bluuebunny/crossref_metadata_2025 huggingface dataset:
Streptococcus pneumoniae antibiotic resistance in Northern Territory children in day care
Authors: Skull SA , Shelby‐James T , Morris PS , Perez GO , Yonovitz A , Krause V , Roberts LA , Leach AJ
Published: March 2003

Background: There is evidence that the rapid rise in Streptococcus pneumoniae (SP) antimicrobial resistance seen in other countries may have commenced in Australia. Streptococcus pneumoniae carriage and resistance levels are described for urban Northern Territory children in day care.

Methods: A prospective cohort study was conducted of 250 children in nine Darwin day care centres between 24 March and 15 September 1997. Each fortnight nasopharyngeal swabs were collected from children, and parents were interviewed about medications administered.

Results: Streptococcus pneumoniae was detected in 52% (1028/1974) of all nasopharyngeal swabs. Streptococcus pneumoniae was isolated from 92% (231/250) of children at some time. Penicillin resistance was found in 30% (312/1028) of isolates using a screening test. Of these, 256 (82%) had resistance confirmed by E‐test. Two hundred and one (20% of all isolates) had intermediate penicillin resistance and 55 (5% of all isolates) had high level resistance. Ceftriaxone resistance was found in 19% of children’s first isolates. Resistance to other antibiotics was also common: co‐trimoxazole 45%, erythromycin 17%, tetracycline 17% and chloramphenicol 13%. A total of 17% (172/1028) of the isolates were multiresistant. The average fortnightly proportion of children given antibiotics was 16% (405/2476).

Conclusions: Levels of intermediate and high level penicillin resistance in this day care population are consistent with previous data from the Northern Territory, and considerably higher than the rest of Australia. The national trend of increasing pencillin resistance is likely to continue.
Elevated creatinine after ingestion of model aviation fuel: Interference with the Jaffe reaction by nitromethane
Authors: Booth CJ , Naidoo D , Rosenberg AR , Kainer G
Published: March 2003

Abstract: A 2 years 9 month‐old‐boy who ingested model aviation fuel was found to have an elevated serum creatinine concentration of 0.53 mmol/L (normal range 0.02–0.05 mmol/L) by the Jaffe (alkaline picrate) reaction. However, when the creatinine concentration was measured using a specific enzymatic assay, it was within the normal range. It was shown that nitromethane, a constituent of aviation fuel, interferes with the Jaffe reaction, leading to a falsely elevated creatinine reading. This phenomenon has been reported only once previously and, despite its potential clinical importance, nitromethane does not appear in published lists of substances that interfere with the Jaffe reaction.
Outcome of respiratory syncytial virus infection and a cost–benefit analysis of prophylaxis
Authors: Numa A
Published: March 2003

Objectives: To determine outcome and length of stay (LOS) for infants younger than 2 years of age admitted to hospital for respiratory syncytial virus (RSV) infection and to perform a cost–benefit analysis of prophylaxis with RSV γ‐globulin (Respigam; CSL Laboratories, Melbourne, Victoria, Australia) and monoclonal antibody (Synagis; Abbott Australasia, Kurnell, NSW, Australia) in the Australian context.

Methods: Retrospective outcome study using data from an Australian hospital and intensive care databases over a 30 month period encompassing three RSV seasons (1 May 1997–31 October 1999).

Results: The mortality for RSV infection was very low, being 0.29% of all patients admitted to hospital and 0% in infants without co‐existing disease. Only 11.4% of infants required admission to the intensive care unit (ICU). Respiratory syncytial virus infection was not associated with prolonged hospitalization; patients managed in the general wards had a mean length of stay (LOS) of 4.13 days with a median of 3.0 days, while those requiring intensive care had a mean LOS of 9.8 days (including 5.1 days in the ICU). Use of RSV prophylaxis would be expected to reduce the requirement for hospital admission; however, the cost of prophylaxis is conservatively estimated to be between 7.2‐ and 65.3‐fold the money saved in hospital care, depending on the weight of the patient and choice of drug.

Conclusions: Respiratory syncytial virus is a major cause of morbidity, but not mortality, in infants. In infants requiring hospitalization for this disease, the LOS is relatively short and the mortality extremely low. Use of prophylactic agents, which reduce the probability of hospital admission but have no effect on mortality, cannot be justified in the Australian context on cost–benefit grounds.
Bed sharing patterns in a cohort of Australian infants during the first six months after birth
Authors: Rigda RS , McMillen IC , Buckley P
Published: March 2003

Objective: To measure bed sharing (BS) activity in healthy term infants.

Methodology: The sleep–wake behaviour and place of infant sleep were recorded for infants aged between 2 and 24 weeks. Infants were then identified as BS or non bed sharing (NBS) according to each of four different definitions of bed sharing.

Results: The mean proportion of infants who spent any time BS during a 24‐h period was significantly greater (P < 0.05) between 2 and 12 weeks (40.9 ± 1.4%) than between 13 and 24 weeks (36.5 ± 1.5%). A significantly greater proportion (P < 0.005) of infants bed shared for more than 2 h (25 ± 1%) than for either 1–2 h (10.5 ± 1.1%) or for less than 1 h/24 h (3.2 ± 0.5%) during the whole study period. Each of the definitions of BS used in the study separated infants on the basis of the amount and frequency of BS activity.

Conclusion: Bed sharing activity was common and varied in this cohort. It was possible, using quantitative definitions, to identify those infants who routinely bed share.
Dietary fibre intake and constipation in children with severe developmental disabilities
Authors: Tse P W T , Leung S S F , Chan T , Sien A , Chan A K H
Published: March 2003

Objective: Constipation is a common problem in children with severe developmental disabilities (DD). This study aimed to evaluate fibre intake of severe DD children living in a residential institution, and the possibility of reducing the use of laxatives by increasing their fibre intake.

Methodology: A baseline study was performed to evaluate the fibre and macronutrient intake in a group of severe DD children. Nutrients including fibre for a standard serving in each meal were calculated and daily macronutrients and fibre intake were estimated. An intervention study was then carried out to evaluate whether increasing fibre intake could relieve constipation. A total of 20 children aged between 3 and 17 years were assessed over a 4‐month period. In a residential unit for severe DD children, laxatives were routinely prescribed if there was no spontaneous bowel motion for two consecutive days. Fibre intake was increased in stages by adding All‐Bran® (Kellogg Company, Battle Creek, MI, USA) and desserts. The mean number of laxative usage per week per child in the different stages were then compared.

Results: The baseline fibre intake was found to be approximately 2 g/day. The mean number of laxatives required per week per child decreased significantly from a baseline value of 1.22 (about 5 laxatives/month) (standard deviation (SD) = 0.36)) to 0.90 (about 3.5 laxatives/month) (SD = 0.75) in the first stage, and 0.71 (about 3 laxatives/month) (SD = 0.40) in the second stage. Using paired t‐test, the difference was statistically significant when compared with the baseline: P < 0.05 for the first, and P < 0.01 for the second stage of fibre supplementation.

Conclusion: Very low daily intake of fibre of 2 g/day was documented. Relief of constipation and a significant reduction in the usage of laxatives was demonstrated by increasing fibre intake to 17 g/day (stage 1). Increasing fibre intake further to 21 g/day (stage 2), showed a further reduction in the use of laxatives. There was, however, no statistical significance between stage 1 and stage 2 of fibre supplementation. Alternative ways to further relieve constipation in severe DD children require further studies.
Congenital splenic cyst: A case report and review of the literature
Authors: Kabra NS , Bowen JR
Published: March 2003

Abstract: There are very few cases of antenatally diagnosed congenital splenic cyst described in literature. The present case of congenital splenic cyst was first suspected on ultrasound examination at 20 weeks of gestation and followed subsequently. Its exact location in the spleen was found on postnatal ultrasound examination. The aetiology, differential diagnosis, complications and management strategies of this lesion are also discussed .
Burkholderia cepacia in cystic fibrosis: Novel Australian cluster strain without accelerated respiratory deterioration
Authors: Fitzgerald DA , Cooper DM , Paul M , Tiley S , Kado J , Cordwell J , Collins C
Published: March 2003

Objective: To determine whether 4 years of colonization with a novel Australian cluster strain (The ‘Hunter’ strain) of Burkholderia cepacia (B. cepacia) in cystic fibrosis (CF) patients was associated with more rapid decline in nutritional status and pulmonary function than in non‐colonized contemporaries from the same CF clinic.

Methodology: A retrospective review of respiratory function and nutritional data from a single multidisciplinary paediatric CF clinic over 4 years (1993–97).

Results: Paired spirometry data for 1993 and 1997 were available in 47 patients without (n = 31) and with B. cepacia (n = 16) colonization (mean (± SD) ages in 1993: 12.1 years ± 4.0 vs 12.6 years ± 6.5; P = 0.83). Their percentage predicted forced expiratory volume in 1 s (FEV1) (94.2%± 16.7 vs 85.9%± 21.2; P = 0.19) were not significantly different. The averaged annual fall in FEV1 over 4 years was also not significantly different (3.8%± 3.8 vs 3.6%± 3.7; P = 0.82). Weight percentile (Wt%), height percentile (Ht%) and percentage age weight for height (%WFH) were not significantly different between groups in 1993. By 1997, Wt% (36.7%± 25.1 vs 22.3%± 19.6; P = 0.04) and Ht% (42.5%± 29.6 vs 17.6%± 19.4; P = 0.002) but not %WFH (102%± 10.0 vs 106%± 11.2; P > 0.10) were lower in subjects with B. cepacia.

Conclusions: In adolescent CF patients, colonization with the Hunter strain of B. cepacia was associated with a deterioration in some nutritional parameters but not with an accelerated decline in FEV1 over 4 years. As varying pathogenicity of B. cepacia strains may account for differing rates of pulmonary decline, further assessment of the consequences of colonization with certain strains of B. cepacia in CF is needed.
Childhood poisoning: Access and prevention
Authors: Ozanne‐Smith J , Day L , Parsons B , Tibballs J , Dobbin M
Published: March 2003

Objectives: To investigate the circumstances and means of access to six poisoning agents by children under 5 years of age and to make recommendations for countermeasures and strategies for implementation.

Methodology: A case series study of access to six poisoning agents was conducted. Cases were identified prospectively through a poisons information centre and hospital emergency departments. Interviews were conducted with 523 parents and caregivers using a structured questionnaire.

Results: The majority of children (94.1%) accessed the agent in their own home or another home and, in 38% of cases (excluding mistakes in administration), the parent or caregiver was present in the immediate area at the time of the incident. In cases in which the child was alone in the room, caregivers were frequently involved in household duties (51%), with only 10% undertaking leisure activities and 8% on the telephone. The span of unsupervised time reported was 5 min or less in 79.5% of these cases. The means of access was generally during periods of use of the agent (75.3%), including just purchased, rather than when agents were in their usual storage place.

Conclusions: There is little scope for improved supervision as a major intervention. Design and regulatory changes such as local safe storage for bench tops and while travelling, improved labelling and packaging, improved child‐resistant packaging and its more general application are required. These and agent‐specific interventions, including child‐resistant bait stations for rodenticides and well covers for vaporizers, are more likely to prevent poisoning. The recent identification of childhood poisoning prevention as a national priority may lead to coordinated action to implement these and other preventive measures.
Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists
Authors: Ward CJB , Purdie J
Published: March 2003

Objective: To assess the diagnostic error rate among echocardiograms undertaken by individuals other than paediatric cardiologists in our referral area.

Methodology: External group: The charts and echocardiographic results of all patients who had undergone outside echocardiograms between January 1996 and December 1999 were reviewed (110). Age at echocardiography, diagnostic complexity, presence of any diagnostic errors and the severity of any diagnostic errors were identified. Internal group: To assess our own error rate, the initial echocardiographic diagnoses of 100 patients undergoing cardiac catheterisation or corrective surgery were compared with the post‐catheterisation or postoperative diagnoses. Age and diagnostic complexity were also assessed in the control group.

Results: Diagnostic errors occurred in 47/110 patients (44%) of the externally studied group (of which 24% were either major or life threatening) as opposed to 3/100 of the internally studied group, despite the internally studied group being of increased diagnostic complexity. Errors were more common and of increased severity in infants less than 1 month of age but extended throughout all age groups. Major and life threatening errors increased with increasing diagnostic complexity. In the externally studied group, 8/47 errors were patients inappropriately designated as normal. Four of these patients required cardiac surgery or interventional cardiac catheterisation.

Conclusions: This study suggests an unacceptably high error rate in paediatric echocardiographic diagnoses by non‐paediatric cardiologists throughout all age groups. Such errors are more likely in younger infants and with increasing diagnostic complexity.
Successful clot lysis using low dose of streptokinase in 22 neonates with aortic thromboses
Authors: Cheah F‐C , Boo N‐Y , Rohana J , Yong S‐C
Published: March 2003

Objective: To determine whether intravenous infusion of low dose of streptokinase was effective in lysing umbilical arterial catheter (UAC)‐associated aortic thrombi.

Method: A prospective cohort study of 31 consecutive newborn infants with UAC‐associated aortic thrombi which were detected by abdominal ultrasonography after removal of UAC. Twenty‐two infants were treated with intravenous infusion of low dose (1000 U/h) streptokinase, while nine others were not treated due to various contra‐indications. Thrombolysis occurred after a mean interval of 2.2 days (standard deviation (SD) = 1.8) in the treated infants. In the untreated infants, spontaneous thrombolysis occurred significantly later, after a mean interval of 16.9 days (SD = 14.7) (95% confidence intervals of difference between mean intervals – 26.0, – 3.4; P = 0.02). Only one treated infant developed mild bleeding directly attributed to streptokinase therapy.

Conclusion: Low dose streptokinase infusion was effective and safe in thrombolysing UAC‐associated aortic thrombi.
Comparison of Dinamap 8100 with sphygmomanometer blood pressure measurement in a prepubertal diabetes cohort
Authors: Jin RZ , Donaghue KC , Fairchild JM , Chan A , Silink M
Published: March 2003

Objective: To compare the conventional sphygmomanometer with the semiautomated Dinamap 8100 (Critikon, Tampa, FL, USA) for the measurement of blood pressure in prepubertal children with insulin‐dependent diabetes mellitus.

Methodology: Blood pressure was measured using both methods in 61 prepubertal children (aged 8–13 years) on 189 occasions over 4 years. The measurements were compared using the Bland–Altman plot. Tracking correlations of blood pressure centiles over time were analyzed by the general estimating equation.

Results: Accuracy criteria of the Association for the Advancement of Medical Instrumentation were met and a British Hypertensive Society ‘B’ grading was reached. Differences in systolic and diastolic blood pressure were found between the two methods (P < 0.01). For systolic blood pressure, common correlations were 0.54 (Dinamap) and 0.51 (sphygmomanometer) and for diastolic blood pressure were 0.33 and 0.42, respectively.

Conclusion: The Dinamap 8100 is an acceptable alternative in clinic practice and research for prepubertal children.
Low‐density lipoprotein subclasses in children under 10 years of age
Authors: Steinbeck KS , Bermingham MA , Mahajan D , Baur LA
Published: March 2003

Objective: To examine the prevalence of small dense low density lipoprotein (LDL) in a cohort of children under 10 years of age and to investigate the relationship to other biochemical variables and to measures of fatness. A preponderance of small dense LDL (pattern B), is associated with obesity, abdominal fat accumulation, insulin resistance and risk of heart disease in adults.

Methodology: LDL peak particle diameter (PPD) was determined by gel electrophoresis in 53 children under 10 years of age and in 65 of their parents: apoproteins A1 and B were determined by turbidimetry. Anthropometric variables, basic lipid profiles, insulin and leptin had been determined previously. Differences between patterns A (large light particles > 25.5 nm diameter) and B were examined by t‐test, Chi‐square, or Mann–Whitney test. Relationships between the variables were reported as Pearson correlation coefficients.

Results: Pattern B (PPD of ≤ 25.5 nm) prevalence was 7.5% in children and 11% in parents (17% in men and 5% in women). Most of the children (86%) who had PPD ≤ 26.0 nm also had parents with PPD in this range. A strong association was found between children’s and mother’s PPD (r = 0.60, P < 0.001), but this was somewhat less with fathers (r = 0.40, P = 0.02). Children in the lowest tertile of PPD had a tendency towards a higher body mass index, waist, fat mass and insulin.

Conclusions: The prevalence of small dense LDL is lower in children under 10 years of age than in their parents; fathers had a higher prevalence of pattern B than mothers and there is some evidence of a familial effect in the inheritance of pattern B.
Children with disruptive behaviours II: Clinical and community service needs
Authors: Hazell PL , Tarren‐Sweeney M , Vimpani GV , Keatinge D , Callan K
Published: March 2003

Objective: To assist in health service planning by determining the perceived clinical and community service needs of families resident in the Hunter region who care for a child manifesting disruptive behaviour.

Methodology: Families were eligible to participate in the survey if they had at least one child known to have one of the DSM‐IV disruptive behaviour disorders, autistic spectrum disorders, behaviour problems associated with rarer forms of brain disease, brain injury or mild intellectual disability or were identified by school personnel as having significant behaviour problems. Families were recruited to the survey via schools, early education centres and clinical services. Parents completed a questionnaire, mailed to them by educational and/or clinical services. Parents were asked to prioritize options for improving or expanding clinical services and for reducing their treatment costs.

Results: A total of 1412 families responded to the survey. The highest‐ranked clinical service options involved the expansion of mainstream community treatment services for children with disruptive behaviour problems and their families, with a particular emphasis on counselling services. Respite care and in‐patient services were given relatively low priority. Subgroup analyses showed that disadvantaged and stressed families gave higher rankings to out of home options, such as respite care, in‐patient care and subsidised holiday camps, than the aggregate sample.

Conclusions: Enhancement of community based counselling services would meet the needs of the greatest number of participating families. Resource‐intense residential services are required by a small but important group of families who experience disadvantage and high levels of stress.
Familial parathyroid carcinoma in a child
Authors: Hamill J , Maoate K , Beasley SW , Corbett R , Evans J
Published: March 2003

Abstract:  Familial hyperparathyroidism and parathyroid carcinoma are rare diseases. A case of parathyroid carcinoma in an 8‐year‐old girl whose mother had previously undergone parathyroidectomy for primary hyperparathyroidism is reported. Parathyroid carcinoma in a preadolescent child has not been described previously, and may have a familial basis.
The Australian National Medicinal Drug Policy
Authors: Sansom L
Published: March 2003

Abstract A responsibility of Government is to ensure that safe and efficacious medicines are available for people, from local industry, to treat illness and to maintain health. However, the cost of these medications to the public must be such that access is not denied because of financial barriers. Accessibility alone does not ensure that health outcomes are maximized. It is also necessary to have in place structures and processes which involve all stakeholders in ensuring the quality use of medicines. All of these components need to be incorporated in a national, co‐ordinated policy which acts as a reference point for appropriate drug use, policy development and evaluation.
Re‐engineering an Australian emergency department: Can we measure success?
Authors: Jelinek GA , Mountain D , O’Brien D , Rogers IR , Wilkes G , Wenban J , Carr J , O’Keefe S , Martin PJ
Published: March 2003

Abstract In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a re‐opened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re‐engineering an emergency department can be shown to improve the quality‐of‐care.
Cerebrovascular accident clinical pathway
Authors: Wilkinson Graham , Parcell Melinda , Macdonald Avis
Published: March 2003

Abstract The cerebrovascular accident (CVA) clinical pathway project was selected to complement the work already underway within the West Moreton Health Services District such as the development of a continuum of care model, revision of work practices to complement the new hospital redevelopment and encouraging team and evidence‐based approaches to problem solving. Specific objectives were set for the project along with a detailed evaluation plan. A steering group was convened to run the project and a full time project officer was appointed. At the end of the 12 month period all the objectives were met. Specific achievements included a reduction in the overall average length of stay for those patients who experience CVA, improved clinical outcomes and a more effective use of resources. Quality of care has been improved through the preparation of specialized clinical pathway documentation, education packages, patient surveys, focus groups, independent reviews and benchmarking. Complementing these measures has been a series of process changes and environmental modifications. Furthermore, good working relationships have been established with private sector providers of health care and other external bodies. The development of the CVA clinical pathway at the Ipswich Hospital has meant timely referrals and a streamlined assessment and referral process to get patients into rehabilitation sooner. It has promoted good communication between, and recognition of, the professional roles of various team members and has put the patient back at the centre of the care process.
Quality assurance and technology assessment: Pieces of a larger puzzle
Authors: Mcdonald Ian G
Published: March 2003

Abstract Increasing integration of health care and health services research has resulted in an overlap between disciplines involved in the evaluation of clinical practice. We have examined the relationships of quality assurance (QA), medical technology assessment (TA), clinical epidemiology (CE) and evidence‐based medicine (EBM) from an historical perspective. Clinicians, patients and administrators need local information on effectiveness of routine care. Information from trials alone, efficacy data, will not suffice nor can it be culled from administrative databases designed for other purposes. The current activities of QA should be therefore be expanded to include the study of the effectiveness of interventions in terms of appropriateness of use, patient outcomes and study of the determinants of outcomes, as seen from the perspective of doctors, patients, administrators and policy makers, using data collected during the course of routine patient care. With the assistance of information technology, with methodological support and multidisciplinary cooperation, clinicians can do this as part of a more broadly defined clinical research. Quality assurance and TA both evolved with the objective of studying clinical care but have quite different historical roots, complementary perspectives and objectives, use different methods and involve a different set of practitioners. Quality assurance is a type of ‘formative’ evaluation conducted in the clinical setting using indicators as flags of process or outcome events of interest, simple surveys and audit studies. Its primary aim is to achieve incremental improvement rather than to simply pass judgement. An important underlying assumption is that health care behaves as a complex dynamic system. Technology assessment, a form of summative evaluation with an orientation towards policy, synthesises information from formal scientific studies of efficacy in the form of clinical trials and studies of cost‐effectiveness. For the evaluation of the impact of any technology more complex than a drug, the complementary contributions of both of these disciplines is needed, and QA and TA should work cooperatively in tandem with the support of CE and EBM.
The Quality Manager
Authors: Wilson Lionel L
Published: March 2003

Abstract In the entire quality management jigsaw, no one piece is more important than an adequately trained and qualified quality manager. The terms quality co‐ordinator and quality improvement officer do nothing to assist the understanding of this vital member of a hospital’s staff. This paper describes the qualifications and role of a quality manager and emphasises that few such qualified quality managers exist in Australian hospitals.
Quality management and the Emergency Services Enhancement Program
Authors: Cobelas Carlos , Cooper Carolyn , Ell Mary , Hawthorne Graeme , Kennedy Marcus , Leach Deborah
Published: March 2003

Abstract Since the introduction of the Emergency Services Enhancement Program (ESEP) in Victoria in 1995, improvements have been demonstrated in the indicators relating to Emergency waiting times, ambulance bypass rates and inpatient bed access block. This study focuses on staff perceptions of changes in these indicators, factors perceived to influence performance improvements and the extent to which ESEP is perceived to have contributed to overall patient care. A questionnaire was directed at four focus groups within each of the hospitals participating in ESEP. These were Chief Executive Officers, Emergency Department Directors and Nurse Unit Managers, bed coordinators and personnel from the Emergency Department floor. A total of 101 staff responded. Emergency Department staff were generally accurate in their perceptions of performance changes. The most important factors effecting the changes were perceived to be changes in staff profile, management of patient flow through the department, changes in administrative policies and changes in work practices. Staff perceived that patient care has improved by 10% since 1995 and that ESEP has contributed 8% of this improvement. Staff have perceived improvements in ESEP performance indicators consistent with actual changes. The possible mechanisms by which these changes have occurred are presented and discussed. Factor analysis indicated that changes perceived to be most likely to result in improvements were: changes in staff profile (seniority), managing the flow of patients through emergency departments, changing administrative policies, changes in work practices and changes in staff numbers. Improvements in patient care were considered partly due to ESEP. In addition, ESEP has raised awareness of quality management issues.
Postnatal depression: Use of health services and satisfaction with health‐care providers
Authors: Webster Joan , Pritchard Margo A , Linnane John WJ , Roberts Janice A , Hinson Janis K , Starrenburg Suzanne E
Published: March 2003

Abstract The objective of this study was to compare health‐care use and satisfaction with health‐care providers between depressed and non‐depressed women in the first 4 months after childbirth. Sixteen weeks after delivery a questionnaire, which included the Edinburgh Postnatal Depression Scale (EPDS) and items about health‐care use and satisfaction, was mailed to women who attended the antenatal clinic, Royal Women’s Hospital, Brisbane. Completed questionnaires were returned by 574 (86.4%) of the 664 women surveyed. During the study period most women (91%) visited a general practitioner at least once and 117 (12%) saw their doctor on five or more occasions. A total of 118 (20.7%) scored above 12 on the EPDS. Depressed women were more likely to visit a psychiatrist (OR, 9.2; 95% CI, 4.3–19.6), social worker (OR, 6.1; 95% CI, 3.3–11.1), postnatal depression group (OR, 4.0; 95% CI, 1.3–12.6), paediatrician (OR, 2.5; 95% CI, 1.6–3.9), or a general practitioner (OR, 2.1; 95% CI, 1.4–3.2) than non‐depressed women. Twenty‐two (18.5%) of the depressed women had contact with a psychiatrist. Compared with non‐depressed women, those scoring above 12 on the EPDS were less satisfied with the services of general practitioners (P = < 0.000), paediatricians (P = 0.002), Nursing Mothers’ Associations of Australia (P = 0.043) and obstetricians (P = 0.045). Postpartum depression leads to an increase use of health‐care services and has a negative effect on satisfaction with some services.
Statistical evaluation of calcium carbonate equilibrium in natural water
Authors: Dabrowski Wojciech , Buchta Robert
Published: March 2003

A simple statistical model for the Langelier Saturation Index has been developed for all drinking water intakes supplying Cracow. The model has been tested by comparison with the solution of the set of equations governing calcium carbonate equilibria. A high degree of agreement with the results of calculations was achieved, including not only the ionic strength of water solutions but also the so‐called ion‐pair effects. The model is summarised by simple formulae, which can be used for manual calculation of the Langelier Saturation Index.
Trends in interannual yield variation of reservoir fisheries in Bangladesh, with special reference to Indian major carps
Authors: Ahmed Khan Kamal Uddin , Hambrey John B. , Rahman Sanzidur
Published: March 2003

Interannual variation in yield per species from a freshwater reservoir in Bangladesh was analysed by using long‐term landing data. Each species was categorized according to characteristics in interannual yield variation. The characteristics were defined with respect to size of the interannual variation in terms of absolute and relative variation around the mean yield and long‐term trends in catch levels. Annual variation was directly (t18 = 7.84; P < 0.01) related to the yield and can serve as a good indication of the status of the fishery when catches are low. The target fish, Indian major carps (IMC) Labeo rohita, Labeo calbasu, Catla catla and Cirrhinus mrigala, showed large variation in annual yield. This might have occurred because of variation in annual recruitment. Illegal use of gears is mostly related to variation in year class strength, and is assumed to be the most important source of change of stock variation. An increase in catch rate was recorded for Corica soborna. Such a stable combination may only be possible for a certain period without a long‐term trend. Trends in the yield rate of the major fish category for three decades reveal a sharp decline in the catch of IMC. In contrast, small clupeid‐like C. soborna have the highest yield rate. Fishing gears can play a crucial role in this fishery. Fisheries managers must always be alert when issuing fishing licenses and on the control on gears. The conclusion is that the IMC fishery of Kaptai Reservoir is an overexploited fish stock. In this fishery, the same gears are usually employed indiscriminately for different species and size classes. To stabilize the fishery, the existing policy needs to be strengthened and more effectively implemented. Also, some fishing gears and traps need to be restricted. An effective stock protection policy is suggested. Further study on catch size of individual species is essential prior to the development and implementation of any management scheme.
Record of mercury pollution in sediments of lakes Nakaumi and Shinji in Japan
Authors: Chandrajith Rohana , Okurnura Minoru , Ueno Takashi
Published: March 2003

Two sediment core profiles from lakes Shinji and Nakaumi were studied in order to understand the level of mercury (Hg) pollution in lakes in northwestern Japan. The sedimentation rates were established on the basis of the activity of [210Pb] and [131Cs] in the sediments. In Lake Shinji, the highest level of Hg (130 ng g–1) in the sediment was found at a depth of 20–22 cm, while 195 ng g–1 was found at a depth of 10–12 cm in the core profiles from Lake Nakaumi. The relative increase in Hg concentration in lake sediments started after 1960 and significant contamination events occurred in the early 1960s. Mercury profiles in lake sediments from lakes Shinji and Nakaumi are found to reflect the anthropogenic Hg released into the environment in the 1950s and 1960s. A pronounced maximun concentration of Hg is found in both lakes, where sediment accumulation rates differ.
Challenges and opportunities in watershed management for Laguna de Bay (Philippines)
Authors: Oledan M. T. T.
Published: March 2003

Laguna de Bay is the largest lake in the Philippines and the second largest freshwater lake in South‐East Asia. The lake is shallow with a mean depth of only 2.8 m. Rice paddies, sugar cane fields, coconut plantations and other agricultural fields make up large portions of the catchment area, although there is also extensive urbanization and industrialization. As industry and population around the lake have grown, the lake and its tributaries have become overwhelmed by industrial, commercial, agricultural and domestic pollution resulting in massive fish kills and polluted water. Laguna de Bay is under the management and protection of a national government agency known as Laguna Lake Development Authority (LLDA). In 1983, the LLDA was given the power to control and abate pollution within the Laguna de Bay watershed. The mandate of the LLDA includes the environmental regeneration and sustainable development and use of the lake’s waters, fisheries and wetlands. The LLDA receives no federal funds but it retains and uses collected fees from regulated industries. The LLDA has instituted an environmental‐user fee or pollution‐charge system that has given corporations an incentive to construct and use wastewater treatment plants at a lower cost than the required fees for dumping waste into Laguna de Bay. User fees provide more flexibility about how and when a user or industrial facility cleans up its manufacturing process. Many medium‐ and large‐sized domestic and multinational corporations have achieved at least 30–50% reductions in pollution loads. The user fees also encourage industry water conservation. Other creative approaches to conserving Laguna de Bay include ‘Environmental Armies’ that consist of volunteers who clean up river banks, demolish illegal fish pens and install low‐cost garbage traps at the river’s mouth. ‘Poison Awards’ are given annually and publicly to companies that continue to dump large amounts of waste into lake tributaries. Organizers also name a ‘Most Improved Company’ to provide a positive incentive. Laguna de Bay stakeholders face a severe shortage of resources to continue their work. Innovative strategies are needed to achieve pollution reductions from smaller industries
Sustainable fisheries management in the Great Lakes: Scientific and operational challenges
Authors: McCrimmon Jr Donald A.
Published: March 2003

Fisheries managers seek to sustain Great Lakes' fish populations in a large, complex lake‐watershed ecosystem responding to often competing issues: non‐indigenous species, resource allocation and environmental quality. Within the past 200 years, human activity has caused dramatic changes in the character of this ecosystem. Before the 1900s, the offshore fish communities in each of the Great Lakes were dominated by the piscivorous lake trout and burbot. The current fish fauna of the Great Lakes' basin includes 179 species representing 29 families in 18 orders and two classes of fish. Twenty‐five non‐indigenous fish species have established populations in the Great Lakes' ecosystem. Sustainable management of Great Lakes' fisheries depends on social, economic and ecological factors. Hundreds of millions of dollars are spent annually to protect and preserve Great Lakes' fisheries and their associated ecosystems. Management of Great Lakes' fisheries on a species‐by‐species basis is pointless. Recreational fishing provides larger economic benefits on the Great Lakes, compared to commercial fisheries. Further, quota management, even when practiced at levels well below maximum sustainable yield, does not lead to stable fish communities. Management will be constrained more by ecological reality than by economic forces, but ultimately a managed system comprised of both indigenous and non‐indigenous fishes is a logical objective.
Dynamics and biogeochemical significance of the physical environment in Lake Biwa
Authors: Kumagai Michio , Ishikawa Kanako , Chunmeng Jiao
Published: March 2003

We have examined two aspects of the dynamics and biogeochemical significance of the physical environment in Lake Biwa. One is the horizontal distribution of cyanobacteria as it relates to the ‘first gyre’ in the north basin of Lake Biwa. We could easily measure the first gyre using a vessel‐mounted acoustic doppler currents profiler. We were able to quantify the dynamics of the horizontal and vertical structure of currents and water temperature of this gyre. The first gyre did not remain at a fixed position; it moved north and south according to the growth of the gyre. This may play a role in the redistribution of cyanobacteria from place to place in the north basin. The second important environmental dynamic we measured was oxygen consumption rates from 1994 to 2000. We found that the minimum oxygen concentration in the hypolimnion has a clear inverse relationship with the apparent oxygen consumption rates in the 80–85 m depth layer. As a reduction in oxygen concentration in the hypolimnion can have a serious impact on benthic organisms, we concluded that the Lake Biwa environment should be monitored carefully and systematically.
Distribution and electron microscopical and immunohistochemical aspects of Lafora bodies in a Lafora patient with a 17‐year clinical course
Authors: Yoshimura N , Kaneko S , Yohimura I , Yamagata K , Ichinohe H , Hagiwara C , Kusumi T , Kudo H
Published: March 2003

Autopsy was performed on a 30‐year‐old man who died of Lafora disease. This patient, one of two siblings with Lafora disease, had onset of symptoms at age 13 years and a clinical course of 17 years. He had frequent tonic‐clonic convulsions and myoclonus, followed by dementia. Due to dysphagia resulting from strong spasms of the pharyngo‐esophageal muscles, he underwent gastrostomy. Routine laboratory data, including liver function tests and an electrocardiogram (ECG), were within the normal range. The autopsy revealed degeneration with polyglucosan accumulations in myocardiac muscle cells, liver cells, and smooth muscle cells of the esophago‐gastrointestinal tract, urinary system, and blood vessels, as well as in striated muscle cells in the skeletal muscles and neurons in the nervous system. In the central nervous system (CNS), numerous intraneuronal polyglucosan accumulations (Lafora bodies) were present in the following structures (listed in decreasing order of density): the substantia nigra, olivary nuclei (superior and inferior), vestibular nucleus (medial and lateral), thalamus, globus pallidus (lateral segment), dentate nucleus, gracile and cuneate nuclei, cerebral cortex (frontal, temporal, parietal and occipital), amygdala, nucleus basalis of Meynert, neostriatum, hypothalamus, reticular formation of the brain stem, locus ceruleus, red nucleus, mesencephalic central gray, solitary nucleus, ambiguus nucleus, dorsal vagal nucleus, and some other cranial nerve nuclei. In the mammillary bodies or subthalamic nucleus no perikaryonal Lafora bodies were found, although a considerable number of intraneuritic Lafora bodies were noted. Electron microscopically, Lafora bodies were composed of granular material and irregular filaments (about 6 nm in diameter), which were immunohistochemically positive for ubiquitin and tau. No Lafora bodies were reactive with Gallyas stain. This study is the first to have revealed that in Lafora disease smooth muscle cells can be systemically involved in specific degeneration for Lafora disease. In this patient, severe myoclonus could potentially spread over the pharynx and esophagus and cause pharyngo‐esophageal spasm and dysphagia. Because of the very long clinical course, the histopathology of this patient may represent the full extension of the degeneration that is specific for Lafora disease.
Central nervous system involvement in Rosai‐Dorfman disease: Report of a case with a review of the literature
Authors: Shuangshoti Shanop Shuangshoti , Navalitloha Yot , Sukpanichnant Sanya , Unhasuta Churaiorn , Shuangshoti Samruay
Published: March 2003

A 55‐year‐old woman had Rosai‐Dorfman disease (RDD) forming multiple masses of abnormal histiocytes, three in the cranial cavity and one in the left orbit that was proptotic. The masses were removed and found to consist of abnormal histiocytes that were immunoreactive to cluster designation 68 (CD68) (KP‐1), alpha‐1‐antitrypsin and S‐100 protein and showed emperipolesis. A review of 28 cases of RDD, including this instance, revealed a ratio of 5:2 between males and females and a mean age of 32 years. Intracranial involvement was much more frequent than that of the spinal cord. Histologically, central nervous system (CNS) RDD must be distinguished from meningioma, Langerhans cell histiocytosis, and plasma cell granuloma. Surgical extirpation appears to be the treatment of choice for this idiopathic histiocytic proliferative disorder of the CNS in comparison with radiotherapy and steroid treatment, which have also been tried.
Neuronal and glial differentiation of neuroblastoma and glioma cells by Rho inhibitory bacterial exo‐enzyme C3
Authors: Komagome Rika , Shuto Bunei , Moriishi Koji , Kimura Kazuhiro , Saito Masayuki
Published: March 2003

Exoenzyme C3 (C3) produced by Clostridium botulinum type C and D strains specifically modifies the small GTP‐binding protein Rho. It has been reported that C3 induces neuronal differentiation of the PC12 cell, an adrenergic cell line. In this study, the effects of C3 on a cholinergic cell line (NG108–15) and a glioma (C6) were examined for their differentiation. Treatment of NG108–15 cells and C6 glioma cells with C3 for 3 days induced neurite or process formation. Moreover, treatment by C3 increased the activities of acetylcholine esterase and choline acetyltransferase in NG108–15 cells, and 2′,3′‐cyclic nucleotide 3′‐phosphohydrolase in C6 cells. These results suggest that C3 induces neuronal differentiation of the cholinergic cell as well as the adrenergic cell, and also glial differentiation of the glioma cell.
Prognostic value of aberrant p53 immunoexpression for the recurrence of ependymoma: An analysis of 76 cases
Authors: Korshunov Andrey , Timirgaz Valery , Golanov Andrey
Published: March 2003

Intracranial ependymoma is the third most common primary brain tumor in children. Although clinical and histological criteria for ependymoma prognosis are recognized, studies have reported contradictory results. Prognostic significance based on the molecular biology of ependymomas has been reported in a few studies. Seventy‐six patients with intracranial ependymomas were examined retrospectively for p53 DO‐7 immunoexpression in tumor specimens. The results indicate significant association of aberrant p53 expression with high‐grade ependymomas and demonstrate a close correlation with recurrence‐free survival. All 22 of the p53‐positive high‐grade ependy‐momas had recurred within the first 24 months after operation with a median recurrence‐free survival time of 12 months. There were nine recurrences among 18 of high‐grade p53‐negative tumors with median recurrence‐free survival time of 27 months. A multivariate analysis using a Cox proportional hazard model including both clinical and pathological factors exhibited an independent prognostic value for the p53 positivity only (P = 0.0015). A multivariate regression tree analysis (CART) graded tumors as follows: (i) low‐grade (36 cases, recurrence rate = 19%); (ii) high‐grade p53‐negative (18 cases, recurrence rate = 50%); and (iii) high‐grade p53‐positive (22 cases, recurrence rate = 100%). A novel classification of ependymomas is proposed that should prove useful in designing an optimal treatment strategy.
Clinical concept of frontotemporal dementia
Authors: Tanabe Hirotaka
Published: March 2003

The clinical concept of frontotemporal dementia is reviewed by discussing its relationships to several related concepts. These include dementia of the frontal lobe type, slowly progressive aphasia without dementia or primary progressive aphasia, semantic dementia and frontotemporal lobar degeneration. A number of examples of confusion in the terminology are also examined.
Minamata disease
Authors: Eto Komyo
Published: March 2003

Minamata disease (methylmercury poisoning) was first discovered in 1956 around Minamata Bay, Kumamoto Prefecture, Japan. A second epidemic in Japan occurred in 1965 along the Agano River, Niigata Prefecture. This paper presents a brief review of Minamata disease with an emphasis on the cases found in Kumamoto Prefecture. At autopsy, the most conspicuous destructive lesion in the cerebrum was found in the anterior portions of the calcarine cortex. Less severe but similar lesions may be found in the post‐central, pre‐central and temporal transverse cortices. Secondary degeneration from primary lesions may be seen in cases with long survival. In the cerebellum, pathological changes occur deep in the hemisphere. The granule cell population was more affected, compared with Purkinje cells. Among peripheral nerves, sensory nerves were more affected than motor nerves. Our recent experimental studies that reveal knowledge of the pathogenesis of methylmercury poisoning will be discussed.