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Biomedical subjects

R Norton

Publications and source records attributed to R Norton.

At least 55 records · Page 3Linked to original sources
PubMed2000

Declines in physical functioning attributable to hip fracture among older people: a follow-up study of case-control participants.

PURPOSE: To identify declines in physical functioning, directly attributable to the effects of hip fracture. METHODS: A follow-up study of participants in a case-control study was conducted in Auckland, New Zealand, between 1993 and 1996. Nine hundred and eleven randomly selected older people with a hip fracture at the time of the initial interview (cases) and 910 randomly selected older people, without hip fracture (controls), were invited to participate in the study. Two year changes in physical functioning, defined in terms of self-reported mobility, functional dependence and physical activity were examined. RESULTS: Data from the survivors (572 cases and 756 controls) showed that, after controlling for pre-existing chronic medical conditions and disabilities, cases were 4.2 times more likely than controls to be community immobile (95% confidence interval (CI) 2.8-6.2, p < 0.001) and 2.6 times more likely to be functionally dependent (95% CI 1.7-4.1, p < 0.001). Cases were also spending less hours per day on their feet (2.9) compared with controls (3.5) (F1,1211 = 55.7, p < 0.001). CONCLUSIONS: Hip fractures are associated with dramatic declines in physical functioning at two years, independent of the effects of increasing age, pre-existing medical conditions and disabilities.

Activities of Daily Living↗
PubMed2000

Motorcycle engine size and risk of moderate to fatal injury from a motorcycle crash.

Current New Zealand law requires that motorcyclists with a learner or restricted licence ride a motorcycle with an engine capacity of 250 cc or less. Previous research has reported inconsistent findings regarding the relationship between cubic-capacity and risk of a crash. We sought to determine: (1) compliance with the law; (2) if the risk of an injury crash is increased for learner/restricted licence holders who do not comply with the cubic capacity regulations; and (3) whether the risk of an injury crash increases with increasing capacity of the motorcycle. A population-based case-control study was conducted in the Auckland region over a 3 year period from February 1993. Among the controls, 66% were riding motorcycles with a capacity greater than 250 cc. The percentages for those with: full, learner and restricted, and no licence were 82, 29 and 60%, respectively. There was no evidence that learner and restricted licence holders who did not comply with the cubic capacity requirement were at increased risk. It should be noted however, that 75% of those who were complying were doing so on motorcycles of 250 cc or less. Relative to motorcycles of less than 250 cc the risk of an injury crash was elevated by at least 50% for all cubic capacity categories, with the exception of the 251-499 group. There was, however, no consistent pattern of increasing risk as cubic capacity increased. The findings of this study coupled with the fact that cubic capacity is a poor measure of power suggest that, if cubic capacity was to remain the sole basis for restricting learner and restricted licence holders, consideration should be given to having a substantially lower cubic capacity than 250 cc. An analysis of risk in terms of power to weight ratio and style of motorcycle may provide a more useful insight into the benefits of motorcycle design restrictions for novice riders.

Accidents, Traffic↗
PubMed2000

Squamous cell carcinoma in esophageal remnant after 24 years: lessons learnt from esophageal bypass surgery.

Cervical esophageal carcinoma has been a vexing problem because of the multicentric nature of the disease, the common advanced stage at presentation (with invasion of important adjacent structures, especially the trachea or larynx), and difficulty in satisfactorily reconstructing pharyngogastric continuity after extensive resection. In this case report, we highlight the complexity of managing squamous cell carcinoma of the cervical esophagus, which can reappear either as a new primary or recurrence, in a retained esophageal segment 24 years after esophageal bypass surgery. We strongly recommend total esophagectomy at the time of initial surgery and not 24 years later.

Aged↗
PubMed2000

Emergi-paths and stroke teams: an emergency department approach to acute ischemic stroke.

In patients with early acute ischemic stroke (AIS), studies have shown improved recovery rates when thrombolytic therapy is appropriately initiated. However, in clinical practice, there are several barriers to rapid patient evaluation and drug administration. To facilitate the management of this population, an AIS clinical pathway, Emergi-path, was developed. Initiated at the time of the patients' arrival to the emergency department, Emergi-path provides a step-by-step guide for early care of AIS patients. A citywide stroke team plays an integral role in this process by responding to stroke codes. Implementation of an AIS pathway and activation of an organized team of stroke specialists can facilitate rapid evaluation and treatment of this high-risk population.

Aged↗
PubMed2000

Increasing age and experience: are both protective against motorcycle injury? A case-control study.

OBJECTIVES: To assess the associations between age, experience, and motorcycle injury. SETTING: Motorcycle riding on non-residential roads between 6 am and midnight over a three year period from February 1993 in Auckland, New Zealand. METHODS: A population based case-control study was conducted. Cases were 490 motorcycle drivers involved in a crash and controls were 1518 drivers identified at random roadside surveys. Crash involvement was defined in terms of a motorcycle crash resulting in either a driver or pillion passenger being killed, hospitalised, or presenting to a public hospital emergency department with an injury severity score > OR =5. RESULTS: There was a strong and consistent relationship between increasing driver age and decreasing risk of moderate to fatal injury. In multivariate analyses, drivers older than 25 years had more than 50% lower risk than those aged from 15-19 years (odds ratio (OR) 0.46; 95% confidence interval (CI) 0.26 to 0.81). In univariate analyses, a protective effect from riding more than five years compared with less than two years was observed. However, this protection was not sustained when driver age and other potential confounding variables were included in the analyses. Familiarity with the specific motorcycle was the only experience measure associated with a strong protective effect (OR (> OR =10,000 km experience) 0.52; 95% Ci 0.35 to 0.79) in multivariate analyses. CONCLUSIONS: Current licensing regulations should continue to emphasise the importance of increased age and might consider restrictions that favour experience with a specific motorcycle.

Accidents, Traffic↗
PubMed2000

Emergency department staff responses to a protocol of care for abused women.

While there is increasing recognition by health care providers of the need to identify and intervene in cases of partner abuse, there has been little evaluation of the interventions that have been implemented. This article documents emergency department staff responses to a five-step protocol of care on partner abuse implemented in a public hospital. It draws on in-depth interviews with a range of emergency department staff members, undertaken as part of the project's process evaluation. Findings suggest protocol training provided staff members with an opportunity to gain a greater awareness and understanding of partner abuse. Protocol use improved and consolidated existing practices; however, staff members were concerned about screening all women for abuse and highlighted areas in which further support and resources are required. Taking these factors into account may assist the appropriate and effective introduction of such protocols in other health care settings.

Attitude of Health Personnel↗
PubMed2000

Refractory Bacillus cereus infection in a neonate.

Bacillus cereus is a Gram-positive aerobic or facultatively anaerobic spore-forming rod, which usually causes food poisoning. Its recognition as a pathogen in neonates has increased over the past two decades. The clinical course of a neonate (gestation 24 weeks) with B. cereus infection refractory to therapy is described. Death occurred after withdrawal of support following persistently positive blood and bone marrow cultures despite therapy with vancomycin, gentamicin, imipenum, clindamycin, ciprofloxacillin, immunoglobulin and granulocyte colony stimulating factor over a period of 49 days. No obvious focus of sepsis was identified. Contamination from the environment into the hospital and clinics occurs because of the ubiquitous presence of B. cereus. Combination therapy with vancomycin and gentamycin is appropriate for meningitis/severe systemic infections related to most bacillus species. The significance of repeated isolation of B. cereus in neonates with compromised host defences is emphasised.

Anti-Bacterial Agents↗
PubMed1999

Elderly trauma patients admitted to the intensive care unit are different from the younger population.

AIMS: This study was undertaken to investigate the demographic profile of elderly (65 years old and over) patients with severe trauma admitted to the Intensive Care Unit of Auckland Hospital and to compare their characteristics with those of the younger (under 65 years) trauma patients. A further aim was to see if specific areas of potential injury prevention could be identified. METHOD: Data analysis covering ten years, from January 1987 to December 1996, on data extracted from the existing database at the Intensive Care Unit of Auckland Hospital. RESULTS: The elderly comprised 8.7% (183 of 2092) of the trauma admissions during the study period. The elderly, when compared with the younger group, were significantly more likely to be female, New Zealand European and admitted as a result of a fall. They were significantly less likely to be drivers in a road traffic crash or, if a driver, to have a blood alcohol above the legal limit. Mortality in the older group (27.8%) was significantly higher, though median injury severity score (25) and length of stay (57.9 hours) were similar. CONCLUSIONS: Elderly trauma patients in the Intensive Care Unit are a group with distinctive demographics, mechanisms of injury, injury types and outcomes. This information needs to be considered for the future planning of trauma and prevention services in New Zealand.

Age Factors↗
PubMed1999

Mortality after hip fracture: regional variations in New Zealand.

AIM: To determine the 35-day and one-year mortality rates following a hospital admission for hip fracture, among individuals aged 60 years or older in New Zealand. METHODS: New Zealand Health Information Service mortality data for the years 1988 to 1992 were examined to determine the case fatality rate among individuals aged 60 years or older admitted to hospital for fractures of the neck of femur (ICD-9 N-code 820). Case fatality rates assessed at 35 days and one year after admission to hospital were examined by age, gender, year of admission, place of residence, area health board region and cause of death. RESULTS: Between 1988 and 1992, the case fatality rate was 8% within 35 days of admission to hospital and 24% within one year of admission. Case fatality rates were found to be twice as high in men compared to women and four to five times higher in individuals aged 85 years and older, compared to people aged between 60 and 64 years. The only regional difference in hip fracture mortality was found in the Canterbury area health board region, which had a 30% higher rate of hip fracture mortality compared to all regions combined. The two main cited underlying causes of death after hip fracture were accidental falls (ICD E880-E888) and ischaemic heart disease (ICD 410-414). CONCLUSION: Over three-quarters of individuals aged 60 years or older who are hospitalised with a hip fracture in New Zealand survive for at least one year after admission. However, significant variations in mortality exist with age and gender. These data highlight the importance of preventive strategies for hip fracture in older people and the need to identify ways of improving post-admission care.

Age Distribution↗
PubMed1999

Structural valve deterioration in mitral replacement surgery: comparison of Carpentier-Edwards supra-annular porcine and perimount pericardial bioprostheses.

BACKGROUND: Bioprostheses preserved with glutaraldehyde, both porcine and pericardial, have been available as second-generation prostheses for valve replacement surgery. The performance with regard to structural valve deterioration with the Carpentier-Edwards supra-annular (CE-SAV) porcine bioprosthesis and the Carpentier-Edwards Perimount (CE-P) pericardial bioprosthesis (Baxter Healthcare Corp, Edwards Division, Santa Ana, Calif) was evaluated to determine whether there was a difference in mitral valve replacement. METHODS: The CE-SAV bioprosthesis was implanted in 1266 overall mitral valve replacements (isolated mitral, 1066; mitral in multiple, 200) and the CE-P bioprosthesis in 429 overall mitral valve replacements (isolated mitral, 328; mitral in multiple, 101). The mean age of the CE-SAV population was 64.2 +/- 12.2 years and that of the CE-P population, 60.7 +/- 11.7 years (P =.0001). For the study, structural valve deterioration was diagnosed at reoperation for explantation. RESULTS: The freedom from structural valve deterioration was evaluated to 10 years, and the freedom rates reported are at 10 years. For the overall mitral valve replacement groups, the actuarial freedom from deterioration was significant (P =.0001): CE-P > CE-SAV for 40 years or younger, 80% versus 60%; 41 to 50 years, 91% versus 61%; 51 to 60 years, 84% versus 69%; 61 to 70 years, 95% versus 75%. The older than 70-year group was 100% versus 92% (no significant difference). The actual freedom from structural valve deterioration also demonstrated the same pattern at 10 years: 40 years or younger, CE-P 82% versus CE-SAV 68%; 41 to 50 years, 92% versus 70%; 51 to 60 years, 90% versus 80%; 61 to 70 years, 97% versus 88%; and older than 70 years, 100% versus 97%. The independent risk factors of structural valve deterioration for the overall mitral valve replacement group were age and age groups and prosthesis type (CE-SAV > CE-P). The prosthesis type either in isolated replacement or in multiple replacement was not predictive of structural valve deterioration. The pathology of structural valve deterioration was different: 70% of CE-P failures were due to calcification and 57% of CE-SAV failures were due to combined calcification and leaflet tear. CONCLUSION: The actuarial and actual freedom from structural valve deterioration, diagnosed at reoperation, is greater at 10 years for CE-P than for CE-SAV bioprostheses. The mode of failure is different, and the cause remains obscure. Long-term evaluation is recommended, because the different modes of failure may alter the clinical performance by 15 and 20 years.

Adolescent↗
PubMed1999

Characteristics and behaviours associated with difficulty in performing activities of daily living among older New Zealand women.

PURPOSE: The objective of this cross-sectional study was to determine the prevalence of self-reported difficulty in performing activities of daily living (ADLs) and the associated characteristics and behaviours among older women in Auckland, New Zealand. METHODS: A sample of 569 community dwelling women aged 65 years and older were studied. Logistic regression was used to calculate odds ratios and 95% confidence intervals for the association of participant characteristics and behaviours with reported difficulty in performing > or = 1 of five basic ADLs. RESULTS: An age adjusted prevalence of 4.6% was found for reported ADL difficulty. Age > or = 85 years (odds ratio [OR] 5.9; 95% confidence interval [CI] 1.1-30.2), history of stroke (OR 9.8; 95% CI 4.1-23.3), history of > or = 1 fall in the past year (OR 3.4; 95% CI 1.6-7.4), low body mass index (OR 2.8; 95% CI 1.2-6.4), and low grip strength (OR 2.6; 95% CI 1.2-5.5) were significantly and independently associated with ADL difficulty. Among women with ADL difficulty, the prevalence of adaptive equipment use was high (> 90%). CONCLUSIONS: Several characteristics, medical conditions, and behaviours, some of which may be preventable, are associated with physical disability in older New Zealand women. Studies like this are an important step toward the development of interventions to reduce or delay disability and improve health and quality of life.

Activities of Daily Living↗
PubMed1999

Residential status and risk of hip fracture.

OBJECTIVE: to examine the association between residential status and risk of hip fracture in older people. DESIGN: population-based case-control study. SETTING: Auckland, New Zealand. SUBJECTS: a random sample of all individuals > or = 60 years, hospitalized with a fracture of the proximal femur between July 1991 and February 1994. Controls were age and gender frequency-matched to the cases, randomly selected from a random sample of general practitioners. MAIN OUTCOME MEASURES: radiographically-confirmed fracture of the proximal femur. Fractures sustained as a result of major trauma, such as in a motor vehicle crash, and those associated with pre-existing pathological conditions were excluded. RESULTS: individuals living in institutions were almost four times more likely to sustain a hip fracture [age- and gender-adjusted odds ratio (OR)=3.8; 95% confidence interval (CI): 3.0-4.8] than those living in private homes. After adjustment for potential confounding factors, the risk of hip fracture associated with living in an institution remained significantly increased (P< 0.0001), although the magnitude of the risk was somewhat diminished (OR=2.2; 95% (CI: 1.5-3.5). CONCLUSIONS: living in an institution is associated with an increased risk of hip fracture in older people. Specific factors that place these individuals at increased risk need to be identified, in order to develop intervention strategies.

Aged↗
PubMed1999

Risk factors for injuries and other health problems sustained in a marathon.

OBJECTIVES: To identify risk factors for injuries and other health problems occurring during or immediately after participation in a marathon. METHODS: A prospective cohort study was undertaken of participants in the 1993 Auckland Citibank marathon. Demographic data, information on running experience, training and injuries, and information on other lifestyle factors were obtained from participants before the race using an interviewer-administered questionnaire. Information on injuries and other health problems sustained during or immediately after the marathon were obtained by a self administered questionnaire. Logistic regression analyses were undertaken to identify significant risk factors for health problems. RESULTS: This study, one of only a few controlled epidemiological studies that have been undertaken of running injuries, has identified a number of risk factors for injuries and other health problems sustained in a marathon. Men were at increased risk of hamstring and calf problems, whereas women were at increased risk of hip problems. Participation in a marathon for the first time, participation in other sports, illness in the two weeks before the marathon, current use of medication, and drinking alcohol once a month or more, were associated with increased self reported risks of problems. While increased training seemed to increase the risk of front thigh and hamstring problems, it may decrease the risk of knee problems. There are significant but complex relations between age and risk of injury or health problem. CONCLUSIONS: This study has identified certain high risk subjects and risk factors for injuries and other health problems sustained in a marathon. In particular, subjects who have recently been unwell or are taking medication should weigh up carefully the pros and cons of participating.

Adolescent↗
PubMed1999

Culture-amplified detection of dengue virus from serum in an outbreak of dengue fever.

An outbreak of dengue type 2 occurred in North Queensland, Australia, between December 1996 and April 1997. Culture of serum in the Aedes albopictus C6/36 cell line with detection using immunofluorescent staining was compared with a culture-amplified detection system using an immunoperoxidase staining method in a microtiter plate format. A total of 374 serum specimens from individuals during the outbreak were tested. Ninety-five specimens were positive using immunofluorescence and ninety-two were positive using the immunoperoxidase method (sensitivity 91.6%; specificity 98.2%). The immunoperoxidase method is quicker, easier to perform, and does not require the use of an immunofluorescent microscope. The method is more suited to the processing of large numbers of specimens in an outbreak and could be used in endemic areas with limited virological resources.

Adult↗
PubMed1998

A qualitative investigation into the receptivity to hip protective underwear among staff and residents of residential institutions.

AIM: To explore the opinions and attitudes of staff and residents among selected licensed residential institutions in the Auckland region concerning hip protective underwear. METHOD: Six focus group discussions were held with principal nurse/managers, caregivers and residents from private hospitals, rest homes, and large combination complexes in the Auckland region. A semi-structured interview schedule about hip protective underwear was used to obtain information relating to perceived effectiveness; acceptability; identification of suitable wearers; barriers to use; and strategies to enhance use. RESULTS: Nursing staff would be willing to supervise the use of hip protective underwear and residents would be willing to wear it. Attention to certain design features could enhance overall acceptability. CONCLUSION: The findings that both staff and residents are receptive to the use of hip protective underwear as a strategy to prevent hip fractures is encouraging. Attention now needs to focus on ensuring that this product is available and accessible.

Aged↗