Australasian Medical Journal
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Induced Chromosomal Damage
No full textBackgroundOne of the most important problems in radiotherapy (RT) with χ and γ-rays is hypoxic cells, in the centre of solids tumors. Due to insufficient blood perfusion, these cells are more resistant to RT. The purpose of this study is to assess the effect of heating cells on chromosomal damages induced by an extremely low dose of neutron or γ irradiation, in human lymphocytes.Method Human blood samples were exposed to hyperthermia (HT), 6 cGy neutron (or γ-rays), HT+neutron/γ, and neutron/γ+HT. HT was applied at 41.5°C for 30 and 60min as well as 43°C for 15 and 30min. The time interval between the two treatments was 1hr. After cell culture, harvesting, fixation, and staining, the chromosomal damages were scored in metaphase stage and statistical analyses were performed.ResultsIn comparison to the control groups, HT alone at 41.5°C (neither for 30 nor 60min) did not induce significantly higher chromosomal damages (p=0.8); however, the number of damages was significantly higher at 43°C for 30min (
Comprehensive Primary Health Care in Australia
Get PDFObjectives: To identify the extent to which the Alma Ata defined Comprehensive Primary Health Care (CPHC) approach is practised and evaluated in Australia and to describe the role that GPs and other medical practitioners play in it along with implications of this for future policy in light of the Health and Hospital Reform Commission (HHRC) and Primary Health Care taskforce reports, 2009 recommendations.Methods: We conducted a narrative review of the literature (published and grey) from 1987 to mid 2007 as part of a global review carried out by teams of researchers in six regions in 2007. Results: In Australia, the CPHC approach occurs chiefly in Aboriginal Controlled Community Health Services, state funded community health and in rural/remote and inner city areas. Participation by GPs in CPHC is limited by funding structures, workforce shortages and heavy workloads. Factors that facilitated the CPHC approach include flexibility in funding and service provision, cultural appropriateness of services, participation and ownership by local consumers and communities and willingness to address the social determinants of health.Conclusions: The recent HHRC and Primary Health Care Taskforce reports recommend an expansion of CPHC services as a means of tackling health inequities. The findings of this review suggest that resources will need to be directed beyond individual treatment to population health issues, cross-sectorcollaboration and consumer participation in order to realise the CPHC model. Without attention to these areas PHC will not be comprehensive and its ability to contribute to reducing inequities will be severely hampered. The absence of an evaluation culture supported with resources for CPHC programs and services also hinders the ability of practitioners and policy makers to assess the benefits of these programs and how their implementation can be improved. Funding structures, workforce issues and evaluation of programs will all need to be addressed if the health sector is to contribute to the goal of reducing health inequities
Patients Admitted with H1N1
No full textBackgroundDuring the spring of 2009, a pandemic of novel flu, popularly called swine flu, emerged in Mexico and spread globally. We describe the profile of the patients who were hospitalised with the flu in two large government hospitals in Bangalore. After warnings of flu outbreak, these two hospitals were identified initially for screening and treatment for novel flu.Method A retrospective review of clinical records is reported. Data including the common clinical features, underlying medical condition and treatment outcome of 112 patients admitted with novel flu to two government hospitals in Bangalore from June to November 15, was collected.Results61 (54.4%) of the patients were in the age group 16–35 years, 69 (61.6%) were males, 41 (36%) presented within two days of symptoms, 93 (83%) presented with fever, 81 (72.3%) presented with cough and 37 (33%) with breathlessness. The data suggests that 17% of the patients had history of travel to novel flu affected areas, 6.2% both travel and contact. For majority of patients, the duration of stay in the hospital was 4–6 days (51.7%), 12 (10.7%) had history of underlying co morbid conditions. In the study, 19 (16.9%) were treated with steroids, 31 (27.6%) were admitted to an ICU (intensive care unit) and 26 (23.2%) died all aged 16–35 years.ConclusionIn our study, majority of the patients were 16–35 years old, presented to the hospital within two days with fever, cough and breathlessness as the predominant symptoms and less than half of them had history of travel or contact. Most of the patients recovered, and death was reported in 23.2% of the patients
Diagnosis of Pulmonary Tuberculosis
Get PDFBackgroundIn India majority of patients with respiratory symptoms initially consult private doctor. Few studies have been performed on the role of private practitioners in TB control. The present study was planned to assess the private practitioners approach in the diagnosis of pulmonary tuberculosis.Method A Cross Sectional study was conducted between September 2008 and October 2009 in rural and urban area of Udupi taluk. The study population included all modern medicine general practitioners and all the specialists practicing Internal Medicine, Chest Medicine, and Paediatrics. The non response rate was 8%. About 15 practitioners who were not in the list were interviewed during field visits. So, the total number of practitioners interviewed was 116. ResultsThe majority (67.4%) of general practitioners and physicians opted for sputum examination as the investigation of choice to diagnose pulmonary Tuberculosis. About 26.1% of general practitioners and physicians used both sputum and chest x-ray to diagnose pulmonary tuberculosis. About 6.5% used chest x-ray alone. However, about 58.3% of paediatricians preferred both sputum and chest x-ray to diagnose pulmonary tuberculosis. ConclusionRelying only on chest x-ray to diagnose pulmonary tuberculosis may lead to over-diagnosis, over-medication and unnecessary utilization of resources. There is a need to improve the awareness among private practitioners regarding the importance of sputum smear examination to diagnose pulmonary tuberculosis
HIV/AIDS Education for Adolescents
Get PDFBackgroundAmong adolescents, girls are particularly vulnerable not only because they are more likely to be coerced for unprotected sex but also because they are more susceptible biologically to sexually transmitted diseases (STDs), including HIV infection. This study was carried out to determine the effectiveness of an educational intervention programme aimed at girls focusing on knowledge of and attitude to HIV/AIDS. MethodAn educational intervention study was carried out among 791 rural girls (16-19 years) randomly selected using stratified cluster sampling from coastal villages in Udupi Taluk, Karnataka, Southern India. They were educated regarding HIV/AIDS and their awareness levels were evaluated immediately and one month following intervention. Results Around 35-50% of the girls had misconceptions regarding the modes of transmission which significantly reduced to about 8 % after intervention (95% CI of difference in proportion = (9.2, 17.9);
Health Literacy Before and After Education
No full textBackgroundIn Nepal tuberculosis, outdoor and indoor air pollution, cigarette smoking, smoking during pregnancy, poor working and health conditions in industries are common. Perceptions about various aspects of lung health among non-medical personnel working in medical schools in Nepal have not been previously studied. Method The study was carried out during January 2009. Basic demographic information was collected. Participants’ perceptions about various aspects of lung health were studied by noting their agreement with a set of 50 statements using a modified Likert-type scale. The median total score and scores of various subcategories were calculated. The scores were compared among various subgroups of respondents using appropriate non-parametric tests. After noting the deficiencies a structured interactive session to correct them was conducted. Participant perceptions were studied immediately after the session using the same questionnaire and the scores compared to those before the session.ResultsFifty-one respondents completed the questionnaire before the education session and 31 did so post-session. The majority of respondents were female, less than 40 years of age, either Brahmins or Chhetris, belonged to middle socioeconomic group; high school educated and used gas at home for cooking. The median total score was 182 before the session and increased to 218 post-session (maximum possible score 250). There was a significant increase in the scores of different subcategories also. ConclusionNon-medical personnel in a Nepalese medical school had good knowledge and understanding of various aspects of lung health which further improved following an educational session
Insulin Intensification for People with Type 2 Diabetes
Get PDFBackgroundType 2 diabetes is a progressive disorder and with time, it is appropriate for insulin therapy to be initiated in the majority of people. Insulin is commonly initiated with once-daily basal insulin. However, when glycaemic control becomes unsatisfactory despite the introduction of basal insulin, no clear guidelines exist for intensifying the insulin regimen. In this article we aim to provide a clinician’s approach to both the optimisation of the basal insulin dose, and strategies to intensify insulin therapy.MethodsAn expert consensus panel, consisting of the authors, was convened to review the current practice of insulin intensification in people with type 2 diabetes and to develop a pragmatic algorithm for clinicians. The panel reviewed the published literature on the use of insulin in clinical practice, the evidence for different intensification strategies, and the potential impact of patient-related factors on insulin choices. ResultsInsulin intensification should only be considered after the basal insulin dose has been optimised. This is achieved by taking into account basal and prandial (pre and post) blood glucose levels, individualised target HbA1c, and dietary factors. If optimal basal insulin together with oral medications is not sufficient to reach glycaemic targets, the next step is to introduce a basal plus 1 regimen or switch to twice-daily premixed insulin. Each has advantages and disadvantages and existing guidelines do not emphasise or support any particular regimen. Therefore, it is important to individualise the choice according to the individual’s needs. A practical algorithm has been developed to help clinicians choose an appropriate second-line regimen.ConclusionAs beta-cell failure progresses in people with type 2 diabetes, basal insulin regimens need to be optimised and then intensified when necessary to maintain agreed glycaemic targets