Weighted multimorbidity indexes predicted mortality, health service use, and health-related quality of life in older women

OBJECTIVE: To develop indexes of multimorbidity, based on self-reported data, to predict mortality, health service use, help with activities of daily living (ADL), and health-related quality of life (HRQOL) in older women. STUDY DESIGN AND SETTING: Cross-sectional survey of 10,434 women, aged 73-78 years, in the Australian Longitudinal Study of Women's Health in 1999, with mortality follow-up to 2005. For analysis, the sample was equally split into a development and validation sample. Weighted and unweighted multimorbidity indexes were developed and tested. RESULTS: Outcomes ranged from 14% for mortality to 47% for specialist doctor visits. Mortality was predicted by heart disease, stroke, low iron, diabetes, cancer (nonskin), bronchitis/emphysema, and Alzheimer's disease. Different patterns of morbidities were associated with the other outcomes. Weighted and unweighted multimorbidity index scores were linearly related to increasing risk of each outcome. For each outcome, the weighted scores fitted the data better and had a wider range of possible values. CONCLUSION: These multimorbidity indexes predict mortality, health service use, help with ADL, and HRQOL in older women. The indexes could be used as covariates in research with weighted scores having a better chance of discriminating between patient groups than unweighted scores.     

Post-neonatal mortality by rurality and Indigenous status in Queensland

AIM: To compare post-neonatal mortality among urban and rural Indigenous babies in Queensland. METHODS: Registrations of deaths at ages 28 days to 12 months were linked to routine data from the Queensland Perinatal Data Collection. RESULTS: Indigenous babies were 2.52 times more likely to die during the post-neonatal period than non-Indigenous babies (95% confidence interval: 1.99, 3.20). The differential remained when urban and rural areas were examined separately: the differential was 2.53 (1.81, 3.54) in urban areas and 2.26 (1.58, 3.23) in rural areas. CONCLUSION: The key demographic variable that determines post-neonatal mortality in Queensland is Indigenous status, not rurality. This has important policy implications because it means that interventions to reduce the disparity in mortality between Indigenous and non-Indigenous babies should be delivered in urban as well as rural areas. Better routine data are needed and in particular clinical classification of deaths, so that interventions can be monitored and avoidable factors identified.     

Whiplash and its effect on the visual system

Whiplash or indirect injuries to the neck as a consequence of motor vehicle collisions are a common occurrence in which the frequency of ocular complications is largely unknown. Ophthalmic and oculomotor function was investigated in a longitudinal study of 39 cases who had their initial ophthalmological assessment within one week of the whiplash injury. Ten of 39 cases had ocular symptoms and signs which developed shortly after the accident. The principal abnormality in 6 of these was decreased convergence and accommodation, superior oblique muscle paresis in 2, decreased stereoacuity in 1 and bilateral vitreous detachments in 1 patient. All but 2 had complete resolution of their symptoms within 9 months. Four other patients were asymptomatic but had ophthalmic signs which resolved within 3 months. Oculomotor abnormalities following whiplash injuries are generally mild, have a good prognosis, and would appear from this study to be commoner than hitherto expected.This paper was presented at the 7th International Orthoptic Congress at Nurnberg, Federal Republic of Germany on 6th June 1991     

Reactivation ofhprt on the inactive X chromosome with DNA demethylating agents

The C86 line of female embryonal carcinoma cells contains one active and one inactive X chromosome. Following methylnitrosourea mutagenesis, a clone called C86AGM2 was isolated that carries a mutated hprtgene on the active X chromosome. This hprt^m allele encodes an HPRT enzyme that has less than 1% normal enzyme activity, is thermolabile, and has an altered isoelectric point. Following treatment with drugs that demethylate DNA, the hprt⁺ gene from the inactive X chromosome in C86AGM2 cells became active as determined by the appearance of HPRT activity with the thermodenaturation and electrofocusing characteristics of the normal enzyme. No expression of this hprt⁺ gene occurred if C86AGM2 cells were induced to differentiate prior to DNA demethylation. Stable lines of C86AGM2 cells expressing both the hprt^m and hprt⁺ genes did not inactivate either gene following differentiation.     

Knowledge of pelvic floor problems: a study of third trimester,primiparous women

Introduction and hypothesis

Pelvic floor problems in women (urinary incontinence, faecal incontinence, uterovaginal prolapse) are common, and have an adverse effect on quality of life. We hypothesized that there is low knowledge of these problems amongst primiparous women in their third trimester of pregnancy.

Methods

We conducted a cross-sectional study in antenatal clinics of three hospitals in London, UK, from 2011 to 2013. Primiparous women aged ≥18 years and in the third trimester of pregnancy answered questions on pelvic floor problems. Knowledge scores were calculated based on the proportion of questions answered correctly.

Results

A total of 249 women completed the question set. The average knowledge score across all domains was low at 45 %. Scores were lowest for the less common problems of faecal incontinence (35 %) and prolapse (36 %). The score for urinary incontinence was higher at 63 %, but low when questions explored more detailed levels of knowledge (41 %). Knowledge scores were positively associated with both education to tertiary level and the use of books as the information source on pregnancy and delivery. Only 35 % of women cited antenatal classes as a source.

Conclusions

Knowledge of pelvic floor problems is low amongst third-trimester, primiparous women in this London-based population. Adequate knowledge of these problems is important for women to be able to make informed choices about their antenatal care and to seek help if problems arise. The data suggest scope for health-care professionals to raise these issues early during pregnancy, and to help women access accurate sources of information.

     

Reticulo-fibroblastoid stromal cell progenitors (CFU-RF) in murine bone marrow.

The hemopoietic inductive microenvironment (HIM) of the bone marrow is responsible for secretion of growth factors that regulate hemopoiesis. It is composed of an extracellular matrix and a complex variety of cell types with a range of functions related to blood cell development. In order to understand how such a complex system operates, it will first be necessary to determine the role(s) of the integral parts. Several of the stromal cell types have been identified morphologically in various culture systems, and some of their functions have been elucidated. We have identified a new stromal cell type in mouse bone marrow that appears similar if not identical to its human counterpart. When bone marrow cells are placed in methylcellulose/plasma clot culture with phytohemagglutinin-stimulated human leukocyte-conditioned medium in the presence of bovine calf serum (BCS), mercaptoethanol, and hydrocortisone, extensive branching colonies develop within 14 days. These "reticulo-fibroblastoid" (RF) colonies arise from a putative reticulo-fibroblastoid colony-forming unit (CFU-RF) stem cell, and many become adipocytic by day 14; the addition of fresh medium, methylcellulose, and BCS on day 7 inhibits this change. The batch of human citrated plasma used in the culture system and the type and source of stimulating factor all influence the number of RF colonies that develop as well as the percent of colonies that become adipocytic. Whether this adipogenesis represents functional maturity or terminal differentiation is not yet known. Information gained on the role of these RF cells in normal and impaired hemopoiesis should contribute to the elucidation of the complicated interactive role of the microenvironment in the support and modulation of hemopoiesis.     

Atelosteogenesis type III: A case report

We present a case of rhizomelic dwarfism with clinical, radiographic and histologic features in keeping with atelosteogenesis type III (spondylohumerofemoral hypoplasia). Unlike most other skeletal chondrodysplasias presenting with neonatal dwarfism, a proportion of patients with atelosteogenesis type III may survive well beyond the neonatal period, and hence early identification of the condition is important. Our surviving patient further defines the radiographic features of the condition and the natural history and prognosis for physical and intellectual disability.     

A feasibility study of email communication between the patient's family and the specialist burns team

We investigated whether the parents of burns patients could capture suitable clinical images with a digital camera and add the necessary text information to enable the paediatric burns team to provide follow-up care via email. Four families were involved in the study, each of whom sent regular email consultations for six months. The results were very encouraging. The burns team felt confident that the clinical information in 30 of the 32 email messages (94%) they received was accurate, although in 11 of these 30 cases (37%) they stated that there was room for improvement (the quality was nonetheless adequate for clinical decision making). The study also showed that low-resolution images (average size 37 kByte) were satisfactory for diagnosis. Families were able to participate in the service without intensive training and support. The user survey showed that all four families found it easy and convenient to take the digital photographs and to participate in the study. The results suggest that the technique has potential as a low-cost telemedicine service in burns follow-up, and that it requires only modest investment in equipment, training and support.     

Evaluation of a pilot second-opinion child telepsychiatry service

A second-opinion child psychiatry service was piloted for six months in the northern-most two-thirds of Queensland. It provided specialist expertise by telehealth to local multidisciplinary teams of mental health staff. During the study period, 28 videoconferences were performed by the service: nine for administrative purposes, two for educational purposes, and 17 for direct and indirect clinical applications. The mean time between a referral being made and a consultation being performed was 4.7 days (range 1-13). A survey administered to referring and non-referring mental health workers showed that the major barriers to service implementation included the limited allied health applications that were offered, a perceived lack of communication during the implementation phase of the service, and the creation of a new referral network that did not conform to traditional referral patterns in the north of Queensland.