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Biomedical subjects

Konrad Jamrozik

Publications and source records attributed to Konrad Jamrozik.

At least 19 recordsLinked to original sources
PubMed2007

Hypertension: its prevalence and population-attributable fraction for mortality from cardiovascular disease in the Asia-Pacific region.

OBJECTIVE: About half of the world's burden of cardiovascular disease is carried by countries in the Asia-Pacific region. This study aimed to quantify the contribution of hypertension to cardiovascular diseases (CVD) at the country level, by calculating the sex-specific, population-attributable fractions (PAFs) for fatal ischaemic heart disease (IHD) and stroke (haemorrhagic and ischaemic) for the World Health Organization Western Pacific and South-east Asian regions. METHODS: The most recent sex-specific prevalence data on hypertension were sought. Age-adjusted hazard ratio (HR) estimates for fatal IHD and stroke associated with hypertension were obtained using Cox analyses of individual participant cohort data from 600,000 adult participants in the Asia-Pacific Cohort Studies Collaboration. HR estimates and prevalence were then used to calculate sex-specific PAFs for fatal IHD and stroke, by country. RESULTS: In 15 countries with available data, the prevalence of hypertension ranged from 5-47% in men and from 7-38% in women. Overall, the fraction of IHD attributable to hypertension ranged from 4-28% in men and from 8-39% in women. Corresponding ranges for haemorrhagic stroke were 18-66% and 15-49%, and for ischaemic stroke were 8-44% and 12-45%. CONCLUSIONS: In the Asia-Pacific region, up to 66% of some subtypes of CVD can be attributed to hypertension, underscoring the immense impact that blood pressure- lowering strategies could have in this populous region.

Adult↗
PubMed2007

Effectiveness of a smoking cessation intervention in older adults.

AIMS: To: (a) identify characteristics of older smokers considering cessation of smoking; (b) evaluate a cessation intervention plus access to nicotine replacement therapy (NRT); (c) identify predictors of those who successfully quit; and (d) evaluate the effectiveness of the intervention in those AGED >or = 75 years. DESIGN: Self-selection of: (a) a cessation of smoking programme; or (b) ongoing smoking. SETTING: Teaching hospital, Perth, Western Australia. PARTICIPANTS: A larger study recruited smokers and never smokers: from this the 215 community-dwelling smokers (>or= 5 cigarettes/day) aged >or= 68 years (171 males) were enrolled. INTERVENTION: Brief intervention with telephone support and access to NRT versus no intervention. MEASUREMENTS: (a) Profile of older adults planning to quit smoking compared with continuing smokers; (b) cessation at 6 months defined as 30-day point prevalence validated via expired carbon monoxide; and (c) factors predictive of successful cessation. FINDINGS: There were 165 intervention participants. Compared with the 50 continuing smokers, participants in the intervention were younger and had significantly less years of regular smoking, more previous quit attempts and greater nicotine dependence scores. At 6 months, the point prevalence of ex-smokers was 25% (n = 42) with 20% (n = 33) being abstinent throughout the study. No continuing smoker had ceased smoking. Among the intervention group, logistic regression showed that those who used NRT (OR 4.36), were male (OR 3.17), had higher anxiety (OR 1.67) or rejected 'more colds and coughs' as a reason for quitting (OR 2.91) were more likely to be successful quitters. Of those aged >or= 75 years (n = 77), 25% matched cessation criteria. CONCLUSIONS: Older smokers can be engaged successfully in a brief intervention plus NRT as aids to cessation of smoking. The intervention was also effective in the older subgroup of participants. Social factors may provide an additional means of motivating older smokers to quit.

Aged↗
PubMed2006

Association of cardiovascular risk factors and disease with depression in later life.

OBJECTIVE: The objective of this study is to determine the association between established cardiovascular risk factors and depression among older men. METHODS: The authors conducted a cross-sectional study of a community-representative sample of 5,439 men aged 71-89 years. Cardiovascular disease and risk factors assessed included history of diabetes, hypertension, angina, myocardial infarction, and stroke; current smoking; total cholesterol and fractions; triglycerides; total plasma homocysteine; and MTHFR677 genotype. Depression was defined by a Geriatric Depression Scale 15 items score of 7 or greater. RESULTS: A complete data set was available for 4,204 men, of whom 212 were depressed (5%). Men who were depressed reported higher frequency of diabetes (23.1% versus 13.2%), angina (30.2% versus 20.4%), myocardial infarction (26.2% versus 16.0%), and stroke (23.6% versus 9.1%) than nondepressed men. Participants with depression were also more likely to have plasma homocysteine above 15 mumol/L (39.1% versus 25.5%) and high triglycerides (32.1% versus 20.9%) than nondepressed subjects. Depressed older men were also more likely to be active smokers (9.9% versus 4.8%). The other factors measured in the study were not significantly associated with depression. Estimation of the population-attributable fraction (PAF) after logistic regression showed that high plasma homocysteine had the highest PAF for depression (PAF:15%, 95% confidence interval [95% CI]: 5%-23%) followed by high triglycerides (PAF: 11%, 95% CI: 2%-18%), angina (PAF: 9%, 95% CI: 2%-15%), stroke (PAF: 8%, 95% CI: 3%-13%), diabetes (PAF: 7%, 95% CI: 1%-13%), myocardial infarction (PAF: 5%, 95% CI: 0%-11%), and smoking (PAF: 5%, 95% CI: 1%-9%). CONCLUSIONS: High plasma homocysteine and triglycerides appear to account for a considerable proportion of cases of depression in older men. The successful management of these risk factors may contribute to decrease the prevalence of depression in later life.

Age of Onset↗
PubMed2006

B-vitamins reduce plasma levels of beta amyloid.

Elevated plasma homocysteine (tHcy) is a risk factor for Alzheimer's disease (AD), and thus B vitamins may have a role in the prevention of AD. The objective of this study was to determine if tHcy lowering vitamins decrease the circulating levels of A-beta protein 1-40 (A beta 40). We randomized 299 older men to treatment with 2mg of folate, plus 25mg of B6 and 400 microg of B12, or placebo. After 2 years of treatment the mean (S.E.) increase of A beta 40 was 7.0 pg/ml (8.4) in the vitamin group (4.9%), and 26.8 pg/ml (7.7) (18.5%) in the placebo group. We conclude that B vitamins may decrease the plasma level of A beta 40 and have a role in the prevention of AD.

Aged↗
PubMed2006

Recent changes in heart failure hospitalisations in Australia.

AIM: To assess trends in admissions of patients with heart failure (HF) to all hospitals in Australia between 1996-1997 and 2003-2004. METHODS AND RESULTS: We carried out a retrospective analysis of the official population-based National Hospital Morbidity Data in Australia. Although the absolute number of separations with a principal diagnosis of HF remained stable, the age- and sex-standardized separation rate for HF recorded as principal diagnosis decreased from 2.0 per 1000 population in 1996-1997 to 1.6 per 1000 population in 2003-2004. The corresponding values for HF recorded in any diagnostic position were 7.7 and 4.7 per 1000 population. Men had higher in-hospital mortality than women (8.9% versus 8.1%, p<0.001) and also a larger decrease in this measure over the study period (21.9% versus 14.4%). While the geometric mean length of stay for HF as principal diagnosis fell from 5.4 days in 1996-1997 to 4.9 days in 2003-2004, the proportion of bed-days related to such diagnoses relative to total bed days attributed to circulatory diseases increased from 12.8% to 13.7% (p<0.001). CONCLUSION: There were no increase in number of admissions involving HF and standardized rates of hospital separations with HF fell in Australia between 1996 and 2004. The explanation for the observed declines in in-hospital case fatality and the separation rates should be sought in whole-of-community studies.

Age Distribution↗
PubMed2006

Unsafe driving behaviour and four wheel drive vehicles: observational study.

OBJECTIVE: To assess the level of compliance with the new law in the United Kingdom mandating penalties for using a hand held mobile phone while driving, to compare compliance with this law with the one on the use of seat belts, and to compare compliance with these laws between drivers of four wheel drive vehicles and drivers of normal cars. DESIGN: Observational study with two phases-one within the "grace" period, the other starting one week after penalties were imposed on drivers using such telephones. SETTING: Three busy sites in London. PARTICIPANTS: Drivers of 38,182 normal cars and 2944 four wheel drive vehicles. MAIN OUTCOME MEASURES: Proportions of drivers seen to be using hand held mobile phones and not using seat belts. RESULTS: Drivers of four wheel drive vehicles were more likely than drivers of other cars to be seen using hand held mobile phones (8.2% v 2.0%) and not complying with the law on seat belts (19.5% v 15.0%). Levels of non-compliance with both laws were slightly higher in the penalty phase of observation, and breaking one law was associated with increased likelihood of breaking the other. CONCLUSIONS: The level of non-compliance with the law on the use of hand held mobile phones by drivers in London is high, as is non-compliance with the law on seat belts. Drivers of four wheel drive vehicles were four times more likely than drivers of other cars to be seen using hand held mobile phones and slightly more likely not to comply with the law on seat belts.

Automobile Driving↗
PubMed2006

National audit of post-operative management in spinal surgery.

BACKGROUND: There is some evidence from a Cochrane review that rehabilitation following spinal surgery may be beneficial. METHODS: We conducted a survey of current post-operative practice amongst spinal surgeons in the United Kingdom in 2002 to determine whether such interventions are being included routinely in the post-operative management of spinal patients. The survey included all surgeons who were members of either the British Association of Spinal Surgeons (BASS) or the Society for Back Pain Research. Data on the characteristics of each surgeon and his or her current pattern of practice and post-operative care were collected via a reply-paid postal questionnaire. RESULTS: Usable responses were provided by 57% of the 89 surgeons included in the survey. Most surgeons (79%) had a routine post-operative management regime, but only 35% had a written set of instructions that they gave to their patients concerning this. Over half (55%) of surgeons do not send their patients for any physiotherapy after discharge, with an average of less than two sessions of treatment organised by those that refer for physiotherapy at all. Restrictions on lifting, sitting and driving showed considerable inconsistency both between surgeons and also within the recommendations given by individual surgeons. CONCLUSION: Demonstrable inconsistencies within and between spinal surgeons in their approaches to post-operative management can be interpreted as evidence of continuing and significant uncertainty across the sub-speciality as to what does constitute best care in these areas of practice. Conducting further large, rigorous, randomised controlled trials would be the best method for obtaining definitive answers to these questions.

Humans↗
PubMed2006

Changes in maternal marital status are associated with young adults' cannabis use: evidence from a 21-year follow-up of a birth cohort.

BACKGROUND: Relatively little is known about why almost half of young adults in Australia have used cannabis. Because the upwards trend in use of cannabis has been coincident with an increase in marital breakdown, this study examines the relationship between marital status, marital changes, and the onset of cannabis use. METHODS: Data are from the Mater-University Study of Pregnancy (MUSP), a 21-year prospective study in Brisbane, Australia. The present study is based on the 3008 mothers and their children for whom there were complete follow-up data at 21 years. Outcomes were self-reported cannabis use at age 21 and early onset (before age 15) cannabis use as judged from a retrospective report obtained at 21 years. Analyses were conducted using multivariate binomial and multinomial logistic regression. RESULTS: Change in maternal marital status when the child was aged between 5 and 14 years was significantly associated with increased risk of cannabis use [odds ratio (OR) = 1.7; 95% confidence interval (95% CI) 1.4-2.0 for one or two marital changes and OR = 2.3; 95% CI 1.5-3.4 for three or more marital changes], after adjustment for a range of potential confounders. CONCLUSION: Experience of changes in maternal marital status in mid- to late-childhood is a significant predictor of subsequent and early use of cannabis by the child. This holds true even after allowing for certain possible causes and consequences of marital breakdown.

Adolescent↗
PubMed2006

Teaching evidence-based medicine to undergraduate medical students: a course integrating ethics, audit, management and clinical epidemiology.

A six-week full time course for third-year undergraduate medical students at Imperial College uniquely links evidence-based medicine (EBM) with ethics and the management of change in health services. It is mounted jointly by the Medical and Business Schools and features an experiential approach. Small teams of students use a problem-based strategy to address practical issues identified from a range of clinical placements in primary and secondary care settings. The majority of these junior clinical students achieve important objectives for learning about teamwork, critical appraisal, applied ethics and health care organisations. Their work often influences the care received by patients in the host clinical units. We discuss the strengths of the course in relation to other accounts of programmes in EBM. We give examples of recurring experiences from successive cohorts and discuss assessment issues and how our multi-phasic evaluation informs evolution of the course and the potential for future developments.

Curriculum↗
PubMed2006

A comparison of the effect of high- and low-dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly.

BACKGROUND: Postoperative cognitive dysfunction (POCD) after coronary artery bypass graft surgery is a common complication for which, despite many clinical investigations, no definitive etiology has been found. The current use of both high- and low-dose fentanyl as anesthetic techniques allowed us to investigate the effect of fentanyl on the incidence of POCD. METHODS: Three hundred fifty patients scheduled to undergo elective coronary artery bypass graft surgery were randomized to receive either high-dose fentanyl (50 microg/kg) or low-dose fentanyl (10 mug/kg) as the basis of the anesthetic. All patients underwent neuropsychological testing before surgery and at 1 week, 3 months, and 12 months after surgery. RESULTS: One hundred sixty-eight patients in the low-dose group and 158 patients in the high-dose group were included in the final analysis. Neuropsychological testing was performed on 88%, 93%, and 92% of patients at 1 week, 3 months, and 12 months, respectively. There was no difference between group mean scores at any of the three testing times. Analysis of individual patients by the 20% rule did not detect any differences between groups. The one SD rule, which has fewer false-positive results, detected significantly more patients with POCD in the low-dose group than in the high-dose group at 1 week (23.6% vs. 13.7%; P = 0.03) but not at the other testing times. Patients with POCD spent an average of 1.2 days longer in the hospital than those without POCD (P = 0.021). CONCLUSIONS: High-dose fentanyl is not associated with a difference in the incidence of POCD at 3 or 12 months after surgery. Low-dose fentanyl leads to shorter postoperative ventilation times and may be associated with a greater incidence of POCD 1 week after surgery. Early POCD is associated with an increased duration of stay in the hospital.

Aged↗
PubMed2006

Successful mental health aging: results from a longitudinal study of older Australian men.

OBJECTIVE: The authors investigated the associations of medical and lifestyle factors with the mental health of men in their 80s. METHODS: This was a prospective study of a community-representative cohort of older men. Successful mental health aging was defined as reaching age 80 years with Mini-Mental State Examination score (MMSE) of 24 or more and Geriatric Depression Scale-15 items (GDS-15) score of 5 or less. RESULTS: Of 601 men followed for 4.8 years, 76.0% enjoyed successful mental health aging. Successful mental health aging was inversely associated with age (hazard ratio [HR] = 0.87; 95% confidence interval [CI]: 0.81-0.94), non-English-speaking background (HR = 0.42; 95% CI: 0.21-0.85), and the consumption of full-cream milk (HR = 0.63; 95% CI: 0.45-0.89), and directly associated with high school or university education (HR = 1.92; 95% CI: 1.34-2.75) and vigorous (HR = 1.89; 95% CI: 1.17-3.05) and nonvigorous physical activity (HR = 1.50; 95% CI: 1.05-2.14). Marital status, smoking and alcohol use, weekly consumption of meat or fish, and a medical history of hypercholesterolemia, hypertension, diabetes, myocardial infarction, and stroke were not associated with mental health outcomes in men aged 80 years or over. CONCLUSION: Three in four men who reach age 80 years undergo successful mental health aging. Factors associated with successful mental health aging include education and lifestyle behaviors such as physical activity. Lifestyle modification by means of increasing physical activity and reducing saturated fat intake may prove to be a safe, inexpensive, and readily available strategy to help maximize the successful mental health aging of the population.

Affect↗
PubMed2006

Do parents' marital circumstances predict young adults' DSM-IV cannabis use disorders? A prospective study.

AIMS: To determine whether parental marital status and marital quality in adolescence are associated with cannabis use disorders in young adults. DESIGN: Prospective birth cohort study. SETTING: A 21-year follow-up of 4815 mothers and their children who participated at 14 years after the child's birth in Queensland, Australia. PARTICIPANTS: Cohort of 2303 young adults who completed the life-time version of the Composite International Diagnostic Interview-computerized version (CIDI-Auto) at the 21-year follow-up. MEASUREMENTS: Young adults' cannabis use disorders were assessed using the CIDI-Auto. Marital status and quality (marital circumstances) and potential confounding factors such as socio-economic status (SES), maternal mental health and maternal substance use were measured when the child was 14 years of age. FINDINGS: Marital circumstances of the mother when child was aged 14 years predicted risk of cannabis use disorders in their offspring. After adjustment for potential confounding factors, adolescents who grew up in step-father families were more likely to have cannabis use disorders in early adulthood and a moderate association was found for those children who experienced maternal marital disagreement [odds ratio (OR) = 1.7; 95% confidence interval (CI): 1.0, 2.9]. There was no significant increase in subsequent risk of cannabis use disorders for children whose mothers were unpartnered at 14 years. CONCLUSIONS: Maternal marital status and marital quality are associated with young adults' subsequent cannabis use disorders. This association is independent of suspected confounding factors measured at 14 years. However, at least part of the association is explained by changes in marital status before 14 years.

Adolescent↗
PubMed2006

Legislative and regulatory measures for preventing alcohol-related drownings and near-drownings.

OBJECTIVE: Alcohol contributes to about 30% of drowning fatalities associated with recreational aquatic activity and to 35% of drownings associated with boating. We consider regulatory and legislative strategies for preventing such deaths. METHODS: We contacted water police in each Australian State and Territory to identify legislation creating alcohol-related offences for operators of recreational boats in their jurisdiction and to determine whether they conducted random breath testing (RBT). We also sought information from all 152 (81 urban and 71 rural) local government councils in NSW regarding restrictions on consumption of alcohol in public places within their shires. RESULTS: Four Australian States (New South Wales, Queensland, Victoria and South Australia) have legislation prescribing maximum blood alcohol concentrations (BACs) for operators of recreational boats; all support this with RBT. Western Australia, Tasmania and the Australian Capital Territory define more general offences for operating vessels while under the influence of alcohol. Prohibitions or restrictions on consumption of alcohol in public places exist in 78 of the 86 shires in NSW that responded: 69 councils had alcohol-free zones, 53 restricted consumption of alcohol in public parks and reserves, and 33 had prohibitions or restrictions in some aquatic environments. CONCLUSIONS/IMPLICATIONS: Legislation restricting BACs for recreational boat operators should be adopted in all Australian States and Territories. Optimal legislation would require that all occupants of recreational boats are required to comply with prescribed BAC levels, including when vessels are at anchor. Extension of by-laws prohibiting or restricting the consumption of alcohol specifically in aquatic environments warrants consideration.

Alcohol Drinking↗
PubMed2006

Neighborhood environmental factors correlated with walking near home: Using SPACES.

PURPOSE: The physical environment plays an important role in influencing participation in physical activity, although the specific factors that are correlated with different patterns of walking remain to be determined. We examined correlations between physical environmental factors and self-reported walking for recreation and transport near home. METHODS: The local neighborhood environments (defined as a 400-m radius from the respondent's home) of 1678 adults were assessed for their suitability for walking. The environmental data were collected during 2000 using the Systematic Pedestrian and Cycling Environmental Scan (SPACES) instrument together with information from other sources. We used logistic regression modeling to examine the relationship between the attributes of the physical environment and the self-reported walking behavior undertaken near home. RESULTS: Functional features were correlated with both walking for recreation (odds ratio (OR) 1.62; 95% confidence interval (CI): 1.20-2.19) and for transport (OR 1.30; 95% CI: 0.97-1.73). A well-maintained walking surface was the main functional factor associated with walking for recreation (OR 2.04; 95% CI: 1.43-2.91) and for transport (OR 2.13; 95% CI: 1.53-2.96). Destination factors, such as shops and public transport, were significantly correlated with walking for transport (OR 1.80; 95% CI: 1.33-2.44), but not recreation. CONCLUSION: The findings suggest that neighborhoods with pedestrian facilities that are attractive and comfortable and where there are local destinations (such as shops and public transport) are associated with walking near home.

Adult↗
PubMed2006

Is mortality from heart failure increasing in Australia? An analysis of official data on mortality for 1997-2003.

OBJECTIVE: To assess whether trends in mortality from heart failure (HF) in Australia are due to a change in awareness of the condition or real changes in its epidemiology. METHODS: We carried out a retrospective analysis of official data on national mortality data between 1997 and 2003. A death was attributed to HF if the death certificate mentioned HF as either the underlying cause of death (UCD) or among the contributory factors. FINDINGS: From a total of 907 242 deaths, heart failure was coded as the UCD for 29 341 (3.2%) and was mentioned anywhere on the death certificate in 135 268 (14.9%). Between 1997 and 2003, there were decreases in the absolute numbers of deaths and in the age-specific and age-standardized mortality rates for HF either as UCD or mentioned anywhere for both sexes. HF was mentioned for 24.6% and 17.8% of deaths attributed to ischaemic heart disease and circulatory disease, respectively, and these proportions remained unchanged over the period of study. In addition, HF as UCD accounted for 8.3% of deaths attributed to circulatory disease and this did not change materially from 1997 to 2003. CONCLUSION: The decline in mortality from HF measured as either number of deaths or rate probably reflects a real change in the epidemiology of HF. Population-based studies are required to determine accurately the contributions of changes in incidence, survival and demographic factors to the evolving epidemiology of HF.

Aged↗
PubMed2005

Efficacy of B vitamins in lowering homocysteine in older men: maximal effects for those with B12 deficiency and hyperhomocysteinemia.

BACKGROUND AND PURPOSE: A higher plasma concentration of total homocysteine (tHcy) is associated with a greater risk of cardiovascular events. Previous studies, largely in younger individuals, have shown that B vitamins lowered tHcy by substantial amounts and that this effect is greater in people with higher tHcy and lower folate levels. METHODS: We undertook a 2-year, double-blind, placebo-controlled, randomized trial in 299 men aged > or =75 years, comparing treatment with a daily tablet containing 2 mg of folate, 25 mg of B6, and 400 microg of B12 or placebo. The study groups were balanced regarding age (mean+/-SD, 78.9+/-2.8 years), B vitamins, and tHcy at baseline. RESULTS: Among the 13% with B12 deficiency, the difference in mean changes in treatment and control groups for tHcy was 6.74 micromol/L (95% CI, 3.94 to 9.55 micromol/L) compared with 2.88 micromol/L (95% CI, 0.07 to 5.69 micromol/L) for all others. Among the 20% with hyperhomocysteinaemia, the difference between mean changes in treatment and control groups for men with high plasma tHcy compared with the rest of the group was 2.8 micromol/L (95% CI, 0.6 to 4.9 micromol/L). Baseline vitamin B12, serum folate, and tHcy were significantly associated with changes in plasma tHcy at follow-up (r=0.252, r=0.522, and r=-0.903, respectively; P=0.003, <0.001, and <0.001, respectively) in the vitamin group. CONCLUSIONS: The tHcy-lowering effect of B vitamins was maximal in those who had low B12 or high tHcy levels. Community-dwelling older men, who are likely to be deficient in B12 or have hyperhomocysteinemia, may be most likely to benefit from treatment with B vitamins.

Aged↗
PubMed2005

Increased use of emergency services by older people after health screening.

BACKGROUND: evaluation of the 'Keep Well At Home' (KWAH) Project in West London indicated that a programme of screening persons aged 75 and over had not reduced rates of emergency attendances and admissions to hospital. However, coverage of the target population was incomplete. The present analysis addresses 'efficacy'-whether individuals who completed the screening protocol as intended did subsequently use Accident & Emergency (A&E) services less often. METHODS: the target population was divided into five groups, depending on whether an individual had completed none, one or both phases of screening, and whether deviations from the protocol related to incomplete coverage or refusal to participate further. We ascertained use of emergency services before screening and for up to 3 years afterwards by linkage of records from KWAH to those of local A&E Departments. Patterns of emergency care were examined as crude rates and, via proportional hazards models, after adjustment for available confounders. RESULTS: there was an increase of 51% (95% CI 22-86%) in the crude rate of emergency admissions in the year after first-phase screening compared with the 12 months before assessment. This was most obvious in individuals deemed at high risk who also underwent the second-phase assessment (adjusted hazard ratio relative to individuals not 'at risk'=2.33; 95% CI 1.59-3.42). CONCLUSIONS: the available data do not allow us to distinguish between several possible explanations for the paradoxical increase in use of emergency services. However, what seem to be sensible policies do not necessarily have their intended effects when implemented in practice.

Aged↗