Biomedical subjects

J Vince

Publications and source records attributed to J Vince.

15 recordsLinked to original sources

PubMed2002

Surgical programme at Royal Alexandra Hospital, Sydney, for Papua New Guinea children with congenital heart disease, 1978-1994.

OBJECTIVE: To report the history of the Royal Alexandra Hospital for Children (RAHC) Papua New Guinea (PNG) cardiac surgical programme and describe the selection, preoperative clinical features and postoperative outcome of children with congenital heart disease managed by the programme. METHODS: Details for each of the PNG cardiac patients admitted to RAHC following selection by visiting cardiologists between 1978 and 1994 were entered into a database, and analysed and interpreted. RESULTS: A congenital heart defect was confirmed in 165 of the 170 children selected. The male to female ratio was 1:1 and the mean age on admission to RAHC was 5.5 years. Almost all of the children for whom data were available (98%) had a weight for age and 41% had a height for age less than the 3rd centile. One-sixth had delayed milestones. A large number were tachypnoeic, in heart failure, or had pulmonary hypertension on admission. Ventricular septal defect and tetralogy of Fallot were the commonest defects, and lesions such as aortic stenosis, coarctation of the aorta and transposition of the great arteries were absent or rare. Thirty-one (19%) of the children selected initially did not receive surgery because of pulmonary hypertension, or because the lesions did not fall within the programme guidelines for operation. One hundred and twenty-nine children had corrective and four had palliative procedures. Half of the operated children had postoperative complications. Eight children died, all following open-heart procedures, giving a case fatality rate of 6%. Preoperative tachypnoea, hepatomegaly, cardiac failure and pulmonary hypertension were strongly associated with poor outcome. CONCLUSIONS: The programme was an arduous exercise for all organizations concerned, but achieved comparatively good short-term outcomes. The experience gained should assist in planning for similar programmes.

Adolescent↗

PubMed2001

Congenital heart disease in Papua New Guinean children.

The aim of the study was to analyse critically the programme for surgical management of children in Papua New Guinea (PNG) with congenital heart disease. A hospital record-based analysis was undertaken to document the pattern, management and short-term outcome of surgery in PNG children referred with a diagnosis of congenital heart disease to the Royal Alexandra Hospital for Children in Sydney, Australia. On admission, physical examination, chest radiogram, electrocardiogram, cross-sectional echocardiogram and, in most cases, cardiac catheterization were performed. Of the 170 children referred over the 17-year period, 1978-1994, 165 were confirmed to have congenital heart disease and were included in the study. Their ages ranged from 2 months to 16 years (median 5.5) and the male to female ratio was 1:1. One-sixth had delayed milestones and one-fifth long-term wasting. A large number were tachypnoeic, in heart failure or had pulmonary hypertension on admission. Ventricular septal defect, 34%, tetralogy of Fallot, 23%, and patent ductus arteriosus, 16.4%, were the predominant defects. lesions such as aortic stenosis, coarctation of the aorta and transposition of the great arteries are under-represented. Altogether, 133 children (81%) had surgery; 75% were open- and 25% closed-heart operations. The complications were unremarkable and the mortality rate (6%) acceptable for the era. The programme was therefore very successful for a small proportion of children born in PNG with congenital heart disease.

Adolescent↗

PubMed1999

Hyperekplexia: a rare differential of neonatal fits described in a developing country.

Hyperekplexia is a rare condition in which there is an exaggerated startle response. We report how a case presented in Papua New Guinea (PNG) and was diagnosed with international support. This is the first reported case in PNG. It is an important diagnosis to make to prevent sudden death and inappropriate treatment. The case illustrates the benefit of having a link with an international specialist and we discuss the importance of communication between developing and industrialized countries.

Anticonvulsants↗

PubMed1999

Protection of breastfeeding in Papua New Guinea.

In Papua New Guinea the bottle-feeding of babies has been increasing, predominantly among unemployed women of low educational status. Many women are unaware of their legal right to have breaks at work for the purpose of breastfeeding, and a high proportion of workplaces have no facilities for mothers who wish to breastfeed their children. The laws on the feeding of infants should be updated and implemented, and an effort is needed to explain the benefits of breastfeeding and the rights of working mothers.

Bottle Feeding↗

PubMed1998

Infant feeding practices in Papua New Guinea.

Concern about a possibly increasing prevalence of bottle-feeding led in 1995 to an Infant Feeding Survey of 1822 mothers attending urban health facilities. Infant feeding practices including feeding of colostrum, exclusive breastfeeding, weaning practices and bottle-feeding were assessed. This revealed that 28.8% of mothers had not given colostrum to their babies, that 43.5% of 3-month-old babies were exclusively breastfed, and that solids were introduced before 4 months of age in over half of the study population. Bottle-feeding was used by 20% of the study population. Feeding practices differed in women of Highlands and of Coastal origin. The findings emphasize the need to strengthen health education programmes which take into account the mothers' different cultural backgrounds. The issue of breast-feeding by mothers in paid employment needs to be addressed.

Bottle Feeding↗

PubMed1997

Screening contacts of children with tuberculosis: an important and worthwhile part of case management.

The outcome of screening the household contacts of 49 newly diagnosed tuberculous children as currently practised in the Paediatric Unit of the Port Moresby General Hospital is described. The screening program generated 182 chest X-rays and 67 Mantoux tests. 32 (39%) of 83 child contacts and 11 (11%) of 99 adults were commenced on antituberculous therapy, and 2 children aged 6 months were started on INAH chemoprophylaxis. Adult contacts were identified in 11 (22%) of the 49 families screened. Such a program is an extremely important part of the case management of children with newly diagnosed tuberculosis and their families.

Adolescent↗

PubMed1996

Assessment of HIV/AIDS knowledge, attitudes and behaviour of high school students in Papua New Guinea.

OBJECTIVE: To assess the knowledge, attitudes and behaviour of high school students (grade 10) with regard to HIV infection and AIDS. METHODS: A self-administered questionnaire survey was carried out in 21 high schools in 6 different provinces. The questionnaire was anonymous and contained questions about HIV transmission, preventive measures, attitudes towards HIV infection and a few questions about personal sexual behaviour. PRELIMINARY RESULTS: A total of 1811 students completed the questionnaire. 46% were female. The average age was 17 years. Over 98% knew what AIDS and HIV were. 97% knew that HIV was sexually transmitted, but many misconceptions existed: one-third thought that HIV was transmitted by mosquitoes, 7% that HIV-infected persons were a danger in the classroom. 72% knew that using a condom at every sexual encounter was a way of protection from HIV infection. Approximately 25% reported to have had sexual contacts, and of 15-year-old students 14% were sexually active. Although STD/AIDS education is part of the curriculum for grade 8 the principals of the majority of the schools reported that no formal teaching was done. DISCUSSION: Although the majority of students knew that HIV is sexually transmitted, basic knowledge about STDs is lacking and is not taught as part of the curriculum in most of the schools. Teaching about STDs and HIV needs to be enforced and safe sexual practices need to be discussed with the students.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Persistent diarrhoea in children admitted to Port Moresby General Hospital.

A retrospective study of the records of children admitted to Port Moresby General Hospital with diarrhoea during 1992 and 1993 was carried out to determine the morbidity, mortality and risk factors associated with persistent diarrhoea. 858 admissions of children under five years of age who had diarrhoea were identified from the ward admission registers, and case records for 724 were studied. Persistent diarrhoea occurred in 20%, and nearly half of these were in the 12-23 months age group. Children with persistent diarrhoea had a case fatality rate of 4.9%. Seasonality was similar for both persistent and non-persistent diarrhoea. In the crude analysis children of 12 months and older had a greater risk of developing persistent diarrhoea than those less than 12 months (odds ratio for children 12-23 months was 2.0 and for children 24-59 months 1.7; confidence intervals were 1.2-3.1 and 1.0-2.9 respectively); however, this difference was not found after logistic regression analysis. Poor nutritional status was a significant risk factor for persistent diarrhoea and remained so after controlling for confounding variables (odds ratio 2.7; confidence interval 1.8-4.0).

Age Factors↗

PubMed1993

Criteria audit: making use of existing data.

The first steps in setting up a criteria audit are presented with the aim of serving as a guide for starting quality assurance activities in Papua New Guinea. These activities need to be based on data, and the systematic and critical analysis of any available data on the process or outcome of health care delivery is a simple, cheap and useful basis for its improvement. Criteria are defined and the completeness and relevance of the data audited are discussed. Recommendations on the use of available recorded data and on the improvement of record-keeping practices are made.

Demography↗

PubMed1990