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Biomedical subjects

K Jamrozik

Publications and source records attributed to K Jamrozik.

At least 55 records · Page 3Linked to original sources
PubMed1999

Tailored advice on exercise--does it make a difference?

OBJECTIVE: A controlled trial to compare the effectiveness of verbal advice from a family physician (FP) combined with either "standard" or "tailored" written information on physical activity in increasing the levels of physical activity in sedentary patients. DESIGN: Sedentary patients (n = 763) were recruited through ten family practices and allocated to a control group or one of two intervention groups. Brief advice on physical activity was given by the FP during the consultation and either a standard or tailored pamphlet was mailed to the home address of patients assigned to the intervention groups within two days of their visit to the FP. RESULTS: The response to follow-up, via a postal survey at one, six, and twelve months after the index consultation was 70%, 60%, and 57%, respectively. Treating all nonresponders as sedentary, the results revealed that although more tailored subjects reported some physical activity at each follow-up compared with the standard group, these differences were not significant. Furthermore, there was no significant difference in movement across the stages of readiness to exercise at follow-up between subjects in the tailored group who received material targeting their current stage (precontemplation or contemplation) and the standard group who received generic material that addressed both stages. CONCLUSION: These findings do not concur with the results from previous research in the areas of nutrition and smoking cessation where additional benefits were seen with a tailored intervention. Future research on the application of the principles of "tailoring" to the promotion of physical activity should focus on identifying which, if any, physical, social, psychological or environmental variables should be addressed to produce improved outcomes over and above the effects of well designed generic materials.

Adolescent↗
PubMed1999

Do simple prudent health behaviours protect men from myocardial infarction?

BACKGROUND: We tested whether behaviours such as discarding obvious fat on meat, cessation of smoking, avoidance of passive smoking, habitual use of reduced fat milk, prudent consumption of alcohol and regular but moderate physical exercise are associated with a reduction of cardiovascular risk. METHODS: This was a population-based case-control study done in Perth, Western Australia. The cases (n = 336) were men aged 27-64 years with a first-ever acute myocardial infarction (AMI) during the period 1992-1993, and who survived at least 28 days. The controls (n = 735) were participants in a population-based survey of cardiovascular risk factors conducted during May-November 1994. Both groups completed the same questionnaire and the data were analysed with multiple logistic regression using backward elimination technique. RESULTS: Among men aged 27-64 years simple measures such as participation in nonvigorous exercise (odds ratio [OR] = 0.5, 95% CI: 0.4-0.7), and avoidance of added salt (OR = 0.6, 95% CI: 0.4-0.9) are associated with significant and important protection from AMI. CONCLUSION: After 25 years of falling mortality in Australia, lifestyles can still be significantly improved to reduce heart disease even further.

Adult↗
PubMed1999

Evidence-based methods to improve anaesthesia and intensive care.

This review concerns the application of the methods of clinical epidemiology to problems in anaesthesia and intensive care. It explores the quality of evidence to guide clinical decision-making and health policy provided by experimental and various non-experimental research designs. Ten recent publications in anaesthesia and intensive care are analysed to provide relevant examples.

Journal Article↗
PubMed1999

Effect of smoke-free policies on the behaviour of social smokers.

OBJECTIVE: To test the hypothesis that proposed amendments to the Occupational Safety and Health Act making all enclosed workplaces in Western Australia smoke free would result in a decrease in cigarette consumption by patrons at nightclubs, pubs, and restaurants without adversely affecting attendance. DESIGN: Cross sectional structured interview survey. PARTICIPANTS AND SETTING: Patrons of several inner city pubs and nightclubs in Perth were interviewed while queuing for admission to these venues. OUTCOME MEASURES: Current social habits, smoking habits; and how these might be affected by the proposed regulations. Persons who did not smoke daily were classified as "social smokers." RESULTS: Half (50%) of the 374 patrons interviewed were male, 51% currently did not smoke at all, 34.3% smoked every day, and the remaining 15.7% smoked, but not every day. A clear majority (62.5%) of all 374 respondents anticipated no change to the frequency of their patronage of hospitality venues if smoke-free policies became mandatory. One in five (19.3%) indicated that they would go out more often, and 18.2% said they would go out less often. Half (52%) of daily smokers anticipated no change to their cigarette consumption, while 44.5% of daily smokers anticipated a reduction in consumption. A majority of social smokers (54%) predicted a reduction in their cigarette consumption, with 42% of these anticipating quitting. CONCLUSIONS: One in nine (11.5%) of smokers say that adoption of smoke-free policies would prompt them to quit smoking entirely without a significant decrease in attendance at pubs and nightclubs. There can be few other initiatives as simple, cheap, and popular that would achieve so much for public health.

Adolescent↗
PubMed1999

Trends in the incidence, severity, and short-term outcome of stroke in perth, Western Australia.

BACKGROUND AND PURPOSE: This report describes trends in the key indices of cerebrovascular disease over 6 years from the end of the 1980s in a geographically defined segment of the city of Perth, Western Australia. METHODS: Identical methods were used to find and assess all cases of suspected stroke in a population of approximately 134 000 residents in a triangular area of the northern suburbs of Perth. Case fatality was measured as vital status at 28 days after the onset of symptoms. Data for first-ever strokes and for all strokes for equivalent periods of 12 months in 1989-1990 and 1995-1996 were compared by age-standardized rates and proportions and Poisson regression. RESULTS: There were 355 strokes in 328 patients and 251 first-ever strokes (71%) for 1989-1990 and 290 events in 281 patients and 213 first-ever strokes (73%) for 1995-1996. In Poisson models including age and period, overall trends in the incidence of both first-ever strokes (rate ratio=0.75; 95% confidence limits, 0.63, 0.90) and all strokes (rate ratio=0.73; 95% confidence limits, 0.62, 0.85) were obviously significant, but only the changes in men were independently significant. Case fatality did not change, and the balance between hemorrhagic and occlusive strokes in 1995-1996 was almost indistinguishable from that observed in 1989-1990. CONCLUSIONS: Our results, which are the only longitudinal population-based data available for Australia for key indices of stroke, suggest that it is a change in the frequency of stroke, rather than its outcome, that is chiefly responsible nationally for the fall in mortality from cerebrovascular disease.

Adolescent↗
PubMed1998

Advice on exercise from a family physician can help sedentary patients to become active.

OBJECTIVES: To test the effectiveness, in the setting of primary health care, of verbal advice on exercise from a family physician (FP) combined with supporting written information. DESIGN: A controlled trial with subjects allocated to a control group or one of two intervention groups using a balanced design based on day of the week. SETTING: Ten general practices in Perth, Western Australia. SUBJECTS: All sedentary patients consulting an FP. INTERVENTION: Verbal advice on exercise from the FP and a pamphlet on exercise mailed to the patient's home address within 2 days of his/her visit to the doctor. MAIN OUTCOME MEASURE: Level of physical activity at follow-up. RESULTS: 6,351 adult patients attending an FP practice completed a screening questionnaire, and 763 sedentary adults were recruited to the project. The response to follow-up, via a postal survey at 1, 6, and 12 months after the index consultation was 70%, 60%, and 57%, respectively. At 1 month a subsample of the control and intervention subjects were contacted for a telephone interview to verify self-reported levels of activity (n = 136). Treating all nonresponders as sedentary, at 1 month significantly more subjects in the combined intervention groups reported doing some physical activity (40%) compared with the control group (31%). Similarly, at 6 months, 30% of the control group and 38% of the combined intervention groups were "now active." There was very little change at follow-up at 12 months (31% control and 36% intervention groups, respectively). CONCLUSION: A simple intervention aimed at the promotion of physical activity to sedentary patients in general practice can help reduce inactivity.

Adult↗
PubMed1998

Outcome after general or regional anaesthesia in high-risk patients.

This review is a critical analysis of research design for studies of outcome comparing epidural anaesthesia and analgesia with general anaesthesia and alternative postoperative analgesia regimens. If important advances in knowledge are to be made, appropriately designed multicentre randomized controlled trials are essential. These trials must incorporate strict controls on patient entry, a comprehensive range of carefully defined and clinically significant morbidity endpoints and the previous determination of sample size through a proper analysis of statistical power.

Journal Article↗
PubMed1998

Refining the risk-benefit equation for thrombolysis: how to identify the low risk patient before administering thrombolytic therapy.

In view of the relative risk of intracranial haemorrhage and major bleeding with thrombolytic therapy, it is important to identify as early as possible the low risk patient who may not have a net clinical benefit from thrombolysis in the setting of acute myocardial infarction. An analysis of 5434 hospital-treated patients with myocardial infarction in the Perth MONICA study showed that age below 60 and absence of previous infarction or diabetes, shock, pulmonary oedema, cardiac arrest and Q-wave or left bundle branch block on the initial ECG identified a large group of patients with a 28 day mortality of only 1%, and one year mortality of only 2%. Identification of baseline risk in this way helps refine the risk-benefit equation for thrombolytic therapy, and may help avoid unnecessary use of thrombolysis in those unlikely to benefit.

Age Factors↗
PubMed1998

Changes in cigarette smoking among adults in 35 populations in the mid-1980s. WHO MONICA Project.

OBJECTIVE: To examine changes in the prevalence of cigarette smoking in 35 study populations of the World Health Organisation's MONICA Project. DESIGN: Data from two independent, community-based surveys conducted, on average, five years apart. SETTING: Geographically defined populations in 21 countries mainly in eastern and western Europe. SUBJECTS: Randomly selected men and women aged 25-64 years. Numbers of participants in each study population ranged from 586 to 2817 in each survey. MAIN OUTCOME MEASURES: Changes in proportions of current smokers, ex-smokers, and never-smokers by age and sex using data collected by standardised methods. RESULTS: Among men, smoking prevalence decreased in most populations, by three to four percentage points over five years. In Beijing, however, it increased in all age groups--overall by 11 percentage points. Among women there were increases in smoking in about half the populations. The increases were mainly in the age group 35-54 years and often in those populations where smoking prevalence among women has been relatively low. CONCLUSIONS: Smoking initiation by middle-aged women in parts of southern and eastern Europe and among men of all ages in Beijing is a matter of concern. The various public health measures that have helped to reduce smoking among men in developed countries should be vigorously extended to these other groups now at growing risk of smoking-related disease.

Adult↗
PubMed1998

Long-term risk of first recurrent stroke in the Perth Community Stroke Study.

BACKGROUND AND PURPOSE: Few community-based studies have examined the long-term risk of recurrent stroke after an acute first-ever stroke. This study aimed to determine the absolute and relative risks of a first recurrent stroke over the first 5 years after a first-ever stroke and the predictors of such recurrence in a population-based series of people with first-ever stroke in Perth, Western Australia. METHODS: Between February 1989 and August 1990, all people with a suspected acute stroke or transient ischemic attack of the brain who were resident in a geographically defined region of Perth, Western Australia, with a population of 138 708 people, were registered prospectively and assessed according to standardized diagnostic criteria. Patients were followed up prospectively at 4 months, 12 months, and 5 years after the index event. RESULTS: Three hundred seventy patients with a first-ever stroke were registered, of whom 351 survived >2 days. Data were available for 98% of the cohort at 5 years, by which time 199 patients (58%) had died and 52 (15%) had experienced a recurrent stroke, 12 (23%) of which were fatal within 28 days. The 5-year cumulative risk of first recurrent stroke was 22.5% (95% confidence limits [CL], 16.8%, 28.1%). The risk of recurrent stroke was greatest in the first 6 months after stroke, at 8.8% (95% CL, 5.4%, 12.1%). After adjustment for age and sex, the prognostic factors for recurrent stroke were advanced, but not extreme, age (75 to 84 years) (hazard ratio [HR], 2.6; 95% CL, 1.1, 6.2), hemorrhagic index stroke (HR, 2.1; 95% CL, 0.98, 4.4), and diabetes mellitus (HR, 2.1; 95% CL, 0.95, 4.4). CONCLUSIONS: Approximately 1 in 6 survivors (15%) of a first-ever stroke experience a recurrent stroke over the next 5 years, of which 25% are fatal within 28 days. The pathological subtype of the recurrent stroke is the same as that of the index stroke in 88% of cases. The predictors of first recurrent stroke in this study were advanced age, hemorrhagic index stroke, and diabetes mellitus, but numbers of recurrent events were modest. Because the risk of recurrent stroke is highest (8.8%) in the first 6 months after stroke, strategies for secondary prevention should be initiated as soon as possible after the index event.

Age Factors↗
PubMed1998

Arrhythmias and mortality after myocardial infarction in diabetic patients. Relationship to diabetes treatment.

OBJECTIVE: To assess the relationship between clinical course after acute myocardial infarction (AMI) and diabetes treatment. RESEARCH DESIGN AND METHODS: Retrospective analysis of data from all patients aged 25-64 years admitted to hospitals in Perth, Australia, between 1985 and 1993 with AMI diagnosed according to the International Classification of Diseases (9th revision) criteria was conducted. Short- (28-day) and long-term survival and complications in diabetic and nondiabetic patients were compared. For diabetic patients, 28-day survival, dysrhythmias, heart block, and pulmonary edema were treated as outcomes, and factors related to each were assessed using multiple logistic regression. Diabetes treatment was added to the model to assess its significance. Long-term survival was compared by means of a Cox proportional hazards model. RESULTS: Of 5,715 patients, 745 (12.9%) were diabetic. Mortality at 28 days was 12.0 and 28.1% for nondiabetic and diabetic patients, respectively (P < 0.001); there were no significant drug effects in the diabetic group. Ventricular fibrillation in diabetic patients taking glibenclamide (11.8%) was similar to that of nondiabetic patients (11.0%) but was lower than that for those patients taking either gliclazide (18.0%; 0.1 > P > 0.05) or insulin (22.8%; P < 0.05). There were no other treatment-related differences in acute complications. Long-term survival in diabetic patients was reduced in those taking digitalis and/or diuretics but type of diabetes treatment at discharge had no significant association with outcome. CONCLUSIONS: These results do not suggest that ischemic heart disease should influence the choice of diabetes treatment regimen in general or of sulfonylurea drug in particular.

Adult↗
PubMed1997

How the NHMRC got its fingers burnt.

On 20 December 1996, Justice J Finn of the Federal Court of Australia handed down his judgment in the case of the Tobacco Institute of Australia (TIA) Ltd and others v the National Health and Medical Research Council (NHMRC) and others. Justice Finn concluded that, in developing its recommendations for control of environmental tobacco smoke, the NHMRC's Working Party on Passive Smoking erred significantly in regard to the consultative procedures that it employed. As the following discussion shows, the legal decision has profound implications for the NHMRC and the provision of expert advice to Australian governments on matters of health and health policy. The discussion has been prepared by three members of the NHMRC Working Party, but reflects their personal views and not necessarily those of the Working Party as a whole or those of the NHMRC.

Australia↗
PubMed1997

Risk factors for post-stroke depression.

OBJECTIVE: To examine possible risk factors in post-stroke depression (PSD) other than site of lesion in the brain DATA SOURCES: 191 first-ever stroke patients were examined physically shortly after their stroke and examined psychiatrically and physically 4 months post-stroke. SETTING: A geographically defined segment of the metropolitan area of Perth, Western Australia, from which all strokes over a course of 18 months were examined (the Perth Community Stroke Study). MEASURES: Psychiatric Assessment Schedule, Mini Mental State Examination, Barthel Index, Frenchay Activities Index, physical illness and sociodemographic data were collected. Post-stroke depression (PSD) included both major depression and minor depression (dysthymia without the 2-year time stipulation) according to DSM-III (American Psychiatric Association) criteria. Patients depressed at the time of the stroke were excluded. PATIENTS: 191 first-ever stroke patients, 111 M, 80 F, 28% had PSD, 17% major and 11% minor depression. RESULTS: Significant associations with PSD at 4 months were major functional impairment, living in a nursing home, being divorced and having a high pre-stroke alcohol intake (M only). There was no significant association with age, sex, social class, cognitive impairment or pre-stroke physical illness. CONCLUSION: Results favoured the hypothesis that depression in an unselected group of stroke patients is no more common, and of no more specific aetiology, than it is among elderly patients with other physical illness.

Activities of Daily Living↗