Biomedical subjects
Publications and source records attributed to D Scrimgeour.
Mary is a 55 year old woman on hormone replacement therapy. She is flying to the UK with her husband in a few weeks time, and is concerned about the recent media attention given to the 'economy class syndrome'. Mary's sister developed a similar problem after surgery some years ago. She is worried that she might be at risk of developing a clot during her flight and asks your advice.
A young couple come to see you for a pretravel consultation. They are planning to spend a month backpacking in Thailand over December and January. They have read about Japanese encephalitis in travel books and seek your advice on the need for vaccination against this disease.
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Community health surveys take place in many Aboriginal communities. We considered these surveys to determine their potential to contribute to Aboriginal health in the 1990s. Community health surveys--also known as health audits, community health screenings or check-ups--usually consist of a team of health professionals travelling to an Aboriginal community to measure a wide variety of parameters on as many of the people in the community as possible. For the individual participant, community health surveys represent a sporadic screening program which should meet the World Health Organization's criteria for screening. From the population health perspective, these surveys represent prevalence surveys which may contribute little new knowledge regarding Aboriginal health and do not, of themselves, change the urgent need for preventive health programs. Community health surveys should meet minimum scientific standards (i.e. have a clearly stated aim and use valid measurements and statistical techniques) and should incorporate practically feasible protocols and services for the follow-up of individuals with screen-detected abnormalities. They must have ethical and community approval and incorporate genuine consultation and feedback of results to the Aboriginal communities involved, in order for them to be justified.
Aboriginal communities and their health services should prepare together and in advance for caring for an HIV-infected person. Good social support will be the keystone to successful clinical management. Health care workers must look to Aboriginal people for the lead in developing appropriate responses.
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Attempts to improve the nutritional status of Aboriginal people through nutritional education programs should be informed by an understanding of contemporary patterns of food procurement, preparation and distribution. This paper describes the results of a survey of food-purchasing behaviour in a central-Australian Aboriginal community. Every transaction occurring in each food outlet in the community over a two-week period was recorded and the data analysed. The results show that women play a much greater role than men in food purchasing, that there is a significant recourse to takeaway foods, that there is a cycle of expenditure determined by distribution of pension and Community Development Employment Project cheques, and that children have sufficient disposable income to be able to provision themselves from the food outlets, so that much of their food consumption is not determined by adult members of their family.
The previously described survey of food-purchasing behaviour in a central-Australian Aboriginal community demonstrated that children have sufficient disposable income to provision themselves directly from food outlets. Subsequently, a community-based intervention project developed strategies to provide healthier choices for these children. Two years after the initial survey, a follow-up survey was conducted in which all food purchases by children under the age of 15 in the community were recorded over a two-week period. The results demonstrate an improvement in the quality of foods and beverages purchased by children at the time of the second survey.
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The evaluation of the Healthy Aboriginal Life Team's (HALT) petrol-sniffing prevention programs at Yuendumu, Kintore and the Pitjantjatjara Lands first required a specification of program outcome--which was not changed in the enumerated prevalence of petrol sniffing, but alteration in parental perceptions of the relevance and effectiveness of families' nurturant authority over recalcitrant youngsters. The evaluation then proceeded by a series of interviews with resident or ex-resident adults (Aboriginal and non-Aboriginal) of Yuendumu, Kintore, Kiwirrkurra, Ernabella, Indulkana and Fregon. Adults articulated their efficacy in different ways in each place. Some favoured the conclusion that HALT had helped them, others clearly identified HALT as an obstacle to or a distraction from the implementation of other preventive and curative community-based action. We discerned a ferment of cultural adjustment in the distribution of authority over children among parents and welfare agencies. We caution against finding in HALT's successes a model procedure for benign interventions into such cultural adjustment.
Perforated jejunal diverticulitis is very rare. We describe two cases seen in one surgical unit in a four month period. The problems in early diagnosis are discussed and the need for prompt surgical intervention emphasised if mortality is to be reduced.
In a series of 72 consecutive elective and emergency colectomies with primary anastomosis, all pre- and perioperative mechanical preparation of the bowel was omitted and the patient covered only by a single peroperative intravenous dose of cefuroxime and metronidazole. No anastomotic dehiscence was clinically apparent and wound infection was noted in only 8.3 per cent of patients.
Venous blood from healthy adult human donors was circulated through a wholly extracorporeal circuit for periods up to 140 min without apparent damage to the lymphocytes. However, when the blood was exposed to short-wave ultraviolet radiation (UVC; lambda, 254 nm), separated mononuclear cells showed a depressed response to mitogen stimulation: the magnitude of this effect was related to the duration of exposure. This depression cannot be attributed to change in blood pH, partial pressures of oxygen and carbon dioxide, temperature of cell trauma. Plasma from irradiated blood was less satisfactory than non-irradiated plasma for the support of growth of phytohaemagglutinin-stimulated lymphocytes in culture, probably because of depletion of essential nutrients, and there was little evidence for the generation of growth-inhibitory humoral factors. The UVC-irradiated lymphocytes had normal ultrastructure when removed from the extracorporeal circuit, but underwent apoptosis and necrosis during the first day of tissue culture with or without mitogen stimulation.