Down's syndrome in South Australia.

In a survey of Down's syndrome in South Australia, 921 persons, both living and deceased, were identified; 717 individuals with the disorder were living in South Australia. Cytogenetic confirmation of the diagnosis had been made in 774 cases. From 1955 to 1977, the over-all incidence of Down's syndrome at birth was found to be 1.175/1000 live births. The incidence of Down's syndrome was significantly lower over the last five years of this period than for the first 18 years; thus it appears that the incidence of Down's syndrome in South Australia is falling. Analysis of maternal age changes with time has not revealed any changes to the maternal age-specific rates for Down's syndrome, although the rate for mothers aged 25 years or younger appears to be falling. The proportion of Down's syndrome babies born to women aged 35 years or more has decreased from 65.7% for those born before 1950 to 30.4% for those born from 1975 to 1977; similarly, the median maternal age has fallen from 37.12 years to 28.25 years. Regression analyses of maternal age rates for Down's syndrome by single years have produced figures suitable for genetic counselling. A plea is made that Down's syndrome should become a notifiable condition.     

Measles in the 1980s

We detail aspects of measles immunization programmes in several countries. Live measles vaccine has been available in Australia for 16 years, yet, in 1981, there were outbreaks of measles in the State of New South Wales (population 5 200 000) which led to 2200 admissions to hospital and five deaths. In response to complaints of "vaccine failure", a survey determined that 22.5% of children with measles seen by general practitioners and 10.3% of those admitted to hospitals had been previously immunized. There was no evidence of waning immunity, and noparticular batch of vaccine was implicated. The vaccine failures are attributed in part to failure of seroconversion in some recipients when immunized at 12 months of age as a result of interference by transplacentally acquired antibodies. As more of the susceptible population is vaccinated, there will be fewer cases of measles, but among these cases will be an increasing proportion of cases occurring in previously vaccinated individuals. The equation to calculate this expected proportion of "vaccine failures" is given. We support the measures to increase immunization compliance.     

Promotion of breast self-examination in South Australia. A short-term evaluation

In early October 1982, a campaign was launched in South Australia to encourage women to practice breast self-examination. A study of data from the State Cancer Registry was conducted to determine the impact of the campaign on the detection rate, the patient-survival rate and the extent of the tumour at the time of diagnosis. In the three months after the launch, 30% more cancer cases were detected than expected from the numbers presenting during similar periods in previous years. The increase was 53% for women under 50 years of age and 21% for older subjects. There is an indication that tumours diagnosed in the three months after the launch of the campaign were diagnosed earlier than those presenting in corresponding periods in earlier years. The proportion of cases with four or more affected nodes at diagnosis was substantially reduced. The slight differences in tumour diameter and one-year patient survival were also consistent with earlier diagnosis.     

Medical computing in the 1980s

Operating systems and programming languages differ widely in their suitability for particular applications. The diversity of medical computing needs demands a diversity of solutions. Compounding this diversity if the decentralization caused by evolution of local computing systems for local needs. Relevant current trends in computing include increased emphasis on decentralization, growing capabilities for interconnection of diverse systems, and development of common data base and file server capabilities. In addition, standardization and hardware in dependence of operating systems, as well as programming languages and development of programmerless systems, continue to widen application opportunities.     

The perinatal autopsy: its conduct and reporting in Australia.

OBJECTIVE: To assess the conduct and reporting on death certificates of perinatal autopsies in Australia. DATA SOURCES: (i) Medical certificates of cause of perinatal death in all States and Territories; (ii) registrations of perinatal deaths in New South Wales in 1985 and 1986. DATA EXTRACTION: Death certificates are assessed on three criteria: (i) an indication that an autopsy was performed; (ii) an indication whether the stated causes of death were based on autopsy findings; and (iii) an indication whether the clinical diagnosis was confirmed by autopsy. DATA SYNTHESIS: Perinatal death certificates give insufficient information in all three areas. Assessment of the accuracy and usefulness of autopsies requires better information. CONCLUSION: A two-part death certificate is suggested. The first part would report clinical diagnoses of the causes of death. The second part would compare these results with those of any autopsy.     

Ethical considerations concerning computers in medicine in the 1980s.

The advent of information technology and computers in medicine two decades ago posed a new set of ethical problems. In recent years, these problems have been compounded by the increasing use of computers for supporting clinical decisions as well as administration and record keeping. This presentation considers some of the problems which are raised by the use of computers to support clinical decisions, under the various headings of beneficence, non-maleficence, autonomy and justice. For each aspect the problems raised are described and the implications discussed.     

The incidence and distribution of RSI in South Australia 1980-81 to 1986-87

Despite the human and financial cost of repetition strain injury (RSI), comprehensive incidence data have been lacking. A unique opportunity exists to obtain such data in South Australia, where since 1980-81 the Australian Bureau of Statistics has assigned all injuries, not explicitly diagnosed as diseases but stated as having been caused by repetitive movement, to a unique "type of accident" code, and has subclassified them according to bodily location. The statistical profile of diseases and accidents affecting the upper limb resulting from repetitive movement is not simply one of a keyboard operators' epidemic. Rather, it has revealed a problem which is endemic in sections of the blue-collar workforce, in whom both the numbers and the incidence rates are higher than in keyboard operators, and were higher even when the incidence in keyboard operators peaked in 1984-85. These conditions have been especially frequent in particular sections of the female blue-collar workforce, and interventions which have resulted in (or coincided with) benefits to keyboard operators have failed to improve the situation in the former group. It is suggested that the groups most at risk are female workers performing unfulfilling, unskilled tasks, and that interventions to benefit these workers will have to give attention to more fundamental issues than those hitherto addressed.     

Curriculum change in the 1980s. A report of 40 southern US medical schools

Forty southern medical schools were surveyed to evaluate the nature and mechanisms of curricular change during 1980 to 1983. Ninety percent of schools experienced change in some aspect of curriculum. Faculty, curriculum committees, the dean, and external forces were stimuli for change. Internal self-review or self-criticism seemed to be the most important reasons for change. Proposals were considered by curriculum committees and the dean, but veto power often rested with the dean, although departmental chairmen and faculty occasionally had veto power. Types of change were divided equally between content, timing of courses, and the educational process. Half the schools stated that they had evaluated the changes or planned to do so. Thirteen of 38 changes in curriculum were in the direction of curricular innovations of the 1960s and 1970s and 25 were in the opposite direction.     

Impact of computerized tomography on neuroradiological investigations in South Australia.

Although there has been a reduction in cerebral angiographic (33%), pneumoencephalographic (70%) and radionuclide brain scanning (28%) investigations since the introduction of computerized tomography in South Australia, there has been a significant increase (56%) in the total number of neuroradiological investigations performed. At the same time, the number of patients who underwent neuroradiological investigations has risen by 75%. This is equivalent to approximately one person in every 290 per year.