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PubMed1998

Use of steroids, tocolytics and antibiotics in the management of preterm labour in Wales.

The management of preterm labour (PTL) remains contentious. Many regimes are used for the management of this common condition and in utero transfer of pregnant women to another unit is not unusual in British practice. Medical staff in the accepting unit may have little or no experience with one or more drug regimes used in this condition which used in isolation and in combination with others may have disastrous consequences for the mother. We have assessed the variation in practice for the management of preterm labour in all consultant-led obstetric units in Wales using a postal questionnaire. The percentage of units with written guidelines for the management of PTL was 40%. All units used corticosteroids although the regimes used varied. Fourteen of the 15 units used tocolytics. Ritodrine and nifedipine were the most frequently used tocolytics but there was much variation in practice. Only seven (46.7%) units used antibiotics and five of these were randomising women in PTL to the ORACLE study. Postal surveys may not reflect accurately what actually happens in clinical practice. These data demonstrate that there is no common policy for the management of PTL even in a relatively small region such as Wales. We would suggest that the development of a regional policy for the management of preterm labour would be a significant step forward in the management of this controversial, but important cause of neonatal morbidity and mortality.

Journal Article↗
PubMed1993

Methadone maintenance treatment in prisons: The New South Wales Experience.

This paper uses the New South Wales experience with methadone maintenance treatment in prison to address the question: should methadone maintenance treatment be provided in Australian prisons for opioid-dependent prisoners? First, it outlines three rationales for providing drug dependence treatment in prisons: as a way of giving prisoners access to community-based forms of drug treatment in the prison setting; as a measure to reduce recidivism in opioid-dependent prisoners; and as a measure to prevent the transmission of HIV and other infectious diseases within prisons, and to the sexual partners of prisoners on their release. Secondly, it reviews the kind of research evidence that supports the effectiveness of community-based methadone maintenance treatment in Australia. Thirdly, the effectiveness of the New South Wales Prison Methadone Programme, one of the few prison-based methadone programmes in the world, is evaluated in the light of the available research evidence.

Journal Article↗
PubMed1998

Survey of amphetamine prescribing in England and Wales.

A survey was undertaken of senior medical specialists in drug dependence in England and Wales, enquiring about their attitudes and practices concerning the prescription of amphetamines to dependent users. Of the 149 who replied, 60% saw a role for amphetamine prescribing, with 46% currently doing so. Of those who did not prescribe, 32% would like to have done so. Respondents often did not know if general practitioners in their area were prescribing amphetamines. Many could not estimate the percentage of injecting amphetamine users in their area. There was a wide range in the dosage of amphetamine prescribed with a mean maximum of 66 mg. There was agreement about entry criteria for prescribing programmes and also on ways of monitoring those receiving amphetamine. Our results indicate that amphetamine prescribing is widespread in England and Wales although there is little scientific evidence for its efficacy. We have developed some guidelines for good practice, drawing on our own and others' experience.

Journal Article↗
PubMedDate not supplied

Cancer incidence among first generation Scottish, Irish, West Indian and South Asian migrants living in England and Wales.

OBJECTIVES: To examine the incidence of cancers among persons born in Scotland, Northern Ireland, the Irish Republic, Caribbean Commonwealth and Indian subcontinent and living in England and Wales. METHODS: Longitudinal Study of 1% of population of England and Wales followed from 1971 to 1989. Standardised incidence ratios (SIRs) were derived for commonly occurring cancers and all cancers using the age-sex-specific rates for all females and all males in the Longitudinal Study. RESULTS: The incidence of all malignant neoplasms among West Indians (females SIR = 67, male SIR = 70) and Indians (female SIR = 32, male SIR = 52) was low. Among South Asians, this pattern was consistent for Hindus, Sikhs and Moslems. Scottish females showed raised incidence of lung cancer (SIR = 149) and those from the Irish Republic of oral cavity and pharynx (SIR = 321), oesophageal (SIR = 219) and liver (SIR = 373) cancers. Among Northern Irish females, incidence of lung cancer (SIR = 193) was raised. West Indian and South Asian females showed low incidence of breast cancer (SIR = 55 and 45, respectively). High incidence of laryngeal (SIR = 229) and renal (SIR = 203) cancers was observed for Scottish males and of oral cancer (SIR = 259) for males from the Irish Republic. At ages 15-64, raised incidence of prostate cancer (SIR = 129) and of leukaemia (SIR = 252) was also observed for men from the Irish Republic. Northern Irish males showed raised incidence of stomach cancer (SIR = 200). CONCLUSION: This study describes patterns of cancer incidence among migrant groups, most of which reflect environmental influences. This has challenging implications for sensitive targeting of primary interventions. It is important not to be complacent about lower risks of main cancers among West Indians and South Asians. In all Longitudinal Study members, breast cancer was the most common malignancy among females and lung cancer among males. This was also true for all migrant groups with the exception of Northern Irish women for whom lung cancer was the most common.

Adolescent↗
PubMed2002

Inclusion of students who are deaf or hard of hearing in government schools in new South wales, australia: development and implementation of a policy.

The inclusion of students who are deaf or hard of hearing in Department of Education and Training (government) schools in the state of New South Wales, Australia, is supported through a policy known as the Special Education Policy (NSW Department of School Education, 1993). The policy is operational for all students with disabilities, learning difficulties, or behavior disorders, regardless of their educational provision. This article focuses on how the policy and continuum of services have developed and the attitudes of stakeholders toward both policy and practice. The article begins by framing the policy in terms of legal mandates and then gives an overview of current educational provisions, followed by a discussion of attitudes toward inclusion as held by stakeholders in New South Wales government schools. The article concludes by attempting to assess the potential effects of both policy and practice on students who are deaf or hard of hearing.

Journal Article↗
PubMed1982

Measles in England and Wales--I: An analysis of factors underlying seasonal patterns.

Examination of the weekly measles notifications for England and Wales, 1950-1979, reveals a regular biennial pattern of major and minor epidemics before the national immunization programme began in 1968, followed by an annual cycle of minor epidemics. Each year the reported incidence reaches its annual low between weeks 36 and 39, very close to the opening of primary schools. Analysis of these data with a simple mass action model reveals that the underlying transmission parameter has had a similar annual pattern in years of major and minor epidemics. The transmission parameter rises three times each year, coinciding with opening of school terms, and falls with school term and mid-term holidays. This pattern of the transmission parameter has been maintained in the decade since national vaccination began, indicating that the importance of schools in the annual dynamics of measles has not changed. The analysis further suggests that the national measles vaccination programme has not lowered the total number of individuals susceptible to measles in England and Wales.

Disease Outbreaks↗
PubMed1984

Mortality of Chinese in New South Wales, 1969-1978.

A high proportion of adult Chinese living in New South Wales were born elsewhere, most commonly in China. Mortality among these males from 1969-78 was due mainly to ischaemic heart disease (IHD) cancer and cerbrovascular disease. Females showed a similar general pattern. Chinese males had double the risk of dying from cerebrovascular death, but death rates from IHD were similar to those of the Australian population, although the risk of IHD was significantly lower in Chinese females. Male Chinese had significantly higher rates for cancers of the nasopharynx, lung, intestines and rectum, and stomach and liver, whereas females had a significantly higher risk for cancers of the lung and stomach. Mortality patterns were similar to those for United States Chinese. Apart from cancer, relatively little is known about the causes of death in China. Crude death rates only are available for very broad categories of causes of death. Most of our information on Chinese general mortality comes from studies of migrants, or their descendants overseas, mainly in South-East Asia and the USA. In the latter more detailed studies have been made of cancer mortality and cancer incidence than of other causes. The purpose of our study was to describe mortality in Chinese, born in China, and dying in the state of New South Wales from 1969-78.

Adolescent↗
PubMed1995

Antenatal care in South Wales 1934-1962.

The records of the Special Antenatal Clinics held by the Rhondda Urban District Council between 1934 and 1962 at the Carnegie Welfare Centre in Trealaw, South Wales, were studied. An analysis is presented of structured samples taken from the clinics of one month in each quinquennium from 1934 to 1962. The collected material is then grouped into a period covering the pre-war and wartime years of 1934-1946, and a post-war period from 1950 to 1962. Examination of these sections shows developments in the mid-twentieth century both in the recording of medical histories and in the care of childbirth in this area of Wales.

Female↗
PubMed1981

The epidemiology of lower limb ischaemia in a new South Wales rural community.

A cross-sectional survey was carried out in the Bangalow Valley on the far north coast of new South Wales to determine the prevalence of lower limb ischaemia. A study was made of 80.2% of the population aged thirty years and over. The presence or absence of peripheral vascular disease was determined by clinical history, clinical examination, and measurement of peripheral arterial pressures with a Doppler ultrasonic velocity detector. Twelve out of 232 (5.2%) males and seven out of 282 (2.5%) females had symptomatic lower limb ischaemia. From these data the predicted incidence of lower limb ischaemia in the sixth and seventh decades in New South Wales is 40/10,000/year in males and 14.5/10,000/year in females. These N.S.W. data re compared with studies in the United Kingdom, the United States of America, and Switzerland, and similarities are noted indicating the universal nature of lower limb atherosclerosis in developed countries.

Adult↗
PubMed1996

Knowledge of cancer risk reduction practices in rural towns of New South Wales.

The Australian Cancer Society has published guidelines for recommended risk reduction strategies for breast, cervical, smoking-related and skin cancer. While knowledge may not be sufficient for change, it is argued to be necessary for change to occur. A measure of the level of health knowledge in the community can be useful for health promotion practitioners, identifying where health messages are not reaching their proposed targets. Our aims were to examine the level of knowledge about risk reduction practices for breast, cervical, smoking-related and skin cancers, for a rural New South Wales sample, and to examine sex and age effects on knowledge levels. A survey of 2846 women and 1732 men from rural New South Wales, which used an unprompted recall strategy, revealed some notable deficits in recall of cancer risk reduction practices: only 26 per cent of women identified mammograms as a risk reduction strategy for breast cancer; only 5 per cent of women knew at which ages mammograms should start and stop; only 6 per cent of women could identify when Pap tests should be discontinued; less than half of the sample could identify common solar protection strategies; and less than one-third of people identified passive smoking as a lung cancer risk.

Adolescent↗
PubMed1997

Effectiveness of two strategies for dissemination of sun-protection policy in New South Wales primary and secondary schools.

With rising rates of skin cancer in Australia, there is a need to examine strategies to reduce sun exposure among children. This study aimed to determine the effectiveness of a multifaceted dissemination strategy compared with a simple mail-out strategy in promoting the adoption of comprehensive SunSmart skin protection policies and practices in primary and secondary schools in New South Wales. It also aimed to examine characteristics of the primary and secondary schools that adopted a comprehensive SunSmart policy before and after the intervention. Four hundred randomly selected primary schools and all 381 high schools in New South Wales were randomised to one of two intervention groups. Pretest and post-test surveys of principals were undertaken in 1991 and 1992. Intervention 1 was a simple mail-out of a sample sun-protection policy kit. Intervention 2 comprised the mail-out of the policy kit and a follow-up mail-out of a staff development module. There was a strong intervention effect on adoption of a comprehensive sun-protection policy in primary schools (21 per cent for the 'mail' group compared with 44 per cent for 'mail and staff support' group) but not in high schools (6 per cent and 11 per cent). There was little relationship between adoption of a comprehensive sun-protection policy and sun-protection practices in primary or secondary schools. Further research is needed to determine the most effective ways of ensuring that adoption of a comprehensive sun-protection policy results in effective implementation of sun-protection practices in schools.

Adolescent↗
PubMed1999

Resistance to ciprofloxacin in non-typhoidal salmonellas from humans in England and Wales-the current situation.

OBJECTIVE: To report on the prevalence of isolates with ciprofloxacin resistance in non-typhoidal salmonellas from humans in England and Wales in 1997. METHODS: All non-typhoidal salmonellas referred to the Laboratory of Enteric Pathogens in 1997 were screened for resistance to ciprofloxacin at 0.125 and 1.0 mg/L and nalidixic acid at 16 mg/L, and results were compared to those for 1994. Full minimal inhibitory concentrations (MICs) of these antimicrobials were also determined for a selection of isolates resistant to ciprofloxacin at 0.125 mg/L but sensitive at 1.0 mg/L, and for all isolates resistant at 1.0 mg/L. RESULTS: Since 1994 there have been increases in the occurrence of resistance to ciprofloxacin (MICs: 0.25-1.0 mg/L) in Salmonella enterica serotypes Enteritidis, Typhimurium, Virchow and Hadar. Of particular importance have been increases in the occurrence of resistance in multiresistant S. Typhimurium DT 104, and also in S. virchow, a serotype with a propensity for causing extraintestinal infections in humans. High-level resistance (MIC >/=2.0 mg/L) was uncommon and was identified in only a few strains, all from patients with a history of recent foreign travel. CONCLUSIONS: There is a strong temporal association between increases in the occurrence of ciprofloxacin resistance in Salmonella serotypes Typhimurium, Virchow and Hadar from humans in England and Wales and with the licensing for use in food animals in the UK of the related fluoroquinolone antibiotic enrofloxacin; in contrast, for S. enteritidis ciprofloxacin resistance was most common in a phage type associated with foreign travel. It is hoped that recent recommendations for the use of fluoroquinolone antimicrobials in food animals in the UK will result in a reduction in the occurrence of resistance to ciprofloxacin in zoonotic salmonellas causing infections in humans.

Journal Article↗
PubMedDate not supplied

Guidelines for gynecological cancer-an audit of current network documents in England and Wales.

The objective of this study was to assess the adequacy of network cancer guidelines paying particular attention to referral criteria, referral routes, tumor diagnosis, staging, and suggested management and care pathways for ovarian and endometrial cancer. Guidelines from 15 regions in England and Wales were analyzed quantitatively and qualitatively as a prospective audit of predefined data items and subsequently agreed management recommendations. Details of unit and center clinicians were included in a minority of documents (2 to 5/15). Multidisciplinary team membership was not usually offered (6/15). Among the least reported data items were histopathology minimum dataset for endometrial cancer and an algorithm for management or summary and clinical symptoms and signs for both cancers. Among the most reported data items were hysteroscopy and ultrasound scanning for endometrial cancer and CA125 and chemotherapy for ovarian cancer. Qualitative analysis revealed differing criteria for the use of endometrial biopsy and radiotherapy in endometrial cancer, for lymphadenectomy and management of recurrent disease in ovarian cancer, and for referral pathways and the use of computed tomography/magnetic resonance (MR) scanning in the assessment of either disease. This study concludes that consideration should be given to the development of national guidelines or templates to ensure consistency of management for gynecological malignancy in England and Wales.

Female↗
PubMed1976

Gastro-intestinal parasites of feral cats in New South Wales.

A total of 146 feral cats from several localities in New South Wales were examined for the presence of gastro-intestinal parasites. The cestodes recorded, and their prevalence, were Taenia taeniaeformis (21.9%), Spirometra erinacei (61.0%) and Dipylidium caninum (11.6%). One animal contained 31 T. serialis scolices considered to be the contents of a recently ingested Coenurus serialis. The common nematodes encountered and their prevalence were Toxocara cati (21.9%) and Ancylostoma spp (23.3%). Uncinaria stenocephala were found in 2 cats and a stomach wall tumour containing Cyathospirura dasyuridis was found in 1 cat, An acanthocephalan resembling Oncicola canis was the most prevalent parasite among feral cats in this survey. High burdens of S. erinacei, D. caninum, Ancylostoma spp and Oncicola sp were found. Samples from 4 localities in New South Wales were compared and there were major differences in the prevalence of T. taeniaeformis, D. caninum and T. cati. Ancylostoma spp occurred only in the Sydney (53.2%) and the Warren (4.8%) areas. Oncicola sp was not present in the Sydney area, but occurred in the Young area in 23.5% of the feral cats examined and in the Warren area (33.3%) and was most prevalent in the Menindee area (79.2%).

Animals↗
PubMed1976

Helminth parasites of the fox (Vulpes vulpes) in New South Wales.

A total of 930 foxes (Vulpes vulpes) from New South Wales were examined for the presence of gastro-intestinal helminth parasites. The cestodes were represented by Taenia pisiformis with a prevalence of 15.7%, T. serialis (22.6%), T. taeniaeformis (0.1%), Spirometra erinacei (28.7%) and Dipylidium caninum (8.3%). No specimens of T. ovis, T. hydatigena or Echinococcus granulosus were encountered. Toxocara canis was the most prevalent nematode and occurred in 35.2% of foxes. Other nematodes encountered were Uncinaria stenocephala with a prevalence of 30.6%, Ancylostoma caninum (7.5%), Trichuris vulpis (2.7%) and Cyathospirura dasyuridis (0.3%). Oncicola sp was found in 1 fox. The prevalence of various parasites in foxes varied between different regions of New South Wales. All parasites, except S. erinacei and D. caninum were less prevalent in the western regions of the State. T. serialis and T. canis were more prevalent in male than female foxes. Of the parasites found T. serialis had the highest average burden per infected fox (17.9) and T. pisiformis had the lowest (2.8).

Animals↗
PubMed1987

Pyrrolizidine alkaloid poisoning of sheep in New South Wales.

Pyrrolizidine alkaloid poisoning of sheep in New South Wales was reviewed, based on the records of the New South Wales Department of Agriculture's Regional Veterinary Laboratories. The plant species causing significant mortalities were Echium plantagineum and Heliotropium europaeum. The syndrome of hepatogenous chronic copper poisoning was more frequently diagnosed than primary pyrrolizidine alkaloid poisoning, particularly when grazing E. plantagineum. The data indicated that adult crossbred ewes were the most commonly affected class of sheep.

Animals↗
PubMed1979

Childhood cystinuria in New South Wales. Results in children who were followed up after being detected by urinary screening in infancy.

Homozygous cystinuria was diagnosed in 45 children and 19 of their siblings in the course of routine urine screening of 6-week-old infants in New South Wales. These children were followed for up to 14 years. During this time there were 5 clinical episodes of renal disease which could be ascribed to cystinuria. There was normal mental development in all the children except one. Of 49 children over 3 years, 4 had height centiles less than the midparent height centile, while 45 had height centiles equal to or above the midparent centiles. Family testing in these 45 cases showed that 60% were type I cystinurics, and 35% were of the mixed or compound type (5% were not classified). Data from the parents and grandparents showed that renal tract calculi had occurred in 14 of them. This study shows that children with homozygous cystinuria, detected by urinary screening in infancy, rarely have renal symptoms. Mental development was normal as was growth in height. There was an increased incidence of noncystine stone formation among the relatives of these children. The incidence of homozygous cystinuria in New South Wales in one in 17 286.

Adolescent↗
PubMed1992

National survey of current arrangements for diversion from custody in England and Wales.

OBJECTIVES: To assess the extent and nature of psychiatric assessment schemes based at magistrates' courts in England and Wales for the early diversion of mentally disordered offenders from custody and to determine the response of the NHS to new initiatives concerning alternatives to custody for this group. DESIGN: Postal survey of the probation service, petty sessional divisions, mental health provider units, and district purchasing authorities in England and Wales. SUBJECTS: All chief probation officers (n = 55), clerks to the justices (n = 284), managers of mental health provider units (n = 190), and purchasers of mental health services (n = 190) in each of the district health authorities. MAIN OUTCOME MEASURES: Number of psychiatric assessment schemes, practical difficulties in their operation, extent of regular liaison with health and social services; current and future intentions to purchase or provide services for diversion from custody. RESULTS: Data were obtained from every magistrates' court. Forty eight psychiatric assessment schemes were identified with another 34 under development. Particular problems were lack of adequate transport arrangements, difficulties with hospital admissions, and overdependence on key people. There was little liaison between health, social services, and members of the criminal justice system. Twenty five of the 106 purchasers who responded had a policy dealing with diversion, and 39 had a scheme under development; 56 purchasers had no current or future plans about diversion. Sixty nine of the 150 providers who responded reported that diversion was included in their current or next business plan. CONCLUSION: Schemes to divert mentally disordered offenders from the criminal justice system are often hampered by lack of adequate transport arrangements, difficulties in hospital admissions, and overdependence on key people.

Commitment of Persons with Psychiatric Disorders↗