Report of the Australian Malaria Register for 1992 and 1993

Australia is free from endemic malaria but several hundred imported cases occur each year. Notification and screening data on malaria cases are collected by State and Territory health authorities and laboratories and forwarded to the Australian Malaria Register (AMR) for national collation and analysis. This report provides information on 758 malaria cases with 5 deaths reported in Australia in 1992 and 712 cases with 1 death in 1993. In both years, just over 70% of cases were male and the modal age group was 20 to 29 years. Cases were reported from all States and Territories, with Queensland reporting the greatest number of cases in both years. The predominant species was Plasmodium vivax, although P. falciparum accounted for just over a quarter of the cases each year. Papua New Guinea (PNG) was the most common source of cases in both years, reflecting the number of people who move between Australia and PNG and the high endemicity of malaria in PNG. The incidence of malaria was also high in travellers from the Solomon Islands in both years and from Ghana in 1992 and Nigeria in 1993. The six deaths over two years highlight the need for medical practitioners to consider malaria as a diagnosis in patients with a history of travel to malarious countries and to provide appropriate advice on malaria prophylaxis to intending travellers.

Detection of hearing loss in infants

Permanent Congenital Hearing Impairment (PCHI) is a major cause of delay in speech and language development. Average age of identification of PCHI and subsequent fitting of a hearing aid is currently 18 months. Technology is available to screen successfully infants in the neonatal period for PCHI. Universal screening of all infants prior to discharge has been shown to be the most equitable and efficient method of identifying PCHI. Targeted neonatal screening is a good alternative if universal screening is not currently available.

Breast feeding and antibiotics

At all times the necessity of prescribing to breast feeding mothers should be questioned. The advantages and disadvantages should be carefully assessed for both mother and baby. Whenever possible the long-acting form of the drug should be avoided. The use of drugs with short half lives minimises the risk of accumulation, e.g. Cefotaxime 1.1 hours, Ceftriaxone 7.25 hours. Aim to avoid breast feeding when milk drug concentrations are at their peak. In general, this occurs 1-2 hours following oral medication. As a general principle, advising the administration of medication immediately following a breast feed is the safest option for the baby but this is not true for all drugs. Where information is available, choose the drug which appears in the least concentration in breast milk. All infants should be monitored for uncharacteristic symptoms and signs. If it is essential that a drug with known potential serious toxicity to the infant has to be prescribed to the mother, then breast feeding should be discontinued. As the infant's metabolic and excretory capacities rapidly improve during the first months of life, the risk of toxicity to the infant will decrease with increasing age of the infant.

Critical examination of Aedes aegypti indices: correlations with abundance

The following immature stage indices for Aedes (Stegomyia) aegypti surveillance were evaluated in four north Queensland, Australia towns with respect to their relationship to immature and adult female densities: Breteau, House, Container, Larval Density, Stegomyia (and modifications thereof), and a newly created Adult Productivity Index. Spearman's correlations of indices that considered larval or immature (larvae and pupae) numbers had a better relationship with immature abundance but this was not necessarily the case against adult abundance. To examine the robustness of the indices, data from 758 premises in Townsville, Charters Towers, Ravenswood, and Mingela were pooled and 30 random subsamples, each consisting of 50 premises were taken. After each subsample was taken, the premises selected were reintroduced into the original data bank of 758 premises, and therefore, were available for further selection, i.e., sampling with replacement. Indices were calculated for each of the 30 subsamples and the coefficients of variation of each index were estimated from these. The Breteau, Adult Productivity, House, and Adult density indices proved to have the smallest coefficients compared with index size. No alternate index was regarded as being superior to the Breteau, including the Adult Productivity Index measuring both container type frequency and immature density. For this reason and in view of the labor intensiveness of estimating immature indices that incorporate productivity, it is recommended that new and cost-effective methods of adult surveillance be pursued.

Historical continuities and constraints in the professionalization of nursing

The support of medicine and the state may be crucial to nursing's current professional aspirations for legitimation and implementation of nursing reforms and for new roles for nurses in health care. As such, medicine and the state are in the invidious position of influencing nursing's occupational future. This situation is not new. An historical analysis of the establishment of nursing at Prince Alfred Hospital, Sydney, Australia, at the end of the nineteenth century reveals that the State Government of NSW and the medical profession supported nursing's occupational development, yet set the framework within which this could occur. For instance, the state provided patronage to nursing through recommendations of the 1873 Royal Commission and because it financially backed Prince Alfred Hospital, while the medical profession defined nursing knowledge and practice through its control of the nursing curriculum. Membership of the hospital board provided both medicine and the state with powerful positions over hospital policies that affected nursing. While nursing became established as a distinct occupation for women with the aid of State and medical support, its subordinate position in health care was, and continues to be, constrained by these traditional supporters. This relationship between nursing, medicine and the state has implications for nursing's current professionalization strategies and aspirations.

Administration of a low dose tiletamine-zolazepam combination to cats

A tiletamine-zolazepam mixture was administered subcutaneously at doses of 2.5 mg/kg, 5.0 mg/kg and 7.5 mg/kg to fifty-nine cats. The response to drug administration, effect on heart rate, pulse quality, respiratory rate and temperature, and intensity and duration of sedation were recorded. As the tiletamine-zolazepam dose was increased, intensity and duration of sedation increased. At the lowest dose, some cats became excited rather than sedated. Heart rate and respiratory rate changed minimally, but body temperature decreased.

Examination of the newborn infant

Child health surveillance means the professional monitoring of not only the physical, but also the mental, behavioural and emotional growth and development of children. Midwives, obstetricians and general practitioners should be able to carry out an examination. It is important to have information about the parents' medical history, drug history, social history and family history along with the pregnancy and delivery details. Some other points should also be noted at this early stage. Have any problems been identified already? Has the baby passed urine/meconium? Is the baby feeding well? It is now possible to test for numerous inherited disorders, in particular inborn errors of metabolism. The best rationale for screening is that parents like to hear that their child is normal and healthy or else know of any problems as soon as possible.

Common problems of newborn infants

Factors to consider in the care of a newborn infant Family history Extremes of body temperature Poor feeding Vomiting Failure to pass urine or meconium Rapid breathing with or without cyanosis Jaundice Rashes and birthmarks 'Jitteriness' Unusual features Collapse

Highly atopic children: formation of IgE antibody to food protein, especially peanut

Highly atopic infants often form IgE antibodies toward multiple food protein in the first 2 years of life. They begin producing IgE antibody to inhalant allergens between the first and second year of life. We hypothesized that highly atopic children would be at significant risk of sensitization to peanut. We defined high atopy as serum IgE greater than or equal to 10 times 1 SD from normal plus multiple positive RASTs. In this study we have characterized the immunologic status of 141 patients by measuring total serum IgE and specific IgE to several allergens, including peanut. These data demonstrated that, independent of clinical history, a positive RAST to peanut was more common in the highly atopic category compared to the low atopy category. Significantly more patients who were highly atopic and had a positive peanut RAST had a positive RAST for egg or milk compared to low atopic patients. More significantly, 33 of the patients had never knowingly received peanut, yet 21 (63.6%) had a positive RAST for peanut, whereas seven (21.2%) had a peanut antibody in the highest RAST category. All these seven patients were considered highly atopic according to the definition above, and three were younger than 2 years of age. These results suggest that highly atopic infants are at special risk for sensitization to peanut, even when they have never received peanut, and that characterization of immunologic sensitization to milk, egg, and peanut will identify the highly atopic infant.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of allergy in different age groups of children: use of mixed allergen RAST discs, Phadiatop and Paediatric Mix

Childhood asthma often begins in children under 3 years of age. Allergy contributes to the severity and persistence of childhood asthma so we examined the application of mixed allergen RAST discs (Paediatric Mix, a mixture of food antigens and Phadiatop, a mixture of inhalants) to the diagnosis of allergy. One hundred and nine children with a median age of 3 years, 71.6% of whom had asthma, were first assessed by one allergist who recorded their atopic status as positive, negative or questionable, on clinical grounds. Serum from each of these patients was used to determine a total IgE and 13 RAST assays. A laboratory definition of atopy was defined as a serum IgE greater than 1 standard deviation from normal, plus one or more positive RAST assays. The laboratory results influenced the assessment of atopy in 41% of cases. The use of just two mixed allergen discs (Paediatric Mix and Phadiatop) correctly assigned the presence or absence of atopy with a sensitivity of 98% and specificity of 98%, compared with the full laboratory evaluation. Very young infants were often just positive to food allergens but the Phadiatop disc could be used to suggest the onset of immunological sensitivity to inhalant antigens. Thus the application of mixed allergen RAST discs facilitated the diagnosis of atopy in young children.

Allergy in asthma. II. The highly atopic infant and chronic asthma

The relationship between allergy and asthma in infants and preschool children was investigated. One hundred nine children, median age 2 1/2 years, were examined immunologically by quantitation of serum IgE, RAST testing to 13 allergens, and culture of peripheral blood lymphocytes for spontaneous IgE formation. We examined a cross-section of infants and toddlers to determine whether the severity of asthma is associated with allergy as has been reported in older children with asthma. We identified a group of highly atopic infants and preschool children who have serum IgE at least 10 times the mean + 1 SE for age, multiple positive RASTs with early formation of IgE to inhalant antigens, and circulating B cells that spontaneously form IgE when these are cultured in vitro. Such highly atopic infants and preschool children were statistically more likely to have chronic asthma requiring multiple continuous medication compared to the rest of the population (p less than 0.01).

Allergic bronchopulmonary aspergillosis in cystic fibrosis: a secretory immune response to a colonizing organism

One hundred and seventeen patients with cystic fibrosis (CF) were evaluated for criteria suggestive of allergic bronchopulmonary aspergillosis (ABPA) and atopy. We found positive skin tests to Aspergillus to be more common in patients with CF than comparison groups with asthma or non-specific nasal symptoms. This increased prick skin test reactivity to Aspergillus was especially noticeable in a group of CF patients having only one or two skin tests positive, preponderantly Aspergillus. Twelve of the CF patients (10%) had further immunologic criteria suggestive of ABPA. These patients had significantly worse lung function than the CF patients without such criteria.

Abnormal responses to ingested substances in murine systemic lupus erythematosus: apparent effect of a casein-free diet on the development of systemic lupus erythematosus in NZB/W mice

To assess the development of oral tolerance to casein in NZB/W female mice, they must be bred and raised on a casein free diet. We examined the specific immune responses of the mice to the long term experimental feeding of casein. Twelve of fifteen casein free mice were still alive at 10 months of age, although by this age only 1/10 mice eating the normal diet was still alive. The casein free mice had markedly less anti-DNA antibody, their IgM to IgG antinative DNA switch was delayed and deposits of immunoreactants in the glomeruli were greatly decreased. The reason for this apparent effect of the removal of casein from the diet is unknown; however, immunostimulatory and endorphin-like regions have recently been reported in casein.

Failure of oral tolerance in (NZB X NZW)F1 mice is antigen specific and appears to parallel antibody patterns in human systemic lupus erythematosus (SLE)

Primary oral antigen exposure normally induces mucosal immunity and an active suppression of the systemic immune response. Patients with systemic lupus erythematosus (SLE) have increased antibodies to bovine gamma-globulin (BGG), which suggested a possible failure of oral tolerance in SLE. We examined this possibility in murine lupus. NZB/W females were fed BGG or saline and were subsequently immunized ip. Primary and secondary responses were assessed. At 1 month of age the mice tolerized normally in response to feeding with BGG but, at 4 months of age, not only did they not tolerize, the mice fed BGG had a 5- to 7-fold higher response to parenteral immunization than did the saline-fed mice. Control strain mice tolerized normally at both ages (a 5- to 10-fold lower response). Conversely, when fed ovalbumin, NZB/W females tolerized normally at both 1 and 4 months of age, and patients with SLE had normal levels of antibody to this antigen. However, we also found increased levels of antibodies to bovine casein in SLE patients, and found that NZB/W mice failed to orally tolerize with this antigen at either 1 or 4 months of age. Thus, the failure of oral tolerance in the NZB/W mice appears to be antigen specific and age dependent and, at least with respect to these three antigens, appears to parallel the antibody patterns seen in human SLE.

Dying of cancer. Factors influencing the place of death of patients

An analysis of factors influencing the place of death of patients seen by two medical oncology units is reported. There were 1295 recorded deaths of patients from the Royal Prince Alfred Hospital, Sydney, and 688 from The Royal North Shore Hospital of Sydney during 1979-1981; the places of death were known in 1724 instances (87%). Of these, 73% of patients died in hospital, 9% died in terminal nursing care (TNC) institutions, and the remainder at home. Factors influencing the place of death were the place of residence, age, home circumstances-social support, diagnosis, and interval from first contact with the medical oncology unit. Our data indicate that a complex interrelation of these factors determines the place of death. Improvements in community services may allow more patients with cancer to die at home or in TNC institutions, but a substantial proportion of these will still die in major hospitals. Therefore, there is a need for the improvement of palliative care services in these institutions.

Cultural perceptions of the mentally ill: Australian and Papua New Guinean high school youth

One hundred and thirty-three (76 male, 57 female) Papua New Guinean (PNG) and 144 (93 male, 51 female) Australian high school students completed a series of structured and open-ended measures on attitudes to the mentally ill, especially opinions about the nature of mental illness, characteristics of the mentally ill, and treatment. Both groups of students suggested hereditary and environmental causes, with PNG students citing more often witchcraft and sorcery. Australian students generally presented more favourable attitudes to mental illness, in that they were more willing to work with or marry the mentally ill. PNG students, however, were more likely to highlight the disruptive, violent behaviour of the long long, and possibly held a much narrower view of the types of persons labelled mentally ill.