Search

An examination of data from the Queensland Hospital Morbidity Collection indicated that the incidence of ectopic pregnancy as a proportion of total births appeared to have doubled between 1971 and 1980. Similar trends were evident in two other Australian regions. A review of possible biases suggested that the true rate of increase was unlikely to be much lower than that observed. In Queensland, venereal disease notifications in women and admissions to hospital for inflammatory diseases of the female reproductive organs have shown an analogous rise.

In a prospective cohort study of 50,282 gravidas and their offspring, over-all rates of congenital malformations were similar in 1,309 children of women exposed to phenothiazine drugs during the first four lunar months of pregnancy and in 48,973 children of women who were not exposed. There was a suspicion of association between phenothiazine exposure and cardiovascular malformations. In a cohort reduced to 41,337 mother-child pairs for technical reasons, perinatal mortality rates and mean birth weight were similar according to phenothiazine exposure or nonexposure, as were intelligence quotient scores measured at four years of age in 28,358 of the children. Control of potential confounding factors with a variety of multivariate techniques did not materially alter the findings.

In a hospital-based case-control study, the risk of a first episode of major upper gastrointestinal tract bleeding in subjects now known to be predisposed was assessed in relation to the use of nonnarcotic analgesics. For aspirin use within the week before the onset of symptoms, the rate ratio estimates, adjusted for potential confounding, were 15 (95% confidence interval, 6.4 to 34) for regular use (at least four days a week) and 5.6 (confidence interval, 2.7 to 12) for occasional use. For aspirin use discontinued at least one week earlier, the estimate was 1.6 (confidence interval, 0.6 to 4.2). There was no evidence that acetaminophen use increased the risk. For the regular use of other analgesics in the week before onset, the adjusted rate ratio estimate was 9.1 (confidence interval, 2.7 to 31); there were insufficient data to evaluate occasional use. The findings suggest that the risk of bleeding is increased substantially by aspirin, even when used occasionally. With the exception of acetaminophen, other nonnarcotic analgesics may also increase the risk, but they remain to be evaluated individually.

In a cohort of 50 282 gravidas and their offspring in the U.S.A., malformation rates were similar in the children of 35 418 women not exposed to aspirin, 9736 with intermediate exposure, and 5128 women heavily exposed during the first four lunar months of pregnancy. After controlling a wide range of potential confounding factors using multi-variate analysis, the observed and expected numbers for a variety of malformation categories were similar in all three comparison groups. The data suggest that aspirin is not teratogenic.

The risk of hepatocellular carcinoma (HCC) and other internal malignancies was examined in patients with genetic hemochromatosis (GH) by following 208 patients from the time of diagnosis to June 1983 and by comparing the numbers of cancers they developed with expected values constructed from cancer registry incidence data by means of actuarial methods. In addition, cancers occurring in a comparison group of 148 subjects with other chronic nonalcoholic liver diseases (CLD) were determined. Among the GH group, 16 new cases of HCC occurred subsequent to the diagnosis of GH, together with 8 other malignancies. The 16 cases of HCC reflect a 200-fold excess risk, which from all indications represents the first quantitation of the risk of this tumor in GH. There appears to be no increased risk of other malignancies in this disease. Among the CLD group only 1 HCC and 1 other malignancy occurred.

In a cohort of 41 337 gravidas and their offspring in the U.S.A. there was no evidence that aspirin taken in pregnancy is a cause of stillbirth, neonatal death, or reduced birth-weight. The women were divided into those who were not exposed to aspirin (14 956), those with intermediate exposure (24 866), and those who were heavily exposed (1515). Stillbirth-rates were similar for all three groups. Differences in neonatal death-rates and mean birth-weights were slight and none were statistically significant. Trends were opposite among approximately equal numbers of White and Black children.

Oral tocainide and disopyramide were compared in a double-blind, crossover trial in 10 outpatients with stable ventricular premature beats (VPBs). Efficacy was assessed by suppression of VPB activity and reduction of VPB grade during an exercise test and an 18-h Holter recording. An estimate of variance of VPB activity was obtained from two separate placebo periods, and a 95% confidence limit for VPB suppression was calculated. During Holter recording, both drugs produced a significant reduction in VPB frequency and grade (p less than 0.05). During the exercise challenge, tocainide produced a reduction in VPB frequency and grade, but this did not reach statistical significance; VPB frequency was unaltered by disopyramide, but VPB grade was significantly reduced (p less than 0.01).

The relationship between common acquired naevi and malignant melanoma of the skin was assessed in a case-control study. IN 183 patients and 183 controls matched for sex, age and area of residence, there was a strong association between the presence of pigmented naevi on the arms and melanoma. In comparison with persons having no naevi on the arms, the crude relative risk of melanoma was 28.0 when naevi were present. After adjusting for hair colour, propensity to sunburn and lifetime sun exposure, the final risk estimate was 30.1. Family history did not appear to be a determinant of disease independent of the above risk factors.

The effect of admission of different types of unit (coronary care, mixed intensive care, medical ward) on survival after documented acute myocardial infarction was examined in nine public hospitals in Queensland. Australia Among 466 subjects, the over-all crude case fatality rate (CFR) was 20.0%. The CFR, after admission to a coronary care unit (CCU), was 18.3%, to an intensive care unit (ICU), 16.1%, and to wards, 25.3%. Adjustment by a multivariate prognostic score gave standardized CFRs of 19.4% (CCU), 16.3% (ICU) and 23.8% (ward). The relative risk of dying (with 95% confidence limits) for CCU/ICU admissions combined, compared with ward admissions, was 0.67 (0.47 to 0.97) (crude), and 0.78 (0.61 to 1.00) (adjusted for prognostic score). The lowered mortality rates among infarct patients who received special care were most marked among those under 60 years of age. These data indicate that subjects who received special care had an increased survival period after myocardial infarction compared with those admitted to medical wards. However, this study provides no support for establishing a CCU in those provincial hospitals which have an adequate number of ICU beds available for the treatment of myocardial infarction.

The results of two studies, one in Finland and one in the U.S.A., raise the possibility that fetal damage previously attributed to phenytoin and other anticonvulsant drugs, principally phenobarbitone, may be due to epilepsy itself. In the U.S.A., drug-exposure information was collected before delivery in a cohort of 50 282 mother/child pairs. The total malformation rate in 305 children born to epileptic mothers was 10.5%, as against 6.4% in the remainder (p less than 0.01); corresponding rates for major malformations were 6.6% and 2.7%. When the fathers had epilepsy, the malformation-rates in their children were intermediate. The rates did not vary significantly according to maternal anticonvulsants therapy. Mental and motor scores as 8 months of age, and intelligence quotient scores at 4 years were lower in children of epileptic mothers, but not in children of epileptic fathers. The scores showed only random variation according to maternal anticonvulsant therapy. In Finland, 2784 children with craniofacial anomalies were compared with an equal number of normal children; 8 and 2 mothers, respectively, received anticonvulsants, while pregnant, for epilepsy. In that study, the separate effects of the disease and its treatmet could not be evaluated. Both studies did not find evidence of fetal damage when phenobarbitone was taken for indications other than epilepsy.

Resuscitation for cardiac arrest was monitored over 4 years to examine the effect on survival of a change in the ventricular fibrillation (VF) protocol to include the routine early use of "high-dose" intravenous or transbronchial adrenaline. A significant reduction in the immediate survival of patients with VF was seen when the protocol was changed (22% after the change, 43% before). Prior predictors of poor response were similar in each group, except for the number of witnessed arrests, delay until cardiopulmonary resuscitation, and occurrence of endotracheal intubation, but multiple logistic regression showed the use of adrenaline to be an independent predictor of outcome. Early high-dose adrenaline was associated with a reduction in immediate survival in patients with persistent VF.

In a prospective cohort study of 20, 282 gravidas and their offspring, congenital malformation rates were similar in the children of over 1,000 women exposed and those not exposed to two components of Bendectin (doxylamine succinate and dicyclomine hydrochloride) during the first four lunar months of pregnancy. In a cohort reduced to 41,337 mother-child pairs for technical reasons, mean birth weight and perinatal mortality rates were similar according to exposure or nonexposure to either drug, as were intelligence quotient scores measured at four years of age in 28,358 of the children. Control of potential confounding factors with a variety of multivariate techniques did not materially alter these findings.

An electron microscopic examination was made of masses identified as altered heterochromatin in the cytoplasm of childhood leukaemic lymphoblasts, and their relation to 'virus-like' particles (VLP). The masses were found to occur more frequently in leukaemic lymphoblasts than in normal lymphocytes, but abnormally frequent occurrence was a feature of non T rather than T or B lymphoblasts. Although these masses may be derived by phagocytosis of dead cells or cellular material, a more likely origin is by detachment of altered portions of the containing cell's own nucleus. Such in situ alterations in nuclei were seen in leukaemic lymphoblasts but not in normal lymphocytes. A close relation demonstrated between altered chromatin and VLP might suggest that VLP are a response to the presence of damaged chromatin. However, the occurrence in some VLP of solid cores and budding might make it more likely that VLP are viral, with chromatin damage as a morphologically recognizable cytopathic effect of their activity.

Elderly persons particularly are liable to falls which in women often cause major fractures and other injuries. In Australia, some two per cent of deaths of women aged 65 and over are attributed to non-traffic accidents, and the length of hospital care and subsequent disability following fractures are both important aspects of the total morbidity resulting from falls suffered by older persons.

A modification of the method of Carr et al. [1976] for the ultrasonic assessment of liver volume was devised for use with a UI Octoson water delay B mode echoscope, and 32 subjects without clinical history or signs of liver disease were examined. In 9 subjects the measurements were repeated by a separate observer. Comparison of the variance between observers and that between subjects showed that the precision of the method is within acceptable limits, the variance ratio (F) being 13.7 (p less than 0.001). The mean liver volume was 1,545.4 +/- (SD) 255 ml. This finding is in close agreement with previously published data. The liver volume was correlated with body weight, height, body surface area, and body mass index. The liver volume was found to correlate best with body weight using partial correlation analysis. This was in accordance with previously published data, with the exception of that of Koischwitz [1979]. However, variations in weight could only account for 0.43 of the variation in liver volume.

A survey was made of patients admitted to hospitals with a diagnosis of acute myocardial infarction in seven Queensland provincial cities between January 1, and December 31, 1975. Estimates of the incidence of, and mortality from, myocardial infarction are made, and details of the type of care offered, patient characteristics, and length of stay in hospital and intensive care units are presented.

In a follow-up study of 50,282 pregnancies (lasting at least five lunar months) and the offspring, malformations identified before the first birthday, or at death before the fourth birthday, were identified in 3248 children (6.5 per cent). A total of 1870 children exposed in utero to meprobamate or chlordiazepoxide were compared with 48,412 children who were not. No significant differences were found either overall or in specific outcomes; rates were also similar when exposures occurred during the first trimester or at other times during pregnancy. Deaths (stillbirth to the fourth birthday) occurred in 2227 children (4.4 per cent), and there was no evidence that antenatal exposure to either drug increased the death rate. Finally, as judged by mental and motor scores at the age of eight months, and intelligence quotient scores at four years, there was no evidence that the drugs cause brain damage.

In a group of 211 schoolchildren in Queensland less than 12 years of age, the mean total melanocytic nevus (mole) count was 28 (median 19), and the mean count for raised nevi was 11 (median 8). The upper aspect of the back and chest were the most commonly affected sites, with the neck being the third. Boys had significantly (p less than 0.01) more melanocytic nevi than girls, and prevalence was highest in children with pale skin and light-colored hair. Nonwhite heritage had a protective effect independent of pigmentary characteristics. Total numbers of nevi on children also were related to maternal tendency to large numbers of moles and to family history of melanoma. The only significant association observed for the presence of large (greater than 5 mm) nevi on children was a family history of melanoma. The children studied come from a general population that has the highest known risk of melanoma. In Australia they have been shown to have the highest prevalence of nevi ever reported in the prepubertal age group. These descriptive data, together with the specific pigmentary and family associations described, extend the known links between benign nevi and malignant melanoma.

Queensland has the highest incidence of cutaneous melanoma in the world, and the reported incidence has more than doubled in the last 15 years. The general geographical distribution of melanoma patients correlates negatively with latitude on a world scale. This suggests that exposure to solar ultraviolet rays is aetiologically important. The geographical distribution of melanoma patients in Queensland was examined by reviewing the residential addresses of all incident cases in a 12-month period from July 1, 1979, and no association with latitude was found. Rather there was a significantly increased incidence of melanoma in coastal, compared to inland, regions. When the distribution of doses of erythemal solar ultraviolet radiation in Queensland is examined, taking into account the effects of cloud cover, surface reflectance, and human behaviour, the observed regional differences in incidence may yet be explained by the variation in actual exposure to ultraviolet radiation received by the population.

One hundred and fifty-one Aboriginal school children and 246 non-Aboriginal children, all aged between 11 and 15 years, performed lung function tests with a Vitalograph spirometer. The results showed that the mean forced vital capacity was 20% larger in non-Aboriginal children of both sexes. Similar differences were found for the one-second forced expiratory volume, which was 15% larger for the non-Aboriginal boys and 17% larger for the non-Aboriginal girls. Comment is made on their smoking practices.

Medication is one important aspect of health care delivery. The sources of information used to select appropriate medication include drug advertisements which appear in professional journals. There is a need to monitor the quality of these advertisements. The study reported in this paper includes a longitudinal (1961 to 1977) and cross-societal (Britain, United States and Australia) content analysis of drug advertisements. Such a comparison contributes to the debate concerning the type of regulation likely to be effective for this form of advertising.