Search PubMed⌕ Search

Biomedical subjects

H Rea

Publications and source records attributed to H Rea.

18 recordsLinked to original sources
PubMed2004

A chronic disease management programme can reduce days in hospital for patients with chronic obstructive pulmonary disease.

BACKGROUND: A steady increase in chronic obstructive pulmonary disease (COPD) admissions was addressed by enhancing primary care to provide intensive chronic disease management. AIM: To compare the effect of a disease management programme, including a COPD management guideline, a patient-specific care plan and collaboration between patients, general practitioners, practice nurses, hospital physicians and nurse specialists with conventional care, on hospital admissions and quality of life. METHODS: One hundred and thirty-five patients with a clinical diagnosis of moderate to severe COPD were identified from hospital admission data and general practice records. General practices were randomized to either conventional care (CON), or the intervention (INT). Pre- and post-study assessment included spirometry, Shuttle Walk Test, Short Form-36, and the Chronic Respiratory Questionnaire (CRQ). Admission data were compared for 12 months prior to and during the trial. RESULTS: For respiratory conditions, mean hospital bed days per patient per year for the INT group were reduced from 2.8 to 1.1, whereas those for the CON group increased from 3.5 to 4.0 (group difference, P = 0.030) The INT group also showed an improvement for two dimensions of the CRQ, fatigue (P = 0.010) and mastery (P = 0.007). CONCLUSIONS: A chronic disease management programme for COPD patients that incorporated a variety of interventions, including pulmonary rehabilitation and implemented by primary care, reduced admissions and hospital bed days. Key elements were patient participation and information sharing among healthcare providers.

Adult↗
PubMed2001

Bcl-xL expression after contusion to the rat spinal cord.

After contusion-derived spinal cord injury, (SCI) there is localized tissue disruption and energy failure that results in early necrosis and delayed apoptosis, events that contribute to chronic central pain in a majority of patients. We assessed the extent of contusion-induced apoptosis of neurons in a known central pain-signaling pathway, the spinothalamic tract (STT), which may be a contributor to SCI-induced pain. We observed the loss of STT cells and localized increase of DNA fragmentation and cytoplasmic histone-DNA complexes, which suggested potential apoptotic changes among STT neurons after SCI. We also showed SCI-associated changes in the expression of the antiapoptotic protein Bcl-xL, especially among STT cells, consistent with the hypothesis that Bcl-xL regulates the extent of apoptosis after SCI. Apoptosis in the injured spinal cord correlated well with prompt decreases in Bcl-xL protein levels and Bcl-xL/Bax protein ratios at the contusion site. We interpret these results as evidence that regulation of Bcl-xL may play a role in neural sparing after spinal injury and pain-signaling function.

Animals↗
PubMed1996

Relationship of non-specific airway hyperresponsiveness (AHR) to measures of peak expiratory flow (PEF) variability.

BACKGROUND: The relationship between airway hyper-responsiveness (AHR) and clinical asthma remains controversial and unclear. AIMS: To test the hypothesis that serial measures of variability of peak expiratory flow rate (PEF) correlate with serial measures of AHR, and to determine which mathematical expression of variability provides the best correlation. METHODS: A longitudinal study over 180 days of 20 atopic, moderately severe asthmatics was undertaken. A diary of medication use and morning and evening PEFR before and after beta agonist was kept and AHR (PD20 histamine) was measured at three-weekly intervals. Using group data (128 sets) in PD20 was correlated with various measures of PEF variability over 9 days. RESULTS: [Table: see text] Within the group there was a weak but highly statistically significant correlation between AHR and measures of PEF variability--the strongest correlation being with mean morning PEF. Within individual subjects, however, the correlation was not a consistent finding and only four patients had a statistically significant relationship (p < 0.05) between AHR and mean morning PEF. CONCLUSIONS: These results suggest that while PEF variability may reflect AHR for the purposes of epidemiologic studies, it is unlikely to be useful as a simple 'non-invasive' means of assessing AHR in individual patients. More complex measures of PEF variability do not have an advantage over simpler measures such as mean morning PEF.

Adolescent↗
PubMed1995

The effects of privet exposure on asthma morbidity.

AIM: To determine whether privet may be an important cause of asthma morbidity. METHODS: The study was conducted in two parts; (1) a longitudinal study of asthma symptoms, medication use, peak expiratory flow rate and airway responsiveness during and after the privet-flowering season, and (2) bronchial challenge of 17 subjects with two species of flowering privet. Subjects were asthmatics who attributed worsening asthma symptoms to privet exposure. All subjects were atopic and had perennial asthma symptoms requiring treatment with inhaled steroids and beta agonists. RESULTS: 1. Twenty subjects completed the longitudinal study. Airway responsiveness (PD20 histamine) was significantly greater during the privet-flowering season (0.4 mumol vs 0.73 mumol, p < 0.05). Symptom scores and bronchodilator use were higher and peak expiratory flow rates lower during the privet-flowering season, but the changes were small and not statistically significant. 2. Seventeen subjects from the longitudinal study subsequently had bronchial challenge studies performed. There were no isolated early responses, but six had late asthmatic responses. Eleven had no airway constrictor response to challenge with either of the two local varieties of privet. CONCLUSION: Although significant increases in airway responsiveness occur during the privet flowering season, only a proportion of this highly select group had a constrictor response to direct challenge. Privet exposure may cause bronchoconstriction in certain individuals, but it is unlikely to be responsible for a large proportion of asthma morbidity in New Zealand.

Adolescent↗
PubMed1995

Major reduction in asthma morbidity and continued reduction in asthma mortality in New Zealand: what lessons have been learned?

Increasing financial barriers to primary health care against a background of social and economic decline are likely to have contributed to asthma morbidity and mortality in New Zealand. Although there would not have been a sufficient increase in asthma prevalence to have accounted for the threefold increase in mortality rates, whether or not there was an increase in asthma severity in the late 1970s remains open to debate. Misuse or poor use of newly available and potent bronchodilator medications by those with the most severe asthma may simply have contributed to further delays in obtaining appropriate care and therefore to an increase in frequency of severe attacks in the community. Despite substantial increases in the use of bronchodilator therapy in New Zealand, there was no immediate improvement in indices of either asthma morbidity or mortality. The initial reduction in mortality rates in the 1980s happened at a time when first admissions for asthma were still increasing and seems to be best explained by an improvement in utilisation of hospital services (which were free until 1992) rather than a reduction in asthma severity. However, the recent reductions in all measures of asthma morbidity and further reduction in asthma mortality since 1989 does now suggest a reduction in asthma severity and would be best explained by the substantial increase in medium and high dose inhaled corticosteroid use, and to the endorsement of the current management strategies for asthma which are being promoted internationally and which were given considerable publicity in New Zealand in 1989 and 1990. Whilst sales of inhaled beta agonists were higher in 1991 than 1989, this may not reflect their pattern of use by individual patients since the need for an increase in inhaled beta agonist treatment has been accepted as indicating a lack of control and the need for either starting or increasing the dose of inhaled steroid treatment.

Adolescent↗
PubMed1994

Drug resistant tuberculosis in Auckland 1988-92.

AIM: To report the prevalence of drug-resistant Mycobacterium tuberculosis in Auckland. METHOD: Review of all M tuberculosis culture positive cases from January 1988 to December 1992. Ethnicity was recorded from the national Paxus medical information data base and drug sensitivity results from the Green Lane Hospital tuberculosis reference laboratory. The clinical details of all patients with drug resistant tuberculosis were extracted from hospital case records. RESULTS: Of the 417 patients with positive cultures, 43 (10%) had isolates resistant to one or more antituberculous drugs. Only 4 patients had multidrug-resistant organisms (defined as resistance to at least isoniazid and rifampicin) and there is no evidence that this is an increasing problem. Resistance rates were highest in those previously treated for M tuberculosis, and those born in, or likely to have acquired their organism from, Samoa, all other Pacific Islands, or South East Asia. CONCLUSIONS: Drug resistant M tuberculosis is a problem in Auckland but rates and patterns are little different from 1980-1982. Multidrug-resistance is not yet a problem in Auckland, as it is in the United States of America. Ways of maintaining this situation are discussed.

Antitubercular Agents↗
PubMed1994

Peak expiratory flow meters (PEFMs)--who uses them and how and does education affect the pattern of utilisation?

BACKGROUND: Asthma control may be assisted by educating patients to use peak expiratory flow meters (PEFMs). AIMS: To find out the sociodemographic and clinical characteristics of asthmatics attending an Emergency Room (ER) who owned PEFMs. METHODS: We undertook a study of 352 asthmatics aged seven to 55 years who attended an ER. The following were analysed: their pattern of peak flow monitoring (PFM), the factors associated with 'appropriate' or daily PFM on entry to the study and then prospectively; whether asthma education influenced utilisation and whether there was a reduction in ER use or admissions in those who acquired a PEFM. RESULTS: Those owning a PEFM at entry to the study (54%) had more asthma morbidity (p = 0.0001), had had asthma for longer (p = 0.0001), had seen their medical practitioners more often in the previous nine months (p = 0.0001), were on more asthma medications (p = 0.0001) and were more likely to have been to an Asthma Clinic (p = 0.0001). Those not owning a PEFM were more likely to be of lower social class (p = 0.016) and of Pacific Island origin (p = 0.0001) suggesting that distribution is not ideal and is influenced by disease severity, amount of health care use and sociodemographics. Patients with a self-management plan (35% of PEFM owners) and those receiving 'good care' or management, were more likely to use PFM 'appropriately' and to mention PFM in a scenario evaluating their response to worsening asthma control and argues for PEFMs to be distributed only in conjunction with a self-management plan, and therefore in close association with the patients' medical practitioners. Most patients (75%) appeared to prefer making management decisions based on symptoms rather than on their peak expiratory flow (PEF) and few (16%) performed daily PFM at entry to the study and fewer (6%) nine months later. There was an improvement in the pattern of PFM after education, but the acquisition of a PEFM made no difference to the frequency of ER use or admission. CONCLUSION: More realistic goals need to be defined in relationship to PFM which may improve patients' acceptance of the strategy, and therefore, hopefully their compliance. Such strategies need to be consistently reinforced over time for them to have an impact on asthma morbidity.

Adolescent↗
PubMed1994

Prospective controlled evaluation of the effect of a community based asthma education centre in a multiracial working class neighbourhood.

BACKGROUND: Previous work has indicated a high rate of non-attendance at hospital based clinics among young, multiracial asthmatic patients of lower socioeconomic class. The efficacy of delivering asthma education from a community health centre established in a multiracial working class neighbourhood was evaluated. METHODS: A prospective controlled study was performed in which asthmatic subjects aged between two and 55 years attending a hospital emergency room with acute asthma and living within a defined geographical area of high emergency room users were randomised to the usual follow up or the education centre plus usual follow up. Measurements were taken at entry into the study and again nine months later. RESULTS: At nine months patients randomised to the education centre had more preventive medications, more peak expiratory flow meters and better flow meter technique, more self-management plans, better knowledge of appropriate action to take when confronted with worsening asthma, less nocturnal awakening, and better self-reported asthma control than the control group. There was no difference between the study groups in measurements of compliance, hospital admission, days lost from school or work, or emergency room use. CONCLUSIONS: The main effects of education were on asthma knowledge and self-management skills, whilst improvements in asthma morbidity were small. Potential reasons for this include heterogeneous study population (in terms of baseline self-management skills, asthma severity, ethnicity and age), pragmatic study design, insensitivity of many of the measurements of morbidity, the modest effectiveness of a single time limited education programme, and inability to limit the effects of such a large community based study to the intervention group (there was a 67% reduction in asthma admissions during the study period from the geographical area targeted compared with a 22% reduction for the rest of Auckland).

Adolescent↗
PubMed1992

Comparison of nedocromil sodium at two dosage frequencies with placebo in the management of chronic asthma.

Nedocromil sodium (4 mg b.d. or q.i.d.) was added to the therapy of 76 chronic asthmatic patients in a four-centre, double-blind cross-over, placebo-controlled trial. Patients had troublesome symptoms uncontrolled by high doses of inhaled corticosteroids (mean 1450 micrograms). In 54 patients who completed the study, nedocromil sodium was significantly more efficacious than placebo (P < 0.01) in relieving morning chest-tightness and cough, in reducing total diary card score and nocturnal bronchodilator usage, and in increasing morning and evening peak flow. Asthma severity at clinic visits decreased significantly (P = 0.001) following treatment with nedocromil sodium, which was globally rated more effective than placebo (P < 0.01). Treatment differences favored q.i.d. over b.d. dosage but without statistical significance. There were no serious adverse effects. Although the pulmonary function changes were small, these findings suggest that the addition of nedocromil sodium may benefit asthmatic patients who are inadequately controlled by high doses of inhaled corticosteroids.

Adolescent↗
PubMed1984

Trends in sales of drugs for asthma in New Zealand, Australia, and the United Kingdom, 1975-81.

As part of an investigation into the recent epidemic of deaths from asthma in New Zealand, trends in the sales of drugs for asthma in New Zealand, Australia, and the United Kingdom during 1975-81 were examined. Data on sales of drugs were obtained from an international pharmaceutical market research organisation. A striking increase in sales of sympathomimetic aerosols, steroid aerosols, and theophylline per caput occurred in all three countries, with the greatest increase occurring in New Zealand. Sales of sodium cromoglycate also increased in New Zealand and the UK but fell in Australia. By 1981 New Zealand had the highest sales of all these drugs per caput. Explanations for the rising mortality from asthma in New Zealand despite large increases in drug sales need to be explored. Although the temporal association between mortality and sales of drugs suggests that direct drug toxicity is unlikely, there may be more subtle adverse effects of drug use.

Adolescent↗
PubMed1982

Asthma deaths.

Explore the source record for details and available documents.

Asthma↗
PubMedDate not supplied

Lung function changes as a reflection of tissue aging in young adults.

We studied 198 healthy young men and women 17 to 40 years of age, 110 blacks and 88 whites, all current non-smokers, with a view to identifying the changes, if any, consistent with lung tissue aging. Measurements were made of the maximal expiratory flow-volume (MEFV) curves (from which were derived forced vital capacity (FVC) and flow rates (Vmax) at 75%, 50% and 25% of expired VC), and transfer factor for carbon monoxide (TL). To describe aging trends, results were corrected for height differences and analysed by sex and race for five age groups. Certain changes (e.g. the age-related increase in FVC in men in the early 20's and decrease in the late 20's in both men and women) may be accounted for by changes in respiratory muscle force and/or increasing weight; in addition, the changes in FVC itself (used as the reference lung volume for reading flow rates off the MEFV curves) may have accounted in part for the age-related changes in Vmax at 75% and 50% VC. Likewise, increasing weight by influencing lung emptying may have contributed to the decrease in the diffusion constant in women. Only the age-related decline in Vmax at 25% VC (seen in women of both races and starting in the early 20's) could not be explained by the above factors, and may therefore reflect tissue aging.

Adolescent↗