A neurological locomotor disorder in sheep grazing Stachys arvensis.

OBJECTIVE: To describe the clinical signs and pathology of a neurological locomotor disorder in sheep associated with ingestion of Stachys arvensis. DESIGN: Field observations and laboratory examinations. PROCEDURE: Clinical and pathological examinations were performed on sheep with suspected S arvensis intoxication. FIELD OBSERVATIONS: Merino sheep in a flock on the southwestern slopes of New South Wales developed a neurological disorder after grazing S arvensis. Affected animals had pelvic limb paresis and a proprioceptive deficit. When forced to exercise they stumbled and collapsed. Recovery following removal from the plant was slow. Many deaths were associated with the outbreak. RESULTS: Affected sheep developed a mild degenerative myelopathy and peripheral neuropathy. Deficiencies of vitamins A and E were also observed in the affected flock. CONCLUSION: Grazing S arvensis is sometimes associated with a neurological locomotor disorder in sheep.

The true rates of injury among workers in New Zealand: comparing 1986 and 1991.

This study has established true injury rates in New Zealand in 1986 and 1991 for the general and working populations. The general population grew by 3% between the two censuses, while the injury rate increased by 23%. The workforce decreased by 7% while the workforce injury rate rose by 11%. The numbers of salary earners and wage earners fell by 10% and the number of self-employed workers rose by 4%, the injury rates in the former rising by 16% and falling by 7% in the latter group. This suggests either a lower injury rate or a lower claim rate among these latter workers. Young males have the highest injury rates in the general and workforce population. Women have half the injury rate of men, suggesting that women should pay lower insurance premiums. Detailed analysis revealed 'high injury rate/high cost' groups in whom targeted intervention strategies should be cost-effective. This study gives a baseline against which changes can be measured. We recommend that this study be repeated.

The Work Rehabilitation Impact Quotient: a tool to assess the effectiveness of early rehabilitation of injured workers.

The Work Rehabilitation Impact Quotient (WRIQ) compares the percentage of long term claimants in a classification group with the percentage of long term claimants overall in the scheme, a value greater than one indicating that more people than expected remain on compensation. We studied the Accident Rehabilitation and Compensation Insurance Corporation of New Zealand (ACC) claims from 1988 to 1994 and data from the 1986 and 1991 census. High WRIQs were found in workers over the age of 50, people injured in motor vehicle crashes, those with head and multiple location injuries, and those with amputations, dislocations, injuries to internal organs, and OOS (Overuse syndromes). Analysis by occupation and industry identified certain groups with high and very high WRIQs. The WRIQ value was not related to the rate of injury or to job availability, but was related to mean claim cost. Thirty six percent of claim costs paid in 1994 were in groups with high or very high WRIQs. Reduction of the WRIQ in these groups to low levels would produce savings of over $100 million in 1994 dollars.

Computerised data collection: practicability and quality in selected general practices.

The objective of the study as to assess the consistency with which a set of pre-defined data about three fictitious patients was entered into a sample group of practice computer systems, and to measure the time required for routine data capture of this kind. The study design was a prospective, piloted, postal survey, in which respondents were requested to enter a variety of general sample data onto their systems, to time the process, and record details of any difficulties. The subjects were 76 (39%) responding general practices in England and Ulster, from a random sample of members of a GP computer specialist group. These results (which in view of the highly motivated characteristics of the responding sample are likely to represent best practice) showed that differing conventions were applied in entering patient data, even among practices using the same type of computer system. Potentially significant errors and distortions were found in the data as recorded in the systems, such as the 29% of immunisation sequences which were slightly inaccurately entered. The main problems with the data entry comprised simple operator errors, inconsistency in the use of terms entered, and difficulties in recording negative data (only 20% of practices could enter patient 'not incontinent'). Practices varied widely in the way they allocated data recording responsibilities to staff, with only 6% of practices involving all staff in data entry.(ABSTRACT TRUNCATED AT 250 WORDS)

Rehabilitation services in the health sector: the perspectives of providers and consumers: Part 2.

AIMS: To gain information from consumers of rehabilitation services about service use and availability, and priorities for future development. To compare this with area health board (AHB) priorities for future services. METHOD: A postal survey of 740 consumers of rehabilitation services used the membership list of the Disabled Persons' Assembly (DPA) of New Zealand. There was a 311 (42%) response rate of whom 84% were people with disabilities and 16% were care givers. RESULTS: Causes of disability included illness (45%), congenital (26%), accidents (22%), and multiple causes (7%). Most people had physical (66%) or multiple disabilities (22%), while few had sensory (7%), intellectual (3%), psychiatric (3%), or learning disabilities (0.4%). The main factors affecting service delivery were lack of information, restricted service, needs not assessed, difficult access to services, lack of coordination, and transport difficulties. Most respondents were aware of statutory services such as district nursing, home help, occupational therapy, physiotherapy, social work and wheelchair assessment and maintenance. One third were aware of regular review, attendant care, and similar programmes. The services that were least known were advocacy and supported accommodation. Consumer priorities were regular review and disability information services, while AHB priorities were attendant care and supported accommodation. CONCLUSIONS: Lack of information, lack of regular assessment, and lack of coordination were major barriers to consumers obtaining adequate rehabilitation services. A single agency purchaser, clear entry points, case management and assessment would provide potent mechanisms for overcoming these difficulties. Priorities for consumers reflected their need for information and support, while provider priorities showed their commitment to the policy of de-institutionalisation. We conclude that it is important that consumers are involved in the planning process so that informed decisions are made about appropriate resource allocation.

Rehabilitation services in the health sector: the perspectives of providers and consumers: Part 1.

AIMS: To establish the degree of implementation of the Strategic Planning Guidelines for Area Health Boards--Services for Adults with Physical Disability, published by the Department of Health in 1989, the services being provided, and the priorities for future service provision. METHODS: Two postal surveys of area health boards (AHB's) were carried out in 1991. The first asked about the terminology of rehabilitation, administrative structure, advocacy, service audit, inventory of services, regional service delivery, and consultation processes. The second asked about the rehabilitation services provided, the type of disability of the consumers of the service, the reasons why services were or were not provided, the service gaps that existed, and the priorities that existed to fill those service gaps. RESULTS: The major finding was that while all area health boards adopted the rehabilitation concepts in principle, service development was impeded in many cases by the failure to provide resources to plan and develop the service. Some were providing comprehensive services. Most AHB's provided services for people with physical or multiple disabilities. All provided statutory services such as district nursing and home help, while most provided regular medical reviews, physiotherapy, occupational therapy, speech therapy, etc. Only about half provided attendant care, driving assessment, and swimming for people with disabilities, while less than half supported disability information services (DIS). Attendant care was seen as high priority to fill gaps in service, but was seen as the funding responsibility of the Department of Social Welfare. CONCLUSIONS: Service provision reflected a traditional approach to the provision of rehabilitation services. The development of innovative service delivery will require crown health enterprises to reevaluate their present level of commitment to rehabilitation services and to assess the effectiveness of reallocating some funds from acute services into rehabilitation.

Young people, drink and the law: a descriptive study covering two London magistrates' courts.

The survey sample consisted of 104 young people between the ages 17 and 25 who appeared in court charged with simple drunkenness, drunk and disorderly and drink and driving charges. Interviewing was carried out in two London magistrates' courts every weekday using a fortnightly rota over a six-month period. The results showed that the majority reported usually drinking in pubs and clubs; lager was the preferred alcoholic beverage. More than half the sample reported drinking in excess of 10 units, often considerably more (one unit = 1/2 pint of beer = 1 single measure of spirits = 1 glass of wine), on a drinking occasion. This rate of consumption was considered moderate drinking by a considerable number who were drinking either almost every day or at least once a week. Responses to a self-administered questionnaire showed that 40% had experienced some degree of psychological or physical dependence during the three months prior to their arrest. Of the sample 67% were surprised by the charge and 70% said that a court appearance would not make them more careful of their alcohol consumption in the future.

Comparison of electron microscopy, enzyme-linked immunosorbent assay, solid-phase radioimmunoassay, and indirect immunofluorescence for detection of human rotavirus antigen in faeces.

Four techniques were compared for their practicability, speed, and sensitivity for the detection of human rotavirus. Radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) were found to be the most sensitive means of identifying rotavirus, and, once processed, up to 40 specimens could be examined daily. Electron microscopy, although less sensitive than these techniques, had the advantage of being able to detect other viral agents present in faecal extracts. Indirect immunofluorescence failed to detect rotavirus as often as the other three methods. In laboratories where routine examination of faecal specimens from patients with gastroenteritis is required, ELISA and RIA are useful alternatives to electron microscopy.

Alcoholism: a controlled trial of "treatment" and "advice".

Two groups of alcoholics received either one counseling session or several months of in- and outpatient treatment. One year later there were no significant differences in outcome between the two groups.