[WHO--focus on accidents and violence].
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Biomedical subjects
Publications and source records attributed to M Andersen.
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While an extensive body of literature has demonstrated an association between socioeconomic status and child mortality, there have been relatively few papers which discuss the impact of socioeconomic inequality on child morbidity. This absence of data is partly attributable to methodological problems (need for large samples, the difficulty of assessing morbidity) and partly to the absence of relevant official health statistics. This paper reports results from the Mater-University of Queensland Study of Pregnancy (MUSP) and its outcomes. The sample comprises 8556 consecutive pregnancies, of which over 90% were followed up to birth. Of those mothers giving birth, approx. 70% of children were successfully given a health assessment five years after the birth (mothers report of the child's health using a set of standard indicators). The results indicate a consistent pattern with the children of the most socioeconomically disadvantaged mothers manifesting the worst health. Thus children living in socioeconomic disadvantage have a higher rate of health service utilisation, more chronic health problems and poorer dental health. The paper discusses some social policies for redressing these inequalities.
Recently, we demonstrated that treatment of LS174T cells with 2 mM butyrate for one day had a significant effect on the composition of cellular fatty acids. In an attempt to further explore this phenomenon, we investigated the effect of long-term butyrate treatment in the presence of different fatty acids in the medium on cellular phospholipids (PLs) and triacylglycerol (TG). Cells were supplemented with 100 microM sodium salts of 18:2 (n-6), 20:4 (n-6), 20:5 (n-3), or 22:6 (n-3) as a fatty acid-free-albumin complex. The molar ratio of the albumin and these long-chain fatty acids (LCFAs) was 3:1. One-half of these cultures were supplied with 2 mM butyrate, and the pH was adjusted to 7.4. The supplementation of the LCFAs and butyrate was maintained for eight days. The present study indicates that butyrate had a differential effect on the fatty acid composition of PLs and TG of LS174T cells. This includes an increase in monounsaturates and elongation of the supplemented LCFA, and this effect was more pronounced on TG than PL fatty acids. Butyrate resulted in a significant reduction in polyunsaturated fatty acid concentration only in PLs. In general, butyrate decreased the unsaturation index (UI) of the PLs but increased that of TG. The present study also confirmed our previous observation regarding the effect of LCFAs on cellular lipids. PL and TG fatty acid chain lengths reflect those of supplemented fatty acids. The UI of these two lipid fractions increased more with supplementation of n-3 than n-6 fatty acids.(ABSTRACT TRUNCATED AT 250 WORDS)
The impact of exposure to measles before 6 months of age has been investigated by comparing survival to 5 years of age for exposed children and controls in an urban (Bandim) and a rural (Quinhamel) area of Guinea-Bissau. In Bandim, cumulative mortality from time of exposure to age 5 years was 34.4% among exposed children and 9.3% among controls. In a matched pair analysis, exposed children had a mortality ratio (MR) of 3.80 (95% confidence interval [CI]: 1.42-10.18) compared with controls. In an unpaired analysis using Cox' regression model to standardize for background variables (sex, measles infection, age at exposure, exposure from own household, measles vaccination), there was little change in the MR (3.84, CI: 1.55-9.48). Even after 2 years of age, the exposed children tended to have higher mortality (MR = 7.96, CI: 0.98-64.74). In the rural area, the MR between exposed children and controls was 11.39 (CI: 1.42-91.51). Limited serological data suggest that at least some of the exposed had subclinical measles. In the urban area, where two studies of early exposure have been carried out, excess mortality among exposed children corresponds to 40% and 52%, respectively, of the acute measles mortality. Since these deaths would not be associated with measles in a study of protection against death after vaccination, measles immunization may have a much greater effect on childhood mortality than has previously been assumed.
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The altered arterial supply to the sternum after use of the internal thoracic artery in coronary bypass surgery was studied by delineation of the sternal arterial system with plastic material and by injection of ink/barium contrast for radiography and microscopy. The study was performed on 17 anterior chest walls from human cadavers. The total arterial supply was charted before and after 'harvest' of the internal thoracic artery. The dominant blood supply to the sternum was found to be periosteal and derived almost exclusively from branches of the internal thoracic artery. Following harvest of that artery, the arterial supply to the upper part of the corpus sterni was compromised, and based only on sparse ramifications to the periosteal membrane from the thoracoacromial artery via branches from the pectoralis major muscle.
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Socio-economic inequalities in adult and child health in Australia have been an issue of national concern. While a large body of data has discussed adult health, there have been relatively few Australian reports of socio-economic inequalities in child health. This occurs in a context where there have been increases in the proportion of Australian children living in poverty and where there has been an increased interest in child developmental delay as an indicator of child health status. This paper reports the result of a longitudinal study of pregnancy outcomes and one indicator of child health, namely child developmental delay. Three indicators of socio-economic status (chronic socio-economic disadvantage, mother's education, family income) were used to predict child developmental delays observed some 5 1/2 years after the study commenced. Mothers who had the lowest socio-economic status (using any of the indicators) had substantially higher rates of children manifesting developmental delays.
An investigation of the long-term psychosocial adjustment of patients with severe burn injuries is presented. In the selected 13-year period (1968-80) 46 patients fulfilled the entry criteria: burns covering more than 30 per cent body surface area (deep dermal or full skin thickness). Seventeen patients died early and one later. Of the remaining 28 patients, contact was made with 25 (89.3 per cent) who all participated. The observation time ranged between 7 and 21 years. The patients received a semi-standardized interview adjusted for age at the time of burn injury, a psychiatric interview and a physical examination to assess the permanent character and functional loss. The principal findings were: no correlation could be found between degree of disfiguration/function loss and the long-term psychosocial adaptation after severe burn injuries. The determinant factor was the premorbid psychiatric/psychological integration and, to some extent, support from staff and relatives.
Adverse drug reactions (ADR) to disulfiram treatment have been reported as single cases, but few systematic investigations exist. In this study we analysed the spontaneous ADR reports to the Danish Committee on Adverse Drug Reactions during 1968-1991. In that period 154 ADRs to disulfiram were reported, mainly of hepatic, neurological, skin, and psychiatric reactions, in decreasing order of frequency. The safety of disulfiram, estimated on the amount produced and the number of reactions reported, corresponds to an intermediate rate of adverse reactions (1 per 200-2000 treatment year). Over the 23-year period, 14 deaths were reported in Denmark and this corresponds to a rate of 1 per 25,000 treatment year; the chief cause was liver toxicity. Reports to the WHO collaborating Centre for International Drug Monitoring in Uppsala, Sweden, showed the same ADR profile, although with a higher rate of neurological and psychiatric and a lower rate of hepatic reactions. The latency time from the start of treatment to the manifestation of the ADR differed according to organ. Hepatitis occurred with a distinct peak after 2 months of treatment, skin reactions peaked after 2 weeks, and the rate of neurological ADR increased with duration of therapy. The relation of skin reactions and hepatitis to nickel allergy is discussed, as is the dose-dependency of neuropathy. Concomitant disulfiram treatment affects the metabolism of several drugs and the dynamics of others, leading to a number of clinically important drug interactions. The disulfiram drug interactions are reviewed.
The tissue solvent capacity of a 2% stabilized sodium hypochlorite solution (Milton) and a commercial calcium hydroxide solution (Calasept) was examined under in vitro conditions where autolyzed human pulp fragments weighing approximately 0.0065 g were immersed in these solutions at 37 degrees C for periods of up to 10 days. It appeared that sodium hypochlorite was able to dissolve half the volume of pulp tissue within 1 h and the remaining tissue after 2-2 1/2 h. Calcium hydroxide dissolved half the pulp volume within 2 h, whereas it took 1 week for the remaining tissue to dissolve. These findings support the use of sodium hypochlorite as an irrigation solution during canal preparation and calcium hydroxide as a canal dressing for the purpose of creating a canal free of pulp remnants before root filling.
During the period from the first marketing of cimetidine in 1977 and until 31 March 1990, the Danish Committee on Adverse Drug Reactions received 494 reports concerning a total of 612 suspected adverse reactions to peptic ulcer drugs (ATC group A02B). Out of these, adverse reactions to H2-receptor antagonists constituted 90%. The investigation confirms the fact that safe drugs are concerned which only rarely cause serious adverse reactions. During the first year after cimetidine, ranitidine and sucralfate became available over-the-counter (27 March 1989-31 March 1990), only one report about side effects caused by cimetidine sold over-the-counter was received. This corresponds to what might be anticipated from the usage figures, if availability over-the-counter does not result in particular adverse reaction problems. Decrease in the number of reports, alterations in the pattern of adverse reactions and under-reporting of known adverse reactions render employment of data from voluntary reports difficult.
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