Biomedical subjects
Publications and source records attributed to F Turnbull.
The alteration of blood flow in the skin and subcutaneous tissue due to mechanical loading is of great importance in the prevention of decubitus ulcers. A technique is described for assessing changes in blood content optically. The results indicate that such changes occur after loading even though the deformation is maintained constant.
OBJECTIVES: To determine whether the rehospitalisation and primary care requirements of infants with chronic lung disease (CLD) during the first two years after birth were influenced by a requirement for supplementary oxygen after discharge from the neonatal intensive care unit. METHODS: Review of records from both the hospital and general practitioner. PATIENTS: 235 infants, median gestational age 27 (range 22-31) weeks, 88 of whom were receiving supplementary oxygen when discharged home. RESULTS: Overall, the infants required a median of 2 (range 0-20) admissions per patient, 8 (0-41) outpatient attendances, 13 (0-76) contacts with the general practitioner, and 17 (0-169) consultations with other primary healthcare professionals. The home oxygen patients required significantly more and longer admissions (p < 0.01) and more outpatient attendances (p < 0.05). The total cost of care per infant of the home oxygen group was greater (p < 0.001); this reflected higher costs for hospital stay (p < 0.01), total inpatient care (p < 0.01), and primary care drugs (p < 0.01). CONCLUSION: Despite routine use of antenatal steroids and postnatal surfactant, certain patients with CLD, particularly those who receive home oxygen treatment, show high rates of utilisation of health service resources after discharge from the neonatal care unit.
AIMS: To compare the use of health care resources and associated costs between infants with chronic lung disease (CLD) who had or had not an admission with a proven respiratory syncytial virus (RSV) infection. METHODS: Review of community care, outpatient attendances, and readmissions in the first two years after birth. PATIENTS: 235 infants (median gestational age 27 weeks) evaluated in four groups: 45 infants with a proven RSV admission (RSV proven); 24 with a probable bronchiolitis admission; 60 with other respiratory admissions; and 106 with non-respiratory or no admissions. RESULTS: The RSV proven compared to the other groups required more frequent and longer admissions to general paediatric wards and intensive care units, more outpatient attendances and GP consultations for respiratory related disorders, and had a higher total cost of care. CONCLUSION: RSV hospitalisation in patients with CLD is associated with increased health service utilisation and costs in the first two years after birth.
The Measles Control Campaign (MCC) conducted in Australia from August to November 1998 resulted in a total of 1.7 million school children being vaccinated. This article reports on the Adverse Events Following Immunisation (AEFI) associated with measles-mumps-rubella vaccine (MMR) administered as part of the MCC. Reports of adverse events that occurred within 30 days of administration of the MMR vaccine were assessed by an expert panel that assigned a causality rating to each AEFI. Reports with missing onset dates or uncertain causality were excluded. Eighty-nine AEFI were classified as associated with MMR vaccine and the overall rate of adverse events was 5.24 per 100,000 doses of vaccine administered. Of these 46 were thought to be certainly caused by MMR vaccine, 23 were probably and 20 were possibly associated with the vaccine. Although 46 reactions were categorised to be certainly caused by the MMR vaccine, the majority of these were syncopal fits, syncope, local reactions, and allergic reactions that were short-lived, and all of these children recovered. The most commonly occurring adverse reaction was syncopal fit with a rate of 1.24 per 100,000. There was only one anaphylactic reaction, giving a rate of 0.06 per 100,000. The combined rate for anaphylaxis, anaphylactoid and allergic reactions was 1.06 per 100,000 administered doses. The rate of seizures (febrile and afebrile) was 0.30 and encephalopathy was 0.06 per 100,000 doses administered. Of the 89 children who had an AEFI, 43 did not require hospitalisation or medical attention while 13 were seen in an emergency room, 14 were hospitalised and 19 were seen by a doctor. There were no deaths reported resulting from the administration of the MMR vaccine during the period of the campaign. All children who had an AEFI have recovered although 9 children could not be followed up for reasons of confidentiality. The overall rate of adverse events was lower than that observed in the 1994 measles campaign conducted in the United Kingdom. On comparing the risks and benefits of MMR vaccine, the benefits of this MCC far outweigh the incidence of serious adverse events associated with immunisation.
BACKGROUND: Since the introduction of childhood vaccination for diphtheria in 1932 and the widespread use of vaccines to prevent tetanus, pertussis (whooping cough) and poliomyelitis in the 1950s, deaths in Australia from vaccine preventable diseases (VPDs) have declined by more than 99%. It is important, however, that the downward trend in morbidity and mortality from VPDs is maintained and carefully monitored, and that changes are interpreted in relation to vaccination coverage. AIM: This report aimed to bring together three national sources of routinely collected data on the morbidity and mortality (notifications, hospitalisations and deaths) from VPDs during the period 1993-1998 for the 8 diseases then on the routine childhood vaccination schedule, and for 4 other diseases potentially preventable by childhood vaccination. It also examined vaccination coverage for the same period. METHODS: Data sources included notifications from the National Notifiable Diseases Surveillance System (NNDSS), hospitalisation data from the Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database, deaths from the Australian Bureau of Statistics (ABS) Causes of Death Collection and vaccination coverage according to the Australian Childhood Immunisation Register (ACIR). All data sources were expected to have some limitations, the most important being under-reporting for notifications and vaccination encounters, and coding errors in the hospital morbidity data. RESULTS: Notifications for the 8 diseases covered by the routine schedule declined by 42%, from an average of 11,537 cases each year in 1993-1997 to 6700 in 1998, and hospitalisations fell by 12%, from an average of 1745 per year to 1536 in 1997/1998, while deaths remained unchanged at 7 each year over the period of review (Table 1). Tetanus caused 1 or 2 of the deaths each year. However, 6 of the 7 deaths in 1997 were in infants during a major outbreak of pertussis. Pertussis caused most of the notifications, hospitalisations and deaths during the review period. While most of these were in children, 46% of the notifications and 13% of the hospitalisations occurred in persons aged 15 years or more. There were notable declines in the numbers of notifications of invasive Haemophilus influenzae type b (Hib) disease in children under 5 years of age (77%), measles (87%) and rubella (75%), and there were no notifications of diphtheria or poliomyelitis. Vaccination coverage estimated using ACIR data increased during the review period. Coverage for the first 3 doses of diphtheria, tetanus, pertussis and Hib vaccines, assessed at 1 year of age, increased from 75% to 85%, while coverage for measles-mumps-rubella (MMR) vaccine, assessed at 2 years of age, increased from 83% to 86%. It is likely that these data underestimated coverage by 5-10%, and that the increase in coverage partly reflected better reporting to the ACIR by providers.
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1. Phototrophic cultures of Rhodomicrobium vanielii do not excrete glycollate when gassed anaerobically with nitrogen plus carbon dioxide, although the addition of alpha-hydroxy-2-pyridine methanesulphonate (HPMS) results in the excretion of a trace amount of glycollate. The inclucion of low amounts of oxygen in this gas mixture results in marked glycollate excretion, higher rates occurring in the presence of HPMS. 2. Cell extracts of Rhodomicrobium vannielii, and also of Rhodospirillum rubrum, which excretes glycollate only under aerobic conditions in the light, catalyze the formation of glycollate from phosphoglycollate and also the oxidation of glycollate to glyoxylate.
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