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J Simons

Publications and source records attributed to J Simons.

At least 73 records · Page 4Linked to original sources
PubMed1995

Measurement properties of the Center for Epidemiological Studies Depression Scale: an Australian community study of aged persons.

The measurement properties of the Center for Epidemiological Studies Depression Scale (CES-D) were examined in an Australian community study of aged persons in order to contribute to international validation of the measure. Confirmatory analysis of polychoric correlations was conducted using the generally weighted least squares method. The original four-factor solution proposed by Radloff was successfully replicated for Australians, showing similar underlying structures as for Americans, Canadians, and Japanese. Schmid-Leiman parameterization of the second order factor analysis showed that little information was lost in considering full-scale scores rather than the four subscales separately. The behavior of the CES-D in an Australian population aligns with existing North American research and thus confirms the exceptional functioning of the Well-Being scale in Japan. More work on the behavior of the CES-D in non-English speaking societies is needed to separate issues of wording and grammar from genuine cultural variations. The CES-D was confirmed as essentially unidimensional and robust to minor changes; therefore, it is recommended for use in cross-cultural studies of depression in elderly persons.

Aged↗
PubMed1995

The continuum of care for older people.

The introduction of casemix in hospitals has increased concerns about cost-shifting to community services. There has been little evidence with which to test claims about shifting balances in the continuum of care, in particular for major user groups like older people. These matters have come into greater prominence with the Council of Australian Governments Communique which agreed in April to radical reforms of health and community services. We used an existing longitudinal study of people aged 60 years and over in the community of Dubbo, New South Wales, to study hospital and aged care service use over 50 months. Fifty-five per cent of those studied were hospitalised but only 1.7 per cent were admitted to nursing homes over the period. In the 12 weeks after hospital discharge, 24 per cent received Home and Community Care services, while 78 per cent visited a general practitioner. All post-acute community services over 12 weeks after discharge cost an average of $150. In the light of this new evidence, current proposals for structural reform are critically discussed.

Aftercare↗
PubMed1994

Coronary risk factors 6-12 months after coronary artery bypass grafting. Comparison of surveys in 1986, 1990 and 1994.

OBJECTIVE: To assess coronary risk factors and management 6-12 months after coronary artery bypass grafting. DESIGN: Patient survey by questionnaire after discharge from hospital in 1994 and comparison with similar surveys from 1990 and 1986. SETTING AND PATIENTS: One hundred and ninety-four patients undergoing coronary artery bypass grafting at one hospital campus between 1 March 1993 and 31 August 1993. Replies to questionnaires were received from 175 patients (90%); we had clinical and biochemical data for 166-175 patients (86%-90%). RESULTS: The proportion with hypercholesterolaemia (serum cholesterol levels > or = 6.5 mmol/L) declined from 60% in 1986 to 9% in 1994. Those with diastolic hypertension (> or = 95 mmHg) declined from 23% to 3%. The proportion of current smokers remained low at 6%. The proportion overweight had increased from 32% in 1986 to 47% in 1994. The proportion taking lipid-regulating drugs increased from 2% in 1986 to 37% in 1994. CONCLUSION: Coronary risk factors after coronary artery bypass grafting appear to be better managed in 1994 than in earlier years, but there may still be a need for improvement in lipid disorders and weight.

Adult↗
PubMed1994

Low serum cholesterol is not associated with depression in the elderly: data from an Australian community study.

BACKGROUND: Low serum cholesterol may contribute to depressive symptoms in the elderly. AIMS: To test the relationship between depressive symptoms and low serum cholesterol in an elderly cohort. METHODS: This was an examination of cross-sectional data in a community study of 1237 men and 1568 women aged 60+ years in Dubbo, NSW. Quintiles of serum cholesterol were defined for men and women. The Center for Epidemiological Studies Depression Scale was used as a continuous, dependent variable in multiple regression analyses. RESULTS: Low serum cholesterol was not associated with depressive symptoms in older men or women. Health status, measured by poorer self-ratings, recent hospitalisation, higher disability levels and higher consumption of prescribed and self-prescribed drugs, predicted depressive symptoms. As well, the significance in the statistical model of financial difficulties, low self esteem, low feelings of self efficacy, the adequacy of practical help and emotional support, and recent widowhood, confirmed the importance of social origins of depressive symptoms.

Age Factors↗
PubMed1994

Size, fatness and relative fat distribution of males of contrasting maturity status during adolescence and as adults.

The somatic characteristics of boys of contrasting biological maturity status during adolescence are compared from 13-18 years and at 30 years of age. Within the mixed longitudinal Leuven Growth Study of Belgian Boys, 173 boys were followed annually from 13-18 years and were subsequently measured at 30 years of age. Age at peak height velocity (PHV) was estimated for 149 boys and the sample was then divided into three contrasting maturity categories based on the age at PHV: early (PHV < 13.37 years), average (PHV between 13.85 and 14.80 years) and late (PHV > 15.27 years) maturers. Using ANOVA for repeated measures and one-way ANOVA, differences in 18 somatic dimensions and five ratios of body proportions and subcutaneous fat distribution among the three maturity groups were tested from 13-18 years and at 30 years of age. There are consistent differences among boys of contrasting breadths, circumferences,and skinfolds on the trunk. There are no differences in skinfolds on the extremities. None of the differences in somatic dimensions and ratios among the three contrasting maturity groups are significant at 30 years of age except those for subscapular skinfold and the trunk/extremity skinfold ratio. Thus, during adolescence and in adulthood, late maturing boys have a distribution of subcutaneous fat that is associated with lower risk for several adult degenerative diseases.

Adipose Tissue↗
PubMed1993

Local recurrence versus new primary: clinical analysis of 82 breast relapses and potential applications for genetic fingerprinting.

PURPOSE: The purpose of this study was to perform a detailed clinical pathological analysis of breast relapses in patients treated with conservative surgery and radiation therapy in an effort to classify those relapses as true local recurrences or second primary tumors, and to assess the prognostic and therapeutic implications of such a classification system. METHODS AND MATERIALS: Of 990 patients treated with conservative surgery and radiation therapy at our facilities prior to December 1987, 82 patients have experienced a relapse in the conservatively treated breast as the primary site of failure. Patients were classified as having new primary tumors if they fulfilled any one of the following criteria: a) breast relapse occurring at a site distinctly removed from the original tumor; b) histology of the breast relapse compared with the original tumor consistent with a new primary; or c) DNA flow cytometry converting from an aneuploid primary to a diploid relapse. RESULTS: As of 2/92, with a median follow-up of 5.4 years from the time of breast relapse, the overall 5-year survival rate following breast relapse was 55%. Forty-seven patients were classified as true recurrences and 33 patients were classified as new primaries. Patients classified as true recurrences had a shorter median time to breast relapse than patients classified as new primaries (3.16 years vs. 5.42 years, p < .05) and an inferior post breast recurrence survival rate compared to patients classified as new primaries (36% vs. 89%, p < .05). Residual disease outside of the recurrent tumor bed was also noted to be more frequent in patients classified as true recurrences compared to patients classified as new primaries (48% vs. 16%, p < .05). CONCLUSION: Based on the clinical and pathological criteria outlined, it appears that a significant portion of patients experiencing a relapse in the conservatively treated breast may have new primary tumors as opposed to true local relapses. Distinction between a true recurrence and a new primary tumor may have significant prognostic implications. Uncertainties associated with the clinical and pathological criteria are presented and further investigations with genetic fingerprinting techniques to establish the clonality of breast relapses are presented and discussed.

Adult↗
PubMed1993

Lipoprotein(a) is not associated with coronary heart disease in the elderly: cross-sectional data from the Dubbo study.

Lipoprotein(a) (Lp(a)) may be an independent risk factor for cardiovascular disease. We have examined Lp(a) concentration in 1202 males and 1512 females, aged 60 years and older, who were participants in an ongoing prospective study of cardiovascular disease in the elderly. This report relates to cross-sectional data at study entry. Median Lp(a) concentration was significantly higher in females than in males (P < 0.001), but did not vary with age. Lp(a) concentration rank was significantly correlated with total (r = 0.16, P < 0.001) and LDL cholesterol (r = 0.19, P < 0.001), but this relationship disappeared after adjustment of LDL cholesterol for Lp(a) cholesterol content. Twenty-four percent of males and 17% of females had prevalent coronary heart disease (CHD) at study entry based on non-invasive criteria. Median Lp(a) concentration was slightly higher in those subjects with CHD, compared with those without CHD, but the difference was not statistically significant (P > 0.20). In a multiple logistic model, the following variables were independent predictors of CHD in this elderly population: age, hypertension (males only), family history of CHD, HDL cholesterol and triglycerides (females only), but not total cholesterol or Lp(a). These relationships were similar whether or not the model included Lp(a) concentration. The findings do require confirmation in the prospective study now in progress.

Age Factors↗
PubMed1993

Non-steroidal anti-inflammatory drugs and hypertension in the elderly: a community-based cross-sectional study.

1. Whether non-steroidal anti-inflammatory drug (NSAID) usage in the elderly elevates blood pressure or antagonises the blood pressure-lowering effect of antihypertensive medication is presently unknown. The primary aims of this study were to estimate the prevalence of NSAID usage, to evaluate the prescription of NSAIDs for arthritis and to determine whether NSAID usage was an independent predictor of hypertension in a large elderly community. 2. All non-institutionalised elderly (> 60 years) residents of Dubbo, NSW who attended for a baseline assessment were enrolled (1237 males, 1568 females). A questionnaire was administered and blood pressure was measured according to the Prineas protocol. The frequency of NSAID usage was determined, with stratification by age, sex, blood pressure group and history of arthritis. 3. NSAID usage was 26% overall (females 28%, males 23%), increased with age and was higher in females than males for every age group studied. Amongst patients with a past history of 'arthritis', 45% were using NSAIDs. Twelve percent were taking NSAIDs and antihypertensive medication concurrently, constituting the population at risk of an adverse drug-drug interaction. Employing a multiple logistic regression model which adjusted for several confounders in the cross-sectional analysis, NSAID usage significantly predicted the presence of hypertension (odds ratio: 1.4, 95% confidence interval: 1.1-1.7) with an attributable risk of 29%. 4. Amongst non-institutionalised elderly persons, NSAID usage may be an independent risk factor for hypertension. Considering the substantial consumption of NSAIDs by elderly patients, physicians should review their NSAID prescribing patterns for this community group.

Age Factors↗
PubMed1993

Characterization of poliovirus-specific T lymphocytes in the peripheral blood of Sabin-vaccinated humans.

Poliovirus-specific cellular immune responses were identified in the peripheral blood mononucleocytes of Sabin-immunized human donors by using a proliferation assay. Complement depletion and monoclonal antibody inhibition studies suggest that the effector population is the major histocompatibility complex (MHC) class II-restricted CD4+ T-helper cell. Immune lymphocytes proliferated to polyacrylamide gel purified-capsid proteins VP1, VP2, and VP3 and, in some individuals, to synthetic VP4, indicating the presence of T-cell epitopes in each of these proteins. Using synthetic peptides, T-cell epitopes have been mapped to specific regions in VP1 which lie near previously identified neutralizing antibody recognition sites. Human leukocyte antigen (HLA) typing of the donor individuals indicated that no MHC class II molecule was held in common between all four donor individuals. Thus, the positive responses observed with peptides p182-201 and p244-261 in three of four and four of four donors suggest that these peptides contain epitopes presented by at least two different MHC molecules. Antibody-blocking experiments suggest that an epitope within VP1 residues 244 to 264 is presented by HLA DQ3.

Adult↗
PubMed1993

Efficient analysis of nonviable poliovirus capsid mutants.

Nonviable poliovirus capsid mutants were studied by an efficient infection-transfection system. Phenotypically, nonviable poliovirus capsid mutants appear to segregate into three classes: those that form only protomers, those that can form pentamers, and one that can form completed virions.

Capsid↗
PubMed1992

Treatment of primary hypercholesterolaemia with pravastatin: efficacy and safety over three years.

OBJECTIVE: To assess the efficacy, safety and tolerability of pravastatin over three years of treatment. DESIGN: An open, multicentre randomised study. SETTING: Subjects receiving tertiary care at three hospital lipid clinics. PATIENTS: Subjects with primary hypercholesterolaemia (type IIa) or combined hyperlipidaemia (type IIb), already stabilised on a cholesterol-lowering diet, with low density lipoprotein (LDL) cholesterol levels of greater than 4.7 mmol/L and triglyceride levels of less than 4.5 mmol/L. Sixty-one subjects were randomly assigned to the treatment groups: 60 completed 12 weeks and 46 completed 30-36 months of treatment. INTERVENTIONS: Subjects were randomly assigned to receive either pravastatin 20 mg/day, pravastatin 40 mg/day or cholestyramine 16 g/day for a period of 12 weeks. Subsequently, dose titration of pravastatin up to 40 mg/day was permitted, if required, and all groups received supplementary therapy with other lipid-lowering drugs. MAIN OUTCOME MEASURES: Lipids, lipoproteins, haematological and biochemical safety parameters were measured at regular intervals. Adverse events were monitored. RESULTS: There were significant reductions in total and LDL cholesterol levels with all treatments over 12 weeks (P < 0.001). The mean reductions (+/- SD) in LDL cholesterol were 26% +/- 14% in the group taking pravastatin 20 mg/day (n = 21), 30% +/- 8% in the group taking pravastatin 40 mg/day (n = 21) and 34% +/- 13% in the group taking resin (n = 18). The percentage changes in LDL cholesterol were independent of age, baseline cholesterol level or lipid phenotype. High density lipoprotein (HDL) cholesterol levels were significantly increased, by 8%-18% with all treatments (P < 0.001). Triglyceride levels were reduced by high-dose pravastatin only (7% +/- 29%), but were found to increase with resin (45% +/- 63%). During long-term treatment over 36 months, still greater reductions in total and LDL cholesterol were found in patients taking pravastatin (n = 35), but not in those taking resin (n = 11). There was an apparent decrease in effect beyond 18 months in both groups, possibly related to reduced compliance with diet or cholestyramine intake. Eight subjects allocated to pravastatin and seven allocated to resin withdrew (one and two subjects respectively because of drug-induced adverse events). Adverse events during 12 weeks' monotherapy with pravastatin included central nervous system (CNS) symptoms (12%), gastrointestinal (GIT) symptoms (7%) and an acute hepatitic reaction (one subject). Of those in the resin therapy group, 22% developed GIT symptoms. Myalgia occurred in three subjects using a combination of pravastatin and clofibrate, but this resolved fully upon clofibrate withdrawal. CONCLUSIONS: Pravastatin was found to be a relatively effective, safe and well tolerated lipid-lowering drug. Still greater LDL reduction was achieved with pravastatin combination therapy and this was essentially maintained over three years.

Adult↗
PubMed1992

Successful management of primary hypercholesterolaemia with simvastatin and low-dose colestipol.

OBJECTIVE: To examine whether a small dose of bile acid sequestrant used in combination with a hydroxymethylglutaryl coenzyme A reductase inhibitor is more effective in reducing serum and low-density lipoprotein (LDL) cholesterol levels than inhibitor used alone. DESIGN: A randomised, double-blind study. SETTING: Subjects receiving tertiary care at a hospital lipid clinic. PATIENTS: Subjects with severe primary hypercholesterolaemia (types IIa and IIb), already stabilised on a cholesterol-lowering diet, with serum cholesterol levels of 7.0 mmol/L or more and triglyceride levels of 6.0 mmol/L or less. Sixty-four subjects were randomly assigned to the treatment groups; three withdrew before any outcome observations; 61 completed the trial and their results were analysed. INTERVENTIONS: Subjects were randomly assigned to receive either colestipol placebo or colestipol 5 g or 10 g each morning in fixed dosage for 18 weeks. They simultaneously received incremental doses of simvastatin: placebo for six weeks, then 20 mg/night for six weeks, then 40 mg/night for a final six weeks. MAIN OUTCOME MEASURES: Lipids, lipoproteins, and haematological and biochemical safety parameters were measured at the end of each treatment period. Adverse events were monitored. RESULTS: Respective maximum reductions (95% confidence intervals) in serum cholesterol, LDL cholesterol and apolipoprotein B (apo-B) values in subjects taking combination therapy were 41% (38%-45%), 50% (46%-53%) and 43% (39%-46%), compared with lesser reductions of 32% (26%-37%), 38% (31%-45%) and 37% (32%-41%) in those taking simvastatin monotherapy. The percentage changes in LDL cholesterol with combination therapy were independent of baseline cholesterol level or lipid phenotype. Combination therapy reduced serum triglyceride levels by up to 24% (15%-32%) and increased high-density lipoprotein (HDL) cholesterol levels by up to 9% (3%-15%). Three subjects withdrew within a few weeks because of severe gastrointestinal side effects related to colestipol; 19 experienced milder gastrointestinal side effects, 15 were taking combination therapy. CONCLUSIONS: A combination of low-dose colestipol and simvastatin was found to be more effective in reducing serum and LDL cholesterol than simvastatin used alone. Such combination therapy offers the possibility of improved cholesterol lowering without the need for full dosage of either drug.

Anticholesteremic Agents↗
PubMed1992

Multiple medication use in the elderly. Use of prescription and non-prescription drugs in an Australian community setting.

OBJECTIVE: To document the extent of polypharmacy or multiple medication use in the elderly. DESIGN: Cross-sectional examination of an age cohort of a community. SETTING: Community-based study in Dubbo, NSW, in 1988-1989. SUBJECTS: All non-institutionalised residents aged 60 years and over, numbering 1237 men and 1568 women. MAIN OUTCOME MEASURES: Assessment of use of prescription and non-prescription drugs, recent hospitalisation, years of education, psychosocial variables. RESULTS: 18% of men and 25% of women were currently using three or more classes of prescription drugs. The corresponding values for two or more classes of non-prescription drugs were 29% and 44%. Of those who were using multiple prescription drugs 56% of men and 76% of women were also using multiple non-prescription drugs. In a multiple logistic model, the following possible predictors of multiple drug use were included: hospitalisation in the last six months, age, sex, depression, life satisfaction and education. Multiple prescription drug use was significantly predicted by recent hospitalisation (odds ratio [OR] = 2.40; 95% confidence interval [CI], 1.63-3.56), increasing age (e.g. 70-79 years versus 60-69 years; OR = 2.54; CI, 1.97-3.25), female sex (OR = 1.59; CI, 1.25-2.01) and increasing depression (e.g. highest tertile of depression scale versus lowest; OR = 2.52; CI, 1.84-3.42). Multiple non-prescription drug use was significantly predicted by female sex (OR = 2.38; CI, 1.95-2.92) and increasing depression (OR = 2.77; CI, 2.16-3.56). For prescription items, non-prescription items, and both categories in combination levels of use 20% above the population average have been documented. CONCLUSIONS: Polypharmacy in the elderly population appears to be predicted by recent hospitalisation, increasing age, female sex and increasing depression. There is potential for drug-drug interaction to occur, but the findings suggest target areas for preventive action.

Aged↗
PubMed1992

Health status and lifestyle in elderly Hawaii Japanese and Australian men. Exploring known differences in longevity.

OBJECTIVE: To contrast health status and lifestyle in two elderly populations with differing longevity. DESIGN: Comparison of two cross-sectional data sets. SETTING: Non-institutionalised subjects. SUBJECTS: Men aged 60-81 years resident in Dubbo, New South Wales (n = 1183, 1988-1989) and Japanese men of the same ages resident in Hawaii (n = 1376, 1980-1982). MAIN OUTCOME MEASURES: Cardiovascular and non-cardiovascular disease prevalence, risk factors, social and health status. RESULTS: A history of heart attack, angina and stroke was twice as prevalent in Dubbo men as in Hawaii Japanese. Other diseases were many times more prevalent in Dubbo--liver disease sixfold, prostate and renal disease twofold, and arthritis 1.5-fold. Hypercholesterolaemia and untreated hypertension were more prevalent in Dubbo (threefold and 1.5-fold respectively). Current smoking was similar in both groups, while diabetes was twice as prevalent in the Hawaii Japanese. More Dubbo men were widowed or lived alone, and fewer remained in paid employment. Dubbo men had more limited physical mobility. CONCLUSIONS: Elderly Dubbo men have an excess of cardiovascular disease and associated risk factors, as well as an excess of non-cardiovascular disease, compared with Hawaii Japanese. This may account, in part, for a higher total mortality rate in elderly Australians compared with Japanese. Some of this disease burden may be amenable to risk factor intervention.

Aged↗
PubMed1992

Age-specific correlation analysis of longitudinal physical fitness levels in men.

This study investigated the age-specific tracking of adult health- and performance-related fitness scores. In addition, the independent contribution of adolescent physical characteristics to the explanation of adult fitness scores was also studied. The sample consisted of 173 adults observed at age 30 years. These subjects had been followed at annual intervals from age 13 to age 18 years and were remeasured at age 30 years. At each age nine fitness tests were administered together with the recording of anthropometric dimensions, biological maturation, sports participation and family characteristics. Tracking was measured by the inter-age correlations at each age between 13 and 18 years and the performance scores at 30 years. The independent contribution of characteristics observed during adolescence to the explanation of adult fitness was investigated through stepwise multiple regression analysis and discriminant analysis with the adult fitness scores as the dependent variables and the fitness, maturation, anthropometric characteristics, sports participation and family background as the independent variables. Tracking between age 13 and age 30 years was moderately high (46% of variance explained) for flexibility, low to moderate (between 19% and 27% of variance explained) for the other fitness parameters and low for pulse recovery and static strength (7% to 11% of variance explained). Between age 18 and age 30 years the tracking was high for flexibility, moderately high for explosive and static strength, and moderate for the other fitness parameters except for pulse recovery. The amount of variance of adult fitness levels explained increased significantly when other characteristics observed during adolescence entered the regressions or discriminant functions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Dubbo Study of the elderly: hypertension and lipid levels.

Untreated hypertension in age groups below 60 years has been shown to be associated with significant elevations in serum cholesterol and triglyceride levels. Drug therapy of hypertension has also been shown to have adverse effects on lipoproteins. We have investigated lipid and lipoprotein levels in a community-based sample of men and women 60 years and older belonging to one of the following groupings: (a) normal blood pressure (n = 1075); (b) untreated hypertension (n = 329); (c) drug-treated hypertension (n = 880). Serum lipid, lipoprotein, apolipoprotein or plasma glucose levels did not vary significantly between untreated hypertensives and normotensives of either sex. In a multiple regression model controlling for possible influences of age, overweight, alcohol and tobacco usage, and presence of coronary heart disease, anti-hypertensive drug therapy significantly predicted increased serum triglycerides (P less than 0.001) and reduced high density lipoprotein (HDL) cholesterol levels (P less than 0.01) in both sexes, reduced apolipoprotein A-I levels in males (P less than 0.001), and increased apolipoprotein B (P less than 0.01) and plasma glucose levels (P less than 0.001) in females. Adjusted triglycerides were 20% higher and HDL cholesterol was 7% lower in the presence of anti-hypertensive drug therapy. These effects were partially consistent with the known actions of thiazide diuretics and beta-blockers which were used by more than 50% and 40% of subjects, respectively.

Adrenergic beta-Antagonists↗
PubMed1992

Lipoprotein(a) levels in chronic renal disease states, dialysis and transplantation.

Lipoprotein(a) is an independent risk factor for cardiovascular disease. Lipoprotein(a) levels were measured in 196 patients (103 Male [M]: 93 Female [F]) with chronic renal diseases and in 116 controls. Median levels of Lipoprotein(a) [Lp(a)] were found to be significantly elevated in patients with untreated chronic renal disease (285,285 mg/L; M,F; range 30-1675 mg/L) and in those treated with continuous ambulatory peritoneal dialysis (320, 603; M,F; range 50-1450) compared with controls (70,51; M,F; range 1-750; p less than 0.01 Males, p less than 0.001 Females). Lp(a) levels in patients treated by haemodialysis (133,35; M,F; range 5-685) and renal transplantation (100,95; M,F; range 10-1700) were not significantly different from controls. Lipoprotein(a) levels correlated inversely with serum albumin in the combined dialysis group (r = -0.34, p less than 0.001), and with urinary protein loss in the combined transplant and chronic renal diseases groups (r = 0.29, p less than 0.01). This correlation of Lp(a) with protein metabolism suggests a similarity with changes in other apolipoprotein-B containing lipoproteins in nephrosis. These findings may be relevant to the increased risk of atherosclerosis in patients with chronic renal disease and to their optimum mode of renal replacement therapy.

Aged↗