Primary Health Care: A Darling Downs Focus

ABSTRACT: Primary health care is a policy model Which integrates social principles into the functioning of the health system at the local level. There is increasing interest in primary health care policy development and in the implementation of primary health care due in part to: the challenge which primary health care raises to existing practice in health service planning and delivery; the changes in roles of health service professionals and consumers which primary health care demands, and the claims on resources which the implementation of primary health care may engender.
The conceptual basis of primary health care demands that decision-making be devolved to the local level. The organisational structure of the public health care system in Queensland, since regionalisation in July 1991, provides an environment which favours this localised decision-making. The Darling Downs Regional Health Authority, one of 13 regional health authorities in Queensland, released a 'Primary Health Care Discussion Paper' as an element in its strategy for primary health care implementation at the regional level. This paper was intended to demystify the concept, raise the level of debate and stimulate discussion about how primary health care might affect health professionals and the community.
This article analyses that discussion paper to illuminate the concept of primary health care emerging in the region and in Queensland Health. It also identifies potential barriers to the implementation of primary health care and outlines activities being undertaken in the region which illustrate ways in which primary health care can be manifested in local communities.     

Clinical Evaluation of a Dual Sensor, Rate Responsive Pacemaker

Dual sensor pacemakers should respond more appropriately during differing exercise modes than a single sensor device. The Topaz™ models 515 (QT and activity count [ACT] sensing) pacemaker shows appropriate rate response during treadmill exercise testing. We postulated that adjustments to relative sensor contribution should allow fine tuning of the onset of rate response. Eleven patients with this pacemaker were studied. Three standard exercise tests were performed with adjustment of sensor blending and activity threshold between each one. We also assessed the response to isometric exercise and a false positive activity signal. Results : Times to 100 ppm (3.7 ± 1.3, 4.4 ± 2.0, 5.3 ±1.5 mins), times to peak rate (6.1 ± 1.6, 5.6 ± 1.4, 6.5 ± 1.3 mins) and accelerations to peak (9.0 ± 2.4, 9.2 ± 5.3, 7.7 ± 2.8 ppm/min) were measured in all three different sensor settings (QT = ACT, QT 相似文献   

A meta-analysis of depressive symptomatology and alcohol consumption over time*

Meta-analysis (eight general population longitudinal studies) describes the relationships (regressions) between quantity per occasion and depressive symptomatology over time. Quantity and depression are the strongest and most consistent predictors of final levels of themselves in all data sets. Age significantly and consistently predicts quantity for both sexes combined (the general pattern is replicated among males only). Depression significantly predicts quantity and quantity significantly predicts depression for females. Controlling for interval between measurements produces stronger prediction (more consistent over shorter intervals) for males. Depression only predicts quantity over longer intervals and quantity only predicts depression over shorter intervals for females. Explicit control for age found stronger relationships between initial and final measurement quantity, and depression for males. Quantity and depression significantly predict quantity and depression among young females. The relationship between quantify and depression among females illustrates the importance of controlling for age and sex. Methodological considerations are discussed.     

SMALL BOWEL BACTERIAL OVERGROWTH IN SYSTEMIC SCLEROSIS: DETECTION USING DIRECT AND INDIRECT METHODS AND TREATMENT OUTCOME

Twenty-four patients with proven systemic sclerosis and withsymptoms suggestive of malabsorption (i.e. chronic diarrhoeaand weight loss) were investigated for small bowel bacterialovergrowth. Of the patients selected, six were suffering fromthe diffuse form of the disease. Jejunal aspiration was performedin all patients, and in nine normal volunteers. A speciallydesigned double-lumen sterile catheter was used or this purposeand was introduced via a gastroscope. Twenty of these patientsunderwent a glucose hydrogen breath test. Eight patients 33%)had significant bacterial counts: > 10⁵ colony forming unitsper ml (cful/ml) of jejunal fluid. Less than 10²cfu/ml werefound in the ejunal fluid from the nine control subjects. Glucosehydrogen breath testing was positive in seven patients, allof whom had significant ejunal bacterial growth. Diarrhoearather than weight loss was shown to be the symptom which correlatedbest with the presence of acterial Overgrowth. Ciprofloxacinwas used in six patients whose diarrhoea1 symptoms ceased dramaticallywithin 48 h of commencing the ntibiotic. Trimethoprim produceda partial response despite bacterial sensitivity. A disadvantageof the hydrogen breath test is that subsequent antibacterialtherapy cannot be specific, as bacterial species, antibioticsensitivity and resistance are unknown. Systemic sclerosis involving he small intestine in the past has been said to more prevalentin patients with diffuse disease, whereas this study showeda preponderance of patients with long-standing limited cutaneoussystemic sclerosis and small bowel involvement. KEY WORDS: Bacterial overgrowth, Small intestine, Jejunal catheter, Malabsorption, Systemic sclerosis, Antibiotics     

INNERVATION OF THE STRIATED MUSCLE OF THE MEMBRANOUS URETHRA OF THE MALE DOG

Purpose

To identify the functional innervation of the striated muscle layer of the post-prostatic urethra of male dogs.

Materials and Methods

Detailed anatomic dissection of the pelvic and pudendal nerves was carried out. The pressure and contractile responses to stimulation of these nerves were recorded in vivo and in vitro.

Results

Small branches of the pelvic nerve entered the membranous urethra but passed through the striated muscle to the inner smooth muscle layer. Stimulation of the nerve with 1 msec pulses at 10 Hz produced a slow contraction of the urethra which was unaffected by d-tubocurarine. Pudendal nerve branches entered the striated layer from the caudal end. Stimulation produced a rapid, visible contraction that was abolished by d-tubocurarine. Field stimulation of isolated strips of striated muscle resulted only in rapid, d-tubocurarine sensitive contractions.

Conclusions

The striated muscle of the membranous urethra is innervated exclusively by the pudendal nerve.