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Biomedical subjects

D Wilkinson

Publications and source records attributed to D Wilkinson.

At least 91 records · Page 5Linked to original sources
PubMed2000

Drugs for preventing tuberculosis in HIV infected persons.

BACKGROUND: People with HIV have a increased risk of developing tuberculosis. Preventive therapy may help prevent progression of tuberculosis infection to disease. OBJECTIVES: The objective of this review was to assess the effects of preventive therapy with anti-tuberculosis drugs in people with HIV infection. SEARCH STRATEGY: The Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase and reference lists of articles were searched. Researchers in the field were contacted. SELECTION CRITERIA: Randomised trials of anti-tuberculosis drugs in people with HIV infection but without evidence of active tuberculosis. DATA COLLECTION AND ANALYSIS: One reviewer assessed eligibility and trial quality. Study authors were contacted for additional information. MAIN RESULTS: Six trials were included. Compared to placebo, preventive therapy was associated with a lower incidence of active tuberculosis (relative risk 0.54, 95% confidence interval 0.39 to 0.76). Risk of death (relative risk 0.96, 95% confidence interval 0.82 to 1.13) was not significantly different in the two groups. Incidence of tuberculosis was reduced in people with a positive tuberculin skin test (relative risk 0.24, 95% confidence interval 0.14 to 0.40), but was not significantly lower in those with a negative skin test (relative risk 0.87, 95% confidence interval 0.56 to 1.36). Similarly death was less frequent in those with a positive skin test who received preventive therapy (relative risk 0.77, 95% confidence interval 0.58 to 1.03), but this difference was not observed among those with a negative skin test (relative risk 1.07, 95% confidence interval 0.88 to 1.30). Each regimen (isoniazid alone, isoniazid plus rifampicin, isoniazid plus rifampicin plus pyrazinamide, rifampicin plus pyrazinamide) had similar protective effects against active tuberculosis for people with positive skin tests. REVIEWER'S CONCLUSIONS: Preventive therapy appears to be effective in reducing incidence of tuberculosis, and death from tuberculosis in HIV infected adults with a positive tuberculin skin test, at least in the short to medium term.

AIDS-Related Opportunistic Infections↗
PubMed2000

Total thyroidectomy for management of thyroid disease.

Total thyroidectomy is a logical treatment for many patients with thyroid disease, including patients in whom the pathologic process requiring surgery involves both lobes of the thyroid or the risk of recurrence is a significant consideration, as in benign multinodular goiter, Graves' disease, and cancer. In earlier times the risks of extensive surgery and problems of adequate hormone replacement deterred surgeons from performing total thyroidectomy. However, as we enter the twenty-first century we are confident that the technical aspects of safe total thyroidectomy are established and that thyroid hormone replacement and monitoring are readily available and accurate. In the future total thyroidectomy is likely to be performed increasingly commonly for both benign and malignant disease.

Humans↗
PubMed2000

A time-resolved fluorescence immunoassay for the determination of a novel respiratory therapeutic agent, AR-C68397XX (Viozan) in human plasma.

A dissociation-enhanced lathanide fluorescence immunoassay (DELFIA) method has been developed for the determination of AR-C68397XX, a novel respiratory therapeutic agent, in human plasma. The method is a 'direct' immunoassay and provides an alternative to the solid phase extraction RIA described in a previous publication, which employs the same specific antiserum. The DELFIA method is suitable for the determination of the analyte at pg ml(-1) concentrations. The non-isotopic label was prepared by complexation of a DTPA derivative of AR-C68397XX with free europium cation (Eu3+). Plasma samples were diluted at least 5-fold prior to analysis to eliminate matrix interference. The calibration range is 10-2000 pg ml(-1), and the LOQ of the method is 50 pg ml(-1) using 50 microl of diluted human plasma sample.

Adrenergic beta-Agonists↗
PubMed2000

A RIA combined with SPE for the determination of a dual D2-receptor and beta2-adrenoceptor agonist, AR-C68397XX, in human plasma.

A radioimmunoassay has been developed for the determination of AR-C68397XX, a dual D2-receptor and beta2-adrenoceptor agonist, in human plasma. The method incorporates solid phase sample extraction and is suitable for the determination of the analyte at pg ml(-1) concentrations. The antiserum was raised in Suffolk cross sheep following primary and booster immunisations with an immunogen prepared by conjugating a carboxyphenylmethyl derivative of AR-C68397XX, to bovine serum albumin. The radioligand was prepared by the 125I-labelled iodination of a derivative of AR-C68397XX. The solid phase extraction procedure, using octadecyl sorbent, was introduced to remove matrix interferences in the plasma and to enhance method sensitivity. The calibration range is 20-500 pg ml(-1), using 0.5 ml of undiluted human plasma sample.

Adrenergic beta-2 Receptor Agonists↗
PubMed2000

HIV heterogeneity and proximity of homestead to roads in rural South Africa: an exploration using a geographical information system.

objective To describe heterogeneity of HIV prevalence among pregnant women in Hlabisa health district, South Africa and to correlate this with proximity of homestead to roads. methods HIV prevalence measured through anonymous surveillance among pregnant women and stratified by local village clinic. Polygons were created around each clinic, assuming women attend the clinic nearest their home. A geographical information system (GIS) calculated the mean distance from homesteads in each clinic catchment to nearest primary (1 degrees ) and to nearest primary or secondary (2 degrees ) road. results We found marked HIV heterogeneity by clinic catchment (range 19-31% (P < 0.001). A polygon plot demonstrated lower HIV prevalence in catchments remote from 1 degrees roads. Mean distance from homesteads to nearest 1 degrees or 2 degrees road varied by clinic catchment from 1623 to 7569 m. The mean distance from homesteads to a 1 degrees or 2 degrees road for each clinic catchment was strongly correlated with HIV prevalence (r = 0.66; P = 0.002). conclusions The substantial HIV heterogeneity in this district is closely correlated with proximity to a 1 degrees or 2 degrees road. GIS is a powerful tool to demonstrate and to start to analyse this observation. Further research is needed to better understand this relationship both at ecological and individual levels, and to develop interventions to reduce the spread of HIV infection.

Female↗
PubMed2000

Impact on perinatal mortality of missed opportunities to treat maternal syphilis in rural South Africa: baseline results from a clinic randomized controlled trial.

OBJECTIVE: To demonstrate the impact on perinatal mortality of inadequate treatment for maternal syphilis despite adequate screening. METHOD: In 12 clinics providing antenatal care in Hlabisa, South Africa 1783 pregnant women were screened for syphilis at their first antenatal visit between June and October 1998. Pregnancy outcome was determined among those with syphilis. RESULTS: A total of 158 women were diagnosed with syphilis: prevalence 9% (95% CI 8-10%). Mean gestation at first antenatal visit was 24 weeks. Thirty women (19%) received no treatment and 96 (61%) received all three recommended doses of penicillin. Among those receiving at least one dose, mean delay to the first dose was 20 days. Among those fully treated mean delay to treatment completion was 34 days. Pregnancy outcome was known for 142 women (90%) and there were 17 perinatal deaths among 15 women (11%). Eleven of 43 women (26%) who received one or fewer doses of penicillin experienced a perinatal death whilst only four of 99 women (4%) who received two or more doses of penicillin did so (P = 0.0001). Protection from perinatal death increased with the number of doses of penicillin: linear modelling suggests that one dose reduced the risk by 41%, two doses by 65% and three doses by 79%, compared with no doses. A dose-specific, categorical model confirmed reduction in risk by 79% for all three doses. CONCLUSION: Despite effective screening, many pregnant women with syphilis remain inadequately treated, resulting in avoidable perinatal mortality. Delays in starting and finishing treatment, as well as incomplete treatment occur. Near-patient syphilis testing in the antenatal clinic with early treatment could improve treatment of syphilis and reduce perinatal mortality, and a randomized trial to test this is underway.

Adolescent↗
PubMed2000

Inequitable distribution of general practitioners in Australia: analysis by state and territory using census data.

The objective of this study was to describe the distribution of general practitioners in each State and Territory, stratified by statistical division and adjusted for estimated community need. The location of general practitioners was obtained from the 1996 Census of Population and Housing. Community need was estimated from crude death rates supplied by the Australian Bureau of Statistics. On average there are 920 people per full-time general practitioner in Australia. Three States are relatively oversupplied by up to 5% (Australian Capital Territory) and the rest are relatively undersupplied by up to 12% (Western Australia). Adjusted for estimated need, the Australian Capital Territory is oversupplied by 71% compared with all of Australia, while Western Australia is undersupplied by 15%. More marked differences occur within the States, with the statistical division containing each capital city in each State that is relatively overserved. The greatest oversupply is in Sydney, where 33% fewer people share a full-time general practitioner than the whole of New South Wales (adjusted for need, oversupply in Sydney is 63%). Relative undersupply is greatest in Queensland, with 133% more people sharing each general practitioner in the north-west statistical division compared with the whole State. The distribution of general practitioners between and within States and Territories is unequal and inequitable. In each State, capital cities tend to be relatively oversupplied compared with more rural areas. While these data do not inform the absolute level of service needed in a community; they do suggest that strategies to redress the inequitable distribution are required.

Australia↗
PubMed2000

Roles and activities of the Commonwealth Government University Departments of Rural Health.

Since 1996, University Departments of Rural Health (UDRH) have been established at Broken Hill, Mount Isa, Shepparton, Launceston, Whyalla, Alice Springs and Geraldton. Each UDRH is underpinned by Commonwealth funding for an initial period of 5 years. The role of the UDRHs is to contribute to an increase in the rural and remote health workforce through education and training programs, as well as a reduction in the health differentials between rural and urban people and between indigenous and non-indigenous peoples. A strong population health focus involving partnerships between existing health providers in a targeted region and the university sector underpins their operation. While UDRHs have been established as a means of addressing a national workforce problem, their organisational arrangements with universities and local service providers vary widely, as does the program mix of activities in education, research service development, facilitation and advocacy. This article outlines some of the activities and progress of the UDRHs to date.

Australia↗
PubMed2000

Selected demographic, social and work characteristics of the Australian general medical practitioner workforce: comparing capital cities with regional areas.

The aim of the present study was to compare selected characteristics of the Australian general medical practitioner workforce in capital cities and regional areas. Data were derived from the 1996 Census of Population and Housing. Characteristics included age, sex, full- or part-time work, place of birth and change in residential address. Analyses were performed for each state and territory in Australia, the statistical division containing each capital city and all other statistical divisions in each state and territory. Of the 26,359 general medical practitioners identified, 68% were male. More female than male general medical practitioners were aged < 45 years (74 vs 52%, respectively; P < 0.0001). The proportion of general medical practitioners aged < 35 years was higher in capital cities (30%) than regional areas (24%; P < 0.0001). Overall, 32% of the general medical practitioner workforce was female and almost 50% of those aged < 35 years were female. The proportion of female general medical practitioners was higher in capital cities than regional areas, by up to 30%. While 13% of male general medical practitioners reported part-time work, 42% of females also reported part-time work and these figures were similar in capital cities and regional areas. Approximately 40% of the Australian general medical practitioner workforce was born outside Australia and while fewer migrants have entered in recent years they were more likely to be living in regional areas than the capitals. The census provides useful medical workforce data. The regional workforce tends to be made up of more males and is older than in capital cities. Monitoring trends in these characteristics could help to evaluate initiatives aimed at addressing regional workforce issues.

Adult↗
PubMed2000

Youth suicide trends in Australian metropolitan and non-metropolitan areas, 1988-1997.

OBJECTIVE: The objective of this study was to examine trends in suicide among 15-34-year-olds living in Australian metropolitan and non-metropolitan areas between 1988 and 1997. METHOD: Suicide and population data were obtained from the Australian Bureau of Statistics. We calculated overall and method-specific suicide rates for 15-24 and 25-34-year-old males and females separately, according to area of residence defined as non-metropolitan (< or = 20,000 people) or metropolitan. RESULTS: Between 1988 and 1997 suicide rates in 15-24-year-old non-metropolitan males were consistently 50% higher than metropolitan 15-24-year-olds. In 1995-1997, for example, the rates were: 38.2 versus 25.1 per 100,000 respectively (p < 0.0001). The reverse pattern was seen in 25-34-year-old females with higher rates in metropolitan areas (7.5 per 100,000) compared with non-metropolitan areas (6.1 per 100,000, p = 0.21) in 1995-1997. There were no significant differences according to area of residence in 25-34-year-old males or 15-24-year-old females. Over the years studied we found no clear evidence that suicide rates increased to a greater extent in rural than urban areas. Rates of hanging suicide have approximately doubled in both sexes and age groups in both settings over this time. Despite an approximate halving in firearm suicide, rates remain 3-fold higher among nonmetropolitan residents. CONCLUSION: Non-metropolitan males aged 15-24 years have disproportionately higher rates of suicide than their metropolitan counterparts. Reasons for this require further investigation. Hanging is now the most favoured method of non-metropolitan suicide replacing firearms from 10 years ago. Although legislation may reduce method-specific suicide the potential for method-substitution means that overall rates may not fall. More comprehensive interventions are therefore required.

Adolescent↗
PubMed2000

Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal.

INTRODUCTION: South Africa's Termination of Pregnancy Act, the most liberal abortion law in Africa, took effect early in 1997. In spite of the anticipated benefits to women's health, however, public reaction has been mixed. In the country's most populous province, KwaZulu/Natal, opposition is strong and most health care providers have refused to provide the service. This study explored attitudes and beliefs about abortion and the Termination of Pregnancy Act among primary care nurses and community members in a rural district in order to better understand barriers to implementation of the new law. METHODS: As part of a community survey on women's reproductive health (n = 138), questions on knowledge, attitudes and beliefs about abortion were asked, as well as awareness of the provisions of the Termination of Pregnancy Act. To better understand the perspectives of health care workers, a survey among primary care nurses on duty (n = 25) was also conducted. In-depth interviews were conducted with both nurses and women in the community to further pursue issues raised in the two surveys. RESULTS: Support for the Act was low (11%) among both community members and nurses, and few supported abortion on request (18 and 6%, respectively). Within each group, however, a clear hierarchy of support was observed: a majority of nurses (56%) and community members (58%) supported abortion in the case of rape or incest, or if the continued pregnancy would endanger a woman's health (61 and 56%, respectively), but few supported abortion for social or economic reasons. In-depth interviews revealed that abortion is seen as contrary to prevailing community norms; nurses were poorly informed about the Termination of Pregnancy Act and felt confused in their professional responsibilities. CONCLUSIONS AND RECOMMENDATIONS: Legalization alone cannot ensure implementation of abortion services. In South Africa, extensive media coverage prior to passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. In spite of general opposition to the law, however, there is an encouraging level of support for abortion in some circumstances. These findings suggest that abortion services can be implemented, even in conservative rural areas, but that a process of information dissemination and community consent prior to implementation is essential. Locating abortion within broader reproductive health services could be an effective way to improve access and acceptability.

Abortion, Legal↗
PubMed2000

Paediatric HIV infection in a rural South African district hospital.

The objective of this study was to determine the prevalence, clinical spectrum, and outcome of paediatric HIV infection in 281 consecutive children admitted to hospital in rural South Africa between October 1996 and January 1997. HIV infection was defined as two positive ELISAs in those aged > 12 months; a positive ELISA plus a positive IgG3 in those aged 6-12 months; and a positive ELISA plus positive p24 antigen or PCR in those aged 0-5 months. In all, 72 (26 per cent) children were HIV infected. Age-specific HIV prevalence was at least 25 per cent in all 1-5 year age groups. HIV-infected children were more likely to have been previously admitted (46 per cent vs. 23 per cent; p = 0.0002), and were more likely to have severe malnutrition (52 per cent vs. 17 per cent; p < 0.0001). Both HIV-infected and HIV-uninfected most frequently presented with diarrhoeal disease (51 per cent vs. 32 per cent), acute respiratory infection (13 per cent vs. 23 per cent), and malnutrition (18 per cent vs. 11 per cent). Satisfactory response to antibiotic therapy was less likely among the HIV-infected (56 per cent vs. 73 per cent; p = 0.02), and mortality was higher among the HIV-infected (21 per cent vs. 7 per cent; p = 0.005). It is concluded that HIV-infected children present with disease syndromes common to this setting, but do so more frequently and with worse outcome than their uninfected counterparts. The high burden of paediatric HIV disease in this setting poses a substantial challenge for health resources.

Analysis of Variance↗
PubMed2000

Effect of coinfection with STDs and of STD treatment on HIV shedding in genital-tract secretions: systematic review and data synthesis.

OBJECTIVE: To determine whether coinfection with sexually transmitted diseases (STD) increases HIV shedding in genital-tract secretions, and whether STD treatment reduces this shedding. DESIGN: Systematic review and data synthesis of cross-sectional and cohort studies meeting predefined quality criteria. MAIN OUTCOME MEASURES: Proportion of patients with and without a STD who had detectable HIV in genital secretions, HIV load in genital secretions, or change following STD treatment. RESULTS: Of 48 identified studies, three cross-sectional and three cohort studies were included. HIV was detected significantly more frequently in participants infected with Neisseria gonorrhoeae (125 of 309 participants, 41%) than in those without N gonorrhoeae infection (311 of 988 participants, 32%; P = 0.004). HIV was not significantly more frequently detected in persons infected with Chlamydia trachomatis (28 of 67 participants, 42%) than in those without C trachomatis infection (375 of 1149 participants, 33%; P = 0.13). Median HIV load reported in only one study was greater in men with urethritis (12.4 x 104 versus 1.51 x 104 copies/ml; P = 0.04). In the only cohort study in which this could be fully assessed, treatment of women with any STD reduced the proportion of those with detectable HIV from 39% to 29% (P = 0.05), whereas this proportion remained stable among controls (15-17%). A second cohort study reported fully on HIV load; among men with urethritis, viral load fell from 12.4 to 4.12 x 104 copies/ml 2 weeks posttreatment, whereas viral load remained stable in those without urethritis. CONCLUSION: Few high-quality studies were found. HIV is detected moderately more frequently in genital secretions of men and women with a STD, and HIV load is substantially increased among men with urethritis. Successful STD treatment reduces both of these parameters, but not to control levels. More high-quality studies are needed to explore this important relationship further.

Cohort Studies↗
PubMed2000

Comparison of trends in method-specific suicide rates in Australia and England & Wales, 1968-97.

OBJECTIVE: To compare secular trends in method-specific suicide rates among young people in Australia and England & Wales between 1968 and 1997. METHODS: Australian data were obtained from the Australian Bureau of Statistics, and for England & Wales from the Office for National Statistics. Overall and method-specific suicide rates for 15-34 year old males and females were calculated using ICD codes E950-9 and E980-9 except E988.8. RESULTS: In both settings, suicide rates have almost doubled in young males over the past 30 years (from 16.8 to 32.9 per 100,000 in Australia and from 10.1 to 19.0 in England & Wales). Overall rates have changed little in young females. In both sexes and in both settings there have been substantial increases in suicide by hanging (5-7 fold increase in Australia and four-fold increase in England & Wales). There have also been smaller increases in gassing in the 1980s and '90s. In females, the impact of these increases on overall rates has been offset by a decline in drug overdose, the most common method in females. CONCLUSIONS: Rates of male suicide have increased substantially in both settings in recent years, and hanging has become an increasingly common method of suicide. The similarity in observed trends in both settings supports the view that such changes may have common causes. Research should focus on understanding why hanging has increased in popularity and what measures may be taken to diminish it.

Adolescent↗
PubMed2000

Inequitable distribution of general practitioners in Australia: estimating need through the Robin Hood Index.

OBJECTIVE: From Census data, to document the distribution of general practitioners in Australia and to estimate the number of general practitioners needed to achieve an equitable distribution accounting for community health need. METHODS: Data on location of general practitioners, population size and crude mortality by statistical division (SD) were obtained from the Australian Bureau of Statistics. The number of patients per general practitioner by SD was calculated and plotted. Using crude mortality to estimate community health need, a ratio of the number of general practitioners per person: mortality was calculated for all Australia and for each SD (the Robin Hood Index). From this, the number of general practitioners needed to achieve equity was calculated. RESULTS: In all, 26,290 general practitioners were identified in 57 SDs. The mean number of people per general practitioner is 707, ranging from 551 to 1887. Capital city SDs have most favourable ratios. The Robin Hood Index for Australia is 1, and ranges from 0.32 (relatively under-served) to 2.46 (relatively over-served). Twelve SDs (21%) including all capital cities and 65% of all Australians, have a Robin Hood Index > 1. To achieve equity per capita 2489 more general practitioners (10% of the current workforce) are needed. To achieve equity by the Robin Hood Index 3351 (13% of the current workforce) are needed. CONCLUSIONS: The distribution of general practitioners in Australia is skewed. Nonmetropolitan areas are relatively underserved. Census data and the Robin Hood Index could provide a simple means of identifying areas of need in Australia.

Censuses↗
PubMed2000

Mortality variation across Australia: descriptive data for states and territories, and statistical divisions.

OBJECTIVE: To describe variation in all cause and selected cause-specific mortality rates across Australia. METHODS: Mortality and population data for 1997 were obtained from the Australian Bureau of Statistics. All cause and selected cause-specific mortality rates were calculated and directly standardised to the 1997 Australian population in 5-year age groups. Selected major causes of death included cancer, coronary artery disease, cerebrovascular disease, diabetes, accidents and suicide. Rates are reported by statistical division, and State and Territory. RESULTS: All cause age-standardised mortality was 6.98 per 1000 in 1997 and this varied 2-fold from a low in the statistical division of Pilbara, Western Australia (5.78, 95% confidence interval 5.06-6.56), to a high in Northern Territory--excluding Darwin (11.30, 10.67-11.98). Similar mortality variation (all p < 0.0001) exists for cancer (1.01-2.23 per 1000) and coronary artery disease (0.99-2.23 per 1000), the two biggest killers. Larger variation (all p < 0.0001) exists for cerebrovascular disease (0.7-11.8 per 10,000), diabetes (0.7-6.9 per 10,000), accidents (1.7-7.2 per 10,000) and suicide (0.6-3.8 per 10,000). Less marked variation was observed when analysed by State and Territory, but Northern Territory consistently has the highest age-standardised mortality rates. CONCLUSIONS: Analysed by statistical division, substantial mortality gradients exist across Australia, suggesting an inequitable distribution of the determinants of health. Further research is required to better understand this heterogeneity.

Age Factors↗
PubMed2000

An unbridgeable gap? Comparing the HIV/AIDS epidemics in Australia and sub-Saharan Africa.

OBJECTIVE: To compare the HIV/AIDS epidemics in Australia and sub-Saharan Africa, to outline reasons for differences, and to consider implications for the Asia and Pacific region. METHODS: Comparison of key indicators of the epidemic in Australia, and Africa viewed largely through the experience of the Hlabisa health district, South Africa. RESULTS: To the end of 1997, for all Australia, the estimated cumulative number of HIV infections was approximately 19,000, whereas in Hlabisa 31,000 infections are estimated to have occurred. Compared with the low and declining incidence of HIV in Australia (< 1%), estimated incidence in Hlabisa rose to 10% in 1997. In all, 94% of Australian infections have been amongst men; in Hlabisa equal numbers of males and females are infected. Consequently, whereas 3000 children were perinatally exposed to HIV in Hlabisa in 1998 alone, 160 Australian children have been exposed this way. In Australia, HIV-related disease is characterised by opportunistic infection whereas in Hlabisa tuberculosis and wasting dominate. Surveys among gay men in Sydney and Melbourne indicate > 80% of HIV infected people receive antiretroviral therapy whereas in Hlabisa these drugs are not available. IMPLICATIONS: It seems possible that Asia and the Pacific will experience a similar HIV/AIDS epidemic to that in Africa. Levels of HIV are already high in parts of Asia, and social conditions in parts of the region might be considered ripe for the spread of HIV. As Australia strengthens economic and political ties within the region, so should more be done to help Pacific and Asian neighbours to prevent and respond to the HIV epidemic.

Adolescent↗