Syrrhaptes paradoxus

Ohne Zusammenfassung     

Hospitalisations for Pelvic Inflammatory Disease Temporally Related to a Diagnosis of Chlamydia or Gonorrhoea: A Retrospective Cohort Study

Objectives

The presence and severity of pelvic inflammatory disease (PID) symptoms are thought to vary by microbiological etiology but there is limited empirical evidence. We sought to estimate and compare the rates of hospitalisation for PID temporally related to diagnoses of gonorrhoea and chlamydia.

Methods

All women, aged 15–45 years in the Australian state of New South Wales (NSW), with a diagnosis of chlamydia or gonorrhoea between 01/07/2000 and 31/12/2008 were followed by record linkage for up to one year after their chlamydia or gonorrhoea diagnosis for hospitalisations for PID. Standardised incidence ratios compared the incidence of PID hospitalisations to the age-equivalent NSW population.

Results

A total of 38,193 women had a chlamydia diagnosis, of which 483 were hospitalised for PID; incidence rate (IR) 13.9 per 1000 person-years of follow-up (PYFU) (95%CI 12.6–15.1). In contrast, 1015 had a gonorrhoea diagnosis, of which 45 were hospitalised for PID (IR 50.8 per 1000 PYFU, 95%CI 36.0–65.6). The annual incidence of PID hospitalisation temporally related to a chlamydia or gonorrhoea diagnosis was 27.0 (95%CI 24.4–29.8) and 96.6 (95%CI 64.7–138.8) times greater, respectively, than the age-equivalent NSW female population. Younger age, socio-economic disadvantage, having a diagnosis prior to 2005 and having a prior birth were also associated with being hospitalised for PID.

Conclusions

Chlamydia and gonorrhoea are both associated with large increases in the risk of PID hospitalisation. Our data suggest the risk of PID hospitalisation is much higher for gonorrhoea than chlamydia; however, further research is needed to confirm this finding.     

Movement heterogeneity of dugongs, Dugong dugon (Müller), over large spatial scales

Seventy dugongs were fitted with satellite PTTs and/or GPS transmitters in sub-tropical and tropical waters of Queensland and the Northern Territory, Australia. Twenty-eight of the 70 dugongs were also fitted with time-depth recorders. The dugongs were tracked for periods ranging from 15 to 551 days and exhibited a large range of individualistic movement behaviours; 26 individuals were relatively sedentary (moving < 15 km) while 44 made large-scale movements (> 15 km) of up to 560 km from their capture sites. Male and female animals, including cows with calves, exhibited large-scale movements (LSM; > 15 km). Body length of travelling dugongs ranged from 1.9 to 3 m. At least some of the movements were return movements to the capture location, suggesting that such movements were ranging rather than dispersal movements. LSMs included macro-scale regional movements (> 100 km) and meso-scale inter-patch local movements (15 to < 100 km) and were qualitatively different from tidally-driven micro-scale commuting movements between and within seagrass beds (< 15 km). The mean ± S.E. macro-scale movement distance per individual was 243.8 ± 35.4 km (N = 14 individuals that travelled > 100 km), with a mean ± S.E. travel time of 179.8 ± 29.0 h. The mean ± S.E. meso-scale movement distance per individual was 49.7 ± 3.3 km (N = 28 individuals that made movements of 15-100 km), with a mean ± S.E. travel time of 52.3 ± 7.1 h. LSMs were rapid and apparently directed (mean ± S.E. travel speeds for GPS tagged animals; meso-scale movements = 1.3 ± 0.11 km/h, min = 0.3, max = 3.0; macro-scale movements = 1.6 ± 0.16 km/h, min = 0.8, max = 1.3). Tracked dugongs rarely travelled far from the coast (mean ± S.E. max distance = 12.8 ± 1.3 km). Dive profiles from the time-depth recorders suggest that dugongs make repeated deep dives while travelling rather than remaining at the surface, increasing their likelihood of capture in bottom set gill nets. Some animals caught in the high latitude limits of the dugongs' range on the Australian east coast in winter apparently undertook long distance movements in response to low water temperatures, similar to migrational movements by Florida manatees. Our findings that dugongs frequently undertake macro-scale movements have implications for management at a range of scales, and strengthen the aerial survey and genetic evidence for management and monitoring at ecological scales that cross jurisdictions.     

Women Commencing Anastrozole,Letrozole or Tamoxifen for Early Breast Cancer: The Impact of Comorbidity and Demographics on Initial Choice

Background

Australian clinical guidelines recommend endocrine therapy for all women with hormone-dependent early breast cancer. Guidelines specify tamoxifen as first-line therapy for pre-menopausal women, and tamoxifen or an aromatase inhibitor (AI) for post-menopausal women depending on the risk of recurrence based on tumour characteristics including size. Therapies have different side effect profiles; therefore comorbidity may also influence choice. We examined comorbidity, and the clinical and demographic characteristics of women commencing different therapies.

Patients and Methods

We identified the first dispensing of tamoxifen, anastrozole or letrozole for women diagnosed with invasive breast cancer in the 45 and Up Study from 2004–2009 (N = 1266). Unit-level pharmacy and medical service claims, hospital, Cancer Registry, and self-reported data were linked to determine menopause status at diagnosis, tumour size, age, comorbidities, and change in subsidy restrictions. Chi-square tests and generalised regression models were used to compare the characteristics of women commencing different therapies.

Results

Most pre-menopausal women commenced therapy with tamoxifen (91%). Anastrozole was the predominant therapy for post-menopausal women (57%), followed by tamoxifen (28%). Women with osteoporosis were less likely to commence anastrozole compared with tamoxifen (anastrozole RR = 0.7, 95% CI = 0.5–0.9). Women with arthritis were 1.6-times more likely to commence letrozole than anastrozole (95% CI = 1.1–2.1). Tamoxifen was more often initiated in women with tumours >1 cm, who were also ≥75 years. Subsidy restriction changes were associated with substantial increases in the proportion of women commencing AIs (anastrozole RR = 4.3, letrozole RR = 8.3).

Conclusions

The findings indicate interplay of comorbidity and therapy choice for women with invasive breast cancer. Most post-menopausal women commenced therapy with anastrozole; however, letrozole and tamoxifen were more often initiated for women with comorbid arthritis and osteoporosis, respectively. Tamoxifen was also more common for women with tumours >1 cm and aged ≥75 years. Subsidy restrictions appear to have strongly influenced therapy choice.