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Biomedical subjects

L M Irwig

Publications and source records attributed to L M Irwig.

At least 37 records · Page 2Linked to original sources
PubMed1994

The management of women with initial minor Pap smear abnormalities.

OBJECTIVE: To describe the management and follow-up of women with initial minor Papanicolaou (Pap) smear abnormalities by general practitioners (GPs) in metropolitan Sydney in 1990. SUBJECTS AND SETTING: One hundred women with cervical intraepithelial neoplasia grade 1 (CIN 1) and 121 women with mild squamous atypia (MSA) on Pap smears taken by GPs in 1990, who had not had Pap smear abnormalities in the previous two years, were sampled from the records of four Sydney pathology laboratories. DESIGN: A descriptive study. Information about the management of women after their Pap smear was obtained from GPs by telephone questionnaire. RESULTS: Of women with MSA, 19% were initially investigated by colposcopy, and 8% went on to have treatment. Of 82 women with MSA who were not initially investigated, 80% had follow-up Pap smears within 12 months. Of women with CIN 1, 84 underwent colposcopy with or without biopsy; 27% of these women had CIN 2/3 and 31% had CIN 1 confirmed by investigation. Overall, 51% of women with CIN 1 on their initial Pap smears were treated by excisional or ablative means, including 78% of women with confirmed CIN 2/3, and 69% of women with confirmed CIN 1. Two and a half years after the original Pap smear, only 46% of women with initial MSA and 51% of women with initial CIN 1 were known by their GP to be having follow-up. CONCLUSIONS: Most women with MSA were managed by initial observation, and those with CIN 1 were managed by initial investigation. However, the range of management practices described suggests a lack of consensus among practitioners about the most appropriate management for women with minor cervical abnormalities. A large randomised controlled trial would help elucidate preferred management guidelines. The difficulty individual GPs experience in following up women after abnormal Pap smears supports the establishment of centralised State cytology registers.

Adult↗
PubMed1994

Who has Pap smears in New South Wales? Patterns of screening across sociodemographic groups.

The aim of this study was to determine whether Pap smear screening at adequate intervals is associated with area of residence, frequency of consultations with a general practitioner, socioeconomic status and non-English-speaking background. A representative 10 per cent sample of women from New South Wales and the Australian Capital Territory, aged 25 to 69 years and registered with the Health Insurance Commission (Medicare) (N = 155,281) was used to obtain age, postcode, frequency of Pap smears and frequency of consultations with general practitioners in the three-year period from February 1985 to January 1988. Census data for each postcode area were used as an indicator of other socio-demographic characteristics. Age-specific screening rates did not vary between Sydney, Newcastle/Wollongong, Canberra, and nonmetropolitan areas. In all age groups, having had a smear was most strongly associated with the frequency with which a woman consulted a general practitioner. Women who visited a general practitioner at least four times a year on average were about twice as likely to have had a recent Pap smear as those who averaged less than one visit per year. Screening rates were lowest among women living in areas with the most non-English-speakers and the lowest socio-economic status. Sociodemographic factors and health service usage patterns influence the proportion of women who are currently being screened. Evaluation of interventions to improve Pap smear screening rates should consider whether the percentage of women screened increases overall, and also whether the imbalances in screening rates between different groups are diminishing.

Adult↗
PubMed1993

The adequacy of management of women with CIN 2 and CIN 3 Pap smear abnormalities.

OBJECTIVE: To assess the adequacy of management of Sydney women with Papanicolaou (Pap) smears showing cervical intraepithelial neoplasia (CIN) grades two and three. DESIGN: A prospective descriptive study of patient management. METHOD: All 206 general practitioners (GPs) who sent Pap smears which were reported as CIN 2 or CIN 3 to three Sydney laboratories between January and June 1990 were included in the sample. The GPs were contacted and management details for the women collected. The adequacy of management was evaluated by comparing it with management guidelines constructed for the study. Management steps were: notification of results, referral for colposcopy, biopsy, treatment and follow-up. The number of women reaching each step, expressed as a proportion of those women who should have reached that step according to the management guidelines, was calculated. The points where management was inadequate were established and the reasons explored. RESULTS: All GPs provided management information about their patients. Ninety-nine per cent of women (95% confidence intervals [CI], 98%-100%) were informed of their Pap smear result and 94% (CI, 90%-97%) of the total sample subsequently underwent colposcopy. Ninety-three per cent (CI, 88%-97%) of the 160 women definitely requiring histological diagnosis had this and 98% (CI, 94%-100%) of the 140 women definitely needing treatment were treated. Following treatment (or equivalent if not indicated) 80% of women (CI, 74%-86%) were known to have had a follow-up Pap smear but only 31% (CI, 24-38%) of women needing follow-up colposcopy were known to have had it. At the time of the study (on average, 17 months after the index Pap smear) only 60% (CI, 54%-67%) of women were still being followed up. CONCLUSIONS: Virtually all women with the more severe cytological abnormalities are being referred by their GPs for further investigation and treatment. However, follow-up after treatment is often inadequate. The responsibility for this follow-up needs to be clarified, as well as communication about it between women, their GPs and gynaecologists. A cytology registry could increase the proportion of Sydney women known to be receiving follow-up.

Adult↗
PubMed1993

A randomized trial of penicillin and streptomycin in the prevention of post-partum infection in Uganda.

We report findings of a randomized trial of penicillin and streptomycin to prevent post-partum infection conducted on 737 women who delivered consecutively at Kawempe Maternity Centre (KMC) in Kampala from 1st October, 1989 to 31st May, 1990. The objectives were: (i) to identify clinical post-partum infection using at least two of its symptoms and signs (fever, lower abdominal pain, lower abdominal tenderness, vaginal discharge); (ii) to identify the causes of post-partum infection using laboratory methods; and (iii) evaluate the effectiveness of prophylactic fortified procaine penicillin (PPF) and streptomycin on post-partum infection. Clinical infection occurred in 36.4% of the group not given antibiotics, 23.3% in the PPF group and 20.3% in the streptomycin group. Laboratory-confirmed infection occurred in 15.5% of the group not given antibiotics, 9.2% in the PPF group and 8.4% in the streptomycin group. However, severe laboratory-confirmed infection (severe clinical infection plus positive laboratory findings) occurred in 4.9% of the group not given antibiotics, 6.1% in the PPF group and 6.6% in the streptomycin group. In general, the organisms isolated included enterobacteria (35.9%), yeast and protozoa (31.6%), staphylococci (23.9%), streptococci (69%) and Neisseria (1.7%). The advantage of PPF and streptomycin was evident in most subgroups defined by clinical characteristics or laboratory findings. In view of the findings in this study, we believe that prophylactic antibiotics given in labor may have a role to play at reducing the incidence of post-partum infection. However, as the cost of antibiotics in developing countries is significant, the development of resistant organisms due to indiscriminate antibiotic use is also a concern and health resources are best used when targeted at specific populations, we feel that antibiotic prophylaxis should not be used routinely and that a more realistic view can be obtained by studying high-risk groups of women with more severe infection.

Adult↗
PubMed1993

The effect of removal of profile requesting on chemical pathology requesting patterns.

We investigated the effect on pathology requesting behaviour in a metropolitan teaching hospital, following the proscription by the Health Insurance Commission of the MBA (multiple biochemical analysis) request. Our laboratory had provided a 20 test profile in response to a request for MBA until February 1991, when the MBA request was no longer accepted. During the period February to June 1991, requesting clinicians had to comply with the new requesting requirements, although they continued to receive the results of the 20 test profile because of limitations imposed by our laboratory instrumentation. After June 1991, with the installation of a new analyzer that allowed discretionary requesting, results were provided only for those tests requested. We studied requesting patterns in the 3 time periods: i.e. (1) before the MBA request was withdrawn, and after the MBA request was withdrawn, (2) firstly while results for the 20 test profile were still provided and (3) secondly when the results were provided only for the tests requested. For each of the 3 periods the average number of requests per day for MBA, group and individual tests was calculated. The effect of removal of the MBA request on the Medicare Benefits payable was estimated. We found compliance by the requesting clinicians with the new requirements and a reduction in the number of tests requested. There was a reduction from 20 to 12 in the average number of tests per request. This was associated with a 2.2% reduction in the Medicare Benefits payable.

Clinical Laboratory Techniques↗
PubMed1991

Invasive Haemophilus influenzae type b disease in Sydney children 1985-1987: a population-based study.

OBJECTIVE: To determine the incidence and age distribution of invasive Haemophilus influenzae type b (Hib) disease in children (0-14 years) in the Sydney Statistical Division (SSD). DESIGN: Retrospective ascertainment from a defined population, 1985-1987. Eligible cases had Hib isolated from a normally sterile site or endoscopically proven epiglottitis. SETTING: Sydney Statistical Division, which had a population of children aged 0-4 years of 229 165 in 1986. PATIENTS: Cases were identified from all potential sources of relevant recorded information. MAIN OUTCOMES: There were 292 eligible cases. Among 284 previously well children, those under 18 months of age contributed 81 of 143 cases (57%) of meningitis and 22 of 71 (71%) of cellulitis/arthritis but only 8 of 91 (11%) of epiglottitis and 4 of 18 (22%) of infection in other foci. Overall, 9% of cases had occurred by 6 months of age, 42% by 18 months and 55% by 24 months. The annual incidence of invasive Hib disease was 38.5 per 100,000 children aged 0-4 years. In areas with the lowest proportion of young children (less than 5.5%), the incidence of Hib disease in the first 12 months of life was significantly lower than in the remainder of Sydney, although there were no differences in overall disease incidence in the age group 0-4 years. CONCLUSIONS: This study indicates that approximately 1 in 500 urban Australian children develop invasive Hib disease by their fifth birthday. Vaccination of children in Sydney with a conjugate Hib vaccine at 18 months of age would result in a greater potential reduction in Hib disease than in the United States, where universal vaccination at this age is current policy.

Adolescent↗
PubMed1991

The management of pulmonary tuberculosis in the border sub-region, 1983.

In order to study the management of pulmonary tuberculosis among black and coloured adults in the Border region of South Africa in 1983, a historical inception cohort representative of tuberculosis hospitals and local authority health services was followed up over 15 months to assess how efficiently the national responsibility is discharged in a region. About 75% of patients were sputum-positive, and 81% were judged to have had active pulmonary tuberculosis. The mean service delay after radiography was about 1 1/2 weeks. About 26% of patients were treated with a rifampicin regimen, 50% were frequent attenders and 41% completed treatment, although about 21% were still being treated after 15 months. There was a deficiency of laboratory information for diagnosis and monitoring of response to treatment. Periodic cohort evaluation and improvement of diagnostic efficiency, of peripheral use of laboratories, and of spending on community service infrastructure are essential for closing the gap between policies and implementation.

Adolescent↗
PubMed1991

Undergraduate education about cancer.

The quality, quantity and balance of undergraduate cancer teaching in Australian Medical Schools were investigated by a survey, using a self-administered questionnaire, of recent graduates from all Australian medical schools. Stratified random cluster sampling was used and a response rate of 84% (389 respondents) was achieved. The results revealed substantial differences in knowledge, experience in, and rating of teaching between the medical, surgical, radiotherapeutic and palliative components of cancer management. The proportions of graduates who had never attended radiotherapy and palliative care clinics or units (42.3% and 49.9%, respectively) were more than double the proportion who had never attended medical and surgical cancer clinics or units (17.5% and 10.9%, respectively). More than twice as many graduates rated their instruction in the palliative management of cancer as poor or very poor (29.4%) compared with those rating their instruction as poor or very poor in both cancer prevention (8.4%) and treatment for cure (14.6%). The respondents displayed a considerable lack of knowledge about radiotherapy treatment options, and reported a lack of perceived competence in doing cervical smears. Their answers to questions about 5-year survival of selected cancers, about the existence of screening tests validly shown to reduce mortality, and the ages at which breast and cervical cancers are likely to develop all revealed worrying levels of incorrect knowledge. There was some important disturbing variation in levels of knowledge, experience and rating of cancer instruction between states and between universities.

Australia↗
PubMed1991

Evaluation of a mass-media-led campaign to increase Pap smear screening.

A health education campaign designed to encourage women between the ages of 18 and 70, especially 'older' women (defined as those 50 and over), to have a Pap smear took place in New South Wales (NSW), Australia in early 1988. The campaign involved the mass media, some related community activities and mailing of an educational package to all General Practitioners. According to a sample survey the media campaign was recalled by just over 40% of its target audience. Outcome evaluation was based on the analysis of Pap smear records for a representative 10% sample (N = 338 000) of women registered with the Australian universal health insurance scheme in NSW and three control States. From logistic regression models we estimate that, for women over 50 years and older in NSW, there was a 30% increase overall in Pap smears during the 4 months following the campaign and a 50% increase amongst those who had not had a smear in the previous 2 years. Smaller increases were observed in some other States. Increases of 13-20% were observed among the younger age groups in NSW. Although the campaign appears to have prompted short-term increases in screening rates, the effect is too small to make a substantial impact on the size of the under-screened population.

Adolescent↗
PubMed1991

Incidence and causes of maternal mortality in five Kampala hospitals, 1980-1986.

This report presents results of a descriptive study to estimate the mortality rate, identify the type and the causes of maternal deaths. The study was conducted in 1987 in Kampala hospitals for a period covering seven years from 1st January 1980 to 31st December, 1986. The non abortion maternal mortality rate (NAMMR) was 2.65 per 1000 deliveries while the abortion related maternal mortality rate (ARMMR) was 3.58 per 1000 abortions. There was a statistically significant increase in NAMMR while the increase in ARMMR was almost significant over the seven year period. Of all maternal deaths, 80 per cent were non abortion while 20 per cent were abortion related. The commonest immediate causes of death, in order of importance, were sepsis, haemorrhage, ruptured uterus, anaesthesia and anaemia. The commonest patient management factors which contributed to death, in order of importance, were lack of blood for transfusion, lack of drugs and intravenous fluids, theatre problems and doctor related factors. We feel that a lot happens to the pregnant mother before she finally reaches a health unit for delivery and that there is a great need to improve on the community's gynaecological and obstetrical services as well as ambulance and emergency services. We also feel that maternal mortality in developing countries could be reduced if the health workers were imaginative in respect to each patient, tried not to operate as though they were working in a developed country, and created relevant solutions for the local problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1990

Risk factors for maternal mortality in five Kampala hospitals, 1980-1986.

A case-control study assessing risk factors for maternal mortality was carried out in five Kampala hospitals covering a period of seven years (1 January 1980 to 31 December 1986). The major predictors of maternal mortality were the general condition on admission, the mode of delivery and the Apgar score of the newborn. These predictors indicate that women at high risk were those admitted to hospital for delivery in a poor state of health. We believe that the risk of maternal mortality can be reduced through appropriate action by health workers and that there is a need for a more complete view of risk factors for both maternal and perinatal mortality to be obtained through population-based studies rather than only those women who deliver in hospital.

Case-Control Studies↗
PubMed1989

Assessing agreement.

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Analysis of Variance↗
PubMed1988

Exposure-response relationship for a dichotomized response when the continuous underlying variable is not measured.

Radiological assessment of pneumoconiosis is an example of a dichotomized variable, namely one that is analysed as a binary response but in fact has an underlying continuum, which in this case is not measurable. Estimates of exposure-response relationships vary greatly for different observers of a dichotomized response variable because of random error of measurement and differences in the threshold implicitly chosen by each observer for categorizing cases. We present a method of using the biserial correlation coefficient and normal distribution theory to estimate exposure-response relationships at any required threshold for each observer. Exposure-response relationships can also be corrected for random observational error using the reliability coefficient, calculated as the tetrachoric correlation between repeat observations by readers.

Asbestosis↗
PubMed1988

Estimation of test error rates, disease prevalence and relative risk from misclassified data: a review.

We review methods for the analysis of categorical clinical and epidemiological data, in which the observations are subject to misclassification. Under certain conditions, it is possible to estimate error parameters such as sensitivity, specificity, relative risk, or predictive value, even though no definitive classification (gold standard) is available. The parameter estimates are obtained by modelling the data, using maximum likelihood, with or without some constraints. The models recognize that the true classification of an individual is unknown, and so are sometimes referred to as "latent class" models. The latent class approach provides a unified framework for various methods found in a dispersed literature, characterising each by the number of populations or subgroups in the data, and the number of observations made on each individual; the statistical degrees of freedom are implied by the sampling design. Data sets with less than three replicate observations per individual necessarily require constraints for parameter estimation to be possible. Data sets with three or more replicates lead directly to estimates of the misclassification rates, subject to some simple assumptions. Some more complex problems are also discussed, including data where the response variable has more than two levels, sequential and irregular designs and the effects of assumption violations.

Classification↗
PubMed1988

Evaluating obstetric risk scores by receiver operating characteristic curves.

The purpose of obstetric risk scoring systems is to identify pregnancies that will end in poor perinatal outcomes such as perinatal death. The proportion of such pregnancies identified by a risk scoring system can be increased by choosing a more lenient threshold criterion for the score beyond which the pregnancy is regarded as being at risk. This increase in sensitivity is gained at the expense of a decrease in specificity. Thresholds differ between published risk scoring systems, making it difficult to assess their relative merits using the measures of sensitivity and specificity. However, risk scores can be compared by constructing receiver operating characteristic curves, i.e., plotting the true positive rate against the false positive rate for multiple thresholds and calculating the area under the receiver operating characteristic curve (theta). In published systems used in this paper, values of theta, used to rank published obstetric risk scoring systems, ranged from 0.49-0.95. All scores used prepregnancy and early antenatal information. The risk scores with the highest predictive accuracy tended to include factors representing past reproductive experience and those from the late antenatal and intrapartum periods. Studies with statistical weighting of risk factors tended to use fewer late prenatal and intrapartum risk factors.

Female↗
PubMed1987

Systolic blood pressure differences in black, colored, and white infants.

Systolic blood pressure was measured in a random cluster sample of three-month-old black (n = 532), colored (n = 496), and white (n = 637) infants in Johannesburg, South Africa, by means of a Parks Doppler ultrasound device with a random zero sphygmomanometer. The study was conducted during a nine-month period in 1981. Major predictors of systolic pressure measurements were which fieldworker had taken the measurement and whether the child was quiet or agitated. After adjustment for predictors as necessary, the mean systolic blood pressure of black infants was about 2 mmHg higher than that of coloreds, which was statistically significant, with suggestive evidence that coloreds have a systolic pressure about 1 mmHg higher than that of whites. Findings at age three months may represent ethnic differences in blood pressure distributions of genetic origin.

Black People↗
PubMed1987

Prevalence of motor impairment and disability in a rural community in KwaZulu.

A study to measure the prevalence of motor disability and impairment using an interview survey and a follow-up medical examination has been carried out in a rural area in KwaZulu, South Africa. A 10% random cluster sample yielded 1659 individuals of all ages. One hundred and forty-three were reported to have motor disability, giving a crude motor disability rate of 86/1000. One hundred and twenty-six were followed up and 86 had demonstrable impairment, giving a crude motor impairment rate of 52/1000. The commonest impairment was osteoarthritis of the hips (20/1000) which may be the same disease as has been reported in neighbouring areas and to which the name Mseleni joint disease (MJD) has been applied.

Adolescent↗