Biomedical subjects
Publications and source records attributed to M Mira.
Although systemic vasculitis can be a complication of inflammatory bowel disease at several locations (skin, eyes, brain, mesentery, and lung) the association of retinal vasculitis with Crohn's disease is rare. We studied a 26-year-old woman with biopsy-demonstrated Crohn's disease who developed a severe bilateral retinal arteritis and phlebitis, with acute loss of vision.
OBJECTIVE: To describe: 1. current arrangements for the delivery of after-hours primary care in general practice. 2. GPs' satisfaction with these arrangements, and 3. the perceived barriers to improving after-hours care in general practice. DESIGN: Telephone survey of a random sample of general practitioners using a standardised questionnaire. SETTING: Two general practice populations, one urban (Central Sydney Division), and one rural (Central Western Division). RESULTS: The response rate was 71%. Almost all rural GPs (95%) provided after-hours care whereas 50% of urban practices provided after-hours care for their patients. Rural GPs expressed a significantly higher degree of satisfaction with their after-hours care arrangements. Half of the GPs providing all their after-hours care reported that they would be prepared to enter into co-operative arrangements with other practices. Thirty-seven per cent of urban GPs who did not provide all their after-hours care indicated that they would be prepared to enter into co-operative arrangements with other practices. CONCLUSIONS: Many of the barriers to providing effective after-hours care may be overcome by establishing after-hours co-operatives.
Explore the source record for details and available documents.
It has been demonstrated that clinical outcome is positively correlated with depletion of total body nitrogen (TBN) and therefore of body protein in certain serious medical conditions such as cystic fibrosis or patients receiving dialysis for chronic renal failure. Patients with anorexia nervosa are not suffering from medical illness per se yet the illness can be chronic and severely debilitating requiring numerous hospitalizations for refeeding and/or management of medical complications. The prediction of chronicity remains an important and difficult issue that this study seeks to address by examining the correlation between several clinical indices in 18 patients suffering from anorexia nervosa with parameters of body composition, namely TBN and percentage body fat. TBN was measured using the technique of in vivo neutron-activation analysis (IVNAA) and expressed as nitrogen index. Percentage body fat was estimated using skinfold measurements. The highest correlation was between nitrogen index and number of hospitalizations (r = -.80). The data support a relationship between depletion of body nitrogen/protein and chronicity in anorexia nervosa.
Body fat and total body nitrogen (TBN) were quantified before and after refeeding in 32 female anorexia nervosa patients and in 29 matched control subjects by using the techniques of anthropometry and in vivo neutron-capture analysis (IVNCA). Mean body weight of patients (mean body mass index; BMI, in kg/m2), 15.4 +/- 1.3, was 72.7% of that of control subjects, increasing to 89.8% of mean weight of control subjects after refeeding (mean BMI 19.0 +/- 1.2). Mean BMI of control subjects was 21.6 +/- 2.7. Compared with the control group, patients' nitrogen was initially depleted by 24.5%, increased by 18.4%, but remained 10.6% below control values (P < 0.001). Body fat was depleted by 58.4%, increased by 89.7%, but remained 21.8% below control values (P < 0.001). Thus, despite a greater initial depletion and subsequently a greater net gain, body fat remained relatively more depleted after treatment than did nitrogen and protein. Anorexia nervosa patients were shown to readily replenish protein during nutritional rehabilitation.
The Central Sydney Area Health Service has developed and piloted a Hospital in the Home program as an alternative to inpatient admission. Hospital in the Home offers the opportunity for increased productivity of existing hospital services, and advantages for patients in terms of satisfaction and improved or comparable clinical outcomes. Having developed treatment protocols and established a core Hospital in the Home team, a wider demonstration project across three hospitals within the Central Sydney Area Health Service is proposed.
BACKGROUND: Hospitalar discharge reports (HDR) are important documents in the data of clinical information of hospital admission. The aim of this study was to evaluate the completion of the HDR and to know the opinion and usefulness of its content. METHODS: The completion of the different sections of the HDR was analyzed (n = 839) in the hospital of Tortosa (Spain) from January to February 1991. A survey was carried out to primary care physicians (PCP) (n = 81) and to hospital doctors (n = 55) in the same health care region concerning the usefulness, extension and content of the HDR. RESULTS: The sections of the HDR which were best filled in were the evolution (88%), reason for admission (91%) and diagnosis (97%), and the worst were follow up plans (51%) and treatment (55%). With respect to the survey (response rate 71%), diagnosis (4.9/7), treatment and follow up plan (3.8/7) and reason for admission (3.7/7) were the most highly evaluated. CONCLUSIONS: To guarantee their usefulness, the hospital discharge reports should at least collect data concerning the reason for admission, diagnosis, disease prognosis, plan for treatment and follow up depicting assistent responsibilities of the hospital and primary health care.
BACKGROUND: The identification of personnel consuming excess quantities of alcoholic beverages in the work place is necessary due to the economic, health, and laboral problems caused by alcohol. The objectivity of laboratory tests provides great credibility and these tests have replaced other methods as the anamnesis. METHODS: A transversal study was carried out of the employees of a Barcelona enterprise. During the periodic medical check ups the consumption of alcoholic beverages and laboratory blood tests were obtained from the employees seven days previously. RESULTS: All the laboratory tests presented a weak positive correlation with the consumption of alcohol. The calculation of diagnostic efficacy for weekly consumption equal to or grater than 280 g of pure alcohol in a male shows that the greatest sensitivity corresponds to mean corpuscle volume (33%) followed by gammaglutamyltranspeptidase (GGT) (16%) with high specificity being observed in both (85% and 93%, respectively). The results are better in employee consuming more than or equal to 420 g of alcohol weekly. CONCLUSIONS: The diagnostic efficacy of laboratory tests in identifying subjects with elevated consumption of alcohol in the work place has low clinical performance and the use of anamnesis on the consumption of alcoholic beverages should first be evaluated.
Explore the source record for details and available documents.
OBJECTIVE: To determine the distribution of blood lead levels in preschool children in inner Sydney and identify possible sources of environmental lead. DESIGN: Cross sectional community based prevalence survey of children and the houses in which they live, and a survey of volunteer children. SETTING: Mort Bay and Summer Hill, residential localities in inner Sydney. PARTICIPANTS: Ninety-five children aged 9-48 months able to be identified in a defined geographic area and 63 children aged 9-48 months volunteered by their parents. OUTCOME MEASURES: Concentrations of lead in venous blood of all children and in samples from the home environment of Mort Bay children. RESULTS: Four of the children (2.5%) had blood lead levels > or = 1.21 mumol/L (25 micrograms/dL, the current Australian threshold of concern), 27 (17.1%) had levels > or = 0.72 mumol/L (15 micrograms/dL, the new US threshold for individual intervention) and 80 (50.6%) had levels > or = 0.48 mumol/L (10 micrograms/dL, the new US threshold for community intervention). Blood lead concentrations were significantly correlated with concentrations of lead in "sink" soil (r = 0.555, P = 0.026), play area soil (r = 0.492, P = 0.016) and dust from vacuum cleaners (r = 0.428, P = 0.05), and with age of child (r = -0.182, P = 0.023). The presence of the child during house renovation was a strong predictor of having a blood lead level above 0.72 mumol/L (15 micrograms/dL) (odds ratio, 4.6; 95% confidence interval, 1.8-11.7, P = 0.001). CONCLUSIONS: Lead in soil and in household dust in older areas of Sydney is likely to represent a significant health hazard to young children. Many thousands of children may be affected in Sydney and other Australian cities. There is an urgent need for expanded prevalence surveys, public education and the development of strategies for the abatement of lead in urban environments.
Explore the source record for details and available documents.
This prospective study examined the time for 93 women to cease to feel discomfort in their perineal areas after the births of their first babies. Sixty-two of the women had experienced a spontaneous delivery that did not require forceps assistance. In 58 patients, an episiotomy was performed. Of the 35 women in whom an episiotomy was not performed, 24 women required sutures and only four women did not suffer any perineal damage. The median time for perineal comfort in general (including walking and sitting) was one month (range, zero to six months); 20% of women took more than two months to achieve general perineal comfort. For comfort during sexual intercourse, the median time was three months (range, one to more than 12 months); 20% of women took longer than six months to achieve comfort during sexual intercourse. Factors that were associated with discomfort for longer than the median time were delivery by forceps; spontaneous vaginal (not perineal) tears; and, in the three to four days after the birth, oedema and the breakdown of muscle or skin sutures. There was no significant difference in these times between patients who did not undergo an episiotomy and those who underwent an episiotomy without a forceps delivery.
The eating and exercise history of women with secondary amenorrhea and failure of ovulation using CC was studied in 14 consecutive women on a GnRH-a program. All had a history of an eating or exercise disorder. At the time of the interview, 7 women continued to have an eating or exercise disorder. There were 15 pregnancies (12 women) with 12 live births, of which 4 weighed less than 2,500 g. Infertility specialists should inquire routinely about a woman's body weight and eating and exercise behaviors, and consider treatment for these before prescribing drugs to induce ovulation.
Explore the source record for details and available documents.
Food intake was weighed and recorded daily during one complete menstrual cycle in 18 healthy normally menstruating women. Urinary luteinizing hormone indicated the time of ovulation. Mean daily intakes of energy, macronutrients, and alcohol were calculated for five phases during the menstrual cycle: menses, postmenses, ovulatory, postovulatory, and premenses. Weekly variations were also measured. Energy intake was lowest during the ovulatory phase compared with postovulatory, premenses, and menses phases (p less than 0.05). The maximum difference, 1.36 MJ (324 kcal)/d, occurred between ovulatory and postovulatory phases and was twofold higher than the increase of 0.64 MJ (152 kcal)/d observed at weekends. This reduction of food intake at ovulation has not been previously described in humans. It coincides with the expected peak in circulating estrogen levels and is consistent with the hypothesis in animal models that estrogen is an appetite suppressant.
We studied biochemical measures of vitamin B-6, zinc, and copper in a group of 96 women and vitamin A and vitamin E concentrations in 89 women, all suffering from an eating disorder. Twenty-three control subjects were studied. Eating-disorder patients not taking vitamin or mineral supplements had significantly higher plasma concentrations of vitamins A and E than did control subjects (also not taking supplements). No difference was found in indices indicating vitamin B-6 status or in plasma zinc or copper concentrations. Self-induced vomiting was the only significant predictor of upper-quartile vitamin A concentrations. Upper-quartile vitamin B-6 activations (indicating lower vitamin B-6 activity) were significantly predicted only by low actual body weight. These results suggest that supplementation of micronutrient intake needs only to be considered for those eating-disorder patients at low weight and then only with water-soluble vitamins.
One hundred and fifty-eight attenders at general practices and family-planning clinics, and 20 young female doctors volunteered to complete a questionnaire about how women take the oral contraceptive pill, their knowledge of the Pill and their attitudes to withdrawal bleeding. Forty-three per cent of female patients has used the Pill to alter the time of withdrawal bleeding. Twenty-two per cent of female patients had taken the Pill daily for more than six weeks on at least one occasion and all reported positive experiences. However, 83% of female patients believed that it was necessary to bleed monthly when taking the Pill and 69% of the female patients believed that continuous use of active medication is undesirable. The over-all knowledge of the Pill was poor and 43% of female patients did not know what to do if they missed two consecutive Pills. Female doctors were better informed but had similar attitudes about the Pill to those of other women. Forty-six per cent of the female patients and 55% of young female doctors would chose to bleed at intervals of three months or greater if they could determine their own Pill regimen.