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Biomedical subjects

J I Mann

Publications and source records attributed to J I Mann.

At least 19 recordsLinked to original sources
PubMed1992

Diabetes--inpatient utilisation, costs and data validity. Dunedin 1985-9.

AIM: to describe the impact of diabetes on the public hospital inpatient services in one New Zealand region over the period 1985-9, from one 450 bedded university teaching hospital in a major urban centre in New Zealand serving a population of approximately 125,000 people. METHODS: by the analysis of routinely collected hospital discharge data and the application thereto of the resource utilisation system (RUS). Data validation was performed by means of a survey of clinical notes. RESULTS: admission, bed utilisation rates and associated costs for diabetes rose over the period by factors of 3.2, 3.8 and 2.8 respectively; due primarily to the management of macrovascular disease in the elderly. The rise was most marked in those 75 years and over; admission rates, bed utilisation rates and costs in this age group being respectively 1.9, 4.3 and 2.9 times greater than the 60 to 74 year age group. For admissions with diabetes as principal diagnosis, admissions for glycaemic control showed a significant decrease in lengths of stay over the period. Admissions with diabetic peripheral vascular disease were cumulatively, and per case, the most costly, the mean cost, at $16,000 per case, being 5.1 times greater than the mean cost of all admissions with diabetes as principal diagnosis. In 1989 diabetes accounted for 5% of the cost of all inpatient care provided by the hospital. These results are an underestimate, as 45% of admissions of people where diabetes should have been cited as a subsidiary diagnosis were omitted from the discharge data. CONCLUSION: diabetes is a major consumer of hospital resources in this region. As the majority of diabetes associated resource use is in the elderly, a population projected to increase significantly, consideration needs to be given to the options for the provision of care. More work also needs to be done on the reasons underlying these changes. If routinely collected data is to be used for these purposes then audit of the data must be performed or use should be restricted to certain defined groups, eg, diabetes as principal diagnosis only.

Adult↗
PubMed1992

Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS)

To assess the effect of dietary reduction of plasma cholesterol concentrations on coronary atherosclerosis, we set up a randomised, controlled, end-point-blinded trial based on quantitative image analysis of coronary angiograms in patients with angina or past myocardial infarction. Another intervention group received diet and cholestyramine, to determine the effect of a greater reduction in circulating cholesterol concentrations. 90 men with coronary heart disease (CHD), who had a mean (SD) plasma cholesterol of 7.23 (0.77) mmol/l were randomised to receive usual care (U, controls), dietary intervention (D), or diet plus cholestyramine (DC), with angiography at baseline and at 39 (SD 3.5) months. Mean plasma cholesterol during the trial period was 6.93 (U), 6.17 (D), and 5.56 (DC) mmol/l. The proportion of patients who showed overall progression of coronary narrowing was significantly reduced by both interventions (U 46%, D 15%, DC 12%), whereas the proportion who showed an increase in luminal diameter rose significantly (U 4%, D 38%, DC 33%). The mean absolute width of the coronary segments (MAWS) studied decreased by 0.201 mm in controls, increased by 0.003 mm in group D, and increased by 0.103 mm in group DC (p less than 0.05), with improvement also seen in the minimum width of segments, percentage diameter stenosis, and edge-irregularity index in intervention groups. The change in MAWS was independently and significantly correlated with LDL cholesterol concentration and LDL/HDL cholesterol ratio during the trial period. Both interventions significantly reduced the frequency of total cardiovascular events. Dietary change alone retarded overall progression and increased overall regression of coronary artery disease, and diet plus cholestyramine was additionally associated with a net increase in coronary lumen diameter. These findings support the use of a lipid-lowering diet, and if necessary of appropriate drug treatment, in men with CHD who have even mildly raised serum cholesterol concentrations.

Angina Pectoris↗
PubMed1992

Distinguishing between persistent and transient impaired glucose tolerance using a prediction model.

Screening for impaired glucose tolerance (IGT) and Type 2 (non-insulin dependent) diabetes was carried out in 777 people and those with high blood glucose levels completed three 2-h oral glucose tolerance tests (OGTT). Blood lipid levels, fasting and 2-h insulin levels, body mass index, and blood pressure were also measured and family history of Type 2 diabetes recorded. Fifty people were identified with IGT and of these 21 were found to have persistent IGT and 29 transient IGT. A model including the variables body mass index, fasting and 2-h insulin levels, fasting triglycerides and family history of Type 2 diabetes was developed using the Speigelhalter-Knill-Jones weighting method to predict subjects with persistent IGT. This model could be useful in identifying people with persistent IGT and therefore eliminate the need for repeat OGTTs which are time consuming and expensive.

Blood Glucose↗
PubMed1991

Blood lipid levels in New Zealand.

OBJECTIVES: the study aimed to determine age and gender specific levels of lipids and lipoproteins in New Zealanders. Participants were randomly selected from 20 general electoral roles, and from a sample of 15-18 year olds. METHODS: plasma cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured in 2941 men and women aged 15-99 years. RESULTS: mean (SD) plasma cholesterol was 6.0 (1.3) mmol/L in men and 6.1 (1.3) mmol/L in women. There was a marked variation in total cholesterol and calculated LDL cholesterol with age, and the pattern was different in men and women. There was also a considerable regional variation; levels tending to increase from north to south. Overall mean cholesterol levels adjusted for age and geographical distribution were 5.8 and 6.0 mmol/L for men and women respectively. CONCLUSION: the fact that approximately a third of the adult population in New Zealand under 65 years have cholesterol levels greater than 6.5 mmol/L indicates the need for effective diet and lifestyle changes to reduce the high rates of CHD.

Adolescent↗
PubMed1991

Risk factors for coronary heart disease in New Zealand and Sweden: Dunedin and Uppsala compared.

OBJECTS: to compare men and women over the age of 35 years in Dunedin (New Zealand) and Uppsala (Sweden) in respect of anthropometric values, dietary habits and certain coronary heart disease risk factors in view of known differences in coronary mortality between the two countries. METHODS: one hundred and ninety-five Dunedin and 94 Uppsala residents were chosen randomly from the respective populations, in the former city by electoral roll, in the latter by use of unique personal number. Measurements of height, weight, waist/hip ratio, blood pressure, blood lipids were made and dietary and smoking habits assessed. RESULTS: the Swedes were taller and leaner than the New Zealanders. Blood pressure and smoking habits were not significantly different but total blood cholesterol levels were lower in Uppsala men and women. Blood triglycerides were higher in Dunedin women but high density lipoprotein cholesterol levels tended to be lower in men and women in Uppsala. CONCLUSIONS: it was found by analysis of variance that the blood lipid level differences between the two populations could be explained by body mass index. Correction of lipid values for the waist/hip ratio partly explained the higher cholesterol values in Dunedin but diet differences may also have been contributory. The differences in coronary mortality between the population of New Zealand and Sweden are compatible with the view that our blood cholesterol findings reflect the different levels of risk.

Adult↗
PubMed1991

Eating disorders in young adults with insulin dependent diabetes mellitus: a controlled study.

OBJECTIVE: To determine the prevalence of clinical eating disorders and lesser degrees of disturbed eating in young adults with insulin dependent diabetes and a matched sample of non-diabetic female controls. DESIGN: Cross sectional survey of eating habits and attitudes in diabetic and non-diabetic subjects. SETTING: Outpatient clinic catering for young adults with diabetes; community sample of non-diabetic women drawn from the lists of two general practices. SUBJECTS: 100 patients with insulin dependent diabetes (54 women and 46 men) aged 17-25 and 67 non-diabetic women of the same age. MAIN OUTCOME MEASURES: Eating habits and eating disorder psychopathology were assessed by standardised research interview adapted for the assessment of patients with diabetes (eating disorder examination). Glycaemic control was assessed by glycated haemoglobin assay. RESULTS: In both non-diabetic and diabetic women disturbed eating was common, and in diabetic women the degree of disturbance was related to control of glycaemia. Twenty of the diabetic women (37%) had omitted or underused insulin to influence their weight. This behaviour was not restricted to those with a clinical eating disorder. None of the men showed any features of eating disorders, and none had misused insulin to influence their weight. CONCLUSIONS: There was no evidence that clinical eating disorders are more prevalent in young women with diabetes than in non-diabetic women. Nevertheless, disturbed eating is common and is associated with poor control of glycaemia, and the misuse of insulin to influence body weight is also common in young women with diabetes.

Adolescent↗
PubMed1991

Performance/outcome measures for area health board diabetes services.

OBJECT: to examine the validity of performance indicators nominated by the Department of Health for area health board diabetes services for 1990-91. METHODS: by examination of admission/discharge data for the Otago region for the years 1985-9, together with a survey of randomly chosen clinical notes to quantify errors in the admission/discharge database. RESULTS: of the proposed indicators, there is marked variation in statistical significance, primarily as a consequence of the often small number of numerator events and denominator populations involved. Further the rates and statistical significance vary markedly depending on the interpretation of the numerator events to be included. Diabetes as the principal diagnosis was correctly recorded in 100% of notes examined. Of these the clinical diagnosis was incorrectly described in the discharge summary in 2% of cases. In 46% of cases where diabetes should have been recorded as a subsidiary diagnosis, it was not. CONCLUSIONS: the potential exists for significant misinterpretation of these indicators with the proposed data sources. Using routinely collected data there are potentially more robust indicators applicable for use at an area health board level. Much work needs to be done if these indicators are to truly reflect all facets of the performance of a diabetes service.

Diabetes Mellitus↗
PubMed1991

Effects of increasing quantities of oat bran in hypercholesterolemic people.

The effects of increasing quantities of oat bran on plasma lipids were examined in 40 hypercholesterolemic men and women. Using a four-by-four Latin-square design, subjects added 30, 60, and 90 g oat bran/d or no oat bran to their usual diet for 1-mo experimental periods. Self-selected background diets remained unchanged and weight did not change significantly. No differences in plasma total or low-density-lipoprotein cholesterol were found. Supplementation of the usual diet with less than or equal to 90 g oat bran does not appear to significantly lower cholesterol in hypercholesterolemic subjects continuing to follow a diet relatively high in saturated fatty acids.

Adult↗
PubMed1991

A population-based study of the incidence of complications associated with type 2 diabetes in the elderly.

One hundred and eighty-eight known Type 2 diabetic patients aged over 60 years identified by a geographically based survey of a population of 40,076 were followed for a median of 6 years to determine the incidence of various complications. There were 63 deaths and two patients were lost to follow-up. The presence of complications was determined using a structured questionnaire and clinical examination. Incidence rates of ischaemic heart disease, stroke, and peripheral vascular disease (PVD) were 56 (95% CI 41-75), 22 (13-35), and 146 (117-174) 1000-person-years-1 of follow-up, respectively. Rates of stroke and PVD rose significantly with age. Retinopathy occurred at a rate of 60 (42-83) 1000-person-years-1 and cataract at 29 (17-46) 1000-person-years-1 although visual acuity in survivors did not deteriorate overall, probably reflecting the high mortality associated with cataract. The rate of proteinuria (albumin concentration greater than 300 mg l-1) was 19 (9-34) 1000-person-years-1. Incidence rates were unrelated to sex or duration of diabetes. Diabetes is associated with a continuing incidence of complications into old age. Adequate facilities are required to assess and treat the resulting morbidity in a population with an increasing proportion of elderly people.

Age Factors↗
PubMed1990

Lipid screening: is it enough to measure total cholesterol concentration?

OBJECTIVES: To determine whether measurement of total cholesterol concentration is sufficient to identify most patients at lipoprotein mediated risk of coronary heart disease without measurement of triglyceride and high density lipoprotein (HDL) cholesterol concentrations. DESIGN: Cross sectional screening programme. SETTING: Six general practices in Oxfordshire. PATIENTS: 1901 Men and 2068 women aged 25-59. MAIN OUTCOME MEASURE: Cardiovascular risk as assessed by fasting venous plasma concentrations of total cholesterol, triglyceride, and HDL cholesterol. RESULTS: 2931 Patients (74% of those screened) had a total cholesterol concentration of less than 6.5 mmol/l. If the triglyceride concentration had not been measured in these patients isolated hypertriglyceridaemia (greater than or equal to 2.3 mmol/l) would have remained undetected in 185. Among these 185 patients, however, 123 were overweight or obese and only 18 (0.6% of those screened) had an increased risk associated with both a raised triglyceride concentration (greater than or equal to 2.3 mmol/l) and a low HDL cholesterol concentration (less than 0.9 mmol/l). Conversely, in the 790 patients with predominant hypercholesterolaemia (cholesterol concentration greater than or equal to 6.5 mmol/l and triglyceride concentration less than 2.3 mmol/l) measurement of HDL cholesterol concentration showed that 348 (9% of those screened) had only a moderately increased risk with a ratio of total to HDL cholesterol of less than 4.5 and 104 had a low risk with a ratio of less than 3.5. CONCLUSIONS: Fasting triglyceride and HDL cholesterol concentrations identify few patients at increased risk of coronary heart disease if the total cholesterol concentration is less than 6.5 mmol/l. HDL cholesterol and triglyceride concentrations should, however, be measured in patients with a total cholesterol concentration exceeding this value. Total cholesterol concentration alone may overestimate risk in a considerable number of these patients, and measurement of HDL cholesterol concentration allows a more precise estimate of risk. Measurement of the triglyceride concentration is required to characterise the lipoprotein abnormality. A patient should not be started on a drug that lowers lipid concentrations without having had a full lipoprotein assessment including measurement of HDL cholesterol concentration.

Adult↗
PubMed1990

The prevalence of hyperlipidemia in renal transplant recipients. Associations with immunosuppressive and antihypertensive therapy.

To determine the extent of persisting hyperlipidemia in renal transplant recipients receiving modern maintenance immunosuppressive and antihypertensive therapy we compared plasma levels of total and high-density lipoprotein and triglyceride in 275 renal transplant recipients with stable graft function with age- and sex-matched groups from the local general population (n = 4055). Total cholesterol and triglyceride were higher in transplanted patients in all age groups, but the difference was much more striking in women. Plasma levels of HDL cholesterol were similar or slightly lower in transplanted patients. Association with parameters of graft function, immunosuppressive therapy, and antihypertensive therapy were studied within the transplanted population using multiple regression. Total cholesterol was significantly and independently associated with age, sex, diuretic therapy, and urinary protein. In 127/134 (95%) of patients the diuretic was a loop diuretic. None of the other classes of antihypertensive drug was independently associated with serum cholesterol. The only variables significantly associated with HDL cholesterol were sex and the plasma creatinine. Plasma triglyceride was significantly and independently associated with both diuretic therapy and beta-blocker therapy and with age, urinary protein excretion, and plasma albumin. Plasma cholesterol, HDL cholesterol, and triglyceride levels were almost identical in patients receiving triple therapy (cyclosporine 3-5 mg/kg; prednisolone 7-10 mg o.d.; azathioprine 1-1.5 mg/kg) to those in patients receiving conventional immunosuppression (prednisolone 7-10 mg o.d.; azathioprine 2-2.5 mg/kg). Thus these results do not support the existence of a persisting long-term effect of cyclosporine on plasma cholesterol and triglyceride at these doses of the drug. The more striking abnormality of plasma cholesterol and triglyceride in females is unexplained but might be connected with greater sensitivity to low doses of corticosteroids.

Adult↗
PubMed1990

Lens opacity and mortality in diabetes.

A population-based cohort of 294 diabetic patients were examined for the presence of lens opacities and followed up for a median of 6 years. Only two patients were lost to follow-up but there were 73 deaths, 49 in the 108 patients with opacities and 24 in the 184 patients without (odds ratio 2.4, 95% Cl 1.5-3.9). Lens opacities were a powerful predictor of death and the effect was independent of other prognostic factors. The presence of cataract identifies a high risk sub-group of elderly diabetic patients.

Age Factors↗
PubMed1990

Preliminary trial of the effect of general practice based nutritional advice.

Despite formal recommendations for dietary change to reduce the incidence of ischaemic heart disease, the acceptability and effectiveness of the proposed diets have not been well investigated in population based studies. In this preliminary investigation of nutritional advice in a well population, subjects in one group practice were randomized to receive either dietary instruction or simple follow up without instruction. The dietary recommendations were well received, and a substantial proportion of subjects reported altering their diets in accordance with them. There were modest beneficial changes in plasma lipid levels among men. Thus, using general practice as an avenue for promoting dietary change is feasible, and may be effective among men.

Adult↗
PubMed1990

Hyperlipidaemia in general practice: three year follow up of an opportunistic screening project.

As part of the national lipid screening project 927 people with a plasma cholesterol level greater than 6.5 mM were detected by screening 4006 men and women aged 25-59 years. Three years later 801 of the 878 patients eligible for a follow-up study (91%) had been followed up at least once. The median number of follow-up visits was two. The bulk of the workload fell on the nursing staff. The mean decrease in cholesterol level was 8-14% in those receiving dietary advice only, 15-25% in those receiving additional drug treatment and 12% for all patients. A proportion of this decrease must be attributable to regression to the mean, loss to follow up when patients were doing well, and the patients' knowledge of their follow-up date. Data on a group of patients not attending for regular follow up suggest that regression to the mean could account for up to 7% of the cholesterol reduction observed. Screening for hyperlipidaemia in general practice is feasible when the necessary infrastructure is provided, but even with a fairly conservative protocol 3% of those screened received drug treatment.

Adult↗
PubMed1988

Blood lipid concentrations and other cardiovascular risk factors: distribution, prevalence, and detection in Britain.

To establish the distribution of blood lipid concentrations and the prevalences of other risk factors for cardiovascular disease in Britain 12,092 men and women aged 25-59 in Glasgow, Leicester, London, and Oxford were studied. Subjects were selected by opportunistic case finding, in which patients consulting their general practitioner for any reason were offered a health check by appointment, or random selection from age-sex registers, in which an invitation for a health check was posted. The overall rate of response was 73%, being 91-94% by opportunistic case finding and 36-63% by random selection. At the health check subjects answered a brief questionnaire about risk factors for cardiovascular disease, and their height, weight, and blood pressure were recorded; a blood sample was taken for measuring plasma concentrations of cholesterol, triglyceride, high density lipoprotein cholesterol, and glucose. The mean cholesterol concentrations were 5.9 (SD 1.2) and 5.8 (1.2) mmol/l in men and women, respectively. In London the mean value was 5.5 (1.2) mmol/l for both men and women and was significantly lower than mean values in the three other centres, among which there were no significant differences. In men and women aged 25-29 concentrations were similar but they increased in men until the age of 45-49, after which they showed no further increase; in women concentrations did not increase until the age of 40-44 and by the age of 50-59 values were higher than in men. Mean triglyceride concentrations were significantly higher in men than in women (1.8 (1.4) v 1.3 (0.9) mmol/l, respectively), and trends with age were similar to those for cholesterol concentrations, except that at no age were values higher in women than in men. Mean triglyceride values overall were higher in Glasgow and London than in Oxford and Leicester. Body mass index was higher in Glasgow and London than in the other two centres and correlated with systolic and diastolic blood pressures and triglyceride concentration. In addition, subjects in Glasgow smoked significantly more than those in the other centres. These observations could contribute to the higher rate of coronary heart disease in Glasgow. Plasma lipid concentrations and the prevalences of other risk factors for cardiovascular disease were similar in subjects selected by opportunistic case finding and by random selection. In Britain cholesterol values have changed little during the past 12 years despite dietary recommendations and health education.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

Adverse effect of cyclosporin on plasma cholesterol in renal transplant recipients.

A prospective study of changes in plasma lipids after renal transplantation was performed in order to compare the effects of cyclosporin and conventional immunosuppression. Twenty-eight patients were studied, 18 of whom were allocated randomly to immunosuppression with either cyclosporin alone (nine subjects) or azathioprine and prednisolone (nine subjects). A further ten patients received cyclosporin and prednisolone. Total cholesterol, triglycerides and HDL, LDL and VLDL cholesterol subfractions were measured before transplantation, 21 and 90 days after transplantation, and also, in 12 patients (six on cyclosporin and prednisolone, and six on azathioprine and prednisolone), 2 years after transplantation. Triglycerides were initially elevated, and decreased after transplantation in all three groups. Total cholesterol was unchanged in the azathioprine and prednisolone group, whereas it increased significantly by 90 days in both the cyclosporin group and the cyclosporin and prednisolone group. This was due primarily to LDL cholesterol, which increased by 45% in the cyclosporin group and 28% in the cyclosporin and prednisolone group. Both total and LDL cholesterol remained elevated 2 years after transplantation in patients receiving cyclosporin and prednisolone, but were unchanged in the azathioprine and prednisolone group. There was no relationship between renal function and plasma lipid changes.

Adult↗