To determine the risk of unanticipated intraoperative events (UIE) in patients assessed at a preanaesthetic clinic compared with those not assessed at the clinic. METHODS: Preoperative and intraoperative data were collected on 6130 elective surgical patients by procedural anaesthetists over a 12-month-period at an Australian tertiary referral hospital. The procedural anaesthetists rated the level of preparation and identified predefined unanticipated intraoperative events. A logistic regression model was used to identify significant risk factors of UIE and was further validated on another sample of 482 patients (one month) by a goodness-of-fit test. RESULTS: Of the 6130 elective surgical patients, 2000 (33%) had been assessed at the preanaesthetic clinic. There was a greater proportion of ASA II to IV patients seen at the clinic than patients not assessed at the clinic (chi 2(3) = 689.92, P < 0.001). Nonclinic patients were more likely to be inadequately prepared than clinic patients (RRunadjusted = 1.61, 95% CI: 1.25 to 2.04, P < 0.001). The overall incidence of intraoperative events was 4.14% (95% CI: 3.64% to 4.64%). Despite adjusting for the preparation level, type of anaesthesia, admission category, ASA physical status and duration of anaesthesia, clinic patients were 1.94 (95% CI: 1.42 to 2.64) times more likely to experience an UIE than nonclinic patients (P < 0.001). CONCLUSION: Although clinic patients were more often optimally prepared, their adjusted risk of UIE was higher than nonclinic patients. The procedural anaesthetist needs to be vigilant with these high risk patients, even if they have been assessed at a preanaesthetic clinic.

Adult↗
PubMed1997

Quality of life outcomes after intensive care. Comparison with a community group.

OBJECTIVE: Compare the health related quality of life of intensive care patients with a community sample. DESIGN: Self-completed questionnaire posted to a consecutive sample of 238 patients 16 months after discharge from an intensive care unit (ICU) and to a random community sample (n = 242). SETTING: The Liverpool Hospital is the main referral and teaching hospital in a community of 620,000 people. It has a ten-bed general ICU. PATIENTS AND PARTICIPANTS: All patients admitted to the ICU over 8 months with a length of stay > or = 24 h and a sample drawn from the community telephone directory. MEASUREMENTS AND MAIN RESULTS: The self completed questionnaire contained physical and psychosocial health and quality of life (QOL) scales. Analysis of variance indicated that ICU patients were more physically ill and anxiously depressed than the community sample. Sixty-three per cent of patients had not attained full health, were functionally impaired and had a poorer QOL than those patients who had returned to full health and the community. Psychosocial health (apart from anxious depression) was related to the level of perceived physical health rather than to whether or not they had been admitted to the ICU. Those subjects not in full health had poorer interpersonal relationships, less positive attitudes about life, more anxious depression and more suicidal depression. CONCLUSIONS: ICU patients following discharge have worse perceived health and more anxiety than others in the community. Sixty-three per cent of patients had a poorer QOL and functional health than those who returned to full health and those in the community.

Analysis of Variance↗
PubMed1997

The comprehensibility of asthma education materials.

Asthma information pamphlets, brochures and other media materials are produced by a range of organisations for a diverse range of educational purposes. It is important to understand the principles of preparing appropriate and intelligible written material, to increase the probability that they will be more likely to improve health outcomes. Asthma patient education material, like many other types of health education material, is often written at a reading age above the target audience, and is less likely to be comprehended. Attention should be paid to the principles of good written communication in the preparation of such material. Such material should ideally be used in conjunction with verbal advice, as part of a medical consultation or asthma education program. Other asthma education media, including public education and mass communications material, should be subject to formative evaluation to assess its suitability and relevance for the proposed target audience.

Asthma↗
PubMed1997

High-dose chemotherapy, autologous bone marrow or stem cell transplantation and post-transplant consolidation chemotherapy in patients with advanced breast cancer.

This study was designed to determine the complete response (CR) rate, event-free survival (EFS) and overall survival (OS) in patients with metastatic breast cancer treated with an adriamycin-based induction regimen, high-dose chemotherapy consisting of cyclophosphamide and thiotepa with autologous bone marrow or stem cell reinfusion, followed by post-transplant 5-fluorouracil and cisplatin. Forty-eight consecutive patients were enrolled and 35 received two to four cycles of a cytoreductive chemotherapy regimen followed by high-dose chemotherapy which included cyclophosphamide and thiotepa. Thirty-three patients with non-progressive disease received at least one cycle of post-transplant 5-fluorouracil and cisplatin. Fifty percent of patients with evaluable disease responded to induction chemotherapy. Three of the 34 patients (9%) evaluable for response to high-dose chemotherapy achieved CR, eight (24%) achieved partial response (PR), 12 (35%) had stable disease (SD) and 11 (32%) had progressive disease (PD). The median time to neutrophil recovery was 11.5 days (range, 8 to 40 days) post- reinfusion. The median time to platelet independence was 14.5 days (range, 8 to 44 days). The median follow-up is 24.5 months (range, 1 to 96 months). The actuarial probability of EFS for all patients is 17% at 4 years. The EFS for patients receiving all four cycles of post-transplant chemotherapy is 27% at 4 years, compared to 36% at 1 year for patients not receiving any post-transplant chemotherapy. Ten of the 48 patients (21%) are alive, and seven of these (15%) have no evidence of disease. High-dose chemotherapy with autologous bone marrow or peripheral blood-derived stem cell transplantation followed by post-transplant consolidation chemotherapy in patients with metastatic breast cancer results in a proportion of patients without evidence of disease at 4 years.

Adult↗
PubMed1997

Relating physical activity to health status, social connections and community facilities.

An important public health goal is to increase the population's participation in regular, moderate physical activity. Descriptive epidemiological studies that focus only on associations between physical activity and demographic and psychological factors are not sufficient to inform exercise promotion strategies, and a broader view of health is required. This study investigates the additional factors of health status, social connections and satisfaction with local area facilities by analysing data from a 1987 community health survey of 1765 residents of Adelaide. Factors associated with low activity were age group, education, general health (women), reduced mobility, number of social connections (men) and degree of satisfaction with recreation facilities. Including social and structural factors is valuable for research into interventions, policy and theory relating to physical activity as it brings theoretical perspectives and links to other areas of public health and social research.

Adolescent↗
PubMed1997

How well does epidemiological evidence hold for the relationship between smoking and adverse obstetric outcomes in New South Wales?

This study examines whether the established epidemiological relationship between cigarette-smoking exposure in pregnancy and adverse obstetric outcomes are confirmed in Australian data from the NSW Midwives Data Collection (MDC). These data were analysed to compare the obstetric complications and pregnancy outcomes between smoking and nonsmoking women confined in 1994. Results showed that smoking mothers had higher rates of antepartum haemorrhage due to placental abruption and placenta praevia. They were also at higher risk of giving birth to low birth-weight babies and preterm delivery. Infants born to smoking mothers were 17% more likely to be admitted to hospital special care nurseries or neonatal intensive care units. Moreover, the risk of reported perinatal death among babies of smoking mothers was 20% higher than babies of nonsmoking mothers. However, smoking during pregnancy was found to confer a protective effect against the development of pregnancy-induced hypertension. These results were compared with existing evidence from the literature. Published research reports on the corresponding smoking effects were identified to assess the consistency of evidence and typical risk ratios. Findings from the literature search showed a near-perfect concordance with the associations in the NSW MDC data. The paper documents the likely complications which might be prevented if smoking in pregnancy were eliminated. There remains a real need for effective programmes to reduce smoking prevalence in pregnancy.

Apgar Score↗
PubMed1997

Asthma mortality in Australia 1920-94: age, period, and cohort effects.

STUDY OBJECTIVE: To investigate asthma mortality during 1920-94 in Australia in order to assess the relative role of period and birth cohort effects. DESIGN: Asthma mortality (both sexes) was age standardised and examined for changes over time. The data were also examined for age, period, and cohort (APC) effects using Poisson regression modelling. SETTING: National Australian mortality data. PARTICIPANTS: Population (both sexes) aged 15-34 years, 1920-94. MAIN RESULTS: Age adjusted period rates indicate an increase in asthma mortality during the 1950's, and increases and subsequent falls (epidemics) during the mid 1960s and late 1980s. APC modelling suggested an increasing cohort effect (adjusted for both age and period) from the birth cohort 1950-54 onwards. Period effects (adjusted for age and cohort) are characterized by an increase in the 1950s (possibly due to changes in diagnostic labelling), minimal or no increases in the mid 1960s and late 1980s (where period peaks had been noted when data were adjusted for age only), and declines in mortality risk subsequent to the periods where age-period analysis had noted increases. Thus, in Australia, some of the mid 1960s epidemic in asthma deaths, and all of the late 1980s mortality increase, seem to be attributable to cohort effects. CONCLUSIONS: The increase in asthma mortality cohort effect is consistent with empirical evidence of recent increases in prevalence (and presumably incidence) of asthma in Australia, and suggests the need for more research into the underlying environmental aetiology of this condition.

Adolescent↗
PubMed1996

Asthma management in eastern Australia, 1990 and 1993.

OBJECTIVE: To compare the prevalence and management of asthma before and after institution of the National Asthma Campaign. DESIGN: Repeat population-based cross-sectional analytic surveys. SETTING: Eastern Australia (Sydney, Brisbane, Melbourne, and the Hunter Valley, New South Wales) in September 1990 and 1993. SUBJECTS: Primary school children and their parents from 33 schools (8746 children) in 1990 and 40 schools (10 106 children) in 1993. OUTCOME MEASURES: Frequency of respiratory symptoms; diagnoses of asthma; medications; lung function measurements; possession of a peak flow meter and a written action plan. RESULTS: Age and sex distribution of the subjects and the reported prevalence of asthma were similar in 1990 and 1993. The frequency of reported episodes of wheezing and troublesome cough increased significantly in children between 1990 and 1993. Asthma management improved in accordance with current recommendations, with significantly decreased use of regular inhaled bronchodilator medication in children and increased use of preventive medication, monitoring of lung function by doctors and use of peak flow meters and written action plans in both children and adults. CONCLUSION: There is evidence that the National Asthma Campaign may have contributed to increased awareness and improved management of asthma in children and adults in eastern Australia.

Adult↗
PubMed1996

The cAMP receptor subtype cAR2 is restricted to a subset of prestalk cells during Dictyostelium development and displays unexpected DIF-1 responsiveness.

Dictyostelium discoidium cells express a family of cell surface cAMP receptors, and these G-protein-coupled receptors are each expressed with unique spatial and temporal patterns. One of these receptors, cAR2, is present during the postaggregative stages of development and our previous work suggests that it is preferentially expressed in prestalk cells. We report here the isolation of the promoter for carB, the gene which encodes cAR2. Using this fragment to generate a carB::lacZ, gene fusion construct, we investigated carB expression in detail. Expression is first detected at the tight aggregate stage and subsequently in a pattern reminiscent of the prestalk-specific gene ecmA. There are subtle differences, however, with, ecmA being expressed significantly in the anterior-like cells of the migrating pseudoplasmodium and in the basal disc and lower cup supporting the sorus during terminal development. carB is not expressed in any of these places. The presence of these different prestalk cell subtypes was confirmed by double indirect immunofluorescence using anti-cAR2 and anti-beta-galactosidase antibodies. While virtually all cAR2-expressing cells also express ecmA::lacZ, a substantial fraction of ecmA::lacZ-positive cells do not express cAR2. We also found the regulation of carB gene expression to differ from that of ecmA. carB expression is induced in vitro by extracellular cAMP, but surprisingly, not by DIF-1, a soluble molecule thought to be essential for the initiation of prestalk differentiation. Thus, cAR2 appears to be a cAMP receptor present on a restricted subset of prestalk cells and whose expression does not respond typically to the prestalk inducer DIF-1. DIF-1 sensitivity may, therefore, not be characteristic of all early prestalk differentiation.

Amino Acid Sequence↗
PubMed1996

Intraabdominal pressure and gastric intramucosal pH: is there an association?

This study evaluated the potential association between increased intraabdominal pressure (IAP) and abnormally low gastric intramucosal pH (pHi) (</= 7.32) in postoperative patients and assessed its effect on patient outcome. Altogether 73 patients undergoing major abdominal surgery over a 9-month period were studied prospectively. All underwent gastric tonometry and intravesical IAP measurements three time daily. An IAP of >/= 20 mmHg and a pHi of </= 7.32 were considered abnormal. The development of the following complications were also documented: hypotension [mean aortic pressure (MAP) < 80 mmHg], abdominal sepsis, renal impairment, and death. The median APACHE II score was 16 (range 5-34). Twenty-two patients had upper gastrointestinal (GI) surgery, 27 lower GI surgery, and 24 aortic surgery; 44 of these patients underwent emergency surgery. Abnormal pHi (</= 7.32) occurred in 36 patients while on the intensive care unit. Compared to patients with normal pHi, abnormal pHi patients were 11.3 times (3.2-43.5) [odds ratio +/- 95% CI] more likely to have an increased IAP. Abnormal pHi was significantly associated with hypotension (chi2 = 6.8;p = 0.009), sepsis (chi2 = 3.7;p = 0.06), renal impairment (chi2 = 28.3;p = 0. 0000001), relaparotomy (chi2 = 4.1;p = 0.04), and death (chi2 = 9. 7;p = 0.002). This study demonstrated a significant clinical association between increased IAP and abnormal pHi. An abnormally low pHi was associated with poor outcome.

Abdomen↗
PubMed1996

Relationship between a 14-day recall measure of leisure-time physical activity and a submaximal test of physical work capacity in a population sample of Australian adults.

This paper reports on the validity of a 14-day recall measure of leisure time physical activity (LTPA) in a sample of Australian adults (N = 986). Submaximal cycle ergometry was used to assess physical work capacity per kilogram of body mass (pwc75/kg). The self-report energy expenditure estimates were used to categorize respondents as vigorously active, moderately active, and low active/sedentary. Multiple regression analyses showed that pwc75/kg increased significantly across energy expenditure categories for adults aged less than 40 years; that the vigorous and moderate activity categories had greater mean pwc75/kg values than the low/sedentary category for 40 to 59-year-olds; and, that there were no differences in pwc75/kg between activity categories for those aged 60 years or older.

Adolescent↗
PubMed1996

Is penetrating injury on the increase in south-western Sydney?

BACKGROUND: Few Australian studies describe the epidemiology of penetrating trauma. This study describes the incidence and demographic features of penetrating injuries with emphasis on trends and severity analysis. METHODS: Case analysis was performed utilizing data from the Liverpool Hospital Trauma Registry (1989-94), NSW Department of Health Hospital Separations (1991-93), and the NSW Bureau of Crime Statistics (1991-93) with reference to the Liverpool and Fairfield Local Government Areas (LGA). RESULTS: The Trauma Registry revealed 251 of penetrating trauma. The median age was 26 years (interquartile range 21-33). Ninety-one per cent of the victims were male. Fourteen per cent of patients had an Injury Severity Score (ISS) > 15. Sixty-five per cent of cases were stab injuries and 20% gunshot injuries with the abdomen being the most commonly injured site. Twenty-one per cent of patients underwent laparotomy, 1.6% thoracotomy and 1.2% thoracotomy and laparatomy. There were 10 (4%) deaths. Trends in incidence of penetrating trauma and violent crime involving weapons were analysed. Static trends were observed for the annual incidence of penetrating trauma from the Liverpool Hospital Trauma Registry. Separations for penetrating trauma from Liverpool and Fairfield hospitals showed a slightly increasing trend. Violent crimes involving weapons in the Liverpool and Fairfield LGA showed a static trend. Nevertheless, separations for penetrating trauma and rates of violent crimes involving weapons were higher in south-western Sydney than metropolitan Sydney or NSW. Eight per cent of the LGA population are Vietnamese but this study identified 16% of victims as being Vietnamese. CONCLUSIONS: This study found no significant increase in penetrating trauma or violent crime predisposing to penetrating injury in south-western Sydney.

Adolescent↗
PubMed1996

Obstetric profiles and pregnancy outcomes of immigrant women in New South Wales, 1990-1992.

This study examined the obstetric profiles and pregnancy outcomes of immigrant women in New South Wales (NSW). The source of data was the NSW Midwives Data Collection. The characteristics of 64,922 immigrant women were compared with 189,357 Australian-born non-Aboriginal women who delivered babies between 1990-1992 in NSW. The study demonstrated that immigrant women were older, generally had less private health insurance coverage and fewer teenage pregnancies. Immigrant women showed lower rates of essential hypertension, but higher rates of hepatitis B and gestational diabetes. While induced labour was conducted less frequently among immigrant women, episiotomy, instrumental delivery and Caesarean section were performed more frequently among this group. The incidence of postpartum complications was higher among immigrant women. Differences were assessed among women from European, Asian, Middle Eastern, American, New Zealand/Oceania and African backgrounds. For example, the higher rates of hepatitis B, gestational diabetes, episiotomy, instrumental delivery, Caesarean section, postpartum haemorrhage, third degree tear and puerperal infection among Asian-born women were of concern. By contrast, pregnancies among Middle Eastern-born women were associated with fewer complications in spite of their high parity and high percentage of teenage pregnancies. Infants of immigrant mothers were more likely to be resuscitated and/or admitted to special care nursery/neonatal intensive care unit. These findings in immigrant women in NSW suggested the need for culturally appropriate obstetric services, clinical practice reviews, and the greater involvement of general practitioners in obstetric care.

Emigration and Immigration↗