Prevalence of abdominal aortic aneurysm in Western Australia

The prevalence of abdominal aortic aneurysm (AAA) in Western Australia was studied using health department mortality data. Age-standardized and age-specific mortality rates related to the disease were calculated for the period 1980-88. The mortality rate has risen by 36 per cent for men and 24 per cent for women. Most of this rise was due to an increase in non-hospital and emergency admission hospital deaths. The number of elective and emergency operations has also risen. Despite two decades of elective surgery, the mortality rate for AAA continues to rise. This rise is highly suggestive of an increasing prevalence. This contrasts with the decline in deaths from other manifestations of arteriosclerosis and provides support for a policy of screening for aneurysm.     

Carcinoembryonic antigen (CEA) expression and heterogeneity in primary and autologous metastatic gastric tumours demonstrated by a monoclonal antibody

The expression of carcinoembryonic antigen (CEA) in gastric malignancies has been assessed using a monoclonal antibody in an immunoperoxidase technique. Of 119 primary tumours examined, 92% reacted with the antibody. Metastases were available for 81 of the patients and 83% were CEA positive. A noteworthy observation was the detection of malignant cells in the lymph nodes of two patients, as a result of the presence of CEA, who were originally reported to be free of metastases. Of those patients whose primary tumours expressed CEA, 86% had at least one CEA positive metastasis. Two or more metastases were available from 60 of the patients and in 20% the secondaries were a mixture of positive and negative for CEA. Consequently, the CEA status of a single lesion does not enable confident prediction of expression in other metastases. In addition to variation between multiple lesions removed from the same patient phenotypic diversity of expression was observed between tumour cells of a given mass. Such distribution of the CEA detected by this monoclonal antibody may impose certain restrictions on its application. However, the high frequency of expression by gastric cancers indicate that it is a potentially useful antigen as a target for radiolocalisation or therapeutic agents.     

Intraspinal tumors in children. A review of 81 cases.

The authors have presented 81 children with intraspinal tumors, all less than 16 years of age. The clinical features indicated that gait disturbance, pain, and sphincter disturbance are the most prominent complaints. Reflex changes, paralysis, and sensory impairment are the most frequent physical findings. Cerebrospinal fluid protein was recorded in 47 patients and was abnormal in 34. Spine radiography was abnormal in 58% of the patients. Seventy of the patients had myelography, and it was diagnostic in 67. Surgery was performed on 79 patients, with a 2.5% operative mortality (30 days postsurgery). Of the 49 patients who are alive, 91.5% are able to walk. Mean follow-up period was 8.5 years. The authors document the benign course of the intramedullary astrocytomas and suggest an approach to their treatment. They encourage an aggressive approach to metastatic intraspinal tumors. The latrogenic origin of some epidermoid tumors is noted. The importance of early diagnosis and treatment of the intraspinal tumors in children is emphasized.     

Rett syndrome: abnormal membrane-bound lamellated inclusions in neurons and oligodendroglia

The brain biopsy of a patient with Rett syndrome showed light microscopic evidence of white matter disease. Ultrastructurally, many neurons and oligodendroglia contained membrane-bound electron-dense inclusions with a distinct lamellar and granular substructure. This substructure suggests that part of these inclusions are derived from phospholipid. If confirmed in other cases of Rett syndrome, the neurochemical study of these inclusions may contribute to an understanding of this disorder.     

The male/female dichotomy in the nursing profession in a time of social change: more male nurses, but increasing numbers of female patients-an international perspective.

We invited a number of internationally well-known nurses to comment, and their responses are published below for consideration and discussion by our readers.
The aim of JANFORUM is to foster debate. We look forward to hearing readers' views on this or related topics.     

Corrigendum to: Changes in smoking,drinking, overweight and physical inactivity in young Australian women 1996–2013

Issue addressed: Smoking, risky drinking, overweight and obesity, and physical inactivity are health‐risk factors (HRFs) that contribute significantly to morbidity worldwide. Several initiatives have been introduced over the past two decades to reduce these HRFs. This paper examines changes in the prevalence of HRFs in young women (aged 18–23 years) between 1996 and 2013, overall and within demographic groups. Methods: Data from two cohorts of the Australian Longitudinal Study on Women's Health, born in 1973–78 (n =14247) and 1989–95 (n =17012) were weighted to provide national estimates. Prevalence ratios were used to compare HRFs in 2013 relative to 1996. Results: In 1996, 32% were current smokers, 38% were risky drinkers, 22% were overweight or obese and 7% were physically inactive. In 2013, corresponding estimates were 19%, 35%, 33% and 6%. Between 1996 and 2013, overall smoking prevalence decreased, but remained over 43% among least educated women. Overweight and obesity increased in all demographic groups. Conclusions: The findings suggest that only smoking, which has been the subject of changes in taxation, legislation and regulation, declined significantly, in all except the least educated women. In contrast, the prevalence of overweight and obesity, which has largely been addressed through awareness campaigns and voluntary actions by the food industry, increased markedly in all demographic sub‐groups. So what?: The findings show that comprehensive health promotion interventions, such as those for tobacco control, are successful (but may still be ineffective among less educated women). In contrast the measures to control population weight gain among young women have been futile so far.     

Physical activity, Body Mass Index and health care costs in mid-age Australian women

OBJECTIVE: This study examined the relationships between combined categories of physical activity (PA) and Body Mass Index (BMI) with health care costs in women and assessed the potential cost savings of improving PA and BMI in sedentary mid-age women. METHODS: Cross-sectional analysis of 2001 survey data linked to health service use data for the same year from 7,004 mid-age women (50-55 years) participating in the Australian Longitudinal Study on Women's Health. RESULTS: The mean (median; interquartile range) annual cost of Medicare-subsidised services was $542 (355; 156-693) per woman. Costs were 17% higher in obese than in healthy-weight women and 26% higher in sedentary than in moderately active women. For sedentary obese women, mean costs were 43% higher than in healthy weight, moderately active women. After adjustment for potential confounders, the relative risk of 'high' claims (>or=15 claims per year) for overweight women who reported 'moderate' or 'high' PA were lower than for women with healthy BMI who reported no PA. CONCLUSIONS AND IMPLICATIONS: Lower PA and higher BMI are both associated with higher health care costs, but costs are lower for overweight active women than for healthy-weight sedentary women. At the population level these data suggest that there would be significant cost savings if all sedentary mid-age women could achieve at least 'low' levels of PA (60-150 minutes a week).