The Medical journal of Australia
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To describe associations between birthweight and infant, child and early adult mortality from natural causes in a remote Australian Aboriginal community against a background of rapidly changing mortality due to better health services. ⋯ The striking improvements in infant and child survival over time must be applauded. We confirmed a predisposing effect of lower birthweights on deaths in infants and children, and showed, for the first time, an association between lower birthweights and deaths in adults. Together, these factors are probably contributing to the current epidemic of chronic disease in Aboriginal people, an effect that will persist for decades. Similar phenomena are probably operating in developing countries.
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Letter Case Reports
Persistent unilateral right diaphragmatic palsy following liver transplantation.
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To assess the extent to which general practitioners in Australia are engaged in identifying age-related hearing loss and facilitating its management. ⋯ In their routine consultations with patients, GPs have opportunities to identify hearing loss and appropriately refer patients to specialists or allied health professionals. Although GPs are responding to patient presentations for hearing loss, referring around 50% of cases, there appear to be relatively few cases in which hearing loss is identified opportunistically. Levels of identification and management of hearing loss by GPs in Australia are relatively low.
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Significant problems in health care, such as access block and long waiting lists for elective surgery, have led to calls for keeping hospital occupancy at no more than 85%. It is elementary queueing theory that a finite-capacity system with variable demand cannot sustain both full utilisation and full availability. However, the statement that there is a single level of ideal or safe occupancy suitable for all situations is a simplistic interpretation and application of the underlying science. We argue that specific study and action are necessary to understand and deal with the problems of long waiting lists and access block in any given health care facility.