Medicine & Health

Publication Search Results

Now showing 1 - 10 of 79
  • (2008) Wani, Erick; Mooney-Somers, Julie; Akee, Angie; Maher, Lisa
    Journal Article
    The Indigenous Resiliency Participatory Action Research (IR PAR) project is one of four components of a collaborative project being conducted by Townsville Aboriginal and Islander Health Service, Derbarl Yerrigan Aboriginal Health Service, Perth, the Aboriginal Medical Service, Redfern and the National Centre in HIV Epidemiology and Clinical Research, UNSW. This part of the project uses a participatory action research framework to bring young Aboriginal and Torres Strait Islander people, staff from Aboriginal community controlled health services (ACCHS), and university researchers together to develop and conduct research on what keeps young people protected against blood borne viruses (BBV) and sexually transmitted infections (STI). This paper focuses on the research process, describing how we developed the IR PAR project in Townsville, reflecting on the challenges and celebrating the strengths we have encountered working together.

  • (2008) Webster, Lucy R.; Lee, Shu-Fen; Ringland, Clare; Morey, Adrienne L.; Hanby, Andrew M.; Morgan, Graeme; Byth, Karen; Mote, Patricia A.; Provan, Pamela J.; Ellis, Ian O.; Green, Andrew R.; Lamoury, Gillian; Ravdin, Peter; Clarke, Christine L.; Ward, Robyn L.; Balleine, Rosemary L.; Hawkins, Nicholas
    Journal Article
    Purpose: Identification of biologically and clinically distinct breast cancer subtypes could improve prognostic assessment of primary tumors. The characteristics of ‘molecular’ breast cancer subtypes suggest that routinely assessed histopathologic feature

  • (2008) Bertrand, P. P; Bian, X
    Journal Article

  • (2008) Monro, R; Bornstein, J; Bertrand, P. P
    Journal Article
    Stimulation of the myenteric plexus results in activation of submucosal neurons and dilation of arterioles, one way that motility and secretion can be coupled together. The present study aimed to examine the converse, whether myenteric neurons receive synaptic input from the submucosal plexus (SMP). Intracellular recordings were made from guinea-pig ileal myenteric neurons while the SMP was electrically stimulated. Of the 29 neurons studied (13 S and 16 AH neurons), stimulation of the SMP evoked a synaptic potential in only seven cells, or 24% of neurons. When the SMP was situated oral to the myenteric plexus, 4 of 13 (31%) myenteric neurons had synaptic input. When it was situated circumferential, 2 of 8 (25%) had input, and when the SMP was situated anal 1 of 8 (13%) had input. Overall, 5 of the 13 (38%) S neurons responded with fast excitatory post-synaptic potentials (EPSPs), one of which also showed a slow EPSP, while 2 of the 16 (13%) AH neurons responded with a slow EPSP. This study indicates that the synaptic input from the SMP to myenteric neurons is relatively sparse. Whether this input is less important than the myenteric to submucosal input or simply represents a more selective form of control is unknown.

  • (2008) Lomax, A; Bertrand, P. P; Barajas, A; Bertrand, R
    Conference Paper
    Serotonin (5-HT) containing enterochromaffin (EC) cells of the intestine detect chemical and mechanical stimuli in the lumen and respond by releasing 5-HT on to afferent nerve terminals. Recent electrochemical studies in healthy mucosa have shown that the real-time release of 5-HT is a dynamic and highly regulated process, but how this might change in disease is unknown. Our aim was to characterize real-time uptake and release of 5-HT in a mouse model of colitis and compare it with ELISA measurements of 5-HT. Real-time electrochemical methods were coupled with an ELISA assay to determine the effect on 5-HT availability of a mouse model of inflammation (5% w/v dextran sodium sulphate (DSS) induced colitis). Peak and steady state (SS) 5-HT concentrations (calculated from the oxidation current at +400 mV; amperometry mode) were measured with our without the serotonin reuptake transporter blocker fluoxetine (1 lM) in control and DSS-treated mice. Paired and unpaired data were compared with a one way ANOVA (P < 0.05). In mouse colon, SS release of 5-HT was 1.9 ± 0.6 lM (n = 9) and compression-evoked release was 7.1 ± 2.5 lM (n = 9). In DSS treated mice, the release of 5-HT was significantly increased (SS: 3.4 ± 0.6 lM; peak: 14.7 ± 3.0 lM; n = 11). In control mice, fluoxetine significantly increased peak (9.9 ± lM) but not SS release (2.6 ± 0.4 lM), while in DSS mice both were significantly increased (SS: 7.3 ± 1.2 lM; peak: 23.4 ± 4.1 lM). The effects of fluoxetine in DSS mice were greater than in control. ELISA assays supported these data, showing an increase in 5-HT release detected from inflamed colon (n = 5) compared to control (n = 5) in unstimulated or mechanically stimulated preparations and with or without fluoxetine. The release and uptake of 5-HT from the EC cells of the mouse colon are increased during DSS colitis. Our electrochemical data show that both peak and steady state levels are increased and these changes are mirrored by the ELISA data. In addition, the localised 5-HT concentrations at the site of release, measured using amperometry, are significantly higher than those reported using ELISA techniques. Overall, these data show that during colitis, 5-HT availability will be increased. These raised concentrations may substantially alter the activation or desensitisation of serotonin receptors on afferent nerve terminals.

  • (2008) Wan, Qing; Harris, Mark; Zwar, N; Vagholkar, Sanjyot
    Journal Article
    Purpose: Despite considerable work in developing and validating cardiovascular absolute risk (CVAR) algorithms, there has been less work on models for their implementation in assessment and management. The aim of our study was to develop a model for a joint approach to its implementation based on an exploration of views of patients, general practitioners (GPs) and key informants (KIs). Methods: We conducted six focus group (three with GPs and three with patients) and nine KI interviews in Sydney. Thematic analysis was used with comparison to highlight the similarities and differences in perspectives of participants. Results: Conducting CVAR was seen as more acceptable for regular patients rather than new patients for whom GPs had to attract their interest and build rapport before doing so at the next visit. GPs' interest and patients' positive attitude in managing risk were important in implementing CVAR. Long consultations, good communication skills and having a trusting relationship helped overcome the barriers during the process. All the participants supported engaging patients to self-assess their risk before the consultation and sharing decision making with GPs during consultation. Involving practice staff to help with the patient self-assessment, follow-up and referral would be helpful in implementing CVAR assessment and management, but GPs, patients and practices may need more support for this to occur. Conclusions: Multiple strategies are required to promote the better use of CVAR in the extremely busy working environment of Australian general practice. An implementation model has been developed based on our findings and the Chronic Care Model. Further research needs to investigate the effectiveness of the proposed model.

  • (2008) Gattellari, Melina; Worthington, John; Zwar, N; Middleton, Susan
    Journal Article
    Background and Purpose: Anticoagulation reduces the risk of stroke in nonvalvular atrial fibrillation yet remains underused. We explored barriers to the use of anticoagulants among Australian family physicians. Methods: The authors conducted a representative, national survey. Results: Of the 596 (64.4%) eligible family physicians who participated, 15.8% reported having a patient with nonvalvular atrial fibrillation experience an intracranial hemorrhage with anticoagulation and 45.8% had a patient with known nonvalvular atrial fibrillation experience a stroke without anticoagulation. When presented with a patient at `very high risk` of stroke, only 45.6% of family physicians selected warfarin in the presence of a minor falls risk and 17.1% would anticoagulate if the patient had a treated peptic ulcer. Family physicians with less decisional conflict and longer-standing practices were more likely to endorse anticoagulation. Conclusion: Strategies to optimize the management of nonvalvular atrial fibrillation should address psychological barriers to using anticoagulation.

  • (2008) Zwar, N
    Journal Article
    Background: Prevalence of tobacco smoking in the Australian community has fallen. However, tobacco smoking remains a major cause of illness and death. General practitioners play an important role in assisting their patients to quit smoking. Objective: This article describes evidence based approaches to smoking cessation that can be applied in general practice. Discussion: Evidence based approaches to smoking cessation include brief counselling, pharmacotherapy, referral to a specialised Service such as Quitline, and follow up. The five As approach - Ask, Assess, Advise, Assist and Arrange follow up - provides a structure for intervention. Smoking cessation pharmacotherapies (nicotine replacement therapy and bupropion) have been shown to double quit rates. A new pharmacotherapy (varenicline) has recently become available which evidence to date suggests is more effective. Clinical suitability, the context of the quit attempt, and patient preference are important considerations in choosing a pharmacotherapy. Active follow up helps to reduce the rate of relapse which is otherwise high in what is commonly a chronic relapsing condition.

  • (2008) Bunker, Jeremy; Winstock, Adam; Zwar, N
    Journal Article
    Australian general practitioners have a pivotal role in helping their patients with problems of alcohol and tobacco dependence, but have been less likely than their peers in the United Kingdom to be involved in the management of opioid dependence. This is despite the fact that most GPs are seeing opioid dependent patients whether they know it or not, and that GPs are ideally placed to manage this problem given the other advantages of the general practice context – continuity, accessibility, and whole patient care, including the ability to address other health issues.

  • (2008) Vagholkar, Sanjyot; Ng, Judy; Chan, Raymond; Bunker, Jeremy; Zwar, N
    Journal Article
    Objective: In 2002, New South Wales (NSW) Health introduced an updated policy for occupational screening and vaccination against infectious diseases. This study describes healthcare worker (HCW) immunity to hepatitis B, measles, mumps, rubella (MMR) and varicella based on serological screening, following introduction of this policy. Methods: HCW screening serology performed at two healthcare facilities in south western Sydney (Bankstown and Fairfield) was extracted for the period September 2003 to September 2005. Immunity to hepatitis B, MMR and varicella was quantitated and cross-tabulated against age, sex and staff risk category. Results: A total of 1,320 HCWs were screened. Almost two thirds were immune to hepatitis B while immunity to MMR and varicella ranged from 88% to 94%. Age stratification showed lower levels of measles immunity in those born after 1965. Conclusions: Despite availability of vaccination for over two decades, a significant proportion of HCWs at these two facilities were non-immune to hepatitis B. This is of concern for those non-immune staff involved in direct clinical care, who are at risk of blood and body fluid exposures. The small group of HCWs non-immune to MMR and varicella pose a risk to themselves and others in the event of an outbreak. Implications: There is a need for improved implementation of the occupational screening and vaccination policy, including better education of HCWs about the risks of non-immunity to vaccine preventable diseases. The revised 2007 NSW Health policy may assist this process and will need evaluation to determine whether HCW immunity improves in the coming years.