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Biomedical subjects

D North

Publications and source records attributed to D North.

At least 19 recordsLinked to original sources
PubMed1996

New Zealand guidelines for the management of dyslipidaemia: implications for treatment in an urban New Zealand population.

AIMS: The paper uses coronary heart disease risk factor prevalence data from a defined urban population to assess the potential impact of implementing the New Zealand National Heart Foundation "Guidelines for detection and management of dyslipidaemia" on the treatment of dyslipidaemia in New Zealand. METHODS: Coronary heart disease risk factor data was collected on an age stratified random sample of Auckland residents aged 35-74 years. The 10 year absolute risk of coronary heart disease was calculated for each participant aged between 35-64 years and management options determined from the National Heart Foundation guidelines. The Framingham equation used in these guidelines was used to extrapolate the 10 year risk of a coronary event in the 65-74 year age group. The proportions of participants potentially requiring treatment with lipid modifying medication were identified and extrapolated to the New Zealand European population. A sensitivity analysis was undertaken to assess the impact of 5% and 10% reductions in total cholesterol following dietary intervention on numbers meeting the drug treatment criteria. RESULTS: The proportion of participants potentially requiring lipid modifying treatment based on the guidelines was considerably higher than estimates of current treatment rates in each age group. The number meeting the treatment criteria increased dramatically with age. By the age of 65-74 years one in five participants met the drug treatment criteria. A 5% and 10% reduction in total cholesterol following dietary intervention reduced the proportion of participants potentially requiring drugs by almost one quarter and one half respectively. CONCLUSION: The approach taken by the New Zealand National Heart Foundation guidelines appropriately gives highest priority to patients at highest risk of a coronary event. If this high risk approach is extrapolated to older age groups, it will lead to more drug treatment among the elderly. Further evidence from randomised controlled trials on benefits of using cholesterol modifying medication in older age groups is required. Future guidelines need to address specifically criteria for use of lipid modifying medications in older age groups. Reductions in the numbers meeting drug treatment criteria following 5% and 10% reductions in total cholesterol reinforces the importance of dietary management.

Adult↗
PubMed1995

Adolescent health--a descriptive study of a school doctor clinic.

AIM: To describe a school doctor clinic at a New Zealand secondary school. METHODS: A three phase study was designed and conducted at a coeducational secondary school in Auckland. Firstly, a health questionnaire was developed to assess adolescents' perceptions of their health status and use of primary health care services. The second phase was descriptive study of a newly established school doctor clinic. The doctor clinic was run twice weekly over a 3 month period in 1993. The third phase of the study was a clinic-based satisfaction survey. RESULTS: A 75% response rate was achieved, with a total of 221 health questionnaires completed from 292. Although the majority of students (n = 184, 84%) considered themselves healthy, 16% (n = 36) described their health as only 'fair' or 'poor'. Seventy one percent (n = 157) of students had seen their general practitioner in the preceeding twelve months. Thirteen percent (n = 142) of the school population consulted the school doctor clinic. Significantly more female, Maori and European students attended the school doctor clinic compared with the school demography. The commonest diagnoses for the doctor clinic were respiratory, skin and musculoskeletal problems. Thirty one percent of the diagnoses related to recognised adolescent health needs such as contraception, sexual health, nutrition, and psychosocial problems. Over two thirds of students at the first consultation had not seen another health provider. Students perceived that the doctor clinic overcame barriers such as access, cost and confidentiality. CONCLUSION: The school doctor clinic was well utilised, overcame some barriers to access and addressed many recognised adolescent health needs.

Adolescent↗
PubMed1995

Management of hypertension and the core services guidelines: results from interviews with 100 Auckland general practitioners.

AIM: To determine if the management of a hypothetical case of essential hypertension by general practitioners conforms with the Report to the National Advisory Committee on Core Health and Disability Services guidelines on the Management of Raised Blood Pressure in New Zealand (Core Services Report on Hypertension) sent to all general practitioners in November 1992. METHOD: A cross-sectional survey of a random sample of 100 Auckland general practitioners using a standard case of a 60 year old man with essential hypertension. Seventy interviews were conducted by a face-to-face interview and 30 by telephone interview. The main outcome measures were. Initial choice of medication and levels at which blood pressure would require treatment. RESULTS: Forty one percent of the interviewed doctors had read the Core Services report on hypertension. Fifty percent of the doctors indicated they would use the recommended first line antihypertensive medication (ie, diuretic or beta blocker). Doctors who prescribed beta blockers had been graduated a significantly longer time than those who did not. The majority of doctors indicated that they would initiate pharmacological treatment at lower blood pressures in younger patients than older patients contrary to the recommendation of the report. CONCLUSIONS: Current reported practice is only partially consistent with that suggested by the Core Services report on hypertension. Approximately half of the doctors interviewed were prescribing the recommended first line medication. Treatment was more likely to be initiated at lower levels in younger patients than in older patients in spite of the higher absolute risk and potential absolute benefit in the latter group. Adherence to the guidelines could see a shift from overtreatment of younger patients to an increase in treatment for older patients who are at higher risk of blood pressure related disease. More specific graduate educational measures will be needed if the Core Services report on hypertension are to be implemented.

Adult↗
PubMed1995

Do cardiovascular disease risk factors predict all-cause mortality?

BACKGROUND: The purpose of this study is to describe associations between a number of standard cardiovascular risk factors and all-cause mortality. METHOD: Mortality data were collected for a randomly selected cohort of 1029 New Zealand men aged 35-64 years, followed up over a 9-year period. A proportional hazards regression model was used to estimate the relative risks (RR) for all-cause mortality associated with a number of cardiovascular risk factors. RESULTS: In all, 96 deaths occurred over the 9-year period, of which 50% were due to cardiovascular causes. All-cause mortality was positively associated with cigarette smoking (age-adjusted RR = 2.01, 95% CI:1.15-3.53, current versus never), systolic blood pressure (age-adjusted RR = 2.18, 95% CI:1.23-4.44, upper versus lower tertile), and body mass index (age-adjusted RR = 1.59, 95% CI:0.94-2.66, upper versus lower tertile) and inversely associated with high density lipoprotein (HDL)-cholesterol (age-adjusted RR = 0.45, 95% CI:0.25-0.80, upper versus lower tertile). All-cause mortality was only weakly associated with serum total cholesterol (age-adjusted RR = 1.19, 95% CI:0.70-1.99, upper versus lower tertile), and there was no evidence of a U-shaped relationship for this risk factor. There was an inverse association between all-cause mortality and socioeconomic status (age-adjusted RR = 1.70, 95% CI:1.03-2.80, lower versus upper). Light alcohol consumption was associated with reduced all-cause mortality (age-adjusted RR = 0.63, 95% CI:0.37-1.05, light versus teetotal), but this benefit did not persist for alcohol consumption above about three standard drinks per day. CONCLUSIONS: The findings of this study indicate that the standard cardiovascular risk factors are likely to have a beneficial impact on all-cause mortality as well as cardiovascular disease in middle-aged and older men.

Adult↗
PubMed1994

Validity of self-reported hospital admission in a prospective study.

This study examines the validity of self-reported hospital admission data obtained by telephone interview from a sample of 563 participants in a follow-up study in Auckland, New Zealand. The personal recall of hospital admissions over a 4-year period between 1988 and 1991 was compared with a national computerized record of all hospital admissions. Only two admissions were recalled by participants but not recorded on the hospital record. However, the study found significant underreporting of admissions by participants. Of those participants who could be contacted, 58% recalled all their admissions recorded on the computerized database. Additionally, 26% recalled some of the admissions, and 16% recalled none of the admissions. The age, sex, and social class status of the participants did not appear to significantly influence recall ability. A greater proportion of "first" admissions (68%) was recalled than that of "readmission" (45%). Follow-up studies that rely on similar methods for collecting self-reported hospital admission data may significantly underestimate admission rates, particularly those of readmissions for the same condition.

Adult↗
PubMed1993

Physicians' usefulness ratings of family-oriented clinical tools.

BACKGROUND: Family-oriented patient care is a cornerstone of family practice. Family practice educators have proposed various methods to help the physician to better assess and treat families. Little is known, however, of the usefulness of family-oriented clinical tools to practicing physicians. METHODS: On a mailed survey questionnaire, 595 members of the Wisconsin Academy of Family Physicians were asked to rate the usefulness of 10 family-oriented tools and indicate the frequency of use and level of training received for each item. In addition, physicians rated their current and desired level of competency for involving families in patient care. RESULTS: Two hundred ninety-nine (50%) physicians responded. Most of the tools were rated as useful but used infrequently. Identifying the effects of chemical dependency on the health of families and conducting family conferences were rated as highly useful and frequently used skills. Clinical tools rated as least useful were record keeping by family charts and folders and family function assessment by the Family APGAR: Physicians who had received training in the use of a tool rated it as more useful, except for the Family APGAR and family charts or folders. Physicians with busier practices rated some of the tools as less useful than did other physicians. Respondents indicated a desire to develop their family counseling skills. CONCLUSIONS: Most family-oriented tools were reported to be useful but used infrequently by practicing physicians. Residency programs should continue to provide training for assessing and treating families, particularly in the areas of family systems theory, self-awareness of the physician's own family background, and the effect of chemical dependency on families. Future research should target larger and more varied groups of family physicians.

Attitude of Health Personnel↗
PubMed1993

Controlling the costs of antibiotic resistance.

Excessive and inappropriate use of antibiotics in hospitals contributes to the development of antibiotic resistance and to increased hospital costs. Denver's three major teaching hospitals have developed a multifaceted approach that has curbed inappropriate antibiotic prescribing and reduced costs for antibiotic purchases. A joint antibiotic-use committee with representatives from each hospital's pharmacy and therapeutics committee developed a single antibiotic formulary for systemically active antibacterial agents, based on simplicity, clinical efficacy, previous use patterns, local resistance patterns, and relative cost. This formulary includes primary agents, ordered at the prescriber's discretion; secondary agents, ordered only for an approved condition; and restricted agents, which had been used excessively or inappropriately in the past, and are now dispensed only after consultation with infectious disease specialists. A computerized antibiotic order-entry program at the Denver V.A. Medical Center requires all physicians to enter antibiotic requests through a centralized computer system. Drug utilization is evaluated using data collected from the computer data base and in vitro data from the microbiology laboratory. In addition, appropriate antibiotic prescribing and infection control practices are taught in an education program for physicians, nurses, and other health care workers.

Anti-Bacterial Agents↗
PubMed1992

Ontogeny of epidermal growth factor, transforming growth factor-alpha, epidermal growth factor receptor, and thyroid hormone receptor RNA levels in rat kidney and changes in those levels induced by early thyroxine treatment.

Ontogenic changes in the mRNA levels of epidermal growth factor (EGF), transforming growth factor-alpha, EGF receptor, and thyroid hormone receptor (r-erbA) were examined in developing rat kidneys. The mRNA levels of both EGF and thyroid hormone receptor rose dramatically during the postnatal period with the rise in thyroid hormone receptor message preceding the rise in EGF message. In addition, we examined renal mRNA levels in 1-wk-old rats treated with thyroxine (T4) from birth through d 6. Neonatal T4 treatment augmented the renal mRNA levels of EGF but decreased the levels of EGF-receptor and transforming growth factor-alpha. T4 treatment did not significantly affect the levels of renal mRNA for thyroid hormone receptor. Although the EGF and transforming growth factor-alpha peptides are similar and interact with the same receptor, our findings indicate that these homologous growth factors are regulated differently during development. In addition, hormones that influence growth and development, such as T4, may function both as positive and negative regulators of growth factor expression.

Age Factors↗
PubMed1991

The functional significance of biochemical alterations in streptozotocin-induced diabetes.

These experiments examined the effects of restraint stress on dopamine (DA) and 5-hydroxytryptamine (5-HT) and their principal metabolites dihydroxyphenylacetic acid (DOPAC) and 5-hydroxyindoleacetic acid (5-HIAA), respectively, in 4 brain regions, as well as on plasma corticosterone concentration (CORT) and behavior in streptozotocin-induced diabetic rats and nondiabetic controls. Diabetic rats had widespread reductions in DA and 5-HT turnover (DOPAC/DA and 5-HIAA/5-HT ratios). Restraint led to equivalent increases in DA turnover in diabetics and nondiabetics, but attenuated increases in 5-HT turnover in diabetic rats. CORT concentration of diabetics and nondiabetics measured in complete quiet did not differ. Relative to these measures, only diabetics had elevated CORT when either restrained or kept in the same room with restrained rats with food and water removed. Open-field exploration was suppressed by restraint in diabetics only. All diabetic rats showed decreased locomotion in a novel environment which was normalized during a second exposure to the apparatus. Together, these results suggest that diabetes-induced disruptions in open-field activity are related to anxiety rather than to motor or energy deficits, and may be related to impaired 5-HT and CORT systems.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1990

Thyroid hormone receptor and receptor-related RNA levels in developing rat brain.

The proto-oncogene c-erbA and its analogues are genes that encode thyroid hormone receptors. In rats, at least two loci have been identified by their homology to c-erbA. Each locus can produce at least two distinct mRNA species via RNA processing. However, one of those transcripts, r-erbA alpha-2, does not yield a triiodothyronine (T3)-binding protein when translated in vitro. Proper development of the rat brain is thyroid hormone-dependent during the perinatal period and there is a documented increase in brin nuclear T3-binding capacity during that time. By hybridizing cDNA probes specific to various rat erbA-like transcripts with RNA extracted from developing rat brain, we sought changes in thyroid hormone receptor mRNA levels that correspond with changes in T3-binding capacity in rat brain during the perinatal period. Three mRNA of the erbA family showed variations in relative abundance during brain development. Oddly, r-erbA alpha-2, a variant that does not code for a T3-binding protein, was the most abundant erbA-like RNA to correlate with the reported changes in T3-binding capacity. The message for rat r-erbA alpha-1 that encodes a functional T3 receptor also varies with T3-binding capacity but at a level that is at least 8-fold lower than the r-erbA alpha-2 message. The level of rat erbA beta-1 message also varies in rat brain during the perinatal period but not in a way that correlates with changes in T3-binding capacity.

Animals↗
PubMed1988

Affinity labeling of the P site of Drosophila ribosomes: a comparison of results from (bromoacetyl)phenylalanyl-tRNA and mercurated fragment affinity reactions.

The binding site of the peptidyl group of peptidyl-tRNA in the P site of Drosophila ribosomes was probed with (bromoacetyl)phenylalanyl-tRNA (BrAcPhe-tRNA). This affinity label binds specifically to the P site by virtue of its ability to participate in peptide bond formation with puromycin following its attachment to ribosomes. As many as nine ribosomal proteins may be labeled under these conditions; however, the majority of the labeling is associated with three large-subunit proteins and two small-subunit proteins. Two of the large-subunit proteins, L4 and L27, are electrophoretically very similar to the proteins labeled by the same reagent in Escherichia coli ribosomes L2 and L27. Reexamination by a different two-dimensional gel system of the ribosomal components labeled by a second P site reagent, the 3' pentanucleotide fragment of N-acetylleucyl-tRNA which is derivatized to contain mercury atoms at the C-5 position of all three cytosine residues, shows two major and three minor labeled proteins. These proteins, L10/L11, L26, S1/S4, S13, and S20, are likely present in the binding site of the 3' end of peptidyl-tRNA, a site that appears to span both subunits. These results have allowed us to construct a model for the protein positions in and near the peptidyl-tRNA binding site of Drosophila ribosomes.

Affinity Labels↗
PubMed1987

Prospective study of symptoms and signs in acutely ill infants in general practice.

A study was made of all cases of acute illness in infants aged 6 months or less presenting in a Gosport practice over five months. The frequency in these patients of the well defined symptoms and signs suggested to be important by the preliminary report of the Department of Health and Social Security's multicentre study of postneonatal mortality was recorded. During the study period there were 161 infants of this age in the practice, who gave rise to 69 consultations with acute illness. Thirty eight of these were given drug treatment and five were referred to a paediatric unit, one of them on social grounds. There were no infant deaths in the practice (total population 11,400), but two occurred in the Gosport area (total population 83,000). It would be unrealistic to refer all patients with any one of the symptoms and signs, even when well defined, in the age group 6 months or less. Analysis of the symptoms and signs found in those children who required admission did not show any pattern differentiating them from those who did not. Although the symptoms and signs studied are of value in assessment and should be sought in these patients, they cannot be used singly or in any pattern to indicate referral per se.

Acute Disease↗