Caseload of a land-based trauma team.

BACKGROUND AND AIMS: Pre-hospital care is provided by a variety of models worldwide. The Tayside Trauma Team responds from Ninewells Hospital in Dundee to provide a physician-led pre-hospital care service targeted primarily at trauma patients. We present a description of the functions of the team, and data detailing the clinical work of the Team over a six-month period. METHODS AND RESULTS: The Team was called out 35 times in six months and attended 22 incidents, some involving multiple casualties. 34 patients received treatment at the scene of an incident. Most incidents were road traffic collisions, although the team also attended falls from height, an assault and a vascular injury. Eight patients (24%) met Injury Severity Score criteria for major trauma (ISS>15). Mean time from 999 calls to Team activation was 20 (range 4-79) min; and mean time from Team dispatch to 'Team mobile' was 4.6 (2-21) min. CONCLUSION: The Tayside Trauma Team provides a physician-led pre-hospital care response on demand from the Scottish Ambulance Service. It provides critical care interventions at the scene of various incidents (primarily traumatic) to attempt to improve patient outcome. Response times are favourable.

Vietnamese women and Pap smears: issues in promotion.

OBJECTIVE: Australian data indicate that Vietnamese-born women in Australia have a significantly higher incidence of cervical cancer than other Australian women. This study explored self-reported factors associated with Vietnamese-born women's participation in cervical screening. METHOD: A structured 60-item questionnaire was used to conduct an interview survey with 199 Vietnamese-born women over the age of 18 years and resident in Adelaide. RESULTS: Eighty-seven per cent (87%) of the women had heard of a Pap smear and 75% had had a test at some time. Reported participation increased with age, education level, marriage and length of stay in Australia. The family doctor was the most important source of information about Pap smears and the majority of the women reported they would have a smear if recommended by their doctor. Friends and family were the second information source about cervix screening. CONCLUSIONS AND IMPLICATIONS: These findings have clear implications for practice. Strategies to promote preventive health messages to this group of women should involve general practitioners and peer networks.

Urea induces the heat shock response in human neuroblastoma cells.

Uremic encephalopathy is a complication of renal failure that reflects stresses exerted by as yet poorly defined uremic toxins. All cells respond to stresses by undergoing the "heat shock" response. Although urea kinetics and creatinine concentration are routinely used to assess dialysis adequacy, the roles of urea and creatinine as uremic toxins remain controversial. To investigate their potential roles in uremic encephalopathy, cultured human neuroblastoma cells (SK-N-SH) were exposed to 0.5 to 14 mg/dL creatinine, or to 20 to 200 mg/dL urea, or to mannitol, NaCl, or glycerol at equivalent osmolalities for 30 min to 48 h, and the induction of Hsp72 (heat shock) protein was used as a marker of cell stress. Although creatinine failed to elicit a heat shock response, urea in clinically relevant concentrations (40 to 200 mg/dL) induced it at 30 min. The response peaked at 10 h and returned to zero by 48 h. Cells exposed to equivalent osmolalities of mannitol, NaCl, or glycerol failed to exhibit this response. Protein extracts from cells exposed to urea showed significant carbamylation that increased as a function of time. These results demonstrate: (1) that urea is neurotoxic in vitro and that creatinine is not: (2) that the insult urea causes is not simply the result of hypertonicity; but rather (3) that urea, via breakdown to cyanate and ammonium ions, may cause cell stress because of its ability to cause carbamylation of cellular proteins. The cells attenuation of the heat shock response after 10 h of exposure to urea suggests that they can adapt to the presence of urea or carbamylation. This may explain, in part, why the same degree of azotemia causes fewer neurological symptoms in patients with chronic as opposed to acute renal failure.

General practitioner attitudes to recall systems for cervical screening.

OBJECTIVES: To document the factors associated with general practitioner (GP) use of Pap smear reminder/recall systems and to canvass options for coordinating these GP-based systems with similar centrally based schemes. METHODS: A questionnaire survey of a random sample of South Australian GPs. RESULTS: 259 (78%) of 334 GPs returned questionnaires. 117 (45.2%) GPs had practice-based reminder/recall systems, with a higher prevalence among metropolitan GPs with a computer and who had been in practice for less than 20 years. 91.9% of GPs reported that the central register would be of some help in ensuring regular cervical screening. 38.2% of the GPs preferred reminder letters from the register to be sent to their practice; 27.8% preferred them to be sent directly to women and 22.8% opted for letters to be sent from the register via the laboratories to their practice. 61.4% of respondents had a method of recording women with abnormal smears and 95.6% of these actively recalled such women. CONCLUSION: Substantial variation exists in the use of practice-based reminder/recall systems among GPs. A central register would assist most GPs by providing a back-up reminder service to follow-up women for cervical screening.

Age differences in understanding of disease causality: AIDS, colds, and cancer.

The development of concepts of disease causality was explored by asking 9-, 11-, and 13-year-olds and college students about risk factors for AIDS, colds, and cancer. Their knowledge became more accurate and differentiated with age. Although younger children knew a good deal about what causes each of the diseases, they lacked knowledge of what does not cause them, often inferring that risk factors for one disease, especially AIDS, cause other diseases as well. Knowledge of true risk factors for a disease was largely independent of knowledge of non-risk factors, and knowledge of one disease was largely independent of knowledge of another. These findings provide clues as to how disease understandings evolve with age and suggest that health educators must both understand students' current knowledge structures and explicitly teach students to make important differentiations between risk and non-risk factors for a given disease and between distinct diseases.

Mexican-American and Anglo-American children's responsiveness to a theory-centered AIDS education program.

Third, fifth, and seventh graders, most of them Mexican-American, were exposed to an empirically based and culturally sensitive AIDS curriculum designed to replace their intuitive theories with a coherent, scientific account of the causal processes that lead from risk behavior to AIDS symptomatology. Compared to students in control classes, experimental students knew more about AIDS risk factors and AIDS generally, displayed more conceptual understanding of the causes of AIDS and flu, and were more willing to interact with people who have AIDS (although not less worried about AIDS) at posttest and typically at follow-up 10-11 months later. The findings point to the potential value of adopting an intuitive theories approach in assessing and modifying children's concepts of health and illness and suggest, contrary to Piagetian formulations, that even relatively young children can, with appropriate instruction, grasp scientific theories of disease.