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Biomedical subjects

E Comino

Publications and source records attributed to E Comino.

At least 19 recordsLinked to original sources
PubMed2002

Management of children after presenting to hospital with acute asthma but not requiring admission.

OBJECTIVE: To examine the treatment of asthma in children aged 4-15 years in the 12 months following presentation to hospital with acute asthma but not requiring admission. METHOD: Questionnaire based survey addressing the child's use of health services, contact with general practitioners before presentation, use of asthma management plans, symptom frequency, and management of asthma. RESULTS: Sixty-six parents (response rate 50%) completed questionnaires. Children usually experienced infrequent episodic symptoms of asthma, and had good or excellent health (68%). Twenty-two children reported no medical follow up post-emergency department (ED). Of the 39 children who had been reviewed by their GP post-ED, 51% (n = 20) recalled discussing the reasons for presentation to ED with the GP, 41% (n = 16) had a lung function measurement and 64% (n = 25) had discussed ways to better manage the child's asthma to avoid the need for future ED attendance. Most parents of children with asthma (n = 57, 86%) recalled the GP explaining how to manage their child's asthma, but only 35 (61.4%) recalled the GP ever writing down these instructions. CONCLUSION: Children with acute asthma who do not require admission may be better managed in the community if there is greater recourse to GP care, use of written management guidelines and opportunities for additional community care are taken up. Further work is needed to identify strategies that will enable GPs to do this.

Acute Disease↗
PubMed2001

Differences in body composition between Tongans and Australians: time to rethink the healthy weight ranges?

OBJECTIVE: The prevalence of obesity varies considerably between countries when compared using the common international standard. This study investigated body size and body composition in Tongan and Australian Caucasian adults. DESIGN: Cross-sectional comparative study. SUBJECTS: A total of 543 Tongans and 393 Australians. MEASUREMENTS: Weight, height, waist and hip circumference, four skinfolds, midarm circumference, elbow breadth, and body composition by bioelectrical impedance using sex- and ethnic-specific regression equations. RESULTS: Tongan women (mean body mass index (BMI)+/-s.e.=32.6+/-0.4 kg/m2) were larger than Australian women (BMI=25.8+/-0.4 kg/m2), with more fat-free mass (FFM; 52.2+/-0.4; 42.6+/-0.3 kg), fat mass (37.1+/-0.7; 26.6+/-0.8 kg) and percentage body fat (%fat) (40.5+/-0.4; 37.0+/-0.5%), respectively. Tongan men also had higher BMI (Tongan= 30.3+/-0.3 kg/m2; Australian=26.5+/-0.3 kg/m2), FFM (70.2+/-0.5; 62.3+/-0.6 kg) and fat mass (23.5+/-0.6; 20.7+/-0.7 kg). When compared with Australians within the same BMI range, Tongans had significantly higher FFM, elbow width, midarm muscle area and significantly lower %fat. The %fat at BMIs of 25 and 30 kg/m2 in Australian women was equivalent to the %fat found in Tongan women at 28.8 and 35.1 kg/m2, respectively. BMIs of 25 and 30 kg/m2 in Australian men corresponded with 27.5 and 35.8 kg/m2 in Tongan men. Skinfold thicknesses, waist, hip and WHR measurements suggested differences in fat distribution and body shape between ethnic groups, particularly in women. CONCLUSION: These results suggest that the standard healthy weight ranges recommended for international use may not be appropriate standards for use in the Tongan population.

Adult↗
PubMed2001

Changing approaches to asthma management in Australia: effects on asthma morbidity.

Asthma is an important public health issue in Australia and is responsible for significant morbidity and mortality in the community. Recognition of the impact of asthma on the health of Australians, and the apparent failure of new medications to reduce mortality and hospital admission rates resulted in a major review by the stakeholders in asthma care. This led to new approaches to asthma management based on strategic use of asthma medications and the development of the Asthma Management Plan (AMP). The AMP drew together current understanding of asthma to develop a simple stepwise approach to management that could be readily applied in patient management. The National Asthma Campaign (NAC), a coalition of the major stakeholders in asthma care, was launched in 1990 to lead the dissemination of the AMP. In association with other organisations interested in asthma care in Australia, the NAC has developed the AMP, and co-ordinated a decade of education and advocacy about asthma that targeted doctors, health professionals and the general public. These activities have been successful in raising awareness about asthma in the community. However, recent research, while demonstrating the continued uptake of written asthma action plans for asthma and decrease in use of inhaled bronchodilator medications, reported a decrease in use of preventive therapy by people with asthma. These activities have had a sustained impact on asthma-related health outcomes with mortality at the lowest level since 1960 and a decline in hospital readmission rates. This is useful information because there is sound evidence that the prevalence and possibly severity of asthma in children has increased. However, review of management in primary care and among people who present to emergency services with acute asthma suggest that many people continue to manage their asthma poorly. Continued education is needed to build on the progress that has been made. There are opportunities to do this through efforts to integrate general practitioners into the wider health system through the formation of Divisions of General Practice. Recognition of asthma as a health priority area at a national level will help to enhance and maintain awareness of the public health importance of asthma and facilitate the further development of the initiatives begun during the last decade or more.

Asthma↗
PubMed2001

Implementation of the enhanced primary care items requires ongoing education and evaluation.

OBJECTIVE: The study aimed to evaluate the uptake and usage of the Federal Government's Enhanced Primary Care (EPC) items by general practitioners in outer urban general practice. METHOD: Faxed questionnaire with telephone follow up of a random sample of 347 GPs in South West Sydney, in March and April 2000. RESULTS: There was a response rate of 70.6%. Seventy-three percent of respondents reported they had heard of the EPC package and 27% of all the respondents had used one or more of the items. Twenty-three percent had claimed for health assessments (median number 3), 4.5% for care plans (median number 3) and 4% for case conferences (median number 1). Just under half of the GPs who had claimed for health assessments had conducted them in the patient's home. Most GPs either had no system for the use of the items or planned to use them opportunistically. Forty-nine percent of GPs had an age-sex register and those who did were more likely to have claimed for an EPC item and to have specific plans for their use. CONCLUSION: While most GPs had heard of the EPC items, only a minority had used them and few planned to use them systematically within their practice. There is a need to address barriers to the uptake of the EPC items and to provide greater support to GPs and health professionals involved with their implementation, especially for care plans and case conferences. Evaluation of the EPC items needs to be an integral part of the implementation process.

Adult↗
PubMed2001

Factors associated with frequent admission to hospital for patients with chronic airflow limitation.

BACKGROUND: Chronic airflow limitation (CAL) is a common cause of admission and readmission to hospital. This study has explored associated factors with repeat hospital admission in patients with CAL. METHOD: A retrospective file review of patients admitted more than once to hospital during the 1999 calendar year, with a diagnosis of CAL. RESULTS: Two hundred and two patients admitted with CAL accounted for 284 admissions and 1815 bed days. Of these, 46 patients were admitted more than once accounting for 115 (40.5%) admissions and 730 (39.8%) bed days. The study found evidence of general practice involvement in 35 (30.5%) admissions immediately before presentation at the hospital emergency department (ED). The discharge summary following that admission revealed only 67 (54%) were referred back to their general practitioners for follow up. The number of admissions attending the ED between the hours of 9.00 am and 5.00 pm were 62 (53.9%) and 96 (83.5%) between the hours of 7.00 am and 10.00 pm. CONCLUSION: Treatments given in hospital were similar, in most cases, to what could be provided at home with appropriate community based support. General practitioners were involved in approximately one-third of those patients requiring admission or re-admission to hospital.

Female↗
PubMed2000

Where's the common ground? A survey of hospitals, community health centres and divisions of general practice in Australia.

BACKGROUND: Divisions of general practice are key structures for integration between general practice and other health services in Australia. AIM: To compare the views of divisions of general practice toward integration of care with those of hospitals and community health services. METHOD: Representative national samples of public hospitals and community health centres (CHCs) and a census of divisions of general practice (DGP) were surveyed on their current collaborations and links as well as barriers to and factors that enhance integration between general practitioners and other health services. RESULTS: There is wide agreement on the need for greater integration. Personal links (via letter, phone and face to face) were thought to be useful. However, general practice liaison officers were seen as especially useful. All organizations rated different accountabilities and responsibilities as a highly significant barrier. Resources, structures for collaboration and high level organisational support were rated as being more useful in enabling greater integration. CONCLUSION: Formalizing collaboration will require changes to funding and accountability. However there is also a need for cultural change to support greater integration of patient care between general practice and both hospitals and community health services.

Australia↗
PubMed1999

Perception of body size in the Tongan community: differences from and similarities to an Australian sample.

OBJECTIVE: The prevalence of obesity in Tonga is high and increasing. Attempts to address this major health issue would be assisted by a realistic concept of current and preferred body sizes. In this study, body size perception in Tongans was compared with that of Australians. DESIGN: Cross-sectional comparative study. SUBJECTS: 542 Tongans, 89 of whom were enrolled in a weight-loss programme (WLP); 481 Australians. MEASUREMENTS: Subjects were weighed and measured. Two series of photographs (one female, one male), representing specific body mass indexes (BMIs) were used to assess body perception. RESULTS: The BMIs of the Tongans were higher than those of the Australians (Tongans: female 32.6+/-0.35 (mean +/- s.e.m); male, 30.4+/-0.33; Australians: female, 25.6+/-0.33; male 26.3+/-0.26 kg/m2). Tongan women underestimated their body size; Tongan men and Australians overestimated. WLP and younger Tongan women preferred smaller body sizes for themselves and for men and women in general. There were gender differences in preferred healthy and attractive female sizes (men: 27 kg/m2; non-WLP women: 25 kg/m2; WLP women: 23 kg/m2) and male sizes (men: 29-30 kg/m2; women: 26-27 kg/m2 chosen by Tongans. Preferred, attractive and healthy body sizes chosen by Australian men and women were similar; about 24 kg/m2 for males and 21-22 kg/m2 for females. CONCLUSION: Tongans preferred larger body sizes than did Australians, particularly the men, but WLP women's preferences were similar to those of Australians. There is evidence that preferences are changing in Tonga with time, and probably with increasing Western influence.

Adult↗
PubMed1997

The formation of professional and consumer solutions: ethics in the general practice setting.

A general practice research project on ethics is underway at the University of New South Wales, funded by GPEP (General Practice Evaluation Program, Commonwealth Department of Human Services and Health, GPEP 386). Ethical issues, as defined and explored by general practitioners and consumers, are being examined across four areas of Sydney. So far, telephone interviews have been conducted (64% response rate) with a random sample of general practitioners (GPs). Face-to-face interviews have been conducted with 107 consumers, randomly sampled using ABS collection district information. Focus groups have been formed to discuss acceptable solutions to GP and consumer identified ethical issues. This report will report on some preliminary findings to date and will explore professional and consumer roles in the formation of ethical solutions.

Bioethical Issues↗
PubMed1997

Asthma mortality in Australia 1920-94: age, period, and cohort effects.

STUDY OBJECTIVE: To investigate asthma mortality during 1920-94 in Australia in order to assess the relative role of period and birth cohort effects. DESIGN: Asthma mortality (both sexes) was age standardised and examined for changes over time. The data were also examined for age, period, and cohort (APC) effects using Poisson regression modelling. SETTING: National Australian mortality data. PARTICIPANTS: Population (both sexes) aged 15-34 years, 1920-94. MAIN RESULTS: Age adjusted period rates indicate an increase in asthma mortality during the 1950's, and increases and subsequent falls (epidemics) during the mid 1960s and late 1980s. APC modelling suggested an increasing cohort effect (adjusted for both age and period) from the birth cohort 1950-54 onwards. Period effects (adjusted for age and cohort) are characterized by an increase in the 1950s (possibly due to changes in diagnostic labelling), minimal or no increases in the mid 1960s and late 1980s (where period peaks had been noted when data were adjusted for age only), and declines in mortality risk subsequent to the periods where age-period analysis had noted increases. Thus, in Australia, some of the mid 1960s epidemic in asthma deaths, and all of the late 1980s mortality increase, seem to be attributable to cohort effects. CONCLUSIONS: The increase in asthma mortality cohort effect is consistent with empirical evidence of recent increases in prevalence (and presumably incidence) of asthma in Australia, and suggests the need for more research into the underlying environmental aetiology of this condition.

Adolescent↗
PubMed1993

[Computerized tomography of cerebrovascular disorders in old age].

The authors present and demonstrate the more typical CT patterns of cerebrovascular diseases in old age, on the basis of literature and of personal experience of more than 1000 CT examinations of old patients in 1991-1992. They stress the basic role of CT in differential diagnosis between hemorrhagic and ischemic lesions. Finally, they propose a protocol for the better use of CT in the early diagnosis and the outcome of cerebrovascular diseases.

Aged↗
PubMed1988

Ultrasonography in the detection of Crohn's disease and in the differential diagnosis of inflammatory bowel disease.

The diagnostic accuracy of abdominal ultrasonography in inflammatory bowel disease (IBD) has been evaluated in a prospective, randomized, blind study. A total of 181 patients (89 with Crohn's disease, 57 ulcerative colitis and 35 controls) were examined. Sensitivity and specificity of diagnosis in Crohn's disease, corrected for prevalence, were 80.8 and 79.2%, respectively, and a very similar accuracy was found in the differential diagnosis of IBD. In conclusion, ultrasonography can play a role in detecting Crohn's disease and in the differential diagnosis of chronic IBD.

Adult↗
PubMed1985

[Evolution and radiologic sequelae of pulmonary tuberculosis].

During the treatment of pulmonary tuberculosis, the radiologist is often asked the following questions: 1) is it really TB?; 2) is there any improvement?; 3) when is the X-ray check-up required?. In our opinion, the radiologist is in a position: 1) to confirm the diagnosis of TB; 2) to give a radiological diagnosis of "abnormality" but without a prognostic opinion; 3) to suggest, case by case, when the X-ray check-up is required. After some month or years, when radiological-clinical sequelae are present, the radiologist is often asked equally difficult questions: 1) is it still TB?; 2) is it still active?; 3) could it have caused the hemoptysis?. Again, in our opinion, the radiologist must bear in mind: 1) the not infrequent possibility of reinfections; 2) that the fine, smooth contour of the cavity, whose shape remains unchanged, does not necessarily signify absence of activity; 3) that, at the present time, other illnesses (bronchitis, bronchiectasis, lung cancer) are more frequently the cause of hemoptysis.

Adult↗
PubMed1985

[Echotomography in the diagnosis of Crohn's disease].

The diagnostic accuracy of abdominal ultrasonography in Crohn's disease has been assessed in a prospective, randomized, simple-blind controlled study. A group of 181 out-patients (89 with accertained Crohn's disease and 92 controls) was studied. Considering "target sign" and/or "probable signs" of Crohn's disease, ultrasonographic sensitivity in diagnosing Crohn's disease was 84% and specificity 83%. Abdominal ultrasonography is indicated in the differential diagnosis of inflammatory bowel diseases, in the screening and follow-up of patients with Crohn's disease and in cases with contraindications to X-Ray examinations.

Adolescent↗
PubMed1984

[Double contrast studies of the small intestine. How, when, why].

The double contrast radiological technique involving duodenal intubation for the examination of the small intestine is described. The technical difficulties involved are discussed with ample illustration. This forms the basis for suggestions on the main indications for the technique in a correct diagnostic protocol.

Adult↗
PubMed1982

[Radiologic determination of total lung capacity].

The authors studied in 50 healthy subjects the cilindroid and the planimetric method for the radiological measurement of TLC. Both methods proved to be accurate, but the first showed a better relation with the pletismographic measurements; in both methods the individual variability was very limited (5 divided by 6%). In a screening protocol comprising double-projection chest X-ray, the radiological measurement of TLC seems to be very useful to evaluate with simplicity and realiability its values and its variations in time.

Adult↗