bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin D deficiency and secondary hyperparathyroidism: clinical and biochemical associations in older non‐institutionalised Southern Tasmanians
Authors: Inderjeeth C. A. , Nicklason F. , Al‐Lahham Y. , Greenaway T. M. , Jones G. , Parameswaran V. V. , David R. 
Published: March 2008

Abstract Aim: To determine the prevalence and associations of vitamin D (25‐OHD) deficiency in a sample of older Tasmanian subjects. Methods: A cross‐sectional survey of: 109 patients with a mean age of 79 years (range 60–101 years) consecutively admitted to a short stay geriatric rehabilitation ward; 52 community dwelling subjects with a mean age of 75 years (range 64–88 years). Subjects answered a questionnaire, had anthropometric measurements and underwent venepuncture. Results: The main outcome measure was 25 hydroxy vitamin D (25‐OHD) level with deficiency defined as < 28 nmol/L. Vitamin D deficiency was found in 67% and secondary hyperparathyroidism in 49% of the hospitalised group. Vitamin D deficiency was also found in 17% of the community group, in particular one in three residents of Independent Living Units was deficient. Subjects who were deficient were older (80 years vs 76 years [p<0.001]), had lower body mass index (23.7 kg/m2vs 25.9 kg/m2 [p<0.001]) and had a lower serum albumin (35 gm/L vs 39 gm/L [p<0.001]). Deficient subjects had poorer physical functional status (p=0.02) and lower activity levels (p<0.001) and reported less habitual sun exposure (p<0.001). Biochemical measures such as parathyroid hormone, alkaline phosphatase and calcium were weakly predictive of vitamin D levels. By stepwise multiple regression analysis, the only significant predictors of vitamin D levels were the Frenchay Activity Index, albumin and calcium. Conclusion: Vitamin D deficiency and secondary hyperparathyroidism is common in community living older people who are hospitalised in Southern Tasmania and is associated with increasing age, poor physical function and activity and low reported sun exposure.
Improved coronary artery flow after coronary angioplasty in patients with unstable angina
Authors: Williams M. J. A. , McCormick M. P. , Kay I. P. , Restieaux N. J. 
Published: March 2008

Abstract Background: Coronary artery flow is impaired after myocardial infarction but there is limited information regarding coronary flow in unstable angina. Aim: To assess baseline coronary artery flow and the effects of coronary angioplasty on coronary flow in patients with unstable angina. Methods: Twenty‐one patients with unstable angina with a culprit lesion suitable for coronary angioplasty were enrolled in the study. Coronary flow was assessed with the Thrombolysis In Myocardial Infarction (TIMI) grade and the Corrected TIMI Frame Count (CTFC) pre and post angioplasty. Results: Baseline flow was impaired in the culprit artery compared to the non culprit artery (42.0±28.1 vs 25.3±7.0 frames, p<0.02). Pre angioplasty coronary flow was TIMI grade 2 in 52% and TIMI grade 3 in 48% of patients. Post angioplasty flow improved with TIMI grade 2 flow in 5% and TIMI grade 3 in 95%. After angioplasty coronary flow improved from 42.0±28.1 frames to 21.6±16.3 (p=0.0001). The culprit coronary stenosis decreased from 74±9% pre angioplasty to 28±12% after intervention (p=0.0001). Conclusions: Angioplasty and stenting of the culprit vessel restores normal coronary flow in most patients with unstable angina. This suggests that impaired flow in unstable angina is predominantly related to the culprit lesion residual stenosis.
The use of evidence‐based medicine in the practice of consultant physicians. Results of a questionnaire survey
Authors: Scott I. , Heyworth R. , Fairweather P. 
Published: March 2008

Abstract Background: Information is lacking about the extent to which Australasian physicians apply methods of evidence‐based medicine (EBM) in routine practice. Aims: To assess the frequency and predictors of use of EBM methods in a sample of consultant physicians in adult medicine. Methods: Self‐administered questionnaires were distributed to a convenience sample of 545 physicians from October 1998 to January 1999. Results: One hundred and eleven questionnaires were returned (20% response rate). Ninety‐eight (88%) respondents formulated five or less clinical questions per week; 69 (62%) undertook five or more evidence searches per week, the majority as MEDLINE searches involving therapeutic topics. Respondents identified insufficient time (74%), limited search skills (41%), and limited access to evidence (43%) as search impediments. In determining evidence quality, 37% frequently relied on global impressions, while 22% frequently applied explicit critical appraisal (p=0.008). Efficiency of literature searches was rated on average as good/very good by 18%, fair by 52% and poor by 30%. As a result of EBM, 47% frequently had confidence in pre‐existing decisions increased, 39% gained improved knowledge, and 5% altered clinical decisions. Frequently encountered inhibitors to changing practice were personal conservatism (40%), organisational constraints (40%), and interdisciplinary tensions (39%). Perceived weaknesses of EBM included: limited applicability to individual patients (26%); evidence deficiencies (25%); and too time consuming (13%). In making EBM more attractive, one third requested reliable evidence sources at the point of care. Conclusions: The application of EBM to routine practice by physicians is constrained by deficient EBM skills, limited access to evidence, lack of time, and cognitive and environmental factors. Targeted education in EBM and systems that quickly deliver high‐quality evidence at the point of care are needed in realising the full potential of EBM to improve care.
The optimal use of allopurinol: an audit of allopurinol use in South Auckland
Authors: Stamp L. , Gow P. , Sharples K. , Raill B. 
Published: March 2008

Abstract: Background: Gout is a common and challenging problem in South Auckland, New Zealand. Allopurinol is widely used but urate reduction remains unsatisfactory. Allopurinol dosing guidelines and a therapeutic range for plasma oxypurinol levels have been published. Aims: We aimed to determine the appropriateness of allopurinol dosing according to current guidelines and to assess the relationship between plasma creatinine, oxypurinol and urate. In addition, we assessed the clinical usefulness of the oxypurinol level. Methods: Thirty‐one patients, on a stable dose of allopurinol for at least three weeks, had plasma creatinine, urate and oxypurinol measured as part of routine clinical assessment. Relationships between the various methods were examined using regression analysis. Fisher's exact test was used to test associations with categorical variables. Results: Fifty‐five per cent of patients were on higher than recommended doses of allopurinol. There was a statistically significant relationship between calculated creatinine clearance and plasma oxypurinol level. Only 50% of patients with a plasma oxypurinol within the therapeutic range (30–100 μmol/L) had a plasma urate <0.42 mmol/L and this did not increase significantly in the patients with an oxypurinol level <100 μmol/L. Conclusions: There is poor adherence to the current recommended dosing guidelines for allopurinol. Creatinine clearance rather than plasma creatinine needs to be used to predict the dose of allopurinol. The current role of the oxypurinol level is to identify non‐compliers with allopurinol therapy. We need further research to clarify whether increasing the dose of allopurinol outside the recommended dose range to reach an oxypurinol level of close to 100 μmol/L may be of benefit in those who have not had sufficient urate reduction.
Non‐urease producing Helicobacter pylori in chronic gastritis
Authors: Ren Z. , Pang G. , Batey R. , Routley D. , Russell A. , Musicka M. , Dunkley M. , Beagley K. , Clancy R. 
Published: March 2008

Abstract Background: Helicobacter pylori infection is the commonest cause of gastritis. Different patterns of immune response to H. pylori infection and characteristics of bacteria are considered to contribute to clinical outcomes. Aim: To determine characteristics of the host H. pylori relationship in subjects with non‐ulcer dyspepsia and a histological diagnosis of gastritis. Methods: Thirty‐five subjects with chronic gastritis undergoing endoscopy (mean age 53 years, range 24–82, 14 male and 21 female) were studied, none of whom was on nonsteroidal anti‐inflammatory drugs or antibiotics. H. pylori infection was determined by rapid urease test (CLOtest), culture, antibody and RT‐PCR for Ure C, Cag A and 26 kDa gene and histology. Cytokine production of mucosal IL‐6 and IL‐8 were measured by ELISA. Results: Fifteen subjects were positive by CLOtest and/or bacterial culture. In these subjects histology showed numerous helical forms of H. pylori (Group I). Nine subjects were negative by CLOtest, bacterial culture, and mRNA for urease C fragment, but positive by PCR for the 26 kDa protein encoding gene. Histology in these subjects showed the presence of either coccoid forms (four), or scant helical forms (two), or mixed coccoid/helical forms (three) (Group II). Eleven subjects were negative by all methods of detection (Group III). IgG and IgA antibody levels in serum (p<0.05) and gastric tissue culture supernatant (p<0.001) were significantly higher in Group I than those in Group II or III. There were significant differences in the IgG serum and IgA supernatant antibody levels (p<0.01 and p<0.05) when Group II was compared to Group III. Supernatant IL‐6 levels were significantly higher in Group I (p<0.01) than those from Groups II and III. EL‐8 levels were higher in Group I (p<0.01) and Group II (p<0.05) when compared to Group III. Conclusions: ‘H. pylori‐negative’ gastritis can be associated with a non‐urease producing form of H. pylori, with a reduction in both local and systemic antibody levels and mucosal pro‐inflammatory cytokines.
A telephone call reminder to improve outpatient attendance in patients referred from the emergency department: a randomised controlled trial
Authors: Ritchie P. D. , Jenkins M. , Cameron P. A. 
Published: March 2008

Abstract Background: Poor compliance with attendance at outpatient clinic appointments in patients referred from emergency departments (EDs) is a major problem in public hospitals. Aims: To determine whether the intervention of a telephone call within three days of ED attendance would improve: 1. the proportion of patients making recommended outpatient appointments; and 2. the proportion of patients attending scheduled appointments. To characterise reasons for non‐attendance at appointments made by patients referred from the ED. Methods: A randomised controlled trial was undertaken of 400 patients recommended to make outpatient appointments during attendance at The Royal Melbourne Hospital ED in July‐August 1999. Intervention: a telephone call one to three days after attendance to remind the patient about the appointment (and its importance for medical follow‐up) if one had been made and to offer to make an appointment if one had not been made. Outcome measures: 1. making the recommended appointment; 2. attendance at the scheduled appointment; and 3. reasons for non‐attendance at scheduled appointments. Results: The telephone intervention improved attendance at scheduled appointments from 54.4% to 70.7% (p=0.002). The proportion of patients making appointments was not significandy affected. The commonest reasons given for non‐attendance were: attended general practitioner (13%), attended private specialist (6.6%), inpatient in hospital at time of appointment (6.6%), too busy or inconvenient (5.3%), claimed to have attended (5.3%) and did not differ by intervention. Conclusions: A significant improvement in the proportion of patients attending outpatients appointments can be made by a simple reminder telephone call one to three days after attendance at the ED.
Does high dose ipratropium bromide added to salbutamol improve pulmonary function for patients with chronic obstructive airways disease in the emergency department?*
Authors: Koutsogiannis Z. , Kelly A.‐M. 
Published: March 2008

Abstract Background: To determine the effect of high dose ipratropium bromide, both alone or in combination with standard dose salbutamol, on pulmonary function in patients presenting to the Emergency Department (ED) with acute exacerbation of chronic obstructive airways disease (COAD). Method: The trial was a prospective, randomised, double blind trial of adult patients with COAD. All patients received nebulised salbutamol 5 mg and 500 μg ipratropium and hydrocortisone 250 mg IV at time=0, then were randomised to receive further nebulisers at time=15 minutes and time=30 minutes of salbutamol 5 mg combined with ipratropium 500 μg or salbutamol 5 mg alone or ipratropium 500 μg alone. Pulmonary function tests were conducted at time=0 and time=90 minutes. The primary endpoints were absolute and percent change in FEV1. Results: The group randomised to receive 5 mg salbutamol and 500 μg ipratropium (n=18) showed a mean percentage change of FEV1 of 6.4% with a mean absolute change of 0.06 L (SD 0.18 L). Those who received 5 mg salbutamol (n=16) had a mean percentage change of 18.6% with a mean absolute change of 0.13 L (SD of 0.21 L). Those who received 500 μg ipratropium (n=16) had a mean percentage change of 4.8% with a mean absolute change of 0.023 L (SD of 0.07 L). There was no significant difference between the groups in FEV1 (p=0.56 for percentage change; p=0.36 for absolute change). Conclusion: The addition of 500 μg ipratropium to 5 mg salbutamol in subsequent nebulisers adds no benefit to pulmonary function after the initial nebuliser of both bronchodilators in the treatment of COAD in the ED.
The angiotensin converting enzyme (ACE) inhibitor, perindopril, modifies the clinical features of Parkinson's disease
Authors: Reardon K. A. , Mendelsohn F. A. O. , Chai S. Y. , Horne M. K. 
Published: March 2008

Abstract Background: Animal studies have demonstrated an interaction within the striatum between the angiotensin and dopaminergic systems. In rats, the angiotensin converting enzyme (ACE) inhibitor, perindopril, crosses the blood brain barrier and increases striatal dopamine synthesis and release. In humans, angiotensin type 1 receptors have been found on dopaminergic neurons in the substantia nigra and striatum. In Parkinson's disease, there is a marked reduction of these receptors associated with the nigrostriatal dopaminergic neuron loss. Aims: We performed a double blind placebo controlled crossover pilot study in seven patients to investigate the effect of the ACE inhibitor, perindopril on the clinical features of moderately severe Parkinson's disease. Results: After a four week treatment period with perindopril, patients had a faster onset in their motor response to L‐dopa and a reduction in ‘on phase’ peak dyskinesia, p=0.021 and p=0.014 respectively. Patients also reported more ‘on’ periods during their waking day in their movement diary, p=0.007. Perindopril was well tolerated without any significant postural hypotension or renal dysfunction. Conclusions: These results suggest that ACE inhibitors such as perindopril may have a place in the management of motor fluctuations and dyskinesia in Parkinson's disease and justify further study.
A multivariate analysis of the association between social class of origin and current social class with self‐rated general health and psychological health among 16‐year‐old Australians
Authors: Siahpush M. , Singh G. K. 
Published: March 2008

Abstract: Background: A recent review of international literature concludes that there is a relative absence of social class differentials in health in early youth. There is an absence of Australian studies on the effect of social class on the health of this age group. Aims: To examine the association between social class and health among 16‐year‐old Australians. Methods: The data on 1048 16‐year‐olds came from the fifth wave (1993) of the Australian Youth Survey conducted by the former Department of Employment, Education and Training. Outcome measures were self‐rated general health and psychological health (GHQ‐12). Binary logistic regression was used to analyse data. Results: Neither social class of origin nor current social class was associated with self‐rated general health or psychological health. Conclusion: The argument that social class inequalities in health exist in childhood, disappear during early youth, and reappear later appears to hold ground within the Australian context.
Cost‐effectiveness and accuracy of exercise stress echocardiography in the non‐invasive diagnosis of coronary heart disease
Authors: Laufer E. , Wahi S. , Lim Y. L. 
Published: March 2008

Abstract: Background: Exercise stress echocardiography (ESE) is a more recent form of totally non‐invasive stress testing which like exercise thallium SPECT scintigraphy (ETS) was developed to overcome the known limitations of ECG stress testing, namely the limited diagnostic accuracy and the inability of ECG stress testing to site the region of coronary artery disease (CAD) induced ischaemia. Aims: To determine the sensitivity and specificity (and overall accuracy) of ESE in a group of patients referred for ETS imaging and compare the relative costs of each technique. Methods: One hundred and fifteen patients referred for ETS consented to a simultaneous ESE. Of this group, 59 patients underwent coronary angiography which was utilised as the gold standard. Results: The feasibility of ESE was 97% (112 of 115 patients of the total study population and 57 of the 59 patients who underwent coronary angiography). Of the 59 patients undergoing coronary angiography, the sensitivity of ESE and ETS were not significantly different (84.1%versus 91.3% respectively). However, despite the apparent marked difference in specificity (92.3%versus 61.5% respectively), p= NS (Fisher's exact test) as there were only 13 normals in the group who underwent coronary angiography. Overall accuracy was also closely similar (86.0%versus 84.7% respectively) and therefore also not significantly different. By contrast, agreement with coronary angiography as measured by the kappa statistic (k±SEk) was good for ESE (0.66±0.11) but only moderate for ETS (0.54±0.13). Moreover, there was a cost saving of at least 594.00 per patient in favour of ESE. Conclusion: ESE is a totally non‐invasive, sensitive, specific and cost‐effective imaging modality for the detection and localisation of CAD.
A CRITICAL REVIEW OF SEA‐LEVEL CHANGES IN EASTERN AUSTRALIA SINCE THE LAST GLACIAL
Authors: Hails J. R. 
Published: March 2008

AbstractAn outline of sea‐level changes is presented, based on field work, bore‐log data, radiocarbon analyses, and a review of the literature. The sequence of eustatic changes, during and since the Pleistocene Epoch, is obscure in Australia, as elsewhere. Evidence suggests that the sea rose rapidly from 17,000 until 6,000 B.P., and that some deltaic plains and coastal depositional features along parts of the New South Wales and Queensland coasts formed since approximately 5,000 B.P. In the areas studied, there is not sufficient evidence to support a lo‐foot higher sea‐level which has been reported in Australia and attributed to a post‐glacial thermal maximum. A possibility of slight epeirogenic movement is considered in attempting to explain some coastal features in southern New South Wales.
Hydraulic Resistance by the River Red Gum, Eucalyptus camaldulensis, in Ephemeral Desert Streams
Authors: GRAEME D. , DUNKERLEY D.L. 
Published: March 2008

Channel roughness in desert streams is generated by the colonisation of beds and banks by trees including the river red gum, Eucalyptus carnaldulensis. Often growing densely over the bed surface, these trees contribute channel roughness which is distributed through the flow; the effects are heightened by substantial barriers of flood‐transported debris which lodge against trunks and branches, offering additional obstruction to water movement. Bed scour often occurs around such obstacles.Field mapping of channels in the Barrier Range, western NSW, where E. camaldulensis growth is common, has permitted the quantification of channel roughness. Results suggest that just under half of the total channel roughness may be contributed by in‐channel vegetation, the remainder coming from boundary friction effects. Site‐to‐site variations in vegetation density are great and assessment of flood discharges and sediment fluxes in these streams without due incorporation of a roughness correction could result in substantial errors of overprediction.
LES ETUDES DE SOCIOLOGIE RURALE EN EUROPE1
Authors: MENDRAS HENRI 
Published: March 2008

Les Etudes De Sociologie Rurale En EuropeRésuméGrâce aux réponses a un questionnaire envoyé aux spécialistes de vingt pays européens, il a êté possible de faire un premier recensement de l'état de l'enseignement et de la recherche dans ces pays. L'enseignement spécialisé de la Sociologie rude, sanctionné par un diplôme particulier n'existe que dans deux pays. Dans de nombreux pays la Sociologie Rude est considérée comme me discipline annexe à un autre enseignement (sociologie générale, économie rurale). Les organismes de recherches sont encore très peu nombreux, par contre dans presque tous les pays quelques recherches sont en cours, et il a été possible d'en établir une liste.Lehre Und Forschung Der LÄNdlichen Soziologie in EuropaZusammenfassungUm einen ersten Überblick uber die Lage der Lehre und Forschung in der ländlichen Soziologie zu gewinnen, wurde ein Fragebogen an geeignete Persönlichkeiten versandt. Dank der erhaltenen Antworten ist es möglich, eine Darstellung der Situation in zwanzig europäischen Ländern zu geben. Ein Spezialstudium der ländlichen Soziologie mit Diplomabschluss gibt es nur in zwei Ländern. In zahlreichen Ländern wird die lädliche Soziologie nur im Abschluss an andere Disziplinen gelehrt z.B. Allgemeine Soziologie und Agrarwirtschaftslehre. Besondere Forschungsinstitute sind nur wenige vorhanden. Dennoch sind in fast allen Ländern Forschungsarbeiten im Gange, die in einem Anhang aufgefühft sind.Studies in Rural Sociology in EuropeSummaryThanks to replies to a questionnaire from specialists in twenty European countries it has been possible for the first time to give an account of teaching and research work in rural sociology in these countries. In two countries only there exists an academic course of instruction in this discipline leading to a specific diploma. In most of the other countries rural sociology is treated as a subsidiary subject to others, for instance, to general sociology and agricultural economics. Very few specialized Research Institutes have been established but some research work is being carried out in nearly all countries. A list of these studies is given in an appendix.