Human leptospirosis in New South Wales, 1975-1985

From July 1975 to June 1985, 14,630 sera from patients in New South Wales were tested for serological evidence of leptospirosis. Among these, 361 sera contained evidence of past infections and 150 of these 361 specimens had evidence of recent or current infections. Serologically-diagnosed cases of leptospirosis were distributed mainly in the central and eastern parts of the State. Pomona, hardjo and icterohaemorrhagiae were the most common serovars to be detected; male abattoir workers and farmers were the most common occupational groups that were infected. An increase in seropositive cases occurred from 1981, largely due to hardjo and to a lesser extent pomona infections among farmers. Clinical histories indicated that most cases presented as pyrexias of unknown origin or as febrile illnesses; however, four patients were reported to have presented with renal failure; three patients were reported to have presented with meningitis; and 10 patients were jaundiced at presentation.     

Trends in self-poisoning with drugs in Newcastle, New South Wales, 1980-1982

A review has been carried out of 747 cases of self-poisoning with drugs which were treated in the three major Newcastle hospitals over the three-year period 1980-1982. The data obtained have been compared with earlier published data for the years 1976-1979. The number of patients who were admitted to hospital fell from 290 in 1980 to 226 in 1982. The most common drugs used were benzodiazepine (34.5% of cases) and antidepressant agents (9.1%), paracetamol (7.9%), barbiturates (7.1%) and phenothiazines (3.8%). Although this indicated a gratifying drop in the use of barbiturate drugs, the use of several drugs in combination in self-poisoning rose disturbingly. Five patients died in hospital; 23 who committed suicide with drugs were not admitted to hospital but were investigated by the Regional Forensic Pathologist.     

Botulism in New South Wales, 1980-1981

The isolation of Clostridium botulinum from the home environment of New South Wales patients with infant botulism is reported. Of the three cases of infant botulism type B, the bacteria were isolated from soil around the dwelling in one, and from tank rainwater in another. In one case with type A, the bacteria were present in the soil, vacuum-cleaner dust, and tank rainwater. The bacteria were not detected in the environment of two adult patients and a child with C. botulinum in their stools. The home location of the patients with infant botulism, and the frequency of isolation of the bacteria from rainwater, soil and vacuum-cleaner dust in Cobar, Nyngan, some Sydney suburbs, and at five pastoral homesteads suggest that infants in rural areas are more at risk than those in large metropolitan areas. The age of the infants with diagnosed botulism in New South Wales, compared with those reported in the United States data, strongly suggests that the disease is not being fully recognised in younger infants.     

Prevalence of Huntington disease in New South Wales in 1996

OBJECTIVE: To estimate the prevalence of Huntington disease (HD) in New South Wales on Australian Census Day (6 August) 1996. DESIGN: Survey of records of the Huntington Disease Service and major hospitals, and of neurologists, psychiatrists, clinical geneticists and genetic counsellors. SUBJECTS AND SETTING: All patients in NSW who, on Census Day 1996, either had a definite diagnosis of HD (motor signs of chorea or ataxia and family history of HD or positive DNA test result) or would have had signs and later received a definite diagnosis (assessed 1 April 1997 to 1 July 1999). MAIN OUTCOME MEASURES: Prevalence (HD patients per 100,000 population); patient characteristics; year and basis of diagnosis. RESULTS: 380 patients with definite HD were identified, giving a prevalence of HD in NSW in 1996 of 6.29 per 100,000 population (95% CI, 5.68-6.96). A third of HD patients were aged 60 years or older. Diagnosis was confirmed by DNA testing for 171 patients (45%), including 30 (8%) with no recorded family history. Average numbers of new diagnoses per year were 11.8 (1984-1988), 21.8 (1989-1993) and 28.6 (1994-1998). Estimated number of people with a 50% risk of inheriting the HD mutation was 25.2 per 100,000 population. Estimated incidence of HD in 1996 was 0.65 per 100,000 population. CONCLUSIONS: Prevalence of HD in NSW is similar to estimated prevalence in other Australian and Western populations. Increasing numbers of cases are being diagnosed, and the 18 chronic care beds currently designated for HD patients in NSW are unlikely to be sufficient.     

Accuracy of packaging of dose administration aids in regional aged care facilities in the Hunter area of New South Wales

OBJECTIVE: To audit the accuracy of dose administration aid (DAA) packaging in regional aged care facilities (RACFs) within the boundaries of the Hunter Urban Division of General Practice. DESIGN, PARTICIPANTS AND SETTING: Each participating RACF audited one DAA for each resident receiving medication between May and August 2006. Registered nurses compared the contents with the medication chart prepared by the general practitioner and recorded any discrepancies as incidents. MAIN OUTCOME MEASURES: Number of medication incidents in the provision of DAAs. RESULTS: 297 incidents were detected from 6972 packs for 2480 residents (incident rate of 4.3% of packs and 12% of residents) from 42 participating RACFs. Reasons for incidents included medications missing from a pack (99 occasions), wrong medication dispensed (12), supply of the wrong strength (32), incorrect labelling (7), pharmacies supplying medication that had been ceased by the GP (37), incorrect dosage instructions (32), medications not delivered to the RACF (13). CONCLUSION: The rate of incidents in DAA packaging in RACFs was high. The error types included incorrect packaging, correct packaging but the DAA was no longer required, and operational problems. Recommendations for improvement include: continuing audit and analysis by RACFs; streamlining of communications among GPs, pharmacists and RACF staff; using electronic methods to chart, order and dispense medications; use of generic names as much as possible; development of guidelines for the supply of medication in DAAs.     

Meningococcal serogroups in New South Wales, 1977-1987

Data are presented on serogroups of meningococci (Neisseria meningitidis) that were submitted to Westmead Hospital and The Children's Hospital, Camperdown, from patients in Sydney and in rural areas of New South Wales, from January 1, 1977 to December 31, 1987. One hundred and ten organisms that were isolated from cerebrospinal fluid or from blood were examined. All organisms were isolated from sporadic cases of meningococcal disease. Patients in the zero-to-two-years' age-group were affected most commonly, but 36.3% of isolates were from older children and adults. The distribution of serogroups was as follows: serogroup B, 43.6; serogroup A, 28.2%; serogroup C, 10.0%; serogroup W135, 8.2%; serogroup Y, 4.5%; and serogroup Z, 0.9%. The isolates that were serogrouped by us represented approximately half the cases of meningococcal meningitis that were notified in New South Wales during this period. Serogrouping of meningococcal isolates is very important in order to follow epidemiological trends in the disease and to monitor the serogroups that cause outbreaks, where vaccination of contacts may be indicated. Our laboratories are prepared to receive isolates for serogrouping and antibiotic sensitivity testing from across New South Wales.     

Tuberculosis in New South Wales

Surveillance of tuberculosis in New South Wales depends on notification of cases by medical practitioners and careful follow-up by public health nurses dedicated to the control of tuberculosis. Evaluation of tuberculosis surveillance data enables identification of patterns of infection, highlighting areas requiring specific interventions. In 1986, 290 cases of tuberculosis were notified to the Department of Health, New South Wales. The majority of patients (72.8%) were diagnosed as having pulmonary disease. The highest rates of infection were in people from Southeast Asian countries. Whereas 5.2% of cases were identified when the patients entered Australia, a substantial proportion of diagnoses (23.1%) were made in people who had been resident in Australia for 10 or more years. This article highlights the need to continue efforts to improve tuberculosis surveillance and control programmes in New South Wales.     

Mitigating the health impacts of a natural disaster--the June 2007 long-weekend storm in the Hunter region of New South Wales

A severe storm that began on Thursday, 7 June 2007 brought heavy rains and gale-force winds to Newcastle, Gosford, Wyong, Sydney, and the Hunter Valley region of New South Wales. The storm caused widespread flooding and damage to houses, businesses, schools and health care facilities, and damaged critical infrastructure. Ten people died as a result of the storm, and approximately 6000 residents were evacuated. A natural disaster was declared in 19 local government areas, with damage expected to reach $1.5 billion. Additional demands were made on clinical health services, and interruption of the electricity supply to over 200,000 homes and businesses, interruption of water and gas supplies, and sewerage system pump failures presented substantial public health threats. A public health emergency operations centre was established by the Hunter New England Area Health Service to coordinate surveillance activities, respond to acute public health issues and prevent disease outbreaks. Public health activities focused on providing advice, cooperating with emergency service agencies, monitoring water quality and availability, preventing illness from sewage-contaminated flood water, assessing environmental health risks, coordinating the local government public health response, and surveillance for storm-related illness and disease outbreaks, including gastroenteritis. The local ABC (Australian Broadcasting Corporation) radio station played a key role in disseminating public health advice. A household survey conducted within a fortnight of the storm established that household preparedness and storm warning systems could be improved.     

Recent advances in ischaemic heart disease

There continue to be important developments in the understanding of the pathogenesis of coronary artery disease. Advances have also been made in both the medical and interventional management of patients with ischaemic heart disease. This review has, however, not focused on the wider developments that have occurred in the area of percutaneous intervention. The vast array of new stent designs and other interventional devices have had a considerable impact on the treatment of obstructive coronary disease. In addition it is likely that further developments will be seen in areas such as intracoronary radiotherapy to reduce restenosis after PTCA and in gene therapy to promote angiogenesis in ischaemic myocardium. Both of which will be discussed in a future review of this area.