Epidemiological aspects of "repetition strain injury" in Telecom Australia

An epidemic of "repetition strain injury" ("RSI") in Telecom Australia is described. In the years 1981-1985, there have been 3976 reports of "RSI". The occupation that was most affected was that of telephonist, with 1886 reports and a rate of 343 per 1000 keyboard staff members over five years; among other occupations that were affected were clerical workers (1421 reports; rate, 284 per 1000 keyboard staff members); telegraphists (17 reports; rate, 34 per 1000 staff members); and process workers (235 reports; rate, 116 per 1000 staff members). Women accounted for 3330 (83%) of all reports; in the telephonist group, 27% of female and 20% of male staff members were affected (P less than 0.001); for women, younger staff members were more affected. There was a significant difference among states in the prevalence of "RSI" in telephonists. There was a high morbidity, and 644 (16%) subjects were affected for more than 26 weeks; the cost-effectiveness of treatment and rehabilitation varied appreciably among state administrations. The costs of the epidemic exceed $15 million, including $1.8 million in medical costs. Reasons for the rise and decline of the epidemic are discussed.     

Breast cancer in young women: Imaging and clinical course

The purpose of this study was to characterize presenting imaging findings in women younger than 40 diagnosed with invasive breast cancer in the context of pathology and clinical course. Retrospective chart and imaging reviews were performed in patients under 40 diagnosed with breast cancer between July 1, 2004, and December 31, 2013. Patient demographic, imaging, pathology, and clinical data were collected. Overall and recurrence-free survival were estimated using the Kaplan-Meier method. Univariate Cox proportional hazards models were performed to identify factors associated with recurrence-free survival. Our study cohort consisted of 110 patients with invasive mammary carcinoma. One hundred one (91.8%) presented with a palpable mass. The mean size of all lesions on imaging was 3.5 cm ± 2.9 cm. Malignant calcifications were present in 54 (49.1%) cases. Imaging demonstrated multifocal or multicentric disease in 45 (40.9%) cases. Seventy four (67.3%) cancers were high grade. Luminal genomic subtypes were the most common (n = 61, 55.5%). At presentation, 4 (3.6%) patients had bilateral malignancy and 8 (7.3%) patients had distant metastatic disease. Ninety seven (88.2%) underwent neoadjuvant chemotherapy and 67 (60.9%) underwent radiation therapy. Seventy five (68.2%) of the patients underwent mastectomy. The restricted mean time to recurrence was 9.01 years (standard error 3.162 months). ER positivity was associated with compromised recurrence-free survival. The overall survival rate was 0.962 at 10 years. Young patients diagnosed with breast cancer typically present with advanced breast imaging findings and undergo aggressive treatment. Recurrence often occurs >5 years from diagnosis, and ER positive subtypes are at increased risk for recurrence.     

Quality of Life Assessment,of Ileogastrostomy

Twenty of 26 (77%) consecutive patients undergoing ileogastrostomy, performed by the same surgeon (IGMC) between February 1989 and May 1992, responded to a mailed quality of life survey. Average present weight was reported as 50.9 kg less than a mean preoperative weight of 139.7 kg. Mean time of follow-up was 24.75 months. When comparing perceptions before and after surgery, several quality of life improvements were noted in the areas of vocation, relationships, emotional well-being and physical well-being. Post-surgery, jobs were rated more satisfying, eating habits improved, self-image and self-confidence increased and body disparagement declined. Satisfaction with sexual relations increased, as did frequency. In general, relations with partners, co-workers and friends seemed to improve. Exercise also increased significantly. In contrast, foul flatus, bloating, and bowel movements regularly hampered activities or caused embarassment when in public. Despite these physical side-effects, we observed that a large majority of persons undergoing ileogastrostomy noted significant improvements in quality of life.     

A comparison of perinatal mortality between ethnic Chinese and ethnic whites: Why the Chinese rate was lower

Objectives. To confirm the observation that has been occasionally reported in the literature that perinatal mortality rate is lower in ethnic Chinese than in ethnic whites, and to assess the reasons for this lower perinatal mortality rate.

Methods. Secondary‐analysis based on published data.

Results. This exercise demonstrates that the perinatal mortality rate was lower in ethnic Chinese than in ethnic whites. The birth weight distribution in ethnic Chinese was more favourable with reduced births at two extremes of the distribution, and the exposure to risk factors for perinatal death by their mothers was also lower.

Conclusion: Perinatal mortality rate is lower in ethnic Chinese than in ethnic whites, and the lower perinatal mortality rate in ethnic Chinese is probably caused by their favourable birth weight distribution and lower exposure to risk factors of perinatal death by their mothers.     

Helicobacter pylori-induced diarrhea post-ileogastrostomy

A retrospective study of all ileogastrostomy procedures (n=26) performed in 1993 by one surgeon (IGMC) was carried out to investigate the hypothesis that Helicobacter pylori may be implicated in certain severe cases of postoperation nausea and diarrhea. Ten of 26 persons (38.5%) displayed nausea and notable diarrhea (greater than or equal to ten bowel movements per day), seven of which warranted upper GI investigation. One hundred per cent (seven of seven) of these persons were found to possess H. pylori upon C-14 breath test. In four of six cases eradication therapy (1 g amoxicillin b.i.d./20 mg omeprazole b.i.d. for 2 weeks) corresponded with a resolution of severe nausea and diarrhea (one additional case involved omeprazole use only), suggesting that H. pylori should be considered as a possible cause of these symptoms post-ileogastrostomy. Additionally, in four of seven cases persons were re-tested (C-14 breath analysis) at least 1 month post-therapy and in this group three persons were found to be free of the organism. All three cases of notable diarrhea and nausea resolved with treatment, providing the strongest evidence for a possible association between infection and these symptoms.     

Reduction in wool follicles prior to birth in Merino sheep

This study was undertaken to identify whether all secondary follicles that are initiated are present at birth in the Merino fetus, and if not, when does net initiation of secondary follicles cease. Skin was sampled from fetal lambs at 36, 26 and 16 days before the estimated date of parturition and from lambs at birth and 2, 4, 6, 8 and 13 weeks after birth. The ratio of secondary to primary follicles (S/P) reached a maximum 16 days before birth and was significantly lower at birth (P<0.002) and at all postnatal ages (P<0.05). There was no difference between S/P at birth and S/P at later ages. Postnatal primary follicle density, secondary follicle density and the percentage of fibre-producing follicles followed similar patterns to those reported by others. This is the first conclusive demonstration that secondary follicle initiation is completed several weeks prior to birth and that there are less secondary follicles at birth than at 134 days of gestation.     

Public involvement in health care priority setting: an economic perspective

Background  Public involvement in health care decision making and priority setting in the UK is being promoted by recent policy initiatives. In 1993, the British Medical Association called for public consultation where rationing of services was to be undertaken. The approach to priority setting advocated by many health economists is the maximization of quality adjusted life years (QALYs). Typically, for a particular health care programme, the QALY calculation takes account of four features: (1) the number of patients receiving the programme, (2) the survival gain, (3) the gain in quality of life and, (4) the probability of treatment success. Only one feature, that relating to quality of life, is based upon public preferences. If the QALY is to be used as a tool for health care resource allocation at a societal level then it should incorporate broader societal preferences.
Methods  This study used an interview-based survey of 91 members of the general public to explore whether the traditional QALY maximization model is a good predictor of public responses to health care priority setting choices.
Results and conclusions  Many respondents did not choose consistently in line with a QALY maximization objective and were most influenced by quality of life concerns. There was little support for health care programmes that provided a prognostic improvement but left patients in relatively poor states of health. The level of respondent engagement in the survey exercise was not sensitive to the provision of supporting clinical information.     

Battlefield analgesia: an advanced approach

We present an advanced battlefield analgesia protocol that is designed to provide the maximum benefit for the greatest number of patients using the minimum of resources. During the development we considered logistics, drug pharmacology and safety, aetiology of the pain and the experience of the expected administrator. Analgesia is only considered after the "ABCD" criteria of the Primary Survey have been satisfied. The analgesics administered range from enteral nonopioids through to intravenous opioids based dynamically upon the Visual Analogue Score (VAS). We suggest this protocol could be used by healthcare workers who may not have been trained in acute pain management but are called to administer analgesia to the serviceman in pain.