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PubMed2004

Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: I. Effectiveness.

CONTEXT: Although individual components of neonatal intensive care have proven efficacy, doubts remain about its overall effectiveness. OBJECTIVE: To determine the changes in effectiveness of neonatal intensive care for extremely low birth weight (ELBW) infants over 2 decades. DESIGN: Population-based cohort study of consecutive ELBW infants born during 4 distinct eras: 1979-1980, 1985-1987, 1991-1992, and 1997, all followed to at least 2 years of age. SETTING: The state of Victoria, Australia. PATIENTS: All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979-1980 [n = 351]; 1985-1987 [n = 560]; 1991-1992 [n = 429]; 1997 [n = 233]). Survivors were assessed at 2 years of age by pediatricians and psychologists blinded to perinatal details. The follow-up rates were high for each ELBW cohort (1979-1980: 100% [89 of 89]; 1985-1987: 100% [212 of 212]; 1991-1992: 98% [237 of 241]; 1997: 99% [168 of 170]). MAIN OUTCOME MEASURES: Survival and quality-adjusted survival rates at 2 years of age. RESULTS: The survival rate to 2 years of age improved significantly between successive eras (absolute increase and 95% confidence interval: 1985-1987 vs 1979-1980, 12.5% and 6.3%-18.4%; 1991-1992 vs 1985-1987, 18.3% and 12.1%-24.4%; 1997 vs 1991-1992, 16.8% and 9.2%-23.9%), as did the quality-adjusted survival rate (absolute increase: 1985-1987 vs 1979-1980, 12.4%; 1991-1992 vs 1985-1987, 13.8%; 1997 vs 1991-1992, 13.2%). Overall, the survival rate increased from approximately 1 in 4 (25%) in 1979-1980 to 3 in 4 (73%) in 1997, and the quality-adjusted survival rate also increased threefold, from 19% in 1979-1980 to 59% in 1997. The biggest gains in survival and quality-adjusted survival in the most recent era were in infants in lighter birth-weight subgroups. CONCLUSION: The effectiveness of neonatal intensive care for ELBW infants in Victoria improved progressively from the late 1970s to the late 1990s.

Child, Preschool↗
PubMed2004

An epidemiologic study of isolated cleft lip, palate, or both in Victoria, Australia from 1983 to 2000.

OBJECTIVES: To report the epidemiological characteristics of isolated cleft lip, cleft palate or both (CL +/- P and CP) using population-based data in Victoria, Australia. DESIGN: Descriptive study of a cohort of children born between 1983 and 2000 notified to the Victorian Birth Defects Register by multiple ascertainment sources. PARTICIPANTS: Data were collected on patients identified with CL +/- P and CP without associated defects classified as live births, stillbirths, neonatal deaths, and terminated pregnancies < 20 weeks' gestation following prenatal identification. Information was collected on sex, plurality, maternal age, and country of birth. RESULTS: The overall prevalence (per 10,000 pregnancies) of CL +/- P was 7.8 (95% confidence interval [CI] = 7.30, 8.33; cleft lip [CL] 3.3; 95% CI = 2.97, 3.65, CL+P 4.5; 95% CI = 4.13, 4.91) and cleft palate (CP), 4.3 (95% CI = 3.89, 4.66). The prevalence of CL + P was higher among stillbirths, neonatal deaths, and terminated pregnancies than CL (without CP) and CP. Boys were at greater risk than girls for CL +/- P and girls at greater risk than boys for CP. Regardless of cleft type, there was a nonsignificant excess of clefts among singleton births than multiple births and no related effects of maternal age or country of birth. CONCLUSIONS: The prevalence of isolated CL +/- P and CP in Victoria parallels other population-based studies of the same conditions. Inclusion of stillbirths, neonatal deaths, and terminations had little impact on rates. The effect of sex and plurality on cleft type is consistent with the literature, but the effects of maternal age and country of birth remain equivocal. Further studies focusing on certain ethnic groups are warranted to explain the higher rates observed.

Analysis of Variance↗
PubMed2006

An epidemiologic study of orofacial clefts with other birth defects in Victoria, Australia.

OBJECTIVE: To describe the epidemiological characteristics of oral clefts occurring with other birth defects in Victoria, Australia. METHODS: Information on infants and fetuses reported to the Victorian Birth Defects Register from 1983 to 2000 was collected. Birth defects were classified as Pierre Robin Sequence, chromosomal anomaly, nonchromosomal syndrome, single-system defect, or multiple-system defect. Pregnancy outcome and associations with selected infant and maternal features was examined. RESULTS: One third of the 2022 oral clefts recorded had other birth defects. There were more overall cleft cases involving multiple systems and chromosomal anomalies than any other birth defect group. The prevalence ratio of cleft lip with or without cleft palate (CL/P) was highest among multiple-system defects and chromosomal anomalies. Perinatal mortality was high, with termination of pregnancy highest in CL/P and chromosomal anomalies and multiple-system defects. There was a nonsignificant excess of clefts among multiple births. Women >or=40 years old had a tendency toward having a child with a cleft palate and another birth defect. There was an increased likelihood that women born in the U.K. would have a baby with CL/P and another birth defect. CONCLUSIONS: This is among the first reports in Victoria, Australia, describing oral clefts and other birth defects and associations between infant and maternal factors. Although some findings confirmed other population-based studies, some continued to be at variance. Nonetheless, the data derived support examination of babies diagnosed with clefts for associated comorbidities.

Abnormalities, Multiple↗
PubMed1996

Interlaboratory variation of GHb assays in Victoria, Australia.

OBJECTIVE: To determine the extent of interlaboratory variation and accuracy in the measurement of glycated hemoglobin (GHb). RESEARCH DESIGN AND METHODS: All laboratories that measure glycated hemoglobin in the State of Victoria, Australia, were invited to participate, and positive responses were received from 27 to 30 laboratories. An aliquot of blood drawn from three patients with diabetes and varied glycemia and from one nondiabetic subject was sent to each participating laboratory. Distribution of results was analyzed according to the reported results and their variance from an assigned reference value and were expressed as differing from this latter value as percentage bias and in absolute terms. A bias > or = 10% or an absolute difference of > or = 1% HbA1c from the reference value was considered significant. RESULTS: Reported results for the same blood sample ranged from 4.1 to 5.8%, 5.1 to 8.2%, 6.7 to 9.3%, and 10.1 to 14.7% for the specimens from the nondiabetic subject and the diabetic patients with good, moderate, and poor glycemic control, respectively. The proportion of laboratories with results that differed by > or = 10% bias from the reference value were 39% (12 of 30), 29% (9 of 30), 16% (5 of 30), and 32% (10 of 30), and the proportion reporting results that differed by > or = 1% HbA1c in absolute terms from the reference values were 3% (1 of 30), 6% (2 of 30), 16% (5 of 30), and 23% (7 of 30) for the specimens from the nondiabetic subject and the diabetic patients with good, moderate, and poor glycemic control, respectively. CONCLUSIONS: A substantial degree of interlaboratory variation for GHb measurement exists in Victoria, Australia. This may lead to difficulties in interpretation when GHb is assayed by different laboratories in the same patient over time. Interlaboratory standardization may be achievable by calibration to a standard assigned by a reference laboratory and distributed to all laboratories measuring GHb.

Diabetes Mellitus↗
PubMed2006

Measles surveillance in Victoria, Australia.

OBJECTIVE: Many countries are implementing measles elimination strategies. In Australia, the State of Victoria has conducted enhanced measles surveillance since 1997 using case interviews and home-based specimen collection for laboratory confirmation. We attempted to identify features of notified cases that would better target surveillance resources. METHODS: We retrospectively classified notifications received from 1998 to 2003 as having been received in an epidemic (one or more laboratory-confirmed cases) or an interepidemic period (no laboratory-confirmed cases). We labelled the first case notified in any epidemic period that was not laboratory-confirmed at the time of notification as a "sentinel case". To maximize detection of sentinel cases while minimizing the follow-up of eventually discarded notifications, we generated algorithms using sentinel cases and interepidemic notifications. FINDINGS: We identified 10 sentinel cases with 422 interepidemic notifications from 1281 Victorian notifications. Sentinel cases were more likely to report fever at rash onset (odds ratio (OR) 15.7, 95% confidence interval (CI) CI: 2.1-688.9), cough (OR 10.4, 95% CI: 1.4-456.7), conjunctivitis (OR 7.9, 95% CI: 1.8-39.1), or year of birth between 1968 and 1981 (OR 31.8, 95% CI: 6.7-162.3). Prospective application of an algorithm consisting of fever at rash onset or born between 1968 and 1981 in the review period would have detected all sentinel cases and avoided the need for enhanced follow-up of 162 of the 422 eventually discarded notifications. CONCLUSION: Elimination strategies should be refined to suit regional and local priorities. The prospective application of an algorithm in Victoria is likely to reduce enhanced measles surveillance resource use in interepidemic periods, while still detecting early cases during measles outbreaks.

Adolescent↗
PubMed2006

Measuring the impact of intimate partner violence on the health of women in Victoria, Australia.

OBJECTIVE: Using burden of disease methodology, estimate the health risks of intimate partner violence (IPV) among women in Victoria, Australia. METHODS: We calculated population attributable fractions (from survey data on the prevalence of IPV and the relative risks of associated health problems in Australia) and determined health outcomes by applying them to disability-adjusted life year estimates for the relevant disease and injury categories for Victoria, Australia for 2001. FINDINGS: For women of all ages IPV accounted for 2.9% (95% uncertainty interval 2.4-3.4%) of the total disease and injury burden. Among women 18-44 years of age, IPV was associated with 7.9% (95% uncertainty interval 6.4-9.5%) of the overall disease burden and was a larger risk to health than risk factors traditionally included in burden of disease studies, such as raised blood pressure, tobacco use and increased body weight. Poor mental health contributed 73% and substance abuse 22% to the disease burden attributed to IPV. CONCLUSION: Our findings suggest that IPV constitutes a significant risk to women's health. Mental health policy-makers and health workers treating common mental health problems need to be aware that IPV is an important risk factor. Future research should concentrate on evaluating effective interventions to prevent women being exposed to violence, and identifying the most appropriate mental health care for victims to reduce short- and long-term disability.

Adolescent↗
PubMed1998

The implications of legislative change on the future of psychiatric nursing in Victoria.

OBJECTIVE: The aim of this paper is to explore the potential implications of the Nurses Act introduced in 1993 upon psychiatric nursing in Victoria. Essentially this Act abolished the existing separate undergraduate education for psychiatric nursing. The focus of this paper is to explore the potential implications of this legislative change to the psychiatric nursing profession, particularly in light of relevant research findings. METHOD: In order to ascertain the impact of legislative change, a survey of psychiatric nursing content was conducted in Schools of Nursing throughout Victoria. RESULTS: A 100% response rate was achieved. The responses indicated that little alteration had been made to existing-general nursing courses to incorporate the change in legislation. The compulsory psychiatric nursing content varies from nil to 17.4% of the total curriculum. CONCLUSIONS: The theory and practice of psychiatric nursing constitute only a small proportion of undergraduate curricula. In view of the comparative unpopularity of psychiatric nursing as a career option for undergraduate students, the implications of this situation for the future psychiatric nursing workforce are serious.

Career Choice↗
PubMed2003

Epidemiology of congenital hearing loss in Victoria, Australia.

The aim of this study was to report the incidence, prevalence and clinical characteristics of congenital hearing loss sufficient to require hearing aid fitting in the first 6 years of life for the 1993 birth cohort of the state of Victoria (population 4.4 million), Australia. In 1993, 64,116 infants born in the state of Victoria survived the neonatal period. Subjects included all children with congenital hearing loss for which hearing aids were fitted, at any time up to and including 31 December 1999, when the youngest member of the cohort reached 6 years of age. Data on the degree, type and etiology of hearing loss were available from the Australian Hearing database for all subjects. Sociodemographic and health data were available from the Victorian Infant Hearing Screening Program (VIHSP) and parent questionnaires. The known prevalence of identified congenital hearing loss increased as the cohort aged. By the time the youngest member had reached the age of 6 years, 134 children (78 boys, 56 girls) had been fitted with hearing aids for permanent congenital hearing loss of any degree (2.09/1000). Fifty-four (40%) of these had known mild losses (20-40 dB HL). The prevalence of known moderate or greater loss (> 40 dB HL) was 1.12/1000; the data suggest that over 90% could have been detectable by neonatal hearing screening. A further seven children from the birth cohort were fitted with hearing aids due to acquired forms of hearing loss (0.11/1000). The etiology was known in only 57 (43%) congenital cases, with known non-syndromal genetic causes accounting for 21 (37%) of these. This study reports on the prevalence of congenital hearing loss requiring hearing aid fitting for an entire birth cohort. These data indicate the possible yield from neonatal screening, and hence the likely benefit of such screening. For a large proportion of cases, the etiology remains unknown. These data have implications for health service delivery and illustrate the usefulness of a population database in monitoring the prevalence of congenital hearing loss.

Child↗
PubMed2000

Legionnaires' disease outbreak: Victoria's largest identified outbreak.

This paper describes and analyses some aspects of an outbreak of Legionnaires' disease in Victoria, commencing in late October 1998. In all, 18 cases caused by Legionella pneumophila serogroup 1 were notified within 10 days making this the largest outbreak in Victoria reported to that date. All cases had epidemiological links to an industrial estate in a northern Melbourne suburb. Extensive environmental sampling revealed Legionella bacteria in five cooling towers. Molecular sub-typing techniques were used to compare clinical and environmental isolates. Isolates from one tower had a pulsed-field gel electrophoresis pattern that was indistinguishable from clinical isolates from eight cases. Control of outbreaks caused by Legionella bacteria requires rapid, coordinated responses to linked cases of disease. The Legionella urinary antigen test facilitated a rapid public health response, and culture and molecular sub-typing of clinical specimens assisted in developing epidemiological links.

Adult↗
PubMed2001

Measles immunity among young adults in Victoria.

Measles outbreaks in Victoria in 1999 and 2001 have suggested that a substantial proportion of young Victorian adults may be susceptible to measles infection. We performed a serosurvey of 300 18-30-year-old healthy blood donors and 312 sera retrieved after diagnostic testing for a non-rash illness in patients of the same age group, with the aim of estimating the proportion of young adults in Victoria immune to measles. We also aimed to define more precisely the birth cohorts at risk of measles infection, with cohorts reflecting the measles immunisation policies of previous years. There was no significant difference in measles immunity between the 300 blood donors (79.0%, 95% confidence interval 73.9-83.5) and the 312 patients whose sera had been stored (84.0%, 95% CI 79.4-87.9, p=0.11). There was, however, a significant difference in immunity by birth cohort. In the combined results from both samples, the proportion of people born between 1968 and 1974 who were immune to measles was 88.4 per cent (95% CI 84.1-91.6) while the proportion of those born between 1975 and 1981 was 74.1 per cent (95% CI 68.7-79.1). This study confirms that a substantial proportion of young Victorian adults are susceptible to measles, but also demonstrates that those born between 1975 and 1981 are more likely to be non-immune than those born before 1975. A review of published Australian data supports this conclusion and confirms the need for a measles control program aimed at young adults.

Adolescent↗
PubMed2002

A measles outbreak among young adults in Victoria, February 2001.

In January 2001 a 19-year-old Sydney resident, who had recently returned from India, visited Melbourne for 4 days while infectious with measles. A further 50 measles cases were subsequently identified, mainly among young adults. Thirty-eight cases (75%) were in the same birth cohort (born between 1968 and 1981). This cohort was identified as being at high risk of measles infection after a previous outbreak in Victoria involving 75 cases. These individuals are now aged between 20 and 33 years. A high proportion of cases, 22 (43%) were hospitalised after multiple visits to various healthcare providers. None of the cases had documentation of receiving the recommended number of doses of measles-containing vaccine for their age. Repeated outbreaks clearly demonstrate that young adults remain the group at highest risk of measles infection in Victoria. More targeted strategies for young adults and healthcare workers are required to better protect these groups against measles.

Adult↗
PubMed2002

An outbreak of Barmah Forest virus disease in Victoria.

This report describes the epidemiological and clinical features of an outbreak of 47 cases of laboratory-confirmed Barmah Forest virus disease (BF disease) that occurred in Victoria between January and May 2002. Laboratory-confirmed cases were investigated, and information on travel history and clinical details was collected. Surveillance data from adult mosquito trappings and climatic conditions in the Wellington Shire were also reviewed. The response rate for interviews was 85 per cent (40/47). The most common symptoms reported by cases included arthralgia (95%), lethargy (90%) and maculopapular rash (72.5%). Transmission of BF disease in the Gippsland region was associated with unusually high numbers of Ochlerotatus camptorhynchus mosquitoes. This outbreak was of interest due to the fact that cases of BF disease outnumbered cases of Ross River virus disease (RR disease) in Victoria for the first time since data were available. Similar outbreaks of BF disease, in the absence of RR disease, occurred in Western Australia in 1993 and New South Wales in 1994/1995. Although the majority of BF disease cases reported regular outdoor activity during which they could be exposed to mosquito populations, they infrequently take precautions to limit exposure. Further efforts need to be made to educate people of the importance of using repellents and other personal preventative measures.

Adolescent↗
PubMed2003

Ciprofloxacin resistance emerges in Neisseria gonorrhoeae in Victoria, 1998 to 2001.

Notifications of gonorrhoea in Victoria increased suddenly in the late 1990s, from an average of 375 cases per year from 1993 to 1997, to over 700 cases in 2000. This paper describes the susceptibility to ciprofloxacin of isolates of N. gonorrhoeae in Victoria from 1998 to 2001, and relates these to the reported epidemiologic characteristics of the cases. The proportion of all isolates of N. gonorrhoeae that was resistant to ciprofloxacin rose from 3 per cent in 1998 to 11 per cent in 2001. Among homosexual and bisexual men, resistant isolates remained rare (< 1 per cent). Among heterosexual men and women whose infection was acquired overseas, the proportion of resistant isolates increased from 14 per cent to 51 per cent. Among heterosexual men and women whose infection was acquired in Australia, the proportion of resistant isolates increased from 6 per cent to 14 per cent, and disproportionately involved persons born overseas. Patterns of antibiotic resistance are intimately linked to epidemiological characteristics of cases. Clinical treatment and public health and control strategies for resurgent sexually transmitted infections benefit from the insights of collaborative microbiological and epidemiological surveillance.

Adult↗
PubMed2005

Influenza and pneumococcal vaccine coverage among a random sample of hospitalised persons aged 65 years or more, Victoria.

This study was undertaken to assess the uptake of influenza and pneumococcal vaccination based on provider records of the hospitalised elderly, a group at high risk of influenza and pneumococcal disease. The study used a random sample of 3,204 admissions at two Victorian teaching hospitals for patients, aged 65 years or more who were discharged between 1 April 2000 and 31 March 2002. Information on whether the patient had received an influenza vaccination within the year prior to admission or pneumococcal vaccination within the previous five years was ascertained from the patient's nominated medical practitioner/vaccine provider. Vaccination records were obtained from providers for 82 per cent (2,804/2,934) of eligible subjects. Influenza vaccine coverage was 70.9 per cent (95% CI 68.9-72.9), pneumococcal coverage was 52.6 per cent (95% CI 50.4-54.8) and 46.6 per cent (95% CI 44.4-48.8) had received both vaccines. Coverage for each vaccine increased seven per cent over the two study years. For pneumococcal vaccination, there was a marked increase in 1998 coinciding with the introduction of Victoria's publicly funded program. Influenza and pneumococcal vaccine coverage in eligible hospitalised adults was similar to, but did not exceed, estimates in the general elderly population. Pneumococcal vaccination coverage reflected the availability of vaccine through Victoria's publicly funded program. A nationally funded pneumococcal vaccination program for the elderly, as announced recently, should improve coverage. However, these data highlight the need for greater awareness of pneumococcal vaccine among practitioners and for systematic recording of vaccination status, as many of these subjects will soon become eligible for revaccination.

Aged↗
PubMed2006

A comparison of data sources for the surveillance of seasonal and pandemic influenza in Victoria.

Understanding the characteristics of available influenza or influenza-like illness (ILI) surveillance systems is important for seasonal influenza surveillance and pandemic preparedness. We compared five influenza or ILI data sources in Victoria: notifications of laboratory-confirmed influenza to the Victorian Department of Human Services; hospital emergency presentations and hospital admissions; sentinel general practitioner surveillance; and medical locum service surveillance. Seasonal trends for influenza and ILI activity were similar for all data sources. Community ILI surveillance, operating as sentinel GP, locum service or hospital emergency department surveillance, in conjunction with notification of laboratory-confirmed influenza, would provide adequate inter-pandemic surveillance for influenza in Victoria and, by extension, in any Australian jurisdiction. Other surveillance systems would be needed for early pandemic case or cluster detection, while pandemic monitoring would be better achieved by a more automated system.

Adolescent↗
PubMed1992

Survey of drug-related deaths in Victoria.

OBJECTIVE: To audit drug-related deaths to determine the types of agents causing death in Victoria and to identify possible strategies for prevention of deaths in future. DESIGN: Retrospective audit of Coroner's case records. SUBJECTS: All deaths reported to the Coroner during 14 months from 1 July 1989 to 31 August 1990 in Victoria in which toxicological investigation was undertaken and drugs or poisons were detected and were believed to be a major cause of death. RESULTS: Of the 231 people who had drug-related deaths, 156 were males, 75 were females and the average age was 35.5 +/- 14 years. Heroin and morphine were judged to be the primary cause of death in 35% of subjects and methadone in a further 4.8%. Tricyclic antidepressants were responsible for 14% of deaths, with no deaths due solely to mianserin. Benzodiazepines were the prime cause of death in 6.5% of subjects, but were identified in 40%. Poisons and chemicals were involved in only 3% of deaths. Prescription drugs were primarily responsible for 47% of deaths. Forty-eight per cent of deaths occurred in known injecting drug users and 42% of all subjects had a clear history of antecedent depression. Only one drug-related death was clearly accidental, that of a two-year-old child taking his parents' medications, but the mode of most deaths was not clear, and may not have been suicide. Most deaths occurred outside hospital, only 25 subjects reaching hospital alive. CONCLUSIONS: Barbiturates and chloral hydrate are no longer major causes of drug-related deaths, probably because of decreased availability. Some drug-related deaths, especially those related to tricyclic antidepressants, may be prevented if deaths and hospitalisations due to toxic substances are monitored and the availability and scheduling of toxic substances are regularly reviewed.

Adolescent↗
PubMed1993

Improving the quality of survival for infants of birthweight < 1000 g born in non-level-III centres in Victoria. The Victorian Infant Collaborative Study Group.

OBJECTIVE: To compare between eras the early care of extremely low birthweight (birthweight < 1000 g) infants born in non-level-III centres, that is, centres without a neonatal intensive care nursery, in Victoria, to identify changes associated with the improved quality of survival over time. DESIGN AND SETTING: The early care and outcome for infants of birthweight 500 to 999 g born in a non-level-III centre in Victoria were compared between two distinct eras, 1979-1980 and 1985-1987. PATIENTS AND OUTCOMES: Mortality data to two years of age were available for all infants liveborn in non-level-III centres in the two eras (1979-1980, n = 106; 1985-1987, n = 129). In 1979-1980, 47 of 52 infants transferred to a level-III centre were transported by the Newborn Emergency Transport Service (NETS); in 1985-1987, all 49 infants transferred were transported by NETS. Data concerning the immediate care after birth and during transport to a level-III centre were available for all infants transferred by NETS. All survivors were assessed for sensorineural impairments and disabilities at two years of age, corrected for prematurity. RESULTS: In both eras, 18 children born outside and transferred to a level-III centre survived to two years of age. Survivors in both eras had almost identical mean birthweights and gestational ages. There were trends for more survivors to be referred by paediatricians--1979-1980, 61%; 1985-1987, 83%; odds ratio (OR), 2.94; 95% confidence interval (CI), 0.7-12.4--and for quicker referral times to NETS in 1985-1987 (1979-1980, median 34.5 minutes after birth; 1985-1987, median 21.5 minutes after birth; z = 1.91, P = 0.056). It was possible only during 1985-1987 to monitor transcutaneous PO2 during transport. Durations of transport were similar in both eras. However, only in 1985-1987 was it possible in survivors to reduce significantly the inspired oxygen concentration during transport (median reductions in inspired oxygen, 1979-1980 3.5%; 1985-1987 20%; P = 0.028). Neurological impairment rates were substantially lower in survivors transported in the latter era (1979-1980 72% impaired; 1985-1987 22% impaired; OR 0.14, 95% CI 0.04-0.52). Of the neurological impairments, fewer had severe developmental delay alone (1979-1980 22%; 1985-1987 0%; OR 0.09, 95% CI 0.018-0.46), and the rate of blindness was lower, but the latter difference was not quite statistically significant (1979-1980 28%; 1985-1987 6%; OR 0.21, 95% CI 0.037-1.19). Over all, neurological disabilities were significantly reduced in the latter era (z = 2.93, P < 0.005). CONCLUSIONS: More active management of extremely low birthweight infants before transfer to a level-III centre, including prompt referral and transcutaneous PO2 monitoring during transport, may be important in improving the sensorineural outcome of survivors.

Blood Gas Monitoring, Transcutaneous↗
PubMed1993

Homosexually acquired gonorrhoea in Victoria, 1983-1991.

OBJECTIVE: To identify trends in the rate of gonorrhoea, particularly homosexually acquired infection. DESIGN: A retrospective descriptive study of records stored in a relational database. Records contain epidemiological, demographic and microbiological data of laboratory confirmed cases of gonorrhoea. SUBJECTS: Individuals with gonorrhoea diagnosed microbiologically in Victoria and from whom isolates were subsequently forwarded to the Microbiological Diagnostic Unit, University of Melbourne, for further bacteriological work for the years 1983-1991. RESULTS: Overall, gonorrhoea is declining in Victoria in the general population but has risen sharply in recent years in homosexually active men. An increased number of cases of rectal gonorrhoea in men has also been noted. An age cohort effect in homosexually active men is only evident for the final year of the study. These men do not tend to acquire gonorrhoea abroad and beta-lactamase producing gonococci are rarely found in this group. CONCLUSIONS: Gonorrhoea in homosexually active men has increased disproportionately to the rate of infection in heterosexual men in recent years, despite intensive education and counselling aimed at the gay community. Implications for risk of acquisition of other sexually transmitted diseases, including the human immunodeficiency virus, are evident.

Adult↗