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Biomedical subjects

Peter Dunn

Publications and source records attributed to Peter Dunn.

7 recordsLinked to original sources
PubMed2006

First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in Maori and Pacific Islanders.

BACKGROUND: Diabetes is an important cause of morbidity and mortality amongst young people. Despite improvements in technology, maintenance of good glycaemic control is hard to achieve. METHODS: In July 2003, 12 paediatric and adult hospital-based diabetes services across New Zealand were invited to take part in an audit of the process and outcomes of care. By March 2004, 9 centres had submitted data on 1282 (1117 with Type 1 diabetes, 105 with Type 2) children and young people born after 1 January 1978. RESULTS: There were significant centre differences in terms of glycaemic control, rates of microvascular complications and complication screening. The group mean HbA1c was 9.1 plus and minus 0.3%. Amongst 789 people aged 16-25 years, the prevalence of retinopathy was 12.8% (range 0-26%); nephropathy was 17.1% (range 7-28 %). Of those with a duration of diabetes <10 years, 25% had retinopathy and 27% nephropathy. Over the age of 12, microalbuminuria was more common amongst Maori and Pacific Islanders (43.8%) compared to Europeans (17%) or Others (17.8%). This was independent of the type of diabetes. CONCLUSIONS: This is the largest study of young people with diabetes undertaken in New Zealand. The results confirm the difficulty of achieving good glycaemic control in children and young adults. Microvascular complications were common, particularly in those of long duration, and cardiovascular risk factors were present in many young adults. The difference in average HbA1c% between centres was highly significant and independent of other factors. Type 2 diabetes mellitus in young people was associated with early onset nephropathy and dyslipidaemia (almost from diagnosis), thus suggesting the need for earlier diagnosis.

Adolescent↗
PubMed2004

Diabetes in children and young adults in Waikato Province, New Zealand: outcomes of care.

BACKGROUND: Diabetes is an important cause of morbidity and mortality among young people. Despite improvements in technology, maintenance of good glycaemic control is hard to achieve particularly during the teenage years. AIMS: To assess the outcomes of care in young people aged under age 26 years with diabetes living in New Zealand's Waikato District Health Board (DHB) area. METHODS: Audit of health records. RESULTS: Two hundred and fifty-one patients who had attended an outpatient consultation at least once in the last 3 years were identified. The mean HbA1c was 9.2% (CI 8.8-9.8). There were no gender differences. The prevalence of retinopathy was 13%, and nephropathy up to 19%. Eleven patients were taking ACE inhibitors and one person had end-stage renal failure treated with continuous ambulatory peritoneal dialysis (CAPD). Forty percent of those patients over 10 years of age had a low density lipoprotein (LDL) cholesterol level of >2.6mmol/L. All of those patients with type 2 diabetes mellitus (T2DM) were overweight, compared to 28% of those patients with type 1 diabetes mellitus (T1DM). CONCLUSIONS: These results confirm the difficulty of achieving good glycaemic control in children and young adults. Microvascular complications are common, particularly in those of long duration. Risk factors for macrovascular disease are present from an early age, especially in those with T2DM. It is likely that these outcomes of care are typical for children and young adults with diabetes in New Zealand.

Adolescent↗
PubMed2004

Temporal changes in allele frequencies and low effective population size in greater prairie-chickens.

The number of greater prairie-chickens in Wisconsin has decreased by 91% since 1932. The current population of approximately 1500 birds exists primarily in four isolated management areas. In previous studies of the Wisconsin populations we documented low levels of genetic variation at microsatellite loci and the mitochondrial DNA control region. Here we investigate changes in genetic structure between the four management areas in Wisconsin over the last 50 years. We estimated the harmonic mean effective population size (Ne) over the last 50 years by comparing allele frequencies from the early 1950s with those from contemporary samples. Using a pseudo-likelihood approach that accounted for migration, estimates of Ne (15-32 prairie-chickens within each management area) were 10 times lower than census numbers from booming-ground counts. These low estimates of Ne are consistent with increased habitat fragmentation and an increase in genetic isolation between management areas over the last 50 years. The reduction of gene flow between areas has reduced Ne, increased genetic drift and, consequently, reduced genetic variation. These results have immediate consequences for the conservation of the prairie-chicken, and highlight the importance of how mating systems and limited dispersal may exacerbate the loss of genetic variation in fragmented populations.

Animals↗
PubMed2003

Screening for diabetic retinopathy using the mobile retinal camera: the Waikato experience.

AIM: To report the results of the Waikato Regional Mobile Diabetic Retinopathy Photoscreening Programme. METHODS: We audited the results of a diabetic retinal photoscreening programme using the mobile retinal camera in the Waikato region for the period August 1993 to December 2001. RESULTS: A total of 8172 patients were screened one or more times, with a total of 15 555 photoscreens, representing approximately 79% of the expected number of patients with diabetes for the region. Seventy eight per cent showed no diabetic retinopathy (NDR), 9.3% had evidence of non-vision-threatening retinopathy (NVR), and 3.1% had evidence of vision-threatening retinopathy (VTR). A further 2281 (14.7%) led to a referral to an eye clinic for specialist review. The percentage of all screening episodes resulting in VTR fell from 11.5% in 1993 to 1.5% in 2002. The overall failure-to-attend rate for photoscreening was high (18.7%), especially in the Maori population (32.3%). CONCLUSION: Mobile retinal photoscreening is practical in a large rural area, and its implementation has been associated with a reduction in presentations with vision-threatening retinopathy within the total community. The rate of subsequent development of VTR in the group with normal eyes on initial photoscreening was low and supports a two-yearly repeat photoscreening schedule for this group. Despite significant efforts to improve physical access to photoscreening, the failure-to-attend rates in all ethnic groups other than Europeans are disappointingly high.

Aged↗
PubMed2002

The evolution of government independent living policies and programmes for Canadians with disabilities.

Government policies and programmes in Canada have been slowly evolving from a focus on institutional care to traditional programmes in the community. Now, a new paradigm of services is emerging which emphasizes the concepts of independent living. This study collected extensive information from government officials and consumer groups across Canada regarding the trends in barrier-free housing, accessible transportation and personal supports from 1980 to the present time. The research documents some of the major issues with government initiatives as well as promising innovations. Although many positive changes were made during the Decade of Disabled Persons (1983-1992), many of these initiatives were eroded with major funding cutbacks in the mid- to late 1990s. This paper concludes with ways to change the present service delivery system to ensure that everyone can live independently in the community.

Activities of Daily Living↗