The thoughts of the late Fred Hollows on the provision of specialist services to rural and remote Australians

ABSTRACT: This paper consists of the late Professor Fred Hollows' responses to questions concerning the provision of specialist services to remote communities. In December 1991, Professor Hollows was invited to meet with a Research Advisory Committee assisting me as I gathered and analysed data concerning the provision of specialist services. Throughout the interview he emphasised three criteria essential for the provision of effective specialist services, namely: credible and competent service providers, regular services, and good liaison and communication with the local community. In addition, he spoke about the role of the specialist in upgrading the skills of general practitioners and the need for medical audits to assess the extent to which local primary care practitioners are able to accurately identify illnesses requiring specialist attention. Finally, Professor Hollows made comment on the importance of empowering local health professionals, specialists and generalists, through skill and knowledge enhancement so that they are able to advocate on behalf of their constituencies.     

Inhibin- A and Pro-αC Are Elevated in Preeclamptic Pregnancy and Correlate with Human Chorionic Gonadotropin

PROBLEM: Serum concentrations of the heterodimeric glycoprotein inhibin-A (α-β_A) and its α-subunit increase during pregnancy. The placenta is the predominant source of inhibin during pregnancy, and a paracrine role in the trophoblast has been suggested. Elevated serum concentrations of inhibin α-subunit as well as the glycoprotein human chorionic gonadotropin (hCG) have been described in preeclamptic pregnancy. The objectives of this investigation were to compare serum concentrations of inhibin-A and inhibin pro-αC in preeclamptic and normotensive pregnancy, and to examine the relationship of hCG and inhibin-A in those pregnancies. METHOD OF STUDY: A case-control design using 32 patients with preeclampsia with a single fetus at 32–40 weeks of gestation and 34 gestation age-matched normotensive control subjects was used for this investigation. Solid-phase enzyme-linked immunosorbent assays were used to measure inhibin-A and inhibin pro-αC in sera. An immunoradiometric assay was used to measure intact hCG. RESULTS: Inhibin-A and inhibin pro-αC concentrations were significantly elevated in the sera of women with preeclampsia compared with those concentrations in normotensive control subjects (P < 0.05). A relationship of inhibin-A or pro-αC with severity of preeclampsia was not observed. There was a significant positive correlation of serum hCG with both inhibin-A and pro-αC (P < 0.05). CONCLUSIONS: Levels of inhibin-A and the subunit pro-αC are increased in pregnancies complicated by preeclampsia. These findings are potentially the effect of a paracrine role of inhibin-A in the development and proliferation of the trophoblast.     

Prison misconduct among mentally retarded inmates

This article examines prison misconduct of inmates who tested as mentally retarded, borderline intellectual functioning, and intellectually normal. The sample is drawn from a cohort of inmates released from the New York State correctional system. Misconduct is measured by examining official documents and is divided into two types: non-violent and violent incidents. Analysis of variance suggests that the mentally retarded had significantly higher reported mean annual rates of involvement in both non-violent and violent incidents. However, results of multiple regression analysis indicate that, when controlling for the effects of several social and criminal history factors, IQ score has a significant effect on the violent, but not the non-violent, incident rate. Age and employment status at time of arrest have the strongest influence on an inmate’s disciplinary incident rate, while IQ score has the smallest influence of the variables examined in this study.     

Studies on Agranulocytosis. II. The Effect of Chlorpromazine upon the Influx of S35 L-Cystine and L-Methionine into Human Leukocytes

1. When whole blood was incubated in vitro with S-35 L-cystine and L-methionine, the blood cells became radioactive.

2. Preincubation of whole blood from normals and from patients susceptibleto agranulocytosis with chlorpromazine showed no effect upon uptake of S-35L-cystine and L-methionine by leukocytes.

3. The in vivo administration of S-35 L-cystine was followed by the appearance of radioactive leukocytes. Peak radioactivity occurred in leukocytes in 5to 12 days.

4. Pretreatment of test subjects with large doses of chlorpromazine did notblock the uptake of S-35 L-cystine by leukocytes in vivo. Leukocytes of womenshowed an increase in the incorporation of S-35 L-cystine, in vivo. Studiesperformed in vivo on two persons during recovery from agranulocytosisshowed enhanced uptake of L-cystine in one and a normal uptake in the other.

Submitted on March 24, 1960 Accepted on July 13, 1960     

Zinc deficiency and energy restriction modify immune responses in mice during both primary and challenge infection with Heligmosomoides polygyrus (Nematoda)

This study characterized the consequences of zinc-sufficient (Zn+, 60 mg zinc/kg diet, ad libitum ), zinc-deficient (Zn−, 0.75 mg zinc/kg diet, ad libitum ) and energy-restricted (ER, 60 mg zinc/kg diet which was restricted to match food intake of Zn− mice) diets on the in vivo and in vitro immune response of BALB/c mice during both primary and challenge infection with Heligmosomoides polygyrus . In Zn+ mice, both primary and challenge infection with H. polygyrus induced not only a strong Th2 response (IgE, IgG1, eosinophilia, IL-4, IL-5, IL-10), but also elements of a Th1 response (IgG3, IFN-γ). Zinc deficiency significantly depressed Th2-dependent antibody production during both primary and challenge infection, and reduced mitogen and antigen-induced T cell proliferation during the challenge infection. Th2 cytokine production was reduced by zinc deficiency (IL-4), energy restriction (IL-5) and by zinc deficiency possibly in combination with energy restriction (IL-10) during the primary infection whereas Th1 cytokine production (IFN-γ) was depressed during the challenge infection by zinc deficiency, possibly together with energy restriction. Both zinc deficiency and energy restriction reduced eosinophilia with the more profound effect being exerted by zinc deficiency. Thus, both zinc deficiency and its concurrent energy restriction modify immune responses in the mice during primary and challenge infection with H. polygyrus.     

Soluble CD16 (sCD16), a marker of malignancy in individuals with monoclonal gammopathy of undetermined significance (MGUS)

There are no well-defined host markers to determine which patients with a diagnosis of monoclonal gammopathy of undetermined significance (MGUS) will progress to multiple myeloma (MM). In this preliminary study we measured plasmatic soluble Fcγ receptor type III (sFcγRIII or sCD16) in 54 individuals with MGUS, 35 patients with multiple myeloma (MM) and 29 healthy controls. We confirmed, through receiver operating characteristic (ROC) curve analysis, that a low level of sCD16 discriminates MM patients from controls. Indeed, for a sCD16 value of 1.3 μg/ml, the sensitivity, as well as the specificity, of this discrimination were both equal to 83%, i.e. 83% of MM patients had a plasmatic sCD16 value <1.3 μg/ml compared with only 17% of controls. Moreover, ROC curve analysis showed that a low sCD16 level also identifies among MGUS patients a subgroup of patients who rapidly progress towards multiple myeloma: in this comparison, for a sCD16 level of 1.3 μg/ml, sensitivity and specificity were 70% and 79% respectively. Therefore a low sCD16 level in MGUS indicated a high likelihood of rapid evolution to MM. In contrast to sCD16, soluble IL-6R did not appear to be discriminant in this study.     

Uptake of amniocentesis in women aged 38 years or more by the time of the expected date of delivery: a two-year retrospective study

Summary. The uptake of amniocentesis for the prenatal diagnosis of chromosome abnormalities in older women ( 38 years by the time of the expected date of delivery) is reviewed over a 2–year period. Overall, 41·3% of women were not tested, including a group of 7% in whom no record of discussion of prenatal diagnosis could be found on review of obstetric records. Refusal of the offer of amniocentesis and late booking were significantly greater in Asian women (P < 0·01). One-third of chromosomally-abnormal infants were not detected antenatally in the study group.