bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of de novo glomerulonephritis with electron‐dense deposits following renal transplantation
Authors: Nakayama Makiko , Kamei Koichi , Matsuoka Kentaro , Nakagawa Atsuko , Iijima Kazumoto
Published: August 2010

Abstract:  We present here a case of de novo glomerulonephritis (GN) two yr after kidney transplantation. The patient was a 13‐yr‐old girl who had renal insufficiency because of bilateral hypoplastic kidneys. She received a renal allograft from her father at the age of 11 yr. Immunosuppressive treatment was started with tacrolimus, mizoribine (MZB), basiliximab, and methylprednisolone (mPSL). There were no findings of GN at the one‐h biopsy (first biopsy). Two yr after transplantation, she showed proteinuria, hematuria and increased serum creatinine level with no apparent trigger. The biopsy specimen (fourth) showed mesangial proliferative GN with electron‐dense deposits in a variety of regions and borderline changes indicating acute rejection. She was treated with mPSL pulse therapy, deoxyspergualin, replacement of MZB with mycophenolate mofetil, an increase of the mPSL dose, and candesartan. Her serum creatinine and urinary protein excretion levels improved after the treatment. One month later, she developed deterioration in her renal function again. Renal biopsy findings (fifth) were almost the same as the lesions observed in the fourth allograft biopsy. After she recovered from these episodes, she appeared to improve in clinical findings of GN. Protocol biopsies at three yr and five months after transplantation (sixth) showed no evidence of acute rejection, but we still observed the features of de novo GN. We could not resolve the underlying causes by reference to the clinical history and serological findings. We speculate that some kind of immunological reactions might be associated with the pathophysiology.
Primary health care personnel faced with cadaveric organ donation: a multicenter study in south‐eastern Spain
Authors: Ríos A. , Ramírez P. , Galindo P.J , Sánchez J , Sánchez E , Martínez‐Alarcón L. , Parrilla P
Published: August 2010

Abstract:  Introduction:  Primary health care (PHC) is the first point of contact between the public and the health system and it is an important channel for the communication and promotion of organ donation and transplantation. The objective of this study was to analyze the attitude of PHC personnel toward donation and to determine the psychosocial variables affecting this attitude.

Materials and methods:  A random sample was stratified by job category and geographical location among PHC personnel (n = 482) from 32 health centers. Attitude was evaluated using a questionnaire validated in our local area. (It was completed anonymously and was self‐administered.)

Results:  The questionnaire completion rate was 86% (n = 414): 78% (n = 325) are in favor and the remaining 22% (n = 89) are either against or are not sure. The reason given for a negative attitude is fear of apparent death (16%; n = 14). There are many independent factors that affect attitude: (i) job category (OR = 2.4); (ii) knowledge of the concept of brain death (OR = 2.2); (iii) a preference for alternatives to burial (OR = 2.99); (iv) being in favor of cremation (OR = 01.87) and (v) knowledge of the attitude of one’s partner toward organ donation (OR = 0.312).

Conclusion:  PHC personnel have a favorable attitude toward donation, especially physicians, although it would be useful to provide more information to PHC personnel. Physicians could be a key element in the direct and indirect promotion of donation and transplantation.
Fetal olfactory ensheathing cells transplantation in amyotrophic lateral sclerosis patients: a controlled pilot study
Authors: Huang Hongyun , Chen Lin , Xi Haitao , Wang Hongmei , Zhang Jian , Zhang Feng , Liu Yancheng
Published: August 2010

Abstract:  This study was designed to clarify whether transplantation of fetal olfactory ensheathing cells (OECs) would affect the clinical course of patients with amyotrophic lateral sclerosis (ALS). Thirty‐five patients with probable or definite ALS were enrolled from December 2004 to September 2006; 15 patients received OECs transplantation and 20 patients did not receive OECs transplantation. OECs were cultured and injected into the bilateral corona radiata involving the pyramidal tracts of the frontal lobes. The primary end point used to indicate effectiveness was the rate of change according to the ALS Functional Rating Scale (ALS‐FRS) total score. All patients were tested five times at baseline and monthly intervals during a four‐month follow‐up period using assessment of ALS‐FRS. Thirty‐one patients (14 in the OECs treated group and 17 in the controls) completed the four‐month study; the remaining four patients were lost to follow‐up. Patients’ data were analyzed four months after OECs transplantation and at the end of the controlled period. There was no significant difference in the rate of progression as measured by the ALS‐FRS total score during the first two months (p > 0.05). The functional deterioration, however, was significantly slower in the treated group than in the control group during the last two months (p < 0.05). The mean (±SD) change for the ALS‐FRS total score was 0.07 ± 4.18 for the treated group and 6.12 ± 5.49 for the control group (p = 0.002) during the four months. Of the 14 patients in the treatment group, seven experienced neurological functional improvements, two were stable compared with their clinical status at entry, and the ALS‐FRS scores in the other five decreased by a mean of 4.4. Of the 17 patients in the control group, only one patient’s condition remained stable while the ALS‐FRS scores in the other 16 decreased by a mean of 6.5. The result indicates OECs transplantation appears to be able to slow the rate of clinical progression of ALS in the first four months posttransplantation.
Use of spiral vein graft in living donor renal transplantation
Authors: Nghiem Dai D.
Published: August 2010

Abstract:  Prosthetic material or vascular homografts have been used for vascular reconstruction in organ transplants. An alternative procedure using the spiral saphenous vein graft to lengthen 19 short‐living donor kidney vessels is described.
Aggressive steroid weaning after cardiac transplantation is possible without the additional risk of significant rejection
Authors: Teuteberg Jeffrey J. , Shullo Michael , Zomak Rachelle , McNamara Dennis , McCurry Kenneth , Kormos Robert L.
Published: August 2010

Abstract: Background: Chronic steroid use after cardiac transplantation (CTX) is accompanied by co‐morbidities that are dependent on length of exposure.

Methods: A retrospective review of all CTX without induction therapy from 1999–2004. After 2001, an aggressive strategy of steroid weaning was introduced.

Results: A total of 165 patients underwent CTX, 82 from 1999–2001 (group 1) and 83 from 2002–2004 (group 2). There were no significant differences in recipient or donor characteristics between group 1 and group 2. The baseline calcineurin was cyclosporine in 41% and 5% (p < 0.0001) and tacrolimus in 59% and 95% (p < 0.0001), respectively. The mean duration of steroid use was 1023 d in group 1 and 383 d in group 2 (p < 0.0001). The overall incidence of any ≥ISHLT grade 3A rejection per year after CTX for group 1 vs. group 2 was as follows: year 1: 40% vs. 49% (p = NS) and year 2: 7.4% vs. 9.2% (p = NS).

Conclusions: Steroid withdrawal by one yr after CTX using a contemporary immunosuppressive regimen is possible in most patients. In comparison with a slower steroid wean, a faster wean is not associated with an excess of significant rejection in the first two yr post CTX.
The financial impact of immunosuppressant expenses on new kidney transplant recipients*,†
Authors: Gordon Elisa J. , Prohaska Thomas R. , Sehgal Ashwini R.
Published: August 2010

Abstract: Background: This study aimed to examine kidney transplant recipients’ ability to afford transplant‐related out‐of‐pocket expenses and the financial impact of these expenses on their lives.

Patients and methods: This cross‐sectional study involved 77 kidney recipients. Variables analyzed were: ability to afford daily necessities; impact of immunosuppressant expenses on patients’ lives; awareness of Medicare support terminating three yr post‐transplant; and strategies used to pay for out‐of‐pocket transplant expenses. The Economic Strain Scale measured financial strain.

Results: Twenty‐nine percent of kidney recipients experienced financial strain. Poor, less educated, and younger patients were more likely to report financial strain. Out‐of‐pocket expenses relating to kidney transplantation adversely affected patients’ ability to afford leisure activities (35%), a house (27%), and a car (26%). Thirty‐one percent reported that immunosuppressant expenses have had somewhat to great (adverse) impact on their lives. Of those on Medicare and not disabled (n = 41), 51% were unaware Medicare coverage will terminate and 71% did not know how long coverage lasts.

Conclusions: Financial strain presents a considerable risk to kidney recipients’ ability to purchase immunosuppression. Socioeconomic disparities in recipients’ financial strain may be a source of disparities in graft survival. Transplant professionals should better inform transplant candidates about financial consequences of transplantation.
Web‐based requests for living organ donors: who are the solicitors?
Authors: Rodrigue James R. , Antonellis Timothy , Mandelbrot Didier A. , Hanto Douglas W.
Published: August 2010

Abstract:  Websites have emerged to highlight the plight of patients awaiting kidney transplantation and to match them to potential good Samaritan living donors. Little is known about the patients who choose to solicit living donors online, so we examined the 224 profiles of potential kidney transplant recipients who registered on one donor matching website. The number of patients soliciting a living kidney donor is less than 0.5% of those who are awaiting kidney transplantation in the United States. Other than blood type, region, and gender surprisingly few sociodemographic and medical details were posted with most solicitation profiles. The considerable variability in what information is provided in patient profiles suggests that we know very little about who the solicitors are and further highlights one of the inherent ethical problems with public solicitation of living donors. Specifically, in some instances, a Good Samaritan’s pursuit of living kidney donation may be based less on information potentially relevant to transplant outcome and more on the persuasiveness of the appeal.
Predictor factors for the development of arterial hypertension following heart transplantation
Authors: Sánchez‐Lázaro Ignacio J. , Martínez‐Dolz Luis , Almenar‐Bonet Luis , Moro‐López José A. , Agüero Jaime , Ortiz‐Martínez Víctor , Izquierdo María Teresa , Salvador A.
Published: August 2010

Abstract:  Introduction:  Up to 95% of the patients with heart transplantation (HT) suffer from arterial hypertension (AHT). The development of de novo AHT after HT has not been greatly studied.

Aim:  To identify the predictor variables for the development of de novo AHT after HT.

Materials and methods:  We retrospectively studied 253 patients with HT and who did not previously have AHT. We excluded cases of early mortality, re‐transplants and combined transplants. We considered AHT as the constant need to take anti‐hypertensive drugs to maintain blood pressure < 140/90 mmHg. We studied all the variables relating to recipient, donor, surgical procedure, immunosuppression and follow‐up. The statistics used were the Student's t‐test, chi‐square statistic and a logistic regression analysis.

Results:  Of the 253 patients, 109 (43%) developed AHT. The variables associated with more prevalent AHT were male recipient/donor, idiopathic dilated cardiomyopathy (IDCM) as cause of HT, having been a smoker as well as renal deterioration (RD) and hypercholesterolemia after HT. The multivariate analysis found smoking prior to the HT and hypercholesterolemia during follow‐up as independent risk factors and urgent HT as a protective variable.

Conclusions:  AHT after HT is frequent. The variables associated in our population were smoking before HT, male recipient/donor, IDCM prior to HT and hypercholesterolemia and RD after HT.
Impact of gastrointestinal‐related side effects on mycophenolate mofetil dosing and potential therapeutic strategies
Authors: Bunnapradist Suphamai , Ambühl Patrice M.
Published: August 2010

Abstract:  In renal transplant patients receiving mycophenolate mofetil (MMF), maintaining an adequate dosing regimen has been shown to maximize short‐ and long‐term outcomes. Gastrointestinal (GI) adverse events associated with MMF are frequent, and lead to MMF dose reduction or withdrawal in 40–50% of cases. Among MMF‐treated patients experiencing GI complications, one analysis has reported MMF discontinuation to be associated with almost a threefold increase in risk of graft loss, while a dose reduction ≥ 50% carried over a twofold increase in risk. If GI symptoms improve and the pre‐reduction MMF dose is resumed the increased risk of graft loss may be reversed, but continuing intolerance can make this difficult to achieve. Investigation of contributing factors is important and may alleviate symptoms. Conversion to enteric‐coated mycophenolate sodium (EC‐MPS) may be an effective option. Two open‐label studies using patient‐reported outcomes data have shown a significant and clinically relevant benefit in GI‐related symptom burden after conversion from MMF to EC‐MPS. In conclusion, monitoring of GI complications is essential following renal transplantation, and maintaining adequate mycophenolic acid exposure should be a priority when considering treatment options.
ESR MEASUREMENTS OF SHORT‐LIVED FREE RADICALS OBTAINED BY ADDITION OF OH TO DL‐METHIONINE
Authors: Bürk G. K. , Schoffa G.
Published: August 2010

The ESR spectrum of DL‐methionine was investigated by the flow method first developed by Dixon & Norman (1962). By means of this spectrum four different types of radicals were detected and their coupling constants were determined.

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Further it could be pointed out that dimethyl sulfoxide (DMSO) treated in the same way showed a radical of the form O–S–CH3 in addition to (CH3 radical).
ON THE ISOLATION AND PURIFICATION OF STRUCTURE‐BOUND PROTEINS
Authors: Akopyan ZH. I. , Veryovkina I. V. , Levyant M. I. , Moskvitina T. A. , Gorkin V. Z. , Orkkhovich V. N.
Published: August 2010

Structure‐bound catalytically active proteins (mitochondrial monoamine oxidases from rat or beef liver and beef brain) have been prepared in non‐sedimentable, soluble form, without significant inactivation, by treatment of mitochondrial membranes with non‐ionic detergents in a strongly alkaline medium with benzylamine ‐ a substrate of monoamine oxidases, which protects the enzymes from inactivation by alkalis. By means of subsequent ammonium sulphate fractionation and treatment with aluminium hydroxydes, enzyme preparations have been obtained which, as evidenced by electrophoresis in polyacrylamide gel and values of specific activity, are highly purified.
RURAL HEALTH SUPPORT, EDUCATION AND TRAINING PROGRAM (RHSET): WHERE TO NOW?
Authors: Harvey David , Webb‐Pullman Julie , Strasser Roger
Published: August 2010

ABSTRACT: The Rural Health Support Education and Training (RHSET) Program is a Commonwealth Government grants program established in 1990 to enhance the access of rural communities to effective health services. The emphasis has been on professional workforce issues. Up until December 1997, 431 applications for funding had been approved and close to $37 million allocated. This article considers the grants awarded in that period according to their main topic of interest within three broad groupings: policy and tertiary service provision; health discipline‐specific groups; and special interest groups such as Aboriginal and Torres Strait Islanders and community organisations. Each subgroup is introduced and its contents outlined. It also suggests that despite heightened government interest in rural and remote health, a niche can still be found for RHSET. It further argues that the time has come for a major evaluation of project activity to ensure non‐duplication and to develop performance indicators for evaluating projects addressing rural and remote area workforce issues.
HEALTH BELIEFS AND PERCEPTIONS OF WOMEN PRESENTING OR NOT PRESENTING FOR MAMMOGRAPHIC SCREENING IN A RURAL HEALTH SETTING
Authors: Speedy Sandra , Hase Stewart
Published: August 2010

ABSTRACT: Breast cancer continues to be a major health concern among Australian women. Recently, free mammography screening has been offered as a joint State and Commonwealth initiative to enable early detection. This program has particular significance in rural areas where access to health‐care facilities, particularly those of a specialist nature, is limited. Attendance for screening is critical to the success of this type of program. Several lines of evidence suggest that health beliefs play a major role in compliance with recommended health behaviour. The present study investigated the role of five health beliefs: response efficacy, seriousness, concern, susceptibility and barriers to the likelihood of attending the North Coast Breast Screening Program in northern NSW. A questionnaire that measured these health beliefs was completed by 127 women who attended breast screening and 185 women who knew about the service but had not attended. Compared with those who had not undergone mammography, those presenting for screening were more health conscious, more likely to have had a mammography previously, more aware that mammography reduced the risk of developing severe breast cancer and less concerned about having a mammogram. A number of barriers to having a mammogram were also identified. The present study raises a number of concerns regarding the level of knowledge about breast self‐examination and mammography as important preventive health measures among women in a rural setting.
THE PATIENT TRANSIT ASSISTANCE SCHEME: A CONSUMER'S PERSPECTIVE
Authors: McGrath Pam , Seguerra Joel
Published: August 2010

ABSTRACT: This article presents findings from State‐wide research in Queensland on experiences with the Patient Transit Assistance Scheme (PTAS) from the point of view of patients with a haematological malignancy who travelled for specialist treatment. The findings indicate that the PTAS is of crucial importance to patients and their families and goes some way to buffering the financial hardship incurred from relocation. However, there are also strong indications that there is insufficient community awareness of the scheme, with the consequence that it is not appropriately accessed by those in need. The results confirm previous research that points to the hardship, both financial and emotional, associated with the experience of relocation for specialist treatment.
EVALUATION OF A PILOT PROJECT TO USE COMPUTERS IN A RURAL GENERAL PRACTICE TERM
Authors: Teague Michele , Talbot Jane , Ward Alison M.
Published: August 2010

ABSTRACT: In 1998, the Department of General Practice (Faculty of Medicine and Dentistry, University of Western Australia) ran a pilot project to use computers in a sixth year rural general practice term. Students were provided with a laptop computer to take into rural and remote areas throughout Western Australia during their 4‐week clinical attachment. An email mailing list was set up for course participants to share experiences and complete set learning activities specifically related to rural general practice. An evaluation of this pilot project found that students felt less isolated on rural attachments, course outcomes were improved and rural preceptors were more involved in the programme. The development of a teaching and learning programme that involves the use of computers in rural general practice for undergraduate students has the potential to improve the quality of their medical education.
LEARNING ISSUES FOR NURSES IN RENAL SATELLITE CENTRES
Authors: Wellard Sally , Bethune Elizabeth
Published: August 2010

ABSTRACT: The introduction of ‘satellite’ dialysis centres has increased local access to renal services for patients living in rural and remote areas across Australia and is, therefore, consistent with rural health policies. Rural health strategies also aim to maintain and improve the skills of health professionals through regular review of the scope of their practice and evaluation of the education required. Yet, the results of the present national study of nurses working in satellite dialysis centres indicate that, for many, the context of practice influences their ability to access ongoing professional education to support and extend their nursing practice. The present study showed that there was a range of educational backgrounds among nurses working in rural ‘satellite’ centres with reportedly limited access to specific dialysis‐related professional development. In the present paper we report on factors that influence the ability of nurses working in satellite dialysis centres to access ongoing professional education.
THE IMPACT OF COORDINATED CARE: EYRE REGION, SOUTH AUSTRALIA 1997–1999
Authors: Harvey Peter
Published: August 2010

ABSTRACT: The SA HealthPlus Coordinated Care Trial in the Eyre Region began in fortuitous circumstances. First, it coincided with the completion of the Eyre Regional Health Service (ERHS) needs assessment in 1996, which highlighted outstanding health service needs and community concerns in relation to health care across the region. Second, although conceived as a formal trial, using standard research techniques, scientific processes and formal control groups to test significant differences between intervention and control groups, the trial did not conform strictly to the rules of social science or pure science and became more an exercise in action research. More significantly still, the Eyre Region became involved in the process, not so much as a way of proving a concept (the SA Health Plus hypotheses around utilisation, funding and health outcomes), but as a way of creating opportunities for change in the regional health system. If nothing else, the region stood to benefit from the implementation of the trial and involvement in the trial process. The present paper outlines the impact of the Eyre Coordinated Care Trial, not in terms of hypotheses and data analysis, but in terms of the impact of the trial processes on systems change and the evolution of an outcome‐based health system. Such a system has the potential to deliver improved health outcomes to communities within existing financial resources and make much more effective use of resources by integrating care delivery and encouraging collaboration between health providers. In addition, the success of the change process in Eyre also supports the notion that change is not necessarily predicated upon scientific processes and research outcomes alone, but also upon the human and social structures associated with such endeavours. This perspective also contributes to the debate about the nature and role of science in the advancement of knowledge.
AMALGAMATION AND COLLABORATION IN RURAL GENERAL PRACTICES: EARLY EXPERIENCE WITH THE GP LINKS PROGRAM IN RURAL SOUTH AUSTRALIA
Authors: Wilkinson David , Symon Brian
Published: August 2010

ABSTRACT: The GP Links program aims to promote the amalgamation of smaller general practices into larger group practices and is one of several strategies being used to modernise Australian family practice. GP Links provides financial incentives to practices willing to amalgamate. The focus of the program has been on urban practices to date and indeed some of the requirements of the program mean that rural practices are less likely to access the scheme. We report our positive and negative experiences of practice amalgamation through the GP Links program in a regional setting of South Australia. From our experience we suggest that for rural practices, a staged approach of increasing collaboration that may lead to amalgamation, which focuses on rural practices developing a supportive network and alliances with others such as Divisions and University Departments of Rural Health might be a positive way ahead.
WORK PRACTICES OF RURAL AND REMOTE PHYSIOTHERAPISTS
Authors: Sheppard Lorraine
Published: August 2010

ABSTRACT: Physiotherapists in rural and remote areas face challenges in their service delivery. The challenge is to provide accessible and comprehensive services to rural and remote Australians. Research was undertaken regarding the work practices of physiotherapists and the availability of other health professionals in rural and remote South Australia and Northern Territory. Rural and remote area physiotherapists in this study are likely to be sole practitioners with a gener‐alist practice. The high number who have practising rights at public hospitals gives rise to service delivery with a wide range of clients and reduced opportunity for specialisation. In addition, the demand for physiotherapists to be multiskilled is increased with the lower number of resident medical specialists and allied health professionals in rural areas. Greater access to other professionals for rural and remote Australians may come from the development of resource networks supported by regional organisation of resources and infrastructure.
DIABETIC FOOT CARE: DEVELOPING CULTURALLY APPROPRIATE EDUCATIONAL TOOLS FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES IN THE NORTHERN TERRITORY, AUSTRALIA
Authors: Watson Jennifer , Obersteller Elizabeth A. , Rennie Linda , Whitbread Cherie
Published: August 2010

ABSTRACT: Evidence shows that Aboriginal and Torres Strait Islander people have the highest national percentage of morbidity in relation to diabetes. Aboriginal and Torres Strait Islander people also suffer the greatest risk of amputation as a complication of diabetes. This participatory action research project sought to discover the opinions of a range of people, including registered nurses, general practitioners, Aboriginal health workers, cross‐cultural liaison officers and Aboriginal and Torres Strait Islander people with diabetes. Focus groups provided valuable information regarding relevant issues of foot care education in the Northern Territory. The emergent themes included communication issues, educational resources, changing behaviour and other practical resources required for health education. The themes provided evidence of the inherent issues of foot care for Aboriginal and Torres Strait Islander people and guidance for the development of a visual educational tool. The results have lead to the development of a foot care educational tool that will be used by health‐care professionals and clients in urban, community, rural and remote areas. The use of a participant action research process will ensure that the educational tool will be owned by Aboriginal and Torres Strait Islander People and health‐care professionals.
REMOTE AREA ABORIGINAL HEALTH SERVICES MANAGERS: KEY PRACTICE CHALLENGES
Authors: Wilson John
Published: August 2010

ABSTRACT: The following reflections on the author's management practice are based on the text of an address given by the author at the 1999 International Conference of the Royal Australasian College of Medical Administrators in Sydney. These reflections arise out of the author's experience for the past 5 years as manager of Nganampa Health Council, an Aboriginal community‐controlled health organisation located in the remote north‐west of South Australia. Nganampa Health Council is a large regional service with a national reputation for clinical and administrative excellence. It has several leading‐edge health programs, which provide an exemplar for other remote health services across Australia. The author discusses three generic key management issues that remote health services managers typically encounter and argues that services are likely to be most effective when resources are applied in a focused and strategic manner and when management practices that are pragmatic and culturally appropriate are adopted.
HELPING HOSPITALISED CLIENTS QUIT SMOKING: A STUDY OF RURAL NURSING PRACTICE AND BARRIERS
Authors: Gomm Murray , Lincoln Pamela , Egeland Paula , Rosenberg Michael
Published: August 2010

ABSTRACT: Brief interventions have been identified as a useful tool for facilitating smoking cessation, particularly in the acute care setting and in areas where access to specialist staff is limited, such as rural Australia. A self‐administered survey was used to determine current rural nursing staff practices in relation to brief intervention for smoking cessation, and to ascertain the perceived level of support, skills, needs and barriers amongst these staff to conducting brief interventions. The major findings include that while the majority of respondents were aware of their patients' smoking status, most were not very confident about assisting smoking patients to quit. Casually employed nurses were much less likely to be aware of patient smoking status than nurses employed full‐time or permanent part‐time. Only one‐quarter to one‐third of nurses did not believe assisting patients to quit was part of their role, and the vast majority of nurses reported that they were non‐smokers. Future programs incorporating the routine use of brief interventions will need to consider these findings.
DEVELOPING STRATEGIES TO GATHER INFORMATION ABOUT THE MATERNITY EXPERIENCES OF INDIGENOUS WOMEN IN AN ACUTE CARE SETTING
Authors: Watson Jennifer , Hodson Katrina , Johnson Rhona
Published: August 2010

ABSTRACT: This project emerged from the concerns of health care professionals at a large acute care hospital in the Northern Territory of Australia. The aim of the project was to develop educational resources through information and experiences provided by Aboriginal and Torres Strait Islander women and health care professionals. The objectives are to optimise collaboration and participation by Indigenous and Torres Strait Islander women in sharing their maternity experiences about the birthing of their baby either in hospital, or out of hospital before arrival. Stage one of a three stage project is reported here. In stage one a modified Delphi method was used to interview ten purposefully chosen professional Indigenous women with insight into the research process and changing social arrangements. Stage two involved the development of an interview schedule and face‐to‐face interviews. Stage three includes the development of a questionnaire to be answered by health care professionals.

Discussion of the background to the study, reviewed literature and issues identified from interviews with the professional Indigenous women regarding best methods and appropriate data collection processes is presented. Research described here explores issues of concern for Indigenous women from the Northern Territory around their child birthing experiences in an acute care setting.
FARM‐RELATED FATAL INJURY OF YOUNG AND OLDER ADULTS IN AUSTRALIA, 1989–1992
Authors: Mitchell Rebecca J. , Franklin Richard C. , Driscoll Timothy R. , Fragar Lyn J.
Published: August 2010

ABSTRACT: This paper describes the types of, and circumstances surrounding, unintentional farm‐related fatal injuries involving young and older adults in Australia. Information was obtained from an inspection of coronial files for the period 1989–1992.

Around 14% of all farm‐related fatalities in Australia during 1989–1992 were of young adults aged 15–24 years and approximately one‐quarter were of older adults aged? 55 years. Young adults were commonly fatally injured in motor vehicle incidents and in incidents involving firearms. Tractors were the most common agent involved in fatal incidents involving older adults.

Intervention measures to prevent fatalities of older adults in agriculture should focus on the safe use of tractors, while for young adults it appears prevention efforts should centre around safe use of firearms and operation of motor vehicles on the farm. Ways to overcome barriers to the use of injury prevention measures in rural Australia should be further explored.
MANAGEMENT OF HIV/AIDS ON THE MID NORTH COAST: A COLLABORATIVE MODEL OF CARE INVOLVING GENERAL PRACTITIONERS AND THE PUBLIC HEALTH SYSTEM
Authors: Andrews Doug
Published: August 2010

ABSTRACT: The Coffs Harbour AIDS Information Network was set up to co‐ordinate care planning and support service delivery for HIV/AIDS patients. This paper describes a collaborative model of care that brought together private general practitioners, a community nurse and a sexual health counsellor. Time involved in delivering services was monitored for each of the health professional groups during a 6 month period.

Twenty‐three patients were involved in our study. Doctors averaged 23 min per consultation over 57 occasions of service. Travel or telephone contact took up 17% of the time spent on these patients. Corresponding figures for the nurse and counsellor were an average of 67 min over 144 services and 71 min over 16 services. They spent 16% and 27% of their time travelling or on the phone, respectively.

HIV/AIDS care is time consuming for health professionals but comprehensive care can be given in rural areas with adequate support and integration.
RURAL DOCTORS‘ SATISFACTION IN JAPAN: A NATIONWIDE SURVEY
Authors: Matsumoto Masatoshi , Okayama Masanobu , Kajii Eiji
Published: August 2010

Objectives: The purpose of this paper was to discover to what degree Japanese rural doctors are satisfied with various aspects of their jobs and lives, and to find out whether they intend to continue their rural careers.

Design: Nationwide postal survey

Setting: Public clinics or hospitals in municipalities that are authorised as ‘rural’ by the national government.

Subjects: A total of 4896 doctors working for public clinics or hospitals.

Interventions: Self‐evaluation questionnaires were mailed. The rural doctors were asked to evaluate their satisfaction with 19 items related to their job conditions and 10 items concerning life conditions, using a four‐point scale. They also were asked to evaluate their intent to stay in rural practice until retirement.

Results: The response rate was 64%. Overall, rural doctors were satisfied with both their work and life conditions. However, only 27% of respondents hoped to continue rural practice beyond the usual age of retirement. Among job‐related items, continuing medical education and interactions with municipal governments were rated as least satisfactory. Among lifestyle‐related items, duration of holidays and workload were unsatisfactory. Subgroup analysis revealed male doctors showed greater intent to stay in rural practice. Doctors aged > 50 years were more satisfied with most aspects of their job and lifestyle than younger doctors. A strong correlation was found between the degree of intent to stay and several items such as interactions with municipal government, human interactions salary and job fulfilment.

Conclusions: Strategies, based on the results of this survey, should be implemented. Particularly in Japan, positive interaction between doctors and municipal governments is crucial.
PSYCHOSOCIAL INVESTIGATION OF INDIVIDUAL AND COMMUNITY RESPONSES TO THE EXPERIENCE OF OVINE JOHNE'S DISEASE IN RURAL VICTORIA
Authors: Hood Bernadette , Seedsman Terence
Published: August 2010

Objective: This paper explores the psychosocial outcomes for individuals and communities in rural Victoria who experienced the outbreak of Ovine Johne's Disease (OJD).

Design: The study uses a qualitative methodology to analyse the minutes of evidence provided by the inquiry into the control of OJD to identify the psychosocial events, experiences and outcomes associated with the control of this outbreak. The inquiry was undertaken by the Environment and Natural Resources Committee of the Victorian State Government.

Setting: Public hearings were undertaken by the committee across several rural Victorian communities and the state capital, Melbourne.

Subjects: The transcripts detail 136 submissions from 98 individuals and 23 organisations.

Outcome measures: The analysis aimed to provide insight into the impact of the disease on individuals and communities and also to explore the factors individuals perceived as associated with these outcomes.

Results: While the paper identifies that aspects of stock loss associated with the outbreak caused substantial emotional and economic distress, for farmers the most significant finding was the impact of the government control program on individuals, families and rural communities. The control program was perceived as having very limited scientific credibility and its implementation was described as heartless, inflexible and authoritarian. Involvement with the program resulted in farmers reporting emotions, such as, trauma, shame, guilt and stigma. Families became discordant and the sense of community within rural townships fragmented. Psychological outcomes of grief, depression and anxiety emerged as prevalent themes within families and communities.

Conclusions: These data highlight the need for significant attention to the management of rural disasters, such as, the OJD program.
CANCER AND CANCER RISK IN SOUTH AUSTRALIA: WHAT EVIDENCE FOR A RURAL–URBAN HEALTH DIFFERENTIAL?
Authors: Wilkinson David , Cameron Kate
Published: August 2010

Objective: To determine the extent of evidence for a rural–urban health differential in cancer and cancer risk in South Australia

Design: Secondary analysis and synthesis of data available between 1977 and 2000 from the publications of the South Australian Cancer Registry and reports of population health surveys carried out by the South Australian Department of Human Services.

Results: The mean annual age‐standardised incidence of all forms of cancer combined was about 4% lower for rural residents (265.2 per 100 000 cf. 274.9 per 100 000). Of 31 types of cancer listed, the incidence of three was significantly higher among rural residents, the incidence of eight was significantly higher among urban residents and for 20 types there was no significant difference. Five year case survival for all cancers combined was 52% in both urban and rural residents. Significant survival differences were identified for only 10 cancers and survival for each was higher among urban residents. Melanomas were diagnosed in situ more often in the country, but invasive cases tended to be thicker. There was no rural– urban difference in early detection rates for breast cancer or bladder cancer. There were no substantial reported differences in major risk factors and early detection experiences apart from higher rates of smoking in the country.

Conclusions: There is little evidence for substantial or systematic differences in risk factors for, and incidence and early detection of cancers between urban and rural South Australia. However, the apparent consistently poorer survival among rural residents warrants further study.
So far and yet so close: quality of management of diabetes in Australian and Canadian Indigenous communities
Authors: Mak Donna B. , Whitehead Sara , Plant Aileen J.
Published: August 2010

Objectives: To compare quality of clinical management of Indigenous people with diabetes in remote areas of Australia and Canada.

Design: Clinical audit of diabetes management.

Setting: The Kimberley region of Western Australia and Northern Saskatchewan in Canada.

Subjects: One hundred and two Saskatchewan and 142 Kimberley patients from seven and 11 primary health services, respectively.

Main outcome measures: Indicators of quality of diabetes clinical management during the preceding two years.

Results: Overall quality of management was poor. Retinopathy screening was better in the Kimberley than Saskatchewan (58% screened in the preceding two years cf 30%). Glycemic control of Saskatchewan patients was better than that of Kimberley patients (16% with optimal control vs. 9%).

Conclusions: Continuing efforts at the level of health service organisation, patient and staff education, and creative ways to reduce barriers to access, as well as primary prevention initiatives, are required to counter the devastating effect of diabetes on Indigenous communities.
Health and wellbeing of older people in Anglo‐Australian and Italian‐Australian communities: A rural–urban comparison
Authors: Lau Rosalind , Morse Carol A.
Published: August 2010

Objective:  The health and wellbeing of urban and rural Anglo‐ and Italian‐Australian residents was compared using five domains which are deemed to influence the outcome ‘ageing well’. The five domains included physical and functional status, social supports, material resources, activity and leisure, and mental efficacy.

Design:  A cross‐sectional survey carried out in a two‐stage data collection process included a brief telephone interview and face‐to‐face interview using semistructured schedules with several psychometric measures.

Settings:  Eastern and Western Melbourne and Mildura, Victoria, Australia.

Main outcome measures:  Health and wellbeing of urban and rural community‐dwelling Anglo‐ and Italian‐Australian men and women aged 50–89 years.

Participants:  Urban and rural community‐dwelling Anglo‐ and Italian‐Australian men and women aged 50–89 years. There were 364 urban Anglo‐Australians, 149 rural Anglo‐Australians, 190 urban Italian‐Australians, and 77 rural Italian‐Australians.

Results:  Urban Anglo‐Australian residents reported significantly higher general and emotional health but also reported significantly higher stress levels than their rural counterparts. The rural Italian‐Australian residents reported higher resilience and personal control but poorer general and emotional health than the urban residents.

Conclusion:  If health disparities between urban and rural residents are to be successfully addressed, the link between place of residence, health status and wellbeing must be explored.
Effect of climate change on Australian rural and remote regions: What do we know and what do we need to know?
Authors: Bi Peng , Parton Kevin A.
Published: August 2010

This paper addresses a very important issue in Australian rural and remote regions: the effects of climate change on various aspects including natural resources, agricultural activity, population health, and social and economic development. The objective is to briefly characterise the consequences of climate change in rural Australia and what we can do to prevent further impact in our rural communities.
Myxoma of the masticator space
Authors: Gandhi MR , Tang YM , Panizza B
Published: August 2010

We describe a rare case of a surgically proven myxoma arising within the masticator space probably from a pterygoid muscle. The lesion showed characteristic hyperintensity on T2‐weighted images and did not enhance following gadolinium.
EFFECTS OF HYPOXIA/REPERFUSION INJURY ON DRUG DISPOSITION IN THE RAT ISOLATED PERFUSED LIVER
Authors: Arab HA , Cheung K , Hickman PE , Potter JM , Kadkhodaee M , Roberts MS
Published: August 2010

Ischaemia–reperfusion injury is known to be associated with a range of functional and structural alterations in the liver. However, the effect of this injury on drug disposition is not well understood. The present study was designed to examine the effects of hypoxia/reperfusion on the disposition of glutamate and propranolol in the rat isolated perfused liver. Both glutamate and propranolol are mainly metabolised in the pericentral region of the liver.

Hypoxia/reperfusion was established using the slow flow–reflow method of perfusion in both anterograde and retrograde perfusion. Glutamate metabolism was measured by the recovery of [14C]‐glutamic acid and [14C]‐labelled metabolites in a single pass in both anterograde and retrograde perfusion in the presence of a steady state concentration of unlabelled glutamic acid. Propranolol disposition, mean transit time and normalized variance were assessed from the outflow concentration–time profile of unchanged [3H]‐propranolol determined after a bolus injection of [3H]‐propranolol using HPLC and liquid scintillation counting.

Hypoxia/reperfusion of livers did not affect oxygen consumption, but caused significant changes in enzyme release, lignocaine hepatic availability and bile flow.

Hypoxia/reperfusion did not affect the hepatic metabolism of glutamate to carbon dioxide or the hepatic extraction of propranolol. Small but significant changes were evident in the distribution parameters of mean transit time and vascular disposition for the hypoxic–ischaemic liver.

It is concluded that reperfusion injury induced by slow flow–reflow perfusion did not influence the extraction of glutamate or propranolol, but may have affected pericentral morphology and solute distribution.
PHARMACOKINETICS AND PHARMACODYNAMICS OF A NITRIC OXIDE‐RELEASING DERIVATIVE OF ENALAPRIL IN MALE BEAGLES
Authors: Okuyama Cristina E , Mendes Gustavo Duarte , Faro Renato , Rezende Vinicius M , Lagos Rodolfo Monaco , Astigarraga Rafael E B , Antunes Edson , De Nucci Gilberto
Published: August 2010

Pharmacological compounds that release nitric oxide (NO) have been useful tools in the evaluation of the broad role of NO in physiopathology and therapeutics. The present study compared the pharmacokinetics and pharmacodynamics of enalapril and an NO‐releasing enalapril molecule (NCX899) in conscious male beagles. The effects of both enalapril and NCX899 in the arterial hypertension and bradycardia induced by acute NO inhibition in anaesthetized dogs were also investigated.

Dogs received either NCX899 (4 µmol/kg, i.v.) or enalapril (4 µmol/kg, i.v.), after which plasma concentrations of the analytes and metabolites were quantified by liquid chromatography coupled to tandem mass spectrometry (LC‐MS/MS).

In the NCX899 group, the area under the time‐course curve (AUC0−24h) was 29.18 ± 4.72, 229.37 ± 51.32 and 5159.23 ± 514.88 µg·h/L for the analytes nitro‐enalapril, enalapril and enalaprilat, respectively. In the enalapril group, the AUC0−24hwas 704.53 ± 158.86 and 4149.27 ± 847.30 µg·h/L for the analytes enalapril and enalaprilat, respectively. Statistical analysis of data from both groups showed a significant difference for the analyte enalapril, but not for enalaprilat. Moreover, NCX899 and enalapril were equally effective in inhibiting the activity of serum angiotensin‐converting enzyme.

In anaesthetized dogs, i.v. administration of the NO synthase (NOS) inhibitorNG‐nitro‐l‐arginine methyl ester (l‐NAME; 0.1–10 mg/kg) significantly elevated arterial blood pressure, with concomitant bradycardia. The compound NCX899 significantly attenuated both arterial hypertension and bradycardia, whereas enalapril had no significant effect.

In conclusion, the present results showed that the NO‐releasing derivative of enalapril NCX899 presents a pharmacokinetic/pharmacodynamic relationship similar to its parent compound enalapril. Moreover, NCX899 (but not enalapril) was effective in protecting against the cardiovascular changes induced by acute NOS inhibition.