Biomedical subjects
L Roberts
Publications and source records attributed to L Roberts.
The self-management of chronic pain: resources.
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It's alive! (or might be). The science and ethics of creating life in a lab.
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Tracking Alzheimer's.
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Australia's notifiable diseases status, 1998. Annual report of the National Notifiable Diseases Surveillance System.
In 1998 there were 85,096 notifications to the National Notifiable Diseases Surveillance System; slightly lower than in 1997 (89,579). The number of measles cases remained low, and well below the number reported in the outbreak years of 1993 and 1994. Rubella notifications further decreased and remained low in 1998. The Measles Control Campaign from August to November 1998, did not impact significantly on the number of measles or rubella cases reported for 1998. Notifications of Haemophilus influenzae type b reached a record low since surveillance began in 1991, and appeared to have stabilised at a low rate since the introduction of the conjugated vaccine in 1992. The previously reported outbreak of pertussis in 1997 tapered off in early 1998. Food-borne disease, or detection of disease, appeared to be on the rise with an increase in notification rates of campylobacteriosis and salmonellosis. Notifications of hepatitis A decreased, correcting the previous high number of notifications in 1997. Sexually transmissible diseases (STDs) increased. Notifications for chlamydial infection were the highest for all sexually transmitted diseases and third highest for all notifiable diseases. Notifications of gonococcal infection also continued to rise and have doubled since 1991, whilst notifications for syphilis increased slightly after falling steadily over recent years. Arbovirus infections of concern in 1998 were dengue outbreaks in Far North Queensland and the first case of Japanese Encephalitis for mainland Australia, highlighting the importance of surveillance of arboviruses and vectors for their detection and management.
A shortcut to the gene pool. Big pharmaceutical companies join forces to map out genetic signposts.
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Can we kiss the polio scourge goodbye?
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Repeat donor HLA-DR mismatches in renal transplantation: is the increased failure rate caused by noncytotoxic HLA-DR alloantibodies?
INTRODUCTION: Data from the UCLA/UNOS and Collaborative Transplant Studies Registries indicate that mismatched HLA-DR alloantigens expressed on a former donor renal allograft should not be repeated because of significantly poorer long-term survival. METHODS: Retransplant candidates waiting for another renal allograft were screened for HLA class II alloantibodies (aAb) using direct complement-dependent cytotoxicity and several sensitive aAb binding assays. RESULTS: When screened by complement-dependent cytotoxicity, 46% of the patients were aAb negative. In contrast, using aAb binding assays, 90% of the patients had HLA-DR aAb specific for previous HLA-DR allograft mismatches. Most important, no directly cytotoxic HLA-DR antibody was detected in 9 of 27 patients. CONCLUSION: Our studies suggest that crossing the same HLA-DR mismatch in a subsequent transplant may result in poorer survival due to underlying donor-specific HLA-DR aAb. If confirmed in a retrospective study of retransplant patients, B cell donor cross-matches using antiglobulin complement-dependent cytotoxicity or flow cytometry would appear essential if this barrier were to be crossed.
Annual report of the National Influenza Surveillance Scheme, 1998.
The National Influenza Surveillance Scheme includes data from sentinel general practice consultations for influenza-like illness, laboratory reports of influenza and absenteeism rates from a national employer. The 1998 season was dominated by an increase in influenza A in all States and Territories and low influenza B activity. All influenza A isolates were characterised as influenza A (H3N2). Peak activity in 1998 was recorded in July and August. Data are coordinated, analysed and disseminated at a national level and published in Communicable Diseases Intelligence during the influenza season.
Obesity. About the size of it.
Severe obesity is on the increase in Britain and accounts for considerable excess hospital costs. The benefits of new treatments need to be assessed in terms of psychological, as well as physical, benefits to patients. Programmes aimed at changing lifestyles will be effective only when obesity is considered in terms of all its effects on the individual.
Mortality in the Democratic Republic of the Congo.
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Perceptions of the effect of an impending restaurant smoking ban on dining-out experience.
BACKGROUND: The introduction of bans on smoking in restaurants is frequently marred by claims that they will lead to a loss of business. METHODS: A representative sample of 3,019 South Australians age 15+ years were asked questions about dining-out frequency and perceived effects of the ban on their dining-out enjoyment and restaurant patronage. RESULTS: Sixty-one percent thought the ban would make dining out more enjoyable, 5% thought it would be less enjoyable, and 34% thought it would make no difference. Overall, 82% thought the ban would make no difference to their likelihood of dining out, 14% would be more likely to dine out, and 4% would be less likely. CONCLUSIONS: These data suggest that the public expects bans on smoking in restaurants to result in both increased enjoyment and increased patronage of restaurants.
Extracellular and intracellular actions of azadirachtin on the electrophysiological properties of cultured rat DRG neurones.
The distinct electrophysiological actions of extracellular and intracellular azadirachtin (type A) were investigated using cultured dorsal root ganglion neurones from neonatal rats and the whole cell variant of the patch clamp technique. The cultured mammalian neurones were relatively insensitive to azadirachtin compared with some invertebrate preparations, such as insect chemosensory systems. Insect preparations have been found to respond to 1-100 nM azadirachtin. However, at concentrations of azadirachtin between 10 and 100 microM significant changes in the electrophysiological properties of cultured DRG neurones were seen. Extracellular application of azadirachtin prolonged the late repolarization phase of evoked action potentials and consistent with this produced modulation of voltage-activated K+ currents. This modulation involved an initial transient increase in K+ current followed by reversible inhibition when azadirachtin was applied at a concentration of 10 microM. Higher concentrations of azadirachtin (50 and 100 microM), had only inhibitory effects on voltage-activated K+ currents. Azadirachtin produced a degree of voltage-dependent inhibition, with a greater level of K+ current inhibition observed when neurones were held at -90 mV compared with -40 mV. Prolonged application of azadirachtin for 24 h reversibly reduced action potential amplitude. In contrast intracellular application of 100 microM azadirachtin via the patch pipette solution had no significant effects on action potentials but produced an increase in conductance. Intracellular azadirachtin activated several conductances including a TEA-sensitive K + current and an inward current that had an estimated reversal potential close to 0 mV. In conclusion, data showed that azadirachtin had different effects when it was applied inside and outside the neurones and that azadirachtin at high concentrations reversibly altered neuronal excitability mainly by modulating potassium conductances. It appears that rat cultured DRG neurones are less affected by azadirachtin than some insect sensory systems.
Streptococcus pneumoniae antibiotic resistance in Northern Territory children in day care.
BACKGROUND: There is evidence that the rapid rise in Streptococcus pneumoniae (SP) antimicrobial resistance seen in other countries may have commenced in Australia. Streptococcus pneumoniae carriage and resistance levels are described for urban Northern Territory children in day care. METHODS: A prospective cohort study was conducted of 250 children in nine Darwin day care centres between 24 March and 15 September 1997. Each fortnight nasopharyngeal swabs were collected from children, and parents were interviewed about medications administered. RESULTS: Streptococcus pneumoniae was detected in 52% (1028/1974) of all nasopharyngeal swabs. Streptococcus pneumoniae was isolated from 92% (231/250) of children at some time. Penicillin resistance was found in 30% (312/1028) of isolates using a screening test. Of these, 256 (82%) had resistance confirmed by E-test. Two hundred and one (20% of all isolates) had intermediate penicillin resistance and 55 (5% of all isolates) had high level resistance. Ceftriaxone resistance was found in 19% of children's first isolates. Resistance to other antibiotics was also common: co-trimoxazole 45%, erythromycin 17%, tetracycline 17% and chloramphenicol 13%. A total of 17% (172/1028) of the isolates were multiresistant. The average fortnightly proportion of children given antibiotics was 16% (405/2476). CONCLUSION: Levels of intermediate and high level penicillin resistance in this day care population are consistent with previous data from the Northern Territory, and considerably higher than the rest of Australia. The national trend of increasing pencillin resistance is likely to continue.
Evaluating the potential for opportunistic vaccination in a Northern Territory hospital.
OBJECTIVE: To evaluate the potential for opportunistic vaccination and a simple intervention aimed at improving vaccination coverage for children in hospital. METHODS: Hospital records were reviewed for children under 7 years, discharged from paediatric wards (PW) and the emergency department (ED) for 4 weeks before and after an intervention (423 and 446 children, respectively). This comprised the education of staff and the introduction of prompts to record vaccination status. RESULTS: Documentation of vaccination status increased in the PW (63-90%) and the ED (24-46%), as did the adequacy of detail recorded (51-77% and 8-36%, respectively). Opportunistic vaccination increased from zero of 84 opportunities during the first audit to six of 139 following the intervention. All but one vaccine was given in the PW. Opportunistic vaccination improved when documentation identified a need for vaccination (P = 0. 02). CONCLUSION: There were numerous missed opportunities to vaccinate children in hospital, especially in the ED. Simple prompts improved documentation of vaccination status and the detail of information recorded. Despite improved documentation, opportunistic vaccination failed to improve in the ED. Improving documentation of vaccination status is not sufficient in itself to improve opportunistic vaccination.
A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water.
From 1 January through 30 June 1997, 8901 cases of typhoid fever and 95 associated deaths were reported in Dushanbe, Tajikistan. Of 29 Salmonella serotype Typhi isolates tested, 27 (93%) were resistant to ampicillin, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. In a case-control study of 45 patients and 123 controls, Salmonella Typhi infection was associated with drinking unboiled water (matched odds ratio, 7; 95% confidence interval, 3-24; P<.001). Of tap water samples, 97% showed fecal coliform contamination (mean level, 175 cfu/100 mL). Samples taken from water treatment plants revealed that fecal coliform contamination occurred both before and after treatment. Lack of chlorination, equipment failure, and back-siphonage in the water distribution system led to contamination of drinking water. After chlorination and coagulation were begun at the treatment plants and a water conservation campaign was initiated to improve water pressure, the incidence of typhoid fever declined dramatically.
Comprehensive performance examination gives insights into the "hidden curriculum".
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Vietnamese parental perceptions of child and adolescent mental illness.
OBJECTIVES: To determine the symptoms and behaviors in children which are considered psychopathological by Vietnamese parents, to identify professionals and agencies in the community whom Vietnamese parents would consult if their child had a mental illness, and to determine Vietnamese parents' awareness of existing community mental health services. METHOD: Structured interviews were conducted with a randomized community sample of 283 Vietnamese parents in Perth, Australia. Parents were asked to identify the symptoms and behaviors they considered psychopathological in children, where they would turn for help with a mentally ill child, their knowledge of community mental health services for children, and their understanding of the causes of child psychiatric disorders. RESULTS: Vietnamese parents identified psychotic symptoms, disorientation, and suicidal thoughts and behavior as psychopathological. They preferentially endorsed Western-style treatment approaches but had little awareness of existing community mental health services for children. A biological/chemical imbalance, traumatic experiences, and a metaphysical/spiritual imbalance were identified as the most likely causes of child mental illness. CONCLUSIONS: Despite a different cultural tradition, Vietnamese parents appear open to services provided by Western-trained mental health professionals. Their very limited awareness of child and adolescent mental health services in the community, however, may severely limit their utilization of such services.