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Biomedical subjects

D Simmons

Publications and source records attributed to D Simmons.

At least 73 records · Page 4Linked to original sources
PubMed1999

Diabetes in New Zealand--better information needed.

AIMS: To review the availability and quality of data on the epidemiology of diabetes in New Zealand. METHODS: A search was undertaken for all Medline-indexed publications on diabetes in New Zealand. Hospitalisation and mortality data (ICD9 code 250) from the New Zealand Health Information Service (NZHIS) were examined. RESULTS: Information on diabetes in New Zealand has come from community surveys, national surveys, diabetes registers, hospitalisation data and mortality data. Much of this information has been valuable, but there is still inadequate national information on diabetes prevalence, incidence and time trends. CONCLUSION: Information technology provides an opportunity to couple the surveillance of diabetes with improved diabetes care. Medical practitioners need to support the development of their own practice-based registers/recall systems and to contribute to the development of district-based diabetes registers where these have a central focus on improving diabetes care.

Diabetes Mellitus↗
PubMed1999

Community development through partnership: promoting health in an urban indigenous community in New Zealand.

Indigenous people who have been dispossessed of their lands and resources bear a disproportionate burden of health problems. Programmes aimed at improving their health status must operate within the context of colonisation history and the contemporary cultural renaissance whereby indigenous populations are asserting their rights to self-determination. Community development strategies incorporating empowerment as both means and end are consistent with the aspirations of the renaissance and reflect the principles of the Ottawa Charter for Health Promotion. This paper describes a formative and process evaluation of a community development partnership for health promotion between a health group and an urban Maori community in New Zealand. Key issues encountered related to trust, prioritisation of health, and appropriate research paradigms. Most significant among these was trust, or more specifically, distrust among Maori engendered by historical and contemporaneous experiences of contact with Europeans. Ultimately, the partnership achieved what it set out to do when the Maori partners took over the running of their own health groups and health programme. Building upon a detailed literature review and data from the evaluation, the paper offers a list of recommended procedures for the development of partnerships, applicable to health and other domains. Recommendations encompass preparatory steps, the formation of a partnership committee, programme planning and development, and the appointment of a community-based liaison worker. A conclusion of the research and premise underpinning the recommendations is that devolution of power is a key aspect of organisational process underlying successful partnerships involving professional groups and indigenous people.

Culture↗
PubMed1999

Expression of DLX5 during human embryonic craniofacial development.

Dlx (distal-less gene) homeogenes encode transcription factors that are involved in the patterning of orofacial skeleton derived from cephalic neural crest cells. In order to study the role of DLX genes during embryonic development in human, DLX5 expression pattern was investigated in 6- to 11-week-old human embryos. A DLX5 PCR fragment was amplified from a human dental cDNA library subcloned and used for in situ hybridization investigations. DLX5 gene expression was primarily detected in the mandible at 6 weeks and then, after in the maxilla. DLX5 gene expression became restricted to progenitor cells of developing tooth germs, bones and cartilages of mandible and maxilla. During odontogenesis from bud to late cap stages, DLX5 transcripts were present in both dental epithelium and mesenchyme tissues. DLX5 expression was restricted to few cells in the vestibular aspect of the dental epithelium, while DLX5 mRNA signal was more widely distributed in dental mesenchyme. The observed expression pattern of DLX5 homeogene extends the proposed site-specific combination of homeogene expression in neural crest derived cells to human specific dentition. Furthermore, during the bud and cap stages of tooth morphogenesis, the asymmetric expression of DLX5 in the dental epithelium and dental mesenchyme may contribute to the complex patterning of human tooth shape.

Brain↗
PubMed1999

N-terminal and C-terminal modifications affect folding, release from the ribosomes and stability of in vitro synthesized proteins.

Important aspects of translation are release and folding of the synthesized protein into its three-dimensional structure. Studies from our group indicated that during in vitro protein synthesis a large portion of full-length polypeptides apparently accumulated as peptidyl-tRNA on ribosomes. We have also shown that some proteins though released in biologically active form may be inactivated without being degraded. These experiments were carried out by coupled transcription/translation using an Escherichia coli extract in which eukaryotic or prokaryotic test proteins were synthesized from their coding sequence inserted into specific plasmids. Experiments described here were designed to analyze the effects of N-terminal and C-terminal modifications of the coding sequence on the ribosomal release/termination process and on the stability of the newly synthesized protein. Elimination of the leader sequence in two proteins tested, mitichondrial rhodanese and bacterial beta-lactamase, caused an increase in the percentage of polypeptides released from the ribosomes relative to total synthesis. Conversely, an N-terminal extension such as a histidine-lag impaired the ribosomal release process. Also, a hydrophobic N-terminal modification of the synthesized protein reduced release of newly formed protein from the ribosomes. A C-terminal extension of the coding sequence for rhodanese by one amino acid decreased the percentage released polypeptide and furthermore affected the stability of the in vitro formed protein. We propose that a regulatory mechanism exists by which N-terminal and C-terminal sequences of a newly synthesized protein have feed-back effects on the termination factor-mediated release and on the stability of the native three-dimensional structure.

Cell-Free System↗
PubMed1999

High impact of nephropathy on five-year mortality rates among patients with Type 2 diabetes mellitus from a multi-ethnic population in New Zealand.

AIMS: Type 2 diabetes mellitus and its complications are common among Polynesians in New Zealand. This study investigated the mortality from diabetes among indigenous Maori and recent migrants from the South Pacific. METHODS: Death certificates and other reports were collected to enumerate those who had died in an across-community cohort study of 765 diabetic patients aged 40-79 years in 1991. Five year mortality status was ascertained in 99.7% and death certificates were obtained from 129 (88%) of the 146 who had died. Diabetes was missed from 36% of death certificates. RESULTS: Compared to Europeans with Type 2 diabetes, Maori with Type 2 diabetes were 2.66 (1.63-4.35) fold as likely to die from diabetes-related conditions, including a 13.1 (3.7-46.4) fold greater risk of death from nephropathy. Pacific Islands Polynesians with Type 2 diabetes had a similar mortality to Europeans with Type 2 diabetes (hazards ratio 1.06 (0.68-1.65)). After 6 years, 10.7 (2.2-19.3)% more Maori had died than Pacific Islands Polynesians. CONCLUSIONS: Maori with Type 2 diabetes are dying from diabetic complications, particularly nephropathy, at an alarming rate. The magnitude of the difference between Maori and Pacific Islands Polynesians suggests environmental rather than inherited factors are involved and these need further investigation.

Adult↗
PubMed1998

Does the "Thunderbirds syndrome" still exist.

Rationing of resources within both the private and public health care systems is a fact of life. The Thunderbirds TV series encapsulated an idealistic philosophy that life should be saved independent of the pecuniary cost. Doctors, in particular, are trapped between their role as advocates for the patient within the "Thunderbirds" philosophy and as citizens with a responsibility to use resources wisely. This dichotomy is challenged by point of care rationing, which can conflict with clinical responsibilities, undermines the patient-doctor relationship and is often undertaken in a clandestine manner. This form of controlling health costs is difficult to justify from an ethical perspective, particularly when other forms of health care rationing and expenditure are frequently modulated by political expediency and inadequate economic modelling. Indeed, focusing on improving quality and disease prevention, rather than reducing marginal costs can often control the long-term growth in health expenditure. Doctors have a responsibility to ensure that rationing decisions are made but these should be made as part of a transparent, evidence-based and democratic process away from the point of care. While the resources to implement the "Thunderbirds Syndrome" have never been available, the philosophy must remain at the heart of patient-doctor relationship.

Cost Control↗
PubMed1998

Junctional adhesion molecule, a novel member of the immunoglobulin superfamily that distributes at intercellular junctions and modulates monocyte transmigration.

Tight junctions are the most apical components of endothelial and epithelial intercellular cleft. In the endothelium these structures play an important role in the control of paracellular permeability to circulating cells and solutes. The only known integral membrane protein localized at sites of membrane-membrane interaction of tight junctions is occludin, which is linked inside the cells to a complex network of cytoskeletal and signaling proteins. We report here the identification of a novel protein (junctional adhesion molecule [JAM]) that is selectively concentrated at intercellular junctions of endothelial and epithelial cells of different origins. Confocal and immunoelectron microscopy shows that JAM codistributes with tight junction components at the apical region of the intercellular cleft. A cDNA clone encoding JAM defines a novel immunoglobulin gene superfamily member that consists of two V-type Ig domains. An mAb directed to JAM (BV11) was found to inhibit spontaneous and chemokine-induced monocyte transmigration through an endothelial cell monolayer in vitro. Systemic treatment of mice with BV11 mAb blocked monocyte infiltration upon chemokine administration in subcutaneous air pouches. Thus, JAM is a new component of endothelial and epithelial junctions that play a role in regulating monocyte transmigration.

Amino Acid Sequence↗
PubMed1998

A pilot urban church-based programme to reduce risk factors for diabetes among Western Samoans in New Zealand.

We have assessed the impact of a 2-year pilot church-base diabetes risk reduction programme on major lifestyle predictors of future Type 2 diabetes mellitus: exercise and weight control in a prospective non-randomized controlled study of a modular lifestyle and diabetes awareness intervention programme using a community development model. The study involved two complete church congregations from an ethnic group at high risk of diabetes (Western Samoans) (intervention church n = 78; control church n = 144). Weight remained stable (0+/-4.8 kg) in the intervention church but increased by 3.1+/-9.8 kg in the control church (p = 0.05). In the intervention church, there was an associated reduction in waist circumference (-4+/-10 cm vs +2+/-7 cm in control, p < 0.001), an increase in diabetes knowledge (46+/-26% vs 4+/-17% in control, p < 0.001) and an increase in the proportion exercising regularly (+22% vs -8% in control, p < 0.05). Consumption of key fatty foods was also reduced in the intervention church. We conclude that diabetes risk reduction programmes based upon lifestyle change, diabetes awareness, and empowerment of high risk communities can significantly reduce risk factors for future Type 2 diabetes.

Adult↗
PubMed1998

Personal barriers to diabetes care: lessons from a multi-ethnic community in New Zealand.

The aim of this study was to identify and quantify barriers to diabetes care perceived by diabetic subjects from a multiethnic, urban community (mainly New Zealand Europeans, Maori, and Pacific Islanders). A qualitative survey including 57 diabetic subjects and health care providers from a diverse range of backgrounds was followed by a cross-sectional household survey. Barriers to care were quantified among 1862 (2.1%) diabetic residents of a total surveyed population of 90477. Thirty barriers to care categories were generated incorporating patient beliefs, internal and external physical barriers, educational, psycho-social and psychological barriers. In spite of major difference in culture, acculturation, and socio-economic status, the top 10 barriers were similar between the ethnic groups. The most important barriers were perceiving that the benefits of self-care were outweighed by the disadvantages (20% Europeans, 20% Maori, 29% Pacific Islanders, 16% others, p<0.001), lack of community-based services (13% Europeans, 27% Maori, 25% Pacific Islanders, 11% others, p<0.001) and the limited range of services available (15% Europeans, 22% Maori, 20% Pacific Islanders, 14% others, p<0.05). It is postulated that definition of these barriers, with subsequent, systematic action to reduce their impact, in both patients and populations could result in an improvement in diabetes outcomes.

Attitude to Health↗
PubMed1998

Early childhood growth in ethnic groups predisposed to NIDDM: a prospective study.

Evidence is accumulating to suggest that the intrauterine environment may not only influence fetal growth and anthropometric indices at birth but also contribute to susceptibility to adult onset diseases such as non-insulin-dependent diabetes (NIDDM). We have followed up 77 out of 123 (65%) children at age 2 years 8 months derived from a population at high risk of NIDDM who were initially studied throughout pregnancy and birth to determine whether their weight, height, and measures of adiposity were predicted by maternal size, glycaemic control during pregnancy, or ethnicity. Adiposity was correlated with maternal pre-pregnancy weight and maternal serum triglyceride concentration. In contrast to the data gathered at birth, ethnic group did not predict any anthropometric variable except that South Asian children demonstrated faster weight gain in infancy compared to Polynesian or European subgroups.

Adult↗
PubMed1998

Cloning, characterization, and tissue expression pattern of mouse tuftelin cDNA.

Tuftelin is a protein that has been suggested to function during enamel crystal nucleation. Published sequences for bovine tuftelin cDNA and genomic clones proposed different reading frames that radically affected the derived amino acid sequence of the tuftelin carboxyl-terminus. We have isolated and characterized a full-length mouse cDNA clone and a partial porcine cDNA clone that include the region of the proposed frame-shift. The mouse tuftelin clone is 2572 nucleotides in length, exclusive of the poly(A+) tail. Translation from the 5'-most ATG yields a protein of 390 amino acids with an isotope-averaged molecular mass of 44.6 kDa and an isoelectric point of 5.9. Comparison of the bovine, mouse, and porcine cDNAs supports the revised bovine tuftelin amino acid sequence and suggests that the bovine tuftelin translation initiation codon be re-assigned to a more 5' ATG. Re-assigning the translation initiation codon lengthens the tuftelin protein by 52 amino acids, 51 of which are identical between bovine and mouse. At the carboxyl-terminus, the revised bovine and the mouse sequences match at 39 of the final 42 amino acid positions, compared with 2 identities with the originally published bovine reading frame. Northern blot analysis reveals that tuftelin is not ameloblast-specific but is expressed in multiple tissues, including kidney, lung, liver, and testis. Two tuftelin RNA messages, of 2.6 and 3.2 kb, were detected. DNA sequence characterization of an RT-PCR amplification product confirmed expression of tuftelin in kidney, and identified an alternatively spliced mouse tuftelin mRNA lacking exon 2.

Amino Acid Sequence↗