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Biomedical subjects

A J Dobson

Publications and source records attributed to A J Dobson.

144 records · Page 8Linked to original sources
PubMed1983

Attack and case fatality rates for acute myocardial infarction in the Hunter Region of New South Wales, Australia, in 1979.

The Hunter Valley Heart Attack Study was conducted throughout 1979 to investigate all cases of suspected heart attack among permanent residents 20 to 69 years of age in a well-defined area in New South Wales, Australia. The study design followed that for the Myocardial Infarction Community Registers coordinated by the World Health Organization (WHO) in Europe and elsewhere around 1971. The attack rates obtained confirm that in Australia myocardial infarction incidence, like mortality, is high by international standards. Case fatality rates were somewhat lower than those reported elsewhere. To discover whether heart attack rates are changing with the decrease in heart disease mortality, it is proposed to carry out longitudinal surveillance in the study population. Experience with this baseline survey indicates that there may be difficulties in reliably interpreting the WHO diagnostic criteria and that changes in medical management of heart disease may affect the numbers of cases diagnosed. This highlights an epidemiologic need for clear definitions of myocardial infarction.

Adult↗
PubMed1982

Mortality from malignant melanoma in Australia: effects due to country of birth.

Mortality from malignant melanoma is much higher among native born Australians than among people born in other countries. For immigrants death rates increase with period of residence in Australia. Our analysis fails to reveal any increased risk associated with fair skin or Celtic origin. Geographic and socio-economic patterns of mortality from melanoma are similar for Australian-born individuals and those born elsewhere. These mortality difference parallel incidence patterns for the disease. Our findings support the theory that sunlight is a major determinant of melanoma and are compatible with the hypothesis that it is initiated by traumatic sunburn.

Adult↗
PubMed1982

Melanoma in New South Wales 1970-76: surgical therapy and survival.

From a survey of melanoma cases in New South Wales, a random sample was selected for histopathological review and follow up concerning surgical therapy and survival. It was found that the principal factors influencing survival were tumour thickness, level of mitotic activity and the age of the patient. The form of treatment in many cases bore little relationship to the severity of the tumour, as determined by its thickness, or to survival. It is hypothesised that survival rates would be higher and unnecessarily extensive surgery avoided if treatment were chosen with greater regard to established prognostic indicators.

Adult↗
PubMed1982

Evaluation of a diabetes education programme.

An education programme was evaluated for 140 insulin-dependent diabetics and their family members from 1978 to 1980. Dietary, biochemical and other assessments were made before and 6 months after the programme. As a group, the diabetics were initially in good metabolic control and this was maintained, or improved, over the study period. The programme recommended a diet in which complex carbohydrate constituted at least 45% of energy intake and fat was limited to 30%. The diabetics and their family members significantly increased their consumption of complex carbohydrate and decreased fat intake. On this regimen, diabetics did not gain weight and their relatives lost weight. There were also improvements in knowledge of the disorder and in perceptions of susceptibility to complications and barriers to compliance.

Attitude to Health↗
PubMed1981

Cigarette-smoking and drug use in schoolchildren in the Hunter Region, New South Wales. 1. Tobacco, alcohol and analgesic use in 10 to 12 year old primary schoolchildren (1979).

In 1979, as the first stage in the evaluation of an educational strategy designed to discourage children from smoking, we surveyed primary school children aged from 10 to 12 years in the Hunter Health Region (New South Wales) determine smoking prevalence rates. The self-report questionnaires also included questions on use of alcohol and analgesics. Our results suggest a possible decline in smoking prevalence from levels observed in earlier Australian studies. Among the smokers, over half the children claimed to smoke one brand (Winfield). Children who admitted to being regular cigarette smokers were more likely to be the children who made regular use of alcohol and analgesics.

Alcohol Drinking↗
PubMed1981

Age-specific trends in mortality from ischemic heart disease and cerebrovascular disease in Australia.

Analysis of ischemic heart disease (IHD) and cerebrovascular disease mortality rates in Australia shows that: first, deaths from IHD increased from 1950 to the mid-1960s with successive cohorts experiencing higher mortality rates. Around 1967 this trend stopped simultaneously in men over 35 years and women over 45 years and mortality rates from IHD began to decline at similar rates throughout the population. Second, deaths from cerebrovascular disease have declined in both sexes and all age groups over 35 years throughout the period 1950-1978. This change has been more pronounced for women than men. Third, the relative frequency of IHD and cerebrovascular disease as the cause of death has changed in women. IHD has become the more frequent cause of death in the older age groups. More recently this change in relative frequency has occurred in younger women as well.

Adult↗
PubMed1981

Tumour thickness and histological type in malignant melanoma in New South Wales, Australia, 1970-76.

A detailed histopathological review was made of 408 cases randomly selected from all malignant melanomata diagnosed in New South Wales, Australia, during the period 1970 to 1976. The distribution of histological types in relation to age, sex and body site was similar to those reported elsewhere. Pigmentation was also related to the histological type of the lesion. Tumour thickness was found to be strongly correlated with mitotic activity, histological type, tumour shape and lymphocytic infiltration at the centre of the lesion. Tumour thickness was also assessed in relation to the physical characteristics of the patient (age, sex and site of primary lesion). Because of the prognostic importance of tumour thickness, this objective measurement is recommended in preference to the subjective assessment of levels of invasion, and a guide to the correspondence between these two measures of severity is suggested.

Adult↗
PubMed1980

Melanoma in new South Wales 1970-1976. Confirmation of increased incidence.

A random sample of 500 cases from a total 5611 cases collected from a survey of melanoma in New South Wales, Australia, has confirmed an incidence rise which is apparent across all degrees of severity and all histogenetic classes. It therefore can be stated that the apparent increasing incidence of melanoma in New South Wales is not due to diagnostic errors. Nor is it due to inadequate registration of early melanomas in the initial years of study. The present study concludes that the increased rate of reporting of melanoma by New South Wales pathology services represents a true rise in the incidence of melanoma in the State.

Adult↗
PubMed1980

Mortality in the Hunter Region, New South Wales, 1970 to 1977.

For the past two decades, crude mortality rates for the Hunter Health Region of New South Wales have been consistently higher by about 5% than those for the State in general. This is, in part, attributable to a concentration of deaths, particularly of those from ischaemic heart disease and stroke, in two major industrial areas within the Region. Favourable modification of these mortality inequalities may be possible in some cases through legislation and education. The importance of these inequalities for planning health care resources is also discussed.

Accidents, Traffic↗
PubMed1979

Mixed-lymphocyte culture response in a related and an unrelated Australian population.

In 256 related combinations in an Australian Caucasian population, the relative responses in one-way mixed-lymphocyte cultures can be divided into four different groups: (i) HLA zero-haplotype different; (ii) HLA-D homozygous-versus-heterozygous; (iii) HLA one-haplotype different: and (iv) HLA two-haplotype different. The median relative responses of the groups were 0.78%, 20%, 64% and 86.5%, respectively; 17.7% of HLA-A, HLA-B identical siblings were found to stimulate significantly in mixed-lymphocyte culture, and 6.3% of HLA one-haplotype different combinations had weak responses. The median relative response of 225 unrelated random combinations was 100%. One mixed-lymphocyte culture combination in this group gave a relative response of 20%, which was found to be a HLA-D homozygous-versus-heterozygous response. A relative response of 20% in mixed-lymphocyte cultures may be taken to indicate relative HLA-D compatibility and would, therefore, predict a favourable outcome in kidney transplantation. The use of mixed-lymphocyte cultures as a routine in selecting suitable donors in living related transplants and, retrospectively, in monitoring the results of cadaveric transplants, is advocated.

Graft Survival↗
PubMedDate not supplied

Underuse of beta-blockers following myocardial infarction: a tale of two cities.

AIMS: To measure factors associated with underuse of beta-blocker therapy after myocardial infarction (MI). METHODS: The Newcastle and Perth collaborating centres of the World Health Organization (WHO) MONICA project (to MONItor trends and determinants of Cardiovascular disease) systematically evaluated all patients admitted to hospital in their respective regions with possible MI. A total of 1766 patients in Newcastle and 4,503 patients in Perth, discharged from hospital after confirmed MI from 1985 to 1993, were studied. Rates of beta-blocker use before and after hospital discharge were evaluated and correlates of beta-blocker use determined. RESULTS: Beta-blocker use was similar in Newcastle and Perth before MI (21% of patients in each centre). During hospital admission, beta-blocker therapy was initiated nearly twice as frequently in Perth compared with Newcastle (66 vs 36%, respectively) and more patients were discharged from hospital on beta-blockers in Perth (68%) than in Newcastle (45%). The main factors associated with underuse of beta-blockers in multivariate analysis were geographical centre (odds ratio (OR) for Newcastle compared with Perth 0.3; 95% confidence interval (CI) 0.3-0.3), a history of previous MI (OR 0.6, 95% CI 0.5-0.7), admission to hospital in earlier years (OR 0.4, 95% CI 0.3-0.4 for years 1985-87 compared with years 1991-93), diabetes (OR 0.6, 95% CI 0.5-0.8) and the concomitant use of diuretics (OR 0.5, 95% CI 0.4-0.6) and calcium antagonists (OR 0.6, 95% CI 0.5-0.8). CONCLUSIONS: Underuse of beta-blockers after MI was strongly related to hospital prescribing patterns and not to community use of beta-blockers. Underuse occurred in patients with diabetes and in patients with left ventricular dysfunction, patients who stand to benefit most from beta-blocker use following MI.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Can ECG changes predict the long-term outcome in patients admitted to hospital for suspected acute myocardial infarction?

7,028 patients with suspected acute myocardial infarction and discharged alive from hospital were followed in a 10-year community-based study. The long-term prognosis was relatively good if the electrocardiograms (ECGs) were normal (5-year all-cause death rate 5%), poor with uncodable ECGs showing rhythm or conduction disturbances (37%), and intermediate with new Q wave, new ST elevation, new T wave inversion or ischemic ECG (17-21%), and with new ST depression (27%). Similar patterns were found for ischemic cardiac death and reinfarction. The long-term prognosis of patients with suspected acute myocardial infarction is relatively good if the ECGs are normal and poor if ECGs are uncodable. ST depression may be a marker for a worse long-term outcome.

Adult↗
PubMedDate not supplied

Heart attacks and the Newcastle earthquake.

OBJECTIVE: To test the hypothesis that stress generated by the Newcastle earthquake led to increased risk of heart attack and coronary death. DESIGN: A natural experiment. SUBJECTS: People living in the Newcastle and Lake Macquarie local government areas of New South Wales, Australia. INTERVENTION: At 10.27 a.m. on 28 December 1989 Newcastle was struck by an earthquake measuring 5.6 on the Richter scale. OUTCOME MEASURES: Myocardial infarction and coronary death defined by the criteria of the WHO MONICA Project and hospital admissions for coronary disease before and after the earthquake and in corresponding periods in previous years. Well established, concurrent data collection systems were used. RESULTS: There were six fatal myocardial infarctions and coronary deaths among people aged under 70 years after the earthquake in the period 28-31 December 1989. Compared with the average number of deaths at this time of year this was unusually high (P = 0.016). Relative risks for this four-day period were: fatal myocardial infarction and coronary death, 1.67 (95% confidence interval [Cl]: 0.72, 3.17); non-fatal definite myocardial infarction, 1.05 (95% Cl: 0.05, 2.22); non-fatal possible myocardial infarction, 1.34 (95% Cl: 0.67, 1.91); hospital admissions for myocardial infarction or other ischaemic heart disease, 1.27 (95% Cl: 0.83, 1.66). There was no evidence of increased risk during the following four months. CONCLUSION: The magnitude of increased risk of death was slightly less than that previously reported after earthquakes in Greece. The data provide weak evidence that acute emotional and physical stress may trigger myocardial infarction and coronary death.

Adult↗
PubMedDate not supplied

The epidemiology of dog walking: an unmet need for human and canine health.

OBJECTIVE: To describe the prevalence of dog walking in New South Wales, and to identify potential health gains if more dogs were walked. DESIGN: Cross-sectional analytical survey. SETTING AND PARTICIPANTS: 894 adults in NSW in 1998 (among the owners of approximately two million domestic dogs in NSW who were potential participants in dog-walking behaviours). INTERVENTIONS: None yet. MAIN OUTCOME MEASURES: Dog walking hours per week; other DogEpi concepts to illustrate the public health gains include the DAF (dog attributable fraction), and the BBR (benefits to bites ratio). RESULTS: The response rate to the survey was 74%. 46% of households in NSW had a dog and, overall, dog owners walked 18 minutes per week more than non-dog owners. However, more than half of dog owners did not walk their dogs, and were less likely than non-owners to meet recommended levels of physical activity sufficient for health benefits. If all dog owners walked their dogs, substantial disease prevention and healthcare cost savings of $175 million per year might accrue. CONCLUSIONS: There are potential benefits of dog walking for human health; currently, among dog owners, much of this benefit remains to be realised. There are also likely benefits for canine health. Dog walking should be promoted through national strategies recommending "Walkies for all by the year 2010".

Adult↗