The burden of group A streptococcal pharyngitis in Melbourne families.

BACKGROUND & OBJECTIVES: There are no recent data from industrialised countries documenting the incidence and costs of group A streptococcal (GAS) pharyngitis. Such data are important in developing policy regarding management (e.g., whether or not to use antibiotics to treat sore throat) and in planning preventive strategies, including preparing for the arrival of GAS vaccines. The present study was undertaken to estimate the incidence and costs of GAS pharyngitis in school aged children in Melbourne, Australia. We report here the results after initial 11 months of surveillance. METHODS: A total of 202 families (852 individuals) with at least one child aged 3 to 12 yr were enrolled across Melbourne in a family-based cohort study, and are being followed prospectively for 24 months. Surveillance data for acute GAS pharyngitis (including serology), throat carriage, and costs of the disease were collected. Additional cases of GAS pharyngitis have been ascertained to improve the precision of costing estimates. RESULTS: Cohort retention was 97 per cent. The spring, summer and winter carriage rates for children were 13.0, 8.0 and 16.0 per cent respectively. The incidence of GAS pharyngitis was 14 per 100 person-years for children. For every primary case there were 0.7 secondary cases and 24 per cent of families experienced at least one episode of GAS pharyngitis per year. Preliminary costing data suggest that 46 per cent of cases lead to school absenteeism and a high rate of antibiotic use. INTERPRETATION & CONCLUSION: The present data suggest that GAS pharyngitis remains very common in childhood, and that it has further implications in terms of secondary cases and costs.

Aging, food, culture and health.

International comparison of food intake and health studies amongst the aged is providing new insight into the importance of food culture in social context for healthy aging. At same time the possible variance in eating behavior compatible with good health requires consideration. The IUNS (International Union of Nutritional Sciences) FHILL (Food Habits in Later Life) Project, comprises (1) a morbidity study on about 2,000 elderly in 13 communities (now available on CD Rom) and (2) a mortality follow-up study. In the morbidity study, a total health assessment score or Later Life Status Score (LLSS) has been considered in relation to non-nutritional and nutritional factors. The elderly Greek cohorts aged 70+ in Melbourne. Australia (M = 94, F = 95) and Spata, Greece (M = 51, F = 53) have been used as a model for multivariate analyses to determine separately the importance of non-nutritional (well-being, memory, general health, medication-use, activities of daily living, exercise, social activity and social networks scores) and nutritional variables (intake of food groups g/day, food group variety scores, nutrients) in accounting for LLSS. A mortality follow-up study on the elderly cohort in Spata, Greece has also been completed and published. The findings from these preliminary analyses on the Greek cohorts will be reviewed as an example of how food culture may be influencing both quality of life and survival in Greek elderly. The most important non-nutritional determinants of LLSS in Greeks included: mobility and independence (exercise and activities of daily living), well-being and memory (collectively explained 80% of the variation of LLSS). For nutritional variables, a high intake and variety of plant foods (in particular vegetables, legumes and fruit); a high intake and variety of seafood and a low intake of meat emerged with statistical and biological significance. Results from the mortality study also agree with findings from the morbidity study--particularly the importance of the overall traditional greek food culture, with its emphasis on plant derived food of various kinds, as opposed to individual food categories, in protecting against premature death. Strategies are advanced which may optimise nutritionally related health problems amongst the aged around the globe.

Prevalence of late orchidopexy is consistent with some undescended testes being acquired.

To diagnose the incidence of orchidopexy versus age over a 15-year period, a study was conducted of all patients discharged from a single institution for orchidopexy with reference to age during operation. The hypothesis drawn was that some boys have acquired UDT and therefore, will present late despite recommendations for early diagnosis and treatment. The study was conducted on patients from Royal Children's Hospital, Melbourne (1980-94). The results suggested that while the optimal age for management of congenital UDT has been lowered to one to two years of age by under-graduate education, the persistence of a significant number of older children undergoing surgery suggests that some UDT's are acquired. It also showed that the proportion of orchidopexies performed in infancy increased over the 15-year period while the proportion performed in late childhood remained constant.