Setting goals for health in a time of prosperity:

Millennium development goals for the world's poorest nations need to be matched by health priority goals for prosperous nations, to relieve the burden of wealth-related disease.     

Health care safety: what needs to be done?

Recent MJA editorials assert that Australian hospitals are no safer than they were when the first hospital safety report was published in 1995. Despite many recommendations by several committees and much activity to improve safety over the past decade, we lack concrete evidence that safety and quality of health care have improved. Efforts to promote hospital safety in the United States and the United Kingdom also remain unevaluated. Incentives for safer care have been implemented locally, but not applied to entire health systems. A recent review in Australia has recommended replacing the current Australian Council for Safety and Quality in Health Care with a smaller Commission on Safety and Quality in Health Care. The Commission will link all national safety activity and report annually to Australian health ministers on hospital safety. We need a system that measures quality and safety, and provides financial incentives for safer care. Implementing the national framework for education about patient safety would develop teamwork skills and skills in techniques of continuous improvement. Linked to this, adequate financial support should be available to make safety changes in the health care environment.     

Delirium Tremens

The varied clinical manifestations and management of 14 male patients with delirium tremens (DT) have been studied. Eight patients were initially hospitalised for diseases unrelated to ethanol abuse i.e. 2 each for gun shot wound, myocardial infarction and stroke, and one each for pneumonia and gastroenteritis. One patient was going through withdrawal because of prodrome of viral hepatitis before he was hospitalised for uncontrolled agitation and delirium. Two known cases of mild essential hypertension on dietary therapy reported for agitation, abnormal behaviour, a single episode of tonic clonic seizure and hypertensive encephalopathy as they could not/did not get alcohol for 3 days. Three patients presented denovo with DT without concomitant illness. The other features besides delirium and hallucinations were tremulousness in 10, tachycardia in 12, fever in 3, diaphoresis in 2 and tonic clonic seizures in 4 patients. The symptoms fluctuated markedly at short intervals and 2 patients did not have any features of sympathetic overactivity. Altered hepatic biochemical parameters and ketonuria with normal blood sugar were noted in 4 and one patients respectively. Other biochemical parameters including serum electrolytes were normal. CT scan brain done for 5 patients revealed subdural haematoma in one. Cerebro spinal fluid (CSF) and EEG findings were noncontributory. All made good recovery with heavy doses of intravenous vitamin B complex, glucose and oral benzodiazepine. Short course of haloperidol was used in 2 patients. Two patients developed pancreatitis during follow up. All patients made complete recovery, and 8 patients have been followed for 8 to 12 months without relapse. The reason for hospitalisation in such cases is often unrelated to alcohol abuse; hence a detailed history of alcoholism is mandatory to identify those at risk as well as for prompt treatment and decreasing the mortality.Key Words: Alcohol withdrawal, Concomitant illnesses, Delirium, Precipitating events     

Acute effects of urban ambient air pollution on respiratory symptoms, asthma medication use, and doctor visits for asthma in a cohort of Australian children

We enrolled a cohort of primary school children with a history of wheeze (n=148) in an 11-month longitudinal study to examine the relationship between ambient air pollution and respiratory morbidity. We obtained daily air pollution (ozone, particulate matter less than 10 microm, and nitrogen dioxide), meteorological, and pollen data. One hundred twenty-five children remained in the final analysis. We used logistic regression models to determine associations between air pollution and respiratory symptoms, asthma medication use, and doctor visits for asthma. There were no associations between ambient ozone concentrations and respiratory symptoms, asthma medication use, and doctor visits for asthma. There was, however, an association between PM(10) concentrations and doctor visits for asthma (RR=1.11, 95% CI=1.04-1.19) and between NO(2) concentration and wet cough (RR=1.05, 95% CI=1.003-1.10) in single-pollutant models. The associations remained significant in multipollutant models. There was no consistent evidence that children with wheeze, positive histamine challenge, and doctor diagnosis of asthma reacted differently to air pollution from children with wheeze and doctor diagnosis of asthma and children with wheeze only. There were significant associations between PM(10) levels and doctor visits for asthma and an association between NO(2) levels and the prevalence of wet cough. We were, however, unable to demonstrate that current levels of ambient air pollution in western Sydney have a coherent range of adverse health effects on children with a history of wheezing.