Suicide in urban New South Wales, Australia 1985-1994: socio-economic and migrant interactions

Variation of suicide with socio-economic status (SES) in urban NSW (Australia) during 1985-1994, by sex and country or region of birth, was examined using Poisson regression analysis of vital statistics and population data (age >? approximately 15 yr). Quintiles of SES were defined by municipality of residence and comparisons of suicide by SES were adjusted for age and country (or region) of birth (COB), and examined by COB. Risk of suicide in females was 28% that of males for all adults and 21% for youth (age 15-24 yr). Suicide risk was lower in males from southern Europe, Middle East and Asia, and higher in northern and eastern European males, compared to the Australian-born. Risks for suicide increased significantly with decreasing SES in males, but not in females. The relationship of male suicide and SES was stronger when controlled for COB. For males, the relative risk of suicide, adjusted for age and COB, was 66% higher in the lowest SES quintile compared to the highest quintile. and 39% higher for youth (age 15-24 yr). For male suicide, the population attributable fraction for SES (less than the highest quintile) was 27%. Analysis of SES differentials in male suicide according to COB indicated a significant inverse suicide gradient in relation to SES for the Australian-born and those born in New Zealand and the United Kingdom or Eire, but not in non-English speaking COB groups, except for Asia. For Australian-born males, suicide risk was 71% higher in the lowest SES group (compared to the highest), adjusted for age. These findings indicate that SES plays an important role in male suicide rates among the Australian-born and migrants from English-speaking countries and Asia, and among youth; but not in female suicide, nor suicide in most non-English speaking migrant groups. Reduction in SES differentials through economic and social policies may reduce male suicide in lower SES groups and should be seen to be at least as important as individual level interventions.     

Care: what it means to Iranian immigrants in New South Wales, Australia

Fat lipid emulsions in Total Parenteral Nutrition (TPN) have been associated to Mononuclear Phagocytary System (MPS) changes. Intravenous lipid emulsions may alter macrophage membrane composition but there are controversies about their effects on MPS function. The aim of the present investigation was to assess the influence of fat free TPN and fat emulsions TPN on the macrophage phagocytosis. Wistar rats (70) with external jugular vein canulation were divided in seven groups. The rats received, intravenously (i.v.) different isocaloric (1.16 kcal/mL), isonitrogenous (1.5 g/mL), and isolipidic (30 to 32% of non-proteic caloric value) TPN regimens or oral diet: 1) Group OS: oral diet with i.v. infusion of saline; 2) Group GLU: fat-free TPN; 3) Group LCT: TPN with 10% long chain triglecide emulsion (TCL); 6) Group MCT: TPN with 10% lipid emulsion with medium chain triglycerides (TCM-50%) and TCL (50%). After 96 hours of TPN or saline infusion, colloidal carbon was i.v. injected at 1.0 mL/kg body weight. The rats were sacrificed after three hours. Liver, spleen and lung were weighted and studied by immunohistochemistry by the avidine-biotine method. Under light microscopy the total macrophage number (MT) and colloidal carbon phagocytic macrophages number (MF) were established. Phagocytic index was MT/MF x 100. The results were statistically analysed (p < 0.05). The group under oral diet (OS) was the only one to gain weight. There were no differences in organ weight in any group. There were changes in MT, MF and phagocytic index in all TPN groups. Fat free TPN inhibited liver, spleen and lung macrophage phagocytosis. Fat TPN with TCL inhibited liver and lung macrophage phagocytosis. At conclusion fat free TPN or with long chain tryglicerides may inhibit MPS phagocytosis. Further studies are necessary to estabilish the effect of TPN on other MPS function.     

Birthweight-specific trends in perinatal mortality by hospital category in South Australia, 1985-1990

OBJECTIVE: To investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985-1990 period. DESIGN: Analysis of birthweight-specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors. SUBJECTS: 114 725 singleton births of at least 400 g birthweight (or at least 20 weeks' gestation) born in hospitals in the 1985-1990 period and notified to the perinatal data collection. MAIN OUTCOME MEASURE: The relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period. RESULTS: Births at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birth-weights, there was a higher risk at non-level-3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500-2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight. CONCLUSIONS: The greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500-2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.     

Second primary cancers following cancers of the kidney and prostate in New South Wales (Australia), 1972-91

In order to find an explanation for the eventual disappearance of all chromosome aberrations in two radiosensitive human tumour cell lines, the type and stability of different aberration types was investigated in more detail. To classify the aberrations into unstable and stable types, three-colour fluorescence in situ hybridization was performed, including a whole-chromosome probe, a pancentromere probe, and a stain for total DNA. This technique enables the appropriate classification of the aberrations principally by the presence (stable) or not (unstable) of a single centromere per chromosome. Unstable-type aberrations were found to disappear within 7 days (several divisions) in the two radiosensitive and the two radioresistant tumour lines investigated. Stable-type aberrations were found to remain at an approximately constant level over the duration of the experiment (14 days; 8-10 divisions) in the two radioresistant lines. In contrast, the majority of these stable-type aberrations had disappeared by 14 days in the two radiosensitive lines. The previous findings of disappearance of total aberrations in radiosensitive cells was therefore not due to a reduced induction of stable-type aberrations, but the complete disappearance of cells with this aberration type. These results could not be explained by differences in apoptosis or G1 blocks. Two possible explanations for these unexpected findings involve non-random induction of unstable-type aberrations, or lethality of stable-type aberrations. The results suggest caution in the use of stable-type aberration numbers as a predictor for radiosensitivity.     

Doctors detected self-administering opioids in New South Wales, 1985-1994: characteristics and outcomes

OBJECTIVE: To describe the characteristics and outcomes of doctors whose drug authorities were withdrawn as a result of self-administering opioids for non-medical purposes. DESIGN: Retrospective review of New South Wales Health Department information relating to all doctors whose authorities to possess, supply, prescribe or administer drugs of addiction had been withdrawn in the period 1985 to 1994 as a result of confirmed self-administration of opioids. OUTCOME MEASURES: Age, sex, geographical location and practice category at the time of intervention; drugs used; period of opioid use before authority withdrawal; means of detection; and registration status as at August 1995. RESULTS: From 1985 to 1994, 79 doctors had their drug authorities withdrawn (0.4% of the NSW medical profession in 1994). The groups significantly over-represented were general practitioners and those aged 30-39 years. Pethidine was the main drug used (66 doctors; 84%). Drug use for more than two years before detection was reported by 34 (43%) doctors. Community pharmacists were the source of reports leading to detection of 28 (35%) doctors. As at August 1995, 27 (34%) of the study group were not practising; 10 (13%) had died. CONCLUSION: Outcomes for these doctors were poor. There was substantial attrition from practice and a high mortality rate.     

Second primary cancers after cancers of the colon and rectum in New South Wales, Australia, 1972-1991

In this article, we present a survey on dental care and oral implantology in Beijing, China. The Chinese population comprises 1.2 billion or about 20% of the world's population. This survey shows: (i) there is a well-developed dental system in China, mostly operated by the Chinese government; (ii) in Beijing, there are 1328 dentists and oral surgeons and 515 special dental nurses working in dental departments of hospitals; (iii) about 2 million new patients visit the dentist every year; (iv) oral implantology is a new technology for the Chinese dentist and oral surgeon, as shown by the finding that in 1992, only 384 persons were treated with oral implants in a few hospitals in Beijing; however, most hospitals are interested in performing oral implantology in the near future; (v) imported implants are too expensive for Chinese patients, and therefore good qualified domestic implants and cheaper imported implants have a great market potential.     

Coroners'' records of rural and non-rural cases of youth suicide in New South Wales

The cytokine interleukin-1 beta (IL-1beta) is an evolutionarily conserved molecule that was originally identified in the immune system. In addition to regulating peripheral immune responses, IL-1beta plays an important role in mediating neural-immune interactions and regulating glial activities during healing and repair in the damaged nervous system. Active IL-1beta is produced by interleukin-converting enzyme (ICE), a caspase thought to be involved in the induction of apoptosis. We report that, in the developing frog, Xenopus laevis, IL-1beta and the IL-1 type 1 receptor proteins are coexpressed in specific neurons that comprise early sensory-motor circuits. IL-1beta and IL-1 type 1 receptor proteins are colocalized in specific midbrain and hindbrain reticular cells, including Mauthner's neuron; specific cells in the trigeminal (fifth), lateral line (seventh), and vestibular (eighth) cranial ganglia; oculomotor neurons; and the primordial Purkinje cells of the lateral cerebellar auricle. In the spinal cord, Rohon-Beard sensory neurons, dorsal root ganglion cells, and primary motoneurons are immunopositive. Anteriorly, the olfactory pits, olfactory nerves, and olfactory bulbs are labeled, as are retinal cells, especially photoreceptor inner segments. With regard to the function of IL-1beta during neural development, IL-1beta and its type 1 receptor are present throughout the course of neural development in identifiable, long-lived neurons, such as Mauthner's neuron. These and other data suggest that IL-1beta and its type 1 receptor may be involved in the maintenance of cell survival rather than induction of neuronal death.     

Culture care of Iranian immigrants in New South Wales, Australia: sharing transcultural nursing knowledge

Discovery and analysis of care meanings, expressions, and practices of Iranian Immigrants in New South Wales, Australia was the focus of this ethnonursing qualitative research. The purpose of the study was to systematically discover, describe and analyse the values, beliefs, and practices of Iranian immigrants in New South Wales, Australia. The aim of the investigation was to discover transcultural nursing knowledge to guide nurses and health professionals to provide culturally congruent nursing and health care to Iranians. Leininger's theory of Culture Care Diversity and Universality (Leininger, 1991) was used as the conceptual framework for the study. It was predicted that care meanings and expressions of Iranian immigrants would be influenced by their worldview, social structure features, language, and cultural values rooted in their long ethnohistorical past and reflected in their lifeways in Australia. Using the ethnonursing qualitative research method, key and general informants were purposefully selected among Iranian immigrants residing in New South Wales. Three care themes supported by a number of universal and some diverse patterns were identified for Iranian immigrants. The three themes were: (1) Care meant family and kinship ties (hambastegie) as expressed in daily lifeways and interactions with family, friends, and community; (2) Care as expressed in carrying out traditional urban gender roles (role-zan-o-mard) (Azadie zan) as well as in fulfilling emerging new role responsibilities related to equality for female Iranian immigrants; and (3) Care as preservation of Iranian identity (inhamoni, hamonandi) as expressed in traditional cultural events and health care practices. Leininger's (1991) three modes of actions and decisions were used to develop appropriate and culturally meaningful nursing care actions and decisions which were in harmony with the cultural beliefs of Iranian immigrants.     

Formal complaints and disciplinary proceedings involving medical practitioners: recent developments in New South Wales, Australia

Complaints against medical practitioners are of interest to all the stakeholders in health care who are concerned with quality assurance and its definition, implementation and monitoring. New South Wales,Australia, has recently made statutory provision for independent structures of complaint investigation and resolution, including revised disciplinary proceedings to protect the public interest and regulate the conduct of the state's medical profession. This article discusses the new mechanisms and recent experience of them. They are intended to offer independence and an integrated and comprehensive system of grievance procedures but there remains a need for disciplinary procedures that afford lay control over the regulation of medical conduct.     

Geographic variations in suicide mortality, 1982-96

This article is the second part of a paper which updates previous analyses of suicide published in Population Trends. Suicide trends are analysed by age and sex for the constituent countries of the United Kingdom. Data for England and Wales are presented by region and by local authority. The analyses show substantial variations in suicide rates both across the United Kingdom and within England and Wales.     

Worldwide trends in suicide mortality, 1955-1989

Expression of keratin K5 (and K14) in multilayered epithelia occurs predominantly in the basal layer of proliferating keratinocytes. When a keratinocyte becomes committed to terminal differentiation, it moves out of the basal layer towards the epithelial surface. As part of this program of terminal differentiation, the expression of K5 (and K14) is downregulated in suprabasal cells, and new pairs of differentiation-specific keratins are expressed. To define the cis-acting DNA sequences required for K5 cell-type- and differentiation-specific expression, chimeric gene fusions between portions of the bovine keratin K5 locus and the Escherichia coli lacZ gene were used to generate transgenic mice. In the genomic fragment consisting of 5.3 kb of 5' flanking sequences, 6.1 kb corresponding to the body of the gene and 4.5 kb of 3' flanking sequences, the subfragment extending from -5300 bp to +138 bp was the smaller region that directed lacZ expression to stratified epithelia in a manner analogous to the endogenous keratin K5. Proximal sequences from -1300 bp to +138 bp were inactive. We also determined the expression pattern of keratin K5 during mouse development using an antiserum specific for mouse keratin K5. Expression was first detected in ectodermal cells of 11.5 days postcoitum embryos, and from day 13.5 postcoitum onwards K5 was detected in the precursors of most epithelia and organs which express K5 at adult stages. This pattern was reproduced, with few differences, by the construct with sequences from -5300 bp to +138 bp fused to the lacZ gene. These findings identify sequences between -5.3 kb and -1.3 kb of the bovine K5 gene as being important for cell-type- and differentiation-specific gene expression both during mouse development and in the adult.     

Community screening for colorectal cancer in north-eastern New South Wales, 1987-1996

OBJECTIVE: To analyse results of Bowelscan, a community-based colorectal cancer screening program using Hemoccult II, and targeting people aged 40 years and over. DESIGN: Survey of data from medical practitioners on follow-up of positive tests. SETTING: North-eastern New South Wales (Rotary District 9650), 1987-1996. SUBJECTS: 3845 people with positive results for faecal occult blood. OUTCOME MEASURES: Investigations performed; final diagnoses; number, site and Dukes' stage of colorectal carcinomas; number and histological diagnosis of colorectal polyps. RESULTS: 239,500 Hemoccult II kits were distributed between 1987 and 1996, with an estimated return rate of 80%-85%. Positive results for faecal occult blood were reported for 3845 tests (1.6% of those distributed), with 78% of these investigated by colonoscopy and/or barium enema. Investigation resulted in diagnosis of 260 colorectal carcinomas in 252 people (6.7%); 74 of these (29%) were in the caecum or ascending or transverse colon. Dukes' tumour stages were: A, 107 (41%); B, 86 (33%); C, 49 (19%); D, 16 (6%); and unknown, 2 (0.8%). (Corresponding figures from the NSW Central Cancer Registry were: A and B, 48%; C, 26%; D, 14% and unknown 12%) [corrected]. Colorectal polyps were found in a further 819 people (21.3%), and were adenomatous in 577 (79% of the 733 in whom histological diagnosis was available). Other gastrointestinal conditions were found in 1343 people (34.9%), while no cause was found for the positive result, despite adequate investigation, in 873 (22.7%). CONCLUSION: Community-based screening with faecal occult blood testing detected colorectal carcinomas at earlier histological stages than colorectal carcinomas reported to the Cancer Registry and should reduce mortality from this disease. Treatment and follow-up of adenomatous polyps detected by such a program might minimise the incidence of colorectal carcinoma in this group.     

Socioeconomic correlates of infant mortality in Hong Kong, 1979-93

Contractions change the configuration of the lesser curvature of the stomach while they indent the greater curvature. We studied these lesser curvature changes by measuring the position and angle of the gastric incisura on still frames captured from videotapes of isolated cat stomachs suspended in physiologic solution. In response to filling with 100 mL Krebs' solution stomachs generated a tonic contraction of the fundus/body segment and gave rise to a peristaltic contraction that spread from the body and through the antrum to the pylorus. In preparations where we left the duodenal cannula open we found that the incisura moves toward the gastro-oesophageal (GO) junction and the angle of the incisura widens as the contraction passes through the stomach and empties its contents. Furthermore, the angle of the incisura is most acute when the full stomach starts contracting in its fundic segment and again when the contraction involves the gastric sinus (the wedge-shaped segment adjacent to the incisura which forms the transition between the body and the antrum of the stomach). In preparations where the duodenal cannula was kept closed, the angle of the incisura becomes most acute when the contraction involves the gastric body and when the luminal pressure peaks. We conclude that changes in the position and angulation of the incisura are part of the mechanical response of the stomach to filling and emptying; unlike the peristaltic contraction along the greater curvature the net movement of the incisura goes in the orad direction. Movements of the incisura profoundly affect the configuration of the stomach and hence the distribution of luminal contents between various gastric segments. The gastric sling muscles are responsible for the formation of the gastric incisura but their role in any movements of the incisura remains to be defined.     

A historical survey of police suicide in Queensland, Australia, 1843-1992

Police suicide research has yielded inconsistent results. An opportunity presented to survey Queensland police suicides in a historical context and add to the existing literature; the study describes changes in police suicide over time, the associated characteristics, and opportunities for intervention. Suicides were examined from the origins of police in Queensland in 1843 up to 1992. Suicide rates were higher earlier, around 60 per 100,000, declining to around 20 per 100,000 recently. The recent rate is lower than most other police studies but the same as the general community (employed). Most suicides were associated with psychological and physical ill health, alcohol abuse, and domestic problems, in keeping with general community surveys. However, occupational problems were more evident than is generally the case. The proximity in time of disciplinary events and suicides was striking. Future studies should explore the interactions between these factors.     

Medical research in New South Wales 1993-1996 assessed by Medline publication capture

OBJECTIVES: To assess medical research publication output in New South Wales (NSW). DESIGN: Analysis of publication information from the Medline indexing database, 1993-1996 inclusive. SETTING: Teaching hospitals and affiliated universities and medical research institutes within NSW, the major sites for NSW medical science publications. MAJOR OUTCOME MEASURES: Cumulative number and location of Medline-identified publications; journal citation indices (impact factor and immediacy index). RESULTS: 8860 published articles were captured for the analysis period. Universities and hospitals accounted for most of the publications (n = 7755). A mean of 73.1% (range, 36%-100%) of all articles were published in overseas journals, and the rest in Australian journals. This average trend applied to most universities and teaching hospitals, whereas research institutes published almost exclusively in overseas journals. Average publication impact factor values for most universities and teaching hospitals were around the average value for all NSW publications (2.203). The range for teaching hospital publications was 1.000-2.823, but for the overseas-publishing medical research institutes it tended to be higher (2.480-5.423). Immediacy index data yielded similar findings. CONCLUSIONS: The universities and teaching hospitals account for most of the medical publications arising from NSW, and also those appearing in Australian journals. Thus, these sites provide the bulk of Australian medical practice end-user information. In contrast, the medical institutes concentrate on publishing in overseas journals with higher and quicker citation rates (higher impact factor and immediacy index).     

Terminal exacerbation of chronic melioidosis in New South Wales

A fatal case of melioidosis, thought to be the third recorded from New South Wales, is presented. Infection probably occurred in Queensland. The patients presented with a subcutaneous abscess complicated by pyaemia, extensive lung involvement and septicaemic shock. The diagnosis was bacteriologically confirmed shortly before death, by isolation of Pseudomonas pseudomallei from blood, pus swabs and tracheal aspirates. There is a need for greater awareness of this disease in persons who have resided in South-East Asia and in North-Eastern Australia.     

Crisis intervention workers in New South Wales: knowledge, skills, qualities and preparation

Ninety-five mental health workers employed by 13 randomly selected crisis intervention and extended hours teams in NSW responded to a questionnaire designed to elicit information concerning the perceived competencies required for crisis intervention. The findings reported and underscore the need for specialized knowledge and skills to address the problems presented by mentally ill clients in crisis. Assessment of suicide risk, being able to work as part of a team, and knowledge of crisis intervention strategies were perceived as the most important competencies required. It is suggested that these competencies are gained through initial induction programmes, 'on-the-job' experience, and clinical supervision rather than previous experience in the mental health field. The lists of competencies provided will be of interest to those involved in the development of induction and continuing education programmes for crisis intervention workers and in the selection of staff for positions in crisis intervention.     

Socioeconomic inequalities in coronary heart disease and stroke mortality among Australian men, 1979-1993

BACKGROUND: During the 1970s in Australia, mortality from coronary heart disease (CHD) and stroke was higher among lower socioeconomic groups and inequalities were widening. This analysis examines subsequent trends in socioeconomic inequalities, with reference to socioeconomic patterns in major cardiovascular risk factors. METHODS: Socioeconomic status was defined by occupation. Age-standardized mortality rates were calculated for men aged 25-64, using death registration data and labour force estimates for 1979-1993. Risk factor data were taken from three cross-sectional population surveys conducted in 1980, 1983 and 1989. RESULTS: Men in manual occupations were at least 35 percent more likely to die from CHD than men in professional occupations and 60 percent more likely to die from stroke. Their 5-year population risk of a coronary event was 30 percent higher. Since 1979, both groups experienced reductions in coronary risk and mortality. CONCLUSIONS: Socioeconomic inequalities in CHD mortality continued to widen during the early 1980s, stabilized thereafter and persisted into the 1990s. Decreases in blood pressure and smoking prevalence contributed most to declines in coronary risk and to socioeconomic differentials.     

Asthma prevalence, morbidity and management practices in South Australia, 1992-1995

BACKGROUND: The Spring South Australian Health Omnibus Survey (SSAHOS) has been used to monitor trends in asthma prevalence, asthma morbidity and asthma management practices between 1992 and 1995. AIMS: To determine if self-reported asthma prevalence and availability of asthma action plans were increasing. To identify deficiencies in asthma management and opportunities for intervention. METHODS: Representative population survey by trained interviewers using a multistage, systematic, clustered area sample of 4200 households in South Australia where people aged 15 years or more are living. RESULTS: Over 3000 interviews were conducted each year. Between 1992 and 1995 the self-reported prevalence of asthma in those aged 15 years or more increased significantly from 15.7% to 20.3% (p < 0.0005), and the prevalence of current asthma increased from 9.3% to 11.4% (p < 0.05). The self-reported availability of individual asthma action plans increased from 21.9% in 1992 to 42.2% in 1995 (p < 0.0005). In 1992, 21% had a nebuliser at home, and 10.5% had a peak flow meter. In 1993, 61.4% were using preventive medications, and 35% thought bronchodilators were 'preventer' medications. In 1994 and 1995, between 12.5% and 15.6% had nocturnal awakening weekly or more often, and 31.4% had morning asthma symptoms weekly or more often. Between 20.1% and 20.8% had lost days from usual activities during the last year. Those on incomes below $20,000 had more symptoms, had more admissions to hospital, and required more medication than those on higher incomes. CONCLUSIONS: Self-reported asthma prevalence has increased. There remains a gap between current asthma management and that recommended by the National Asthma Campaign.