Search PubMed⌕ Search

Biomedical subjects

Mark R Nelson

Publications and source records attributed to Mark R Nelson.

At least 37 records · Page 2Linked to original sources
PubMed2004

Managing 'metabolic syndrome' and multiple risk factors.

BACKGROUND: Risk factors tend to cluster and are shared across common diseases seen in general practice. The 'metabolic syndrome' is a cluster of fasting hyperglycaemia, abdominal adiposity, dyslipidaemia and hypertension. This syndrome is associated with both insulin resistance and behaviourally modifiable risk factors such as smoking, physical activity and unhealthy diet. OBJECTIVE: This article aims to provide pragmatic guidance on conditions that are lifestyle based and present as a number of disease states that require multiple interventions. Management of comorbidity and multiple risk factors is discussed using a case vignette. DISCUSSION: Metabolic disease states have common bases and their management is directed toward identifying all the risk factors, establishing absolute risk and intervening sequentially.

Behavior Therapy↗
PubMed2003

Interleukin-2-associated viral breakthroughs induce HIV-1-specific CD4 T cell responses in patients on fully suppressive highly active antiretroviral therapy.

The combination of intermittent subcutaneous IL-2 and highly active antiretroviral therapy in individuals infected with HIV-1 has been shown to have a beneficial quantitative effect on the CD4 T cell count. We observed IL-2-associated viral load 'blips' inducing HIV-1-specific lymphoproliferative responses at 24 weeks in such individuals. This immunotherapeutic approach, utilizing autologous virus as autovaccination, may be a viable, safer alternative to structured treatment interruption and potentially more efficacious than therapeutic vaccines.

Antiretroviral Therapy, Highly Active↗
PubMed2003

Short-term predictors of maintenance of normotension after withdrawal of antihypertensive drugs in the second Australian National Blood Pressure Study (ANBP2).

BACKGROUND: Antihypertensive drug therapy is considered lifelong but in the family practice environment drug cessation may provide an opportunity to attempt nonpharmacologic strategies for blood pressure (BP) control with a clear outcome, maintaining drug-free status. The identification of simple predictors would assist the family physician to select who may or may not have their medication ceased. METHODS: To monitor a drug cessation program in currently treated hypertensive patients in Australian family practice, 25,826 patients aged 65 to 84 years currently receiving antihypertensive medication, were offered drug withdrawal as part of the run-in phase of a large clinical trial. Outcomes investigated were the proportion of patients completing drug withdrawal and maintaining short-term BP control and factors that predicted these patients. RESULTS: A total of 18,993 patients did not enter the withdrawal program; 6291 (92% of those who entered) completed drug withdrawal. In comparison to patients who did not complete drug withdrawal, they were younger and more likely male. A total of 1,228 (18% of those who entered) ceased medication and maintained adequate BP control for 0 to 76 weeks (median, 4 weeks). Cox regression analysis identified lower on therapy systolic and diastolic BP, younger age, type of agent, and monotherapy as predictors of successful drug withdrawal and maintenance of BP control. CONCLUSIONS: Cessation of antihypertensive drug therapy is possible in a substantial proportion (18%) of patients attending family practice who are willing to do so and is most successful in those who are younger with BP controlled on monotherapy. Where this strategy is initiated, use of such predictors, effective behavioral change, and systematic follow-up is recommended.

Age Distribution↗
PubMed2003

Factors influencing family physician adherence to hypertension treatment guideline recommendations on the initiation of pharmacotherapy: questionnaire survey.

BACKGROUND: Family physicians do not prescribe antihypertensive medication according to current guidelines. This study investigates possible reasons for this. The objectives were to measure the knowledge, attitude and stated practice of family physicians to the initiation of pharmacotherapy for uncomplicated hypertension and to explore the reasons why clinical practice differs from guideline recommendations. STUDY DESIGN: A cross-sectional postal survey conducted between June and October 1999. Simple frequency analysis and a chi(2) test comparing family physician characteristics and responses. METHODS: A three-phase postal survey was undertaken of a random sample of family physicians. Telephone and facsimile contact was made to non-responders. The survey instrument included respondent characteristics, preference for initiation of antihypertensive drug therapy and their opinion of efficacy, adverse effects and long-term safety, as well as knowledge of guidelines. PARTICIPANTS: Family physicians in the state of Victoria, Australia. MAIN OUTCOME MEASURES AND RESULTS: Ranked preference of drugs for uncomplicated hypertension. Opinion of drug efficacy, adverse effects, safety and cost. Knowledge of guidelines for first-line antihypertensive drugs. Newer agents are preferred to older agents in the initiation of antihypertensive drug therapy contrary to current guideline recommendations. Newer agents were thought to be more efficacious, have better short- and long-term adverse effect profiles and be more expensive than older agents. Younger doctors most often held these attitudes. Guidelines influenced decision making but were not the most important factor. CONCLUSIONS: There is a demonstrable need for governments to invest in the promotion of accurate information on drugs through continuing education of prescribers and facilitating the production of standardized paper and web-based clinical guidelines. A program of targeted investment in clinical trials that examine the justification for more expensive classes of agents should also be considered in appropriate circumstances.

Antihypertensive Agents↗
PubMed2002

The mummy's curse: historical cohort study.

OBJECTIVE: To examine survival of individuals exposed to the "mummy's curse" reputedly associated with the opening of the tomb of Tutankhamen in Luxor, Egypt, between February 1923 and November 1926. DESIGN: Retrospective cohort study. PARTICIPANTS: 44 Westerners identified by Howard Carter as present in Egypt at the specified dates, 25 of whom were potentially exposed to the curse. MAIN OUTCOME MEASURES: Length of survival after date of potential exposure. RESULTS: In the 25 people exposed to the curse the mean age at death was 70 years (SD 12) compared with 75 (13) in those not exposed (P=0.87 for difference). Survival after the date of exposure was 20.8 (15.2) v 28.9 (13.6) years respectively (P=0.95 for difference). Female sex was a predictor for survival (P=0.02). CONCLUSIONS: There was no significant association between exposure to the mummy's curse and survival and thus no evidence to support the existence of a mummy's curse.

Aged↗
PubMed2002

Predictors of normotension on withdrawal of antihypertensive drugs in elderly patients: prospective study in second Australian national blood pressure study cohort.

OBJECTIVES: To identify simple long term predictors of maintenance of normotension after withdrawal of antihypertensive drugs in elderly patients in general practice. DESIGN: Prospective cohort study. SETTING: 169 general practices in Victoria, Australia. PARTICIPANTS: 503 patients aged 65-84 with treated hypertension who were withdrawn from all antihypertensive drugs and remained drug free and normotensive for an initial two week period; all were followed for a further 12 months. MAIN OUTCOME MEASURES: Relative likelihood of maintaining normotension 12 months after drug withdrawal; relative likelihood of early return to hypertension after drug withdrawal. RESULTS: The likelihood of remaining normotensive at 12 months was greater among younger patients (65-74 years), patients with lower "on-treatment" systolic blood pressure, patients on single agent treatment, and patients with a greater waist:hip ratio. The likelihood of return to hypertension was greatest for patients with higher "on-treatment" systolic blood pressure. CONCLUSIONS: Age, blood pressure control, and the number of antihypertensive drugs are important factors in the clinical decision to withdraw drug treatment. Because of consistent rates of return to antihypertensive treatment, all patients from whom such treatment is withdrawn should be monitored indefinitely to detect a recurrence of hypertension.

Aged↗
PubMed2002

Virological suppression at 6 months is related to choice of initial regimen in antiretroviral-naive patients: a cohort study.

BACKGROUND: Guidelines recommend both protease inhibitor (PI)- and non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimens for initial therapy in HIV-positive individuals whilst clinical trial data comparing treatment options remain limited. OBJECTIVE: To assess whether drug selection (PI versus NNRTI) in antiretroviral-naive patients is related to virological response at 6 months within a clinical cohort. DESIGN: Databases from two large clinics were used to identify all treatment-naive patients initiating highly active antiretroviral therapy (PI/ two PI or NNRTI). Statistical models determined the likelihood of suppressing HIV viral load < 500 copies/ml, the risk of treatment failure by 6 months, and factors associated with treatment success. RESULTS: Of 1109 potentially eligible patients 888 met study criteria and were included; 484 were prescribed a PI (40% indinavir, 41% nelfinavir) and 404 were prescribed NNRTI (40% efavirenz, 60% nevirapine). Three treatment arms were compared: efavirenz versus nevirapine versus PI. After stratification by year and centre and adjustment for baseline variables, only treatment group and baseline viral load remained significantly associated with virological suppression at 6 months. Patients on efavirenz were significantly more likely to achieve an undetectable viral load than those on PI or nevirapine. The relative hazard for nevirapine was 0.77 (95% confidence interval, 0.61-0.96, P = 0.02) and that for PI was 0.74 (95% confidence interval, 0.58-0.94, P = 0.01). Efavirenz also performed better in the analysis of treatment failure at 6 months. CONCLUSION: Although observational cohort data may be susceptible to significant bias, this study suggests a better initial virological response for efavirenz compared to either nevirapine or the PI. Clinical trial data is required to confirm these findings.

Adult↗