Viral hepatitis in Bermuda—1972

In 1972, 73 cases of viral hepatitis (VH) were recognized in Bermuda. This representedthe most cases in any year since 1968 when 166 cases were reported. Cases in 1972 were randomly distributed both geographically and chronologically. The incidence of hepatitis was greater among individuals 15–29 years of age than among those ≤ 14 years. While the majority of illnesses are believed to have been due to hepatitis-A virus (HAV) infection, some hepatitis-B virus (HBV) disease was also recognized. Twenty-three ill individuals were examined for presence of the hepatitis-B antigen (HBAg), and 4 were positive. No common source or single exposure appeared responsible for the increase in cases in 1972; rather, the illnesses resulted from a number of different factors including (a) person-to-person transmission during close personal contact in households, (b) sharing of needles and/or close intimate contact with parenteral drug abusers, and (c) occupational exposures.     

Doppler ultrasound assessment of fetal and uteroplacental circulations in severe second trimester oligohydramnios

Summary. Doppler blood flow studies in 41 pregnancies with oligohydramnios in the second trimester found abnormal patterns in all 14 pregnancies with intrauterine growth retardation but in only one of nine pregnancies with premature rupture of the membranes, and one of 10 with fetal renal defects. Mixed patterns were found in a heterogeneous group of fetuses with other malformations or intrauterine infection. Unlike previous reports a diagnosis was achieved in all pregnancies, suggesting that Doppler studies should be an integral part of the antenatal investigation in such pregnancies.     

Public policy and quality of healthcare

Anaesthesiologists have long been interested in improving the quality of clinical care. However, clinical care is but one contributor to healthcare quality, which is influenced by a wide range of factors including health policy, health system funding, and organization. It is the interaction between these drivers and a nation's social and economic conditions (such as education and personal income) that determines the population's health. Whereas public debate has focused on healthcare funding, health systems face similar problems in achieving the best outcomes most affordably. The ability to measure outcome is limited in most jurisdictions, mainly by the lack of information systems. Nevertheless, public reporting of quality indicators has increased. Affordability is threatened by new technologies, population growth and ageing. This threat is creating renewed interest in prevention and population health, particularly through the use of leading indicators. With this interest in population health, the role and education of physicians may need to change.