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Biomedical subjects

R Norton

Publications and source records attributed to R Norton.

At least 73 records · Page 4Linked to original sources
PubMed1998

Preventing falls and fall-related injuries among older people living in institutions: current practice and future opportunities.

AIMS: To identify existing falls prevention activities and support for future initiatives among residential institutions for older people. METHODS: A self-administered questionnaire was sent to all principal nurses/managers of residential institutions. Information was sought on whether falls were perceived to be a problem in the Auckland region, current falls prevention practice and interest in future prevention initiatives. RESULTS: Falls were perceived to be a problem by over 75% of 175 participating institutions. Assessments of footwear, medication use and environmental audits were the most common prevention strategies employed by over 80% of institutions. Almost 70% of institutions indicated their willingness to participate in future prevention projects. CONCLUSION: The current use of fall prevention strategies in institutions is encouraging. However, the strategies that are being employed are not consistent with current evidence about effectiveness. Increased use of vitamin D and possibly calcium supplementation needs to be encouraged as does the use of hip protectors and lower extremity strength training.

Accidental Falls↗
PubMed1998

Physical inactivity in New Zealanders aged 60 years and older.

AIMS: To determine the prevalence of physical inactivity among older New Zealanders (> or = 60 years) and to examine the patterns of physical inactivity by sex, age, residential and cognitive status. METHODS: Information on housework-related and leisure-time physical activities obtained from the 910 controls in the Auckland Hip Fracture Study, was used to determine the prevalence of inactivity. Direct standardisation was used to extrapolate the inactivity prevalence figures from the study population to the general Auckland population. Logistic regression analyses were undertaken to examine the patterns of physical inactivity by sex, age, residential and cognitive status. RESULTS: Of the study participants 48.7% did not undertake any leisure-time physical activities and 15.6% did not undertake any physical activity. Extrapolation of these data to the Auckland population indicated that 38.9% of older people do not participate in any leisure time activity and 6.1% do not partake in any physical activity. Non-participation in physical activities was shown to be greater for women (odds ratio = 1.92; 95% confidence interval: 0.98-4.07); those in the older age groups (> or = 90 years, 7.00; 1.88-45.60); those living in institutions (6.52; 4.01-10.64); and for those who were cognitively impaired (13.96; 7.06-28.92). CONCLUSION: Policies and programmes should focus on encouraging and supporting older people to become physically more active, by engaging in activities in which they enjoy participating; by educating older people as to the feasibility and benefits of physical activities, including maintenance of an independent active life; and by encouraging residents in institutions to continue their involvement in housework-related activities, such as gardening, home maintenance and general housework.

Aged↗
PubMed1998

Colonic mucosal concentrations of folate correlate well with blood measurements of folate status in persons with colorectal polyps.

BACKGROUND: Estimates of habitual dietary folate intake are known to be imprecisely correlated with systemic measures of folate status. Furthermore, measurements of blood folate concentrations may not accurately reflect the concentration of folate in tissues of interest. This issue is important for assessing folate status in the colorectal mucosa because low dietary intake or blood concentrations of folate are associated with an increased risk of colorectal neoplasia. OBJECTIVE: We examined whether conventional measures of folate in blood and a more sensitive, inverse indicator of systemic folate status, serum homocysteine, accurately reflected folate concentrations in human colonic mucosa obtained by endoscopic biopsy. DESIGN: In 30 persons with colorectal polyps, blood samples were taken and biopsies of normal rectosigmoid mucosa performed at the time of colonoscopic polypectomy. Serum, red blood cell, and colonic mucosal folate and serum homocysteine concentrations were measured. RESULTS: Serum and red blood cell folate and serum homocysteine concentrations accurately reflected colonic mucosal folate concentrations; among these, serum homocysteine correlated best with mucosal concentrations. Folate concentrations in the normal rectosigmoid mucosa were significantly lower in persons with adenomatous polyps than in those with hyperplastic polyps (P=0.04). Conventional measures of systemic folate status were not significantly lower in those with adenomas, although serum homocysteine was mildly elevated (P=0.04). CONCLUSIONS: Our data underscore the ability of systemic measures of folate status, particularly serum homocysteine, to reflect folate concentrations in the colonic mucosa. Nevertheless, future studies that examine the ability of folate to modulate colorectal carcinogenesis may benefit from direct measurement of folate in the colon.

Adenoma↗
PubMed1998

The determinants of fat intake in a multi-ethnic New Zealand population. Fletcher Challenge--University of Auckland Heart and Health Study Management Committee.

BACKGROUND: The New Zealand diet is high in total and saturated fat and this is likely to be contributing to the increasing prevalence of obesity and relatively high rates of coronary heart disease in New Zealand. The identification of subgroups with a high-fat intake will enable nutrition-related public health strategies to be better targeted. METHODS: Subjects from two surveys were included in the study: 7574 employees from a large multinational workforce survey and 2447 people aged 35-84 years selected from a stratified random sample of the electoral roll in central Auckland. Fat and saturated fat intake were assessed by short questionnaire which gave a dietary fat habits (DFH) score and supplemented by a six-item food frequency questionnaire. RESULTS: The DFH scores were higher in males than in females at all ages, and there was an inverse relationship with age which was stronger for males. Age-adjusted scores showed significantly higher DFH scores for Maori than for Europeans. Lower socioeconomic status was associated with higher DFH scores in males. Current smoking and heavy drinking (in males) were associated with significantly higher DFH scores after controlling for socioeconomic status. The results of the limited food frequency questionnaire supported the trends in DFH scores. CONCLUSIONS: The subgroups with high total and saturated fat intakes which should be a priority for public health action are young and middle-aged males, Maori and lower socioeconomic status males. The clustering of high-fat intake with smoking and heavy drinking should be considered when developing preventative strategies.

Adult↗
PubMed1998

Characterisation and molecular typing of Burkholderia pseudomallei: are disease presentations of melioidosis clonally related?

Eighteen cases of culture positive melioidosis caused by Burkholderia pseudomallei, were seen in four geographically separate communities in North Queensland, Australia. The genetic inter-relatedness of the clinical isolates were compared utilising random amplification of polymorphic DNA (RAPD) and multilocus enzyme electrophoresis (MEE). The isolates segregated into two groups that correlated with clinical presentation rather than geographical location. This is the first described association between the varied clinical presentations of this condition and specific molecular type. If proven on larger studies, this may further our understanding of the pathogenesis of this important condition.

Adolescent↗
PubMed1998

Actinobacillus equuli septicemia: an unusual zoonotic infection.

We describe the isolation of Actinobacillus equuli from the blood of a 53-year-old butcher with septicemia. This species of the genus Actinobacillus is primarily associated with animals and animal diseases, especially septicemia in foals. This is the first report of the isolation of A. equuli from a human with septicemia.

Actinobacillus↗
PubMed1998

Association of environmental tobacco smoke exposure with socioeconomic status in a population of 7725 New Zealanders.

OBJECTIVE: To test the hypothesis that environmental tobacco smoke (ETS) exposure is inversely associated with socioeconomic status. DESIGN: Survey. SETTING: General community, New Zealand. PARTICIPANTS: 7725 non-smoking adults (volunteer sample of a multi-industry workforce, n = 5564; and a random sample of urban electoral rolls, n = 2161), including 5408 males; mean age 45 years. MAIN OUTCOME MEASURES: ETS exposure was assessed as self-reported number of hours per week spent near someone who is smoking, and as prevalence of regular exposure to some ETS. Socioeconomic status was assessed as educational level, occupational status, and median neighbourhood household income. RESULTS: Both measures of ETS exposure were steeply and inversely associated with all three indicators of socioeconomic status (all p < 0.0001). Geometric mean ETS exposure ranged from 16 minutes per week among university-educated participants to 59 minutes per week in the second lowest occupational quintile (95% confidence intervals: 14-18 minutes per week and 54-66 minutes per week). The associations with occupational status and educational level were steeper than those with neighbourhood income. The socioeconomic gradients of ETS exposure were steeper among participants aged less than 35 years than among participants aged over 50 years, among men than women, and among Maori than Europeans. CONCLUSIONS: In this study population, ETS exposure was inversely associated with socioeconomic status. Greater ETS exposure might therefore contribute to the higher risks of disease and death among low socioeconomic groups. These results provide a further rationale for targeting tobacco control measures to people in low socioeconomic groups.

Adult↗
PubMed1998

Developing and implementing an intervention. Evaluation of an emergency department pilot on partner abuse.

This article discusses the role of formative and process evaluation in the development and implementation of a pilot intervention to improve the identification, treatment, and referral of women abused by their partners who present to an emergency department (ED). These evaluations were undertaken in conjunction with an outcome evaluation of training in and use of a five-step protocol of care piloted in a New Zealand public hospital. The outcome evaluation showed there was an improvement in identification and acute care of abused women following the intervention. The article highlights key factors that were relevant to the intervention's development and implementation, including social context, development processes, appropriateness for the setting, and level of support from key stakeholders. Factors identified as key to intervention effectiveness included its appropriateness for abused women and responsiveness to specific hospital, department, and staff needs. The key role of formative and process evaluation in the development and implementation of pilot interventions is highlighted, and the particular lessons gained from this study have relevance and application to other interventions.

Adolescent↗
PubMed1998

Twelve-year experience with Carpentier-Edwards PERIMOUNT pericardial valve in the mitral position: a multicenter study.

BACKGROUND AND AIMS OF THE STUDY: The study aim was to assess the durability of the Carpentier-Edwards PERIMOUNT pericardial bioprosthesis in the mitral position. METHODS: This seven-center retrospective clinical study involved the follow up of 333 patients who underwent isolated mitral valve replacement and 102 patients who underwent double (mitral and aortic) valve replacement with the PERIMOUNT pericardial valve between 1984 and 1989. Mean patient age at implant was 60.7 +/- 11.6 years; 41.1% were males. The most common etiology was rheumatic heart disease (53.9%) and the most common mechanism mitral insufficiency. All patients but six were followed for an average of 7.2 +/- 3.6 years after surgery; total follow up was 3071.7 patient-years (pt-yr). RESULTS: The total operative mortality rate was 7.6%; this included a valve-related mortality rate of 0.2%. The late mortality rate was 5.2% per pt-yr, of which 1.4% per pt-yr was considered valve-related. At 11 years, the overall actuarial survival rate was 53.3 +/- 2.8%, and actuarial freedom from valve-related death 83.9 +/- 2.6%. At follow up, 80% of patients were in NYHA class I or II, and 74% showed improvement. Twenty-eight incidences of deterioration requiring explant were observed. At 11 years the actuarial freedom from explant due to structural failure was 84.9 +/- 3.1%. Rates of structural failure decreased with age: the actuarial freedom from explant due to structural failure was 78.1 +/- 4.8% for patients aged < or = 60 years, 89.4 +/- 4.4% for those aged 61-70 years, and 100% for those aged over 71 years. CONCLUSION: The Carpentier-Edwards PERIMOUNT pericardial bioprosthesis is a reliable choice when a tissue valve is required, especially in patients over 60 years of age.

Bioprosthesis↗
PubMed1997

A computer-administered telephone interview to identify mental disorders.

CONTEXT: Common mental disorders are often not identified in primary care settings. OBJECTIVE: To evaluate the validity and clinical utility of a telephone-assisted computer-administered version of Primary Care Evaluation of Mental Disorders (PRIME-MD), a brief questionnaire and interview instrument designed to identify psychiatric disorders in primary care patients. DESIGN: Comparison of diagnoses obtained by computer over the telephone using interactive voice response (IVR) technology vs those obtained by a trained clinician over the telephone using the Structured Clinical Interview for DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition] Diagnosis (SCID). A subsample also received the clinician-administered version of PRIME-MD. PATIENTS: Outpatients (N=200) from 4 primary care clinics, an eating disorders clinic, an alcohol treatment facility, psychiatric outpatients, and community controls. SETTING: Interviews conducted by telephone, except for face-to-face administration of PRIME-MD, which was conducted at either the primary care clinic or a research clinic. MEASUREMENTS AND MAIN RESULTS: Prevalence rates for any psychiatric disorder were similar between diagnoses made by the computer and those made by a mental health professional using the SCID (60.0% vs 58.5%). Prevalence rates for individual diagnoses were generally similar across versions. However, primary care patients reported twice as much alcohol abuse on the computer (15.0%) as on either the SCID (7.5%) or the clinician-administered PRIME-MD (7.5%). Using the SCID as the criterion, both the computer- and clinician-administered versions of PRIME-MD demonstrated high and roughly equivalent levels of sensitivity and specificity. Overall agreement (K) for any diagnosis was 0.67 for the computer-administered PRIME-MD and 0.70 for the clinician-administered PRIME-MD. CONCLUSIONS: The computer-administered PRIME-MD appears to be a valid instrument for assessing psychopathology in primary care patients. Interactive voice response technology allows for increased availability, and provides primary care physicians with information that will increase the quality of patient care without additional physician time and at minimal expense.

Adult↗
PubMed1997

Socioeconomic distribution of smoking in a population of 10,529 New Zealanders.

AIMS: This study aimed to investigate the associations of several smoking variables with socioeconomic status. METHODS: Cross-sectional analyses of data about smoking behaviour and socioeconomic status (education, occupation and neighbourhood income) were performed using baseline data from the Fletcher Challenge-University of Auckland Heart and Health Study (10,529 participants). RESULTS: After adjustment for age and sex, lower educational level was associated with: (1) higher frequency of ever having smoked (65% of participants who had attended secondary school for fewer than two years, versus 43% of participants who had attended university; 2p < 0.0001); (2) lower likelihood of having quit (46% versus 71%; 2p < 0.0001); (3) higher likelihood of being a current smoker (35% versus 12%; 2p < 0.0001); (4) higher tobacco consumption per smoker (13 manufactured cigarettes/day versus 8 manufactured cigarettes/day; 2p < 0.0001); and (5) higher tobacco consumption per participant (1980 cigarette-equivalents/year versus 450 cigarette-equivalents/year; 2p < 0.0001). Similar, but shallower, associations of these smoking variables were observed with occupation and neighbourhood income (with the exception that tobacco consumption per smoker was not associated with neighbourhood income). The socioeconomic gradients of tobacco consumption per study participant with all three socioeconomic indicators were particularly steep among younger participants, men and Maori. CONCLUSIONS: Participants of low socioeconomic status consumed a disproportionately large amount of tobacco. Policies that prevent smoking initiation and promote smoking cessation in low socioeconomic groups are therefore needed. These should include targeting of mass media messages to low socioeconomic groups, public subsidisation of nicotine replacement therapy and higher taxes on tobacco.

Adult↗
PubMed1997

Emergence of further serotypes of multiple drug-resistant Streptococcus pneumoniae in Queensland.

We describe 27 cases of multiple drug-resistant pneumococcal infection in Queensland children (7 cases) and adults (20 cases), between February 1995 and October 1996. Seven patients had invasive disease. Serotypes were those commonly associated with paediatric infections and included types 19F (15 strains), 14 (6), 23F (4), 6A (1) and 19A (1). No rifampicin or vancomycin resistance was encountered. However, pneumococci fully resistant to cotrimoxazole, erythromycin and tetracycline were isolated from 25 of 27 cases (93%). Strains with high level resistance to penicillin and chloramphenicol were also recovered from 16 (59%) and 19 (70%) patients respectively. Twelve of 16 penicillin-resistant isolates showed intermediate resistance to ceftriaxone and two strains were fully resistant to this antibiotic. Clones of types 19F and 14 pneumococci, each with two distinctive resistance patterns, appear to be established in south-east Queensland.

Adult↗
PubMed1997

Regional variation in the incidence of hip fracture in New Zealand.

AIM: To determine the regional incidence of hip fracture among individuals aged 60 years or older in New Zealand. METHODS: New Zealand Health Information Service inpatient morbidity data for the years 1988-92 were examined by area health board region to identify all hip fractures (ICD N820) among individuals aged 60 years or older. RESULTS: Substantial regional variation exists in the incidence of hip fractures among older people in New Zealand. Among both men and women, similar regional variations were observed with the age-standardised rates being consistently highest in the West Coast (790 per 100,000 for women and 360 per 100,000 in men) and lowest in Northland (540 per 100,000 in women and 185 per 100,000 in men). CONCLUSION: These findings have implications for resource allocation, both in terms of targeting prevention initiatives and in providing acute and long term management of hip fracture patients. In addition, they raise questions as to why such variations in hip fracture incidence exist in New Zealand.

Aged↗
PubMed1997

Migraine: a risk factor for motor vehicle driver injury?

To test the hypothesis that migraine is associated with motor vehicle driver injury, data collected from 10,529 individuals on personal history of migraine and motor vehicle injury were analysed cross-sectionally. In multiple logistic regression analyses, the adjusted odds ratio for motor vehicle driver injury associated with migraine was 2.3 [95% confidence interval (CI) 1.9-2.7]. After excluding those who also had a history of head injury, the odds ratio was 1.5 (95% CI: 1.2-2.0). These results suggest that migraine may be associated with a 50% increase in the risk of motor vehicle driver injury and that in this population may account for as many as one in every 20 motor vehicle driver injuries. These findings require confirmation in prospective studies of motor vehicle driver injuries.

Accidents, Traffic↗
PubMed1997

The economic cost of homicide in New Zealand.

Violence has become increasingly recognised as a public health issue, with significant impact on the health of individuals. In addition, there is increasing awareness that there are substantial economic costs associated with violence. The present study estimated the economic costs associated with homicide in New Zealand, using a human capital approach. Direct costs were assessed using information on incidence and costs from government agencies, and indirect costs were assessed based on loss of productivity resulting from death. The total estimated cost of homicides in 1992 was NZ $82997065 (U.S. $53948092), averaging NZ $1012159 per homicide (U.S. $657903). This total was comprised of the estimated total cost associated with homicide victims of NZ $37017010 (U.S. $24061056) and the estimated total cost associated with homicide perpetrators of NZ $45980055 (U.S. $29887035). Limitations of the incidence data and the methods employed suggest that these costs are likely to be underestimates. Nevertheless, the figure calculated represents an enormous drain on New Zealand's economic resources.

Adolescent↗