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Anthony Rodgers

Publications and source records attributed to Anthony Rodgers.

51 records · Page 3Linked to original sources
PubMed2003

Comparative quantification of health risks conceptual framework and methodological issues.

Reliable and comparable analysis of risks to health is key for preventing disease and injury. Causal attribution of morbidity and mortality to risk factors has traditionally been conducted in the context of methodological traditions of individual risk factors, often in a limited number of settings, restricting comparability.In this paper, we discuss the conceptual and methodological issues for quantifying the population health effects of individual or groups of risk factors in various levels of causality using knowledge from different scientific disciplines. The issues include: comparing the burden of disease due to the observed exposure distribution in a population with the burden from a hypothetical distribution or series of distributions, rather than a single reference level such as non-exposed; considering the multiple stages in the causal network of interactions among risk factor(s) and disease outcome to allow making inferences about some combinations of risk factors for which epidemiological studies have not been conducted, including the joint effects of multiple risk factors; calculating the health loss due to risk factor(s) as a time-indexed "stream" of disease burden due to a time-indexed "stream" of exposure, including consideration of discounting; and the sources of uncertainty.

Journal Article↗
PubMed2003

Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk.

BACKGROUND: Cardiovascular disease accounts for much morbidity and mortality in developed countries and is becoming increasingly important in less developed regions. Systolic blood pressure above 115 mm Hg accounts for two-thirds of strokes and almost half of ischaemic heart disease cases, and cholesterol concentrations exceeding 3.8 mmol/L for 18% and 55%, respectively. We report estimates of the population health effects, and costs of selected interventions to reduce the risks associated with high cholesterol concentrations and blood pressure in areas of the world with differing epidemiological profiles. METHODS: Effect sizes were derived from systematic reviews or meta-analyses, and the effect on health outcomes projected over time for populations with differing age, sex, and epidemiological profiles. Incidence data from estimates of burden of disease were used in a four-state longitudinal population model to calculate disability-adjusted life years (DALYs) averted and patients treated. Costs were taken from previous publications, or estimated by local experts, in 14 regions. FINDINGS: Non-personal health interventions, including government action to stimulate a reduction in the salt content of processed foods, are cost-effective ways to limit cardiovascular disease and could avert over 21 million DALYs per year worldwide. Combination treatment for people whose risk of a cardiovascular event over the next 10 years is above 35% is also cost effective leading to substantial additional health benefits by averting an additional 63 million DALYs per year worldwide. INTERPRETATION: The combination of personal and non-personal health interventions evaluated here could lower the global incidence of cardiovascular events by as much as 50%.

Adolescent↗
PubMed2003

Leg ulceration as a long-term complication of deep vein thrombosis.

OBJECTIVE: To evaluate the role of deep vein thrombosis as a cause of leg ulcers. PATIENTS AND METHODS: A population-based, case-control study was conducted in Central and North Auckland, New Zealand. Cases comprised 241 people aged 40 to 99 years and on the electoral roll, with current leg ulcers (all types). Cases were identified by means of notification from health professionals and by self-referral. Controls were 224 people in the same age group, without leg ulcers, who were selected from the electoral roll by using a stratified random sampling process. MAIN OUTCOME MEASURES: The occurrence of leg ulceration as a consequence of exposure to deep vein thrombosis or being at high risk of deep vein thrombosis (that is, people with a family history of deep vein thrombosis, and/or a history of leg fracture and/or hip, leg, or foot surgery). RESULTS: After adjustment for age, sex, and other potential confounding factors, people who had a diagnosed thromboembolism were at almost three times higher risk of having a leg ulcer (odds ratio, 2.92; 95% confidence interval (CI), 1.47 to 6.08). In addition, people who had been at high risk of a venous thrombosis but were not diagnosed with this condition (eg, people with a history of major leg surgery) were also at increased risk of ulceration (odds ratio, 2.25; 95% CI, 1.49-3.42). Overall, 56% (95% CI, 33% - 71%) of leg ulcers were attributed to being at high risk of deep vein thrombosis. CONCLUSIONS: Deep vein thrombosis and factors that place people at high risk of deep vein thrombosis are an important cause of leg ulcers in older people. This finding strengthens the rationale for the routine and long-term use of thromboprophylaxis, particularly in high-risk patients.

Adult↗
PubMed2002

Selected major risk factors and global and regional burden of disease.

BACKGROUND: Reliable and comparable analysis of risks to health is key for preventing disease and injury. Causal attribution of morbidity and mortality to risk factors has traditionally been in the context of individual risk factors, often in a limited number of settings, restricting comparability. Our aim was to estimate the contributions of selected major risk factors to global and regional burden of disease in a unified framework. METHODS: For 26 selected risk factors, expert working groups undertook a comprehensive review of published work and other sources--eg, government reports and international databases--to obtain data on the prevalence of risk factor exposure and hazard size for 14 epidemiological regions of the world. Population attributable fractions were estimated by applying the potential impact fraction relation, and applied to the mortality and burden of disease estimates from the global burden of disease (GBD) database. FINDINGS: Childhood and maternal underweight (138 million disability adjusted life years [DALY], 9.5%), unsafe sex (92 million DALY, 6.3%), high blood pressure (64 million DALY, 4.4%), tobacco (59 million DALY, 4.1%), and alcohol (58 million DALY, 4.0%) were the leading causes of global burden of disease. In the poorest regions of the world, childhood and maternal underweight, unsafe sex, unsafe water, sanitation, and hygiene, indoor smoke from solid fuels, and various micronutrient deficiencies were major contributors to loss of healthy life. In both developing and developed regions, alcohol, tobacco, high blood pressure, and high cholesterol were major causes of disease burden. INTERPRETATION: Substantial proportions of global disease burden are attributable to these major risks, to an extent greater than previously estimated. Developing countries suffer most or all of the burden due to many of the leading risks. Strategies that target these known risks can provide substantial and underestimated public-health gains.

Adult↗
PubMed2002

Leg ulcers in New Zealand: age at onset, recurrence and provision of care in an urban population.

AIM: To describe the age at onset, recurrence rate, and provision of care for people with leg ulcers in New Zealand. METHODS: Between 1997 and 1998, people with current leg ulcers were identified from the North Auckland and Central Auckland health districts via notification from relevant health professionals and by self-referral. All ulcer types were investigated. Identified cases, aged between 40 and 99 years and on the general electoral roll, were interviewed as part of a case-control study. Descriptive information relating to interviewed cases is presented. RESULTS: 241 people with leg ulcers were interviewed. The average age was 75 years and almost 60% were women. The average age at ulcer onset was 65 years, 59% of people had recurrent ulcers, and 24% had been hospitalised in the last five years because of their leg ulcers. Those people with recurrent leg ulcers had lived with their condition for an average of fifteen years, with an average time to healing for their last ulcer of thirteen months. Treatment of this condition was largely community-based, with 136 different treatment options employed. CONCLUSIONS: Leg ulceration remains a chronic and recurring condition, with substantial practice variation in terms of treatment. Urgent attention needs to be given to the management of leg ulcer patients in this country, particularly given that New Zealand has a rapidly ageing population.

Adult↗
PubMed2002

The occurrence of leg ulcers in Auckland: results of a population-based study.

AIM: To estimate the cumulative incidence rate and prevalence of leg ulcers in Auckland. METHODS: A cross-sectional study was conducted to identify all individuals who had or developed a leg ulcer in the North Auckland and Central Auckland health districts between 1997 and 1998. Cases were identified through multiple sources, including community-based and hospital-based health professionals and by self-notification. All ulcer types were investigated. RESULTS: 611 individuals with healed or current leg ulcers were identified during the study period, of whom 426 had current leg ulcers. The annual cumulative incidence rate was 32 per 100,000. The point prevalence of current leg ulcers was 39 per 100,000, with a period prevalence of 79 per 100,000 per year. Men had lower age-adjusted incidence rates than women, but a higher age-adjusted point prevalence of leg ulceration, indicating that ulcers take longer to heal in men. Annual cumulative incidence rates increased steeply with age (< 60 years = 4, 60-69 years = 62, 70-79 years = 191, 80+ years = 466 per 100,000 per year), as did point prevalence (< 60 years = 5, 60-69 years = 76, 70-79 years = 238, 80+ years = 564 per 100,000). CONCLUSIONS: These data indicate that the risk of developing leg ulcers increases dramatically with age, with individuals aged 60 years and over particularly at risk. Given New Zealand's rapidly ageing population, the number of older people with leg ulcers each year is expected to double in the next 25 years.

Adolescent↗
PubMed2002

Changing patterns of pharmacological thromboprophylaxis use by orthopaedic surgeons in New Zealand.

BACKGROUND: A survey conducted in 1992 found that New Zealand orthopaedic surgeons relied on non-pharmacological methods of deep vein thrombosis prevention in most arthroplasty patients and almost all hip fracture patients. This survey was repeated in 1999 to ascertain whether this pattern of use had changed. METHODS: All orthopaedic consultants in New Zealand who performed hip or knee surgery in 1999 were asked to complete a one-page postal questionnaire, asking for information regarding: the frequency with which chemoprophylaxis was employed in patients undergoing surgery for hip fracture, hip arthroplasty, or knee arthroplasty; the drug regimes used; the factors that influenced the choice of chemoprophylaxis;and the factors that limited chemoprophylaxis use in orthopaedic practice. RESULTS: Between 1992 and 1999, the proportion of patients given chemoprophylaxis increased from 3% to 25% for patients with hip fracture, and from 32% to 57% for elective arthroplasty patients. The proportion of surgeons using low molecular weight heparin increased over the 7-year period from 55% to 76%,while aspirin use remained stable at 7% and standard heparin and warfarin decreased to less than 5%. There was a shift away from starting chemoprophylaxis preoperatively towards continuing until discharge, rather than until the patient was mobile. Opinions on indications and contraindications for chemoprophylaxis had not changed substantially during the 7-year period. CONCLUSIONS: Orthopaedic surgeons' use of chemoprophylaxis has increased in New Zealand. However, since hospital stays have decreased considerably and most orthopaedic patients are now discharged within a fortnight,prophylaxis may now cover a shorter duration of the at-risk period.

Anticoagulants↗
PubMed2002

The emerging role of induced hypothermia in the management of acute stroke.

Current treatment of acute stroke remains unsatisfactory. This review presents experimental and clinical data which suggest that mild induced hypothermia could be a potent and practicable neuroprotective treatment of acute ischaemic stroke and intracerebral haemorrhage. Hypothermia, if proven to be safe, effective and widely practicable in patients with acute stroke, could have an enormous positive impact on reducing the burden of stroke worldwide. Critical issues that will need to be considered in a well designed randomised controlled trial of induced hypothermia in acute stroke patients are discussed.

Acute Disease↗
PubMed2002

Blood pressure and coronary heart disease: a review of the evidence.

Overviews of randomized controlled trials and prospective observational studies provide the most reliable data on the association between blood pressure and coronary heart disease (CHD). The totality of evidence indicates a strong association between blood pressure and CHD, which is continuous down to levels of at least 115 mm Hg systolic. Overall, for those 60 to 69 years of age, a 10 mm Hg lower systolic blood pressure is associated with about one-fifth lower risk of a CHD event. The size and shape of this association is consistent across regions, for males and females, and for fatal events as well as nonfatal myocardial infarction. Trials comparing active treatment to placebo or no treatment have demonstrated that the benefits of blood pressure lowering with different classes of drugs (e.g., diuretics, beta-blockers, ACE inhibitors, calcium antagonists) are broadly similar, with approximately one-fifth reduction in CHD. ACE inhibitors achieve this with relatively modest blood pressure reductions, but the size of the reduction for calcium antagonists remains uncertain and appears somewhat less than expected from the blood pressure reduction. Trials confirm the expectation from cohort studies of benefits increasing with the amount of blood pressure lowering, and benefit accruing among those with average or even below average blood pressure. Observational data suggest that the proportional association is attenuated with age, but attenuation is less evident in trial data. However, in both cohort studies and clinical trials, CHD risk differences associated with a given blood pressure difference increase with age. The important points to emerge from this review are, first, that the relative benefits of blood pressure lowering for CHD prevention are likely to be consistent across a range of different populations. Second, there is likely to be considerable benefit with blood pressure lowering below "traditional" hypertension thresholds, especially in those with high absolute risk. Third, initiating and maintaining the maximum tolerated blood pressure reduction is a more important issue than choice of initial agent. Finally, and most importantly, the large majority of people have suboptimal blood pressure (e.g., systolic > 115 mm Hg) and so initiatives to lower blood pressure population-wide are an essential adjunct to targeted treatment programs.

Adult↗
PubMed2002

Does capture-recapture analysis provide more reliable estimates of the incidence and prevalence of leg ulcers in the community?

OBJECTIVE: To determine whether capture-recapture analysis provides more reliable estimates of the cumulative incidence and prevalence of leg ulcers in Auckland, New Zealand. METHODS: A population-based, cross-sectional study was conducted in the Central and North Auckland health districts of New Zealand in 1998. Cases were identified through health professional referral and by self-notification. All ages and ulcer types were investigated. Both traditional and capture-recapture methods of analysis were used to estimate the cumulative incidence and prevalence of leg ulcers in the study population. RESULTS: Four hundred and twenty-six people with current leg ulcers were identified during the 12-month study period. Using traditional methods of analysis, the annual cumulative incidence rate of leg ulcers in Auckland was 32 per 100,000, with a point prevalence of 39 per 100,000 and a period prevalence of 79 per 100,000 per year. Results from capture-recapture analysis, however, suggest an annual cumulative incidence rate of 252 per 100,000, with a point prevalence of 248 per 100,000 and a period prevalence of 530 per 100,000 per year. CONCLUSIONS: The traditional method of calculating cumulative incidence and prevalence clearly under-estimates the frequency of leg ulcers in the Auckland region. Capture-recapture analysis provides a more reliable estimate of disease frequency, since cases that remain unidentified in the population are considered.

Adolescent↗
PubMedDate not supplied

Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk.

In this review, we outline the rationale for targeting blood pressure and blood cholesterol lowering drug treatments to patients at high absolute cardiovascular risk, irrespective of their blood pressure or blood cholesterol levels. Because the specific levels of blood pressure and cholesterol are of little clinical relevance when considered in isolation from other risk factors, terms such as hypertension or hypercholesterolaemia have limited value. Separate management guidelines for raised blood pressure and blood cholesterol need to be replaced by integrated cardiovascular risk management guidelines, and absolute cardiovascular risk prediction scores should be used routinely. Since cardiovascular risk factors interact with each other, moderate reductions in several risk factors can be more effective than major reductions in one. An affordable daily pill combining low doses of various drugs could be useful for the many individuals with slightly abnormal cardiovascular risk factors.

Adult↗
PubMedDate not supplied

Cardiovascular risk factors after antenatal exposure to betamethasone: 30-year follow-up of a randomised controlled trial.

BACKGROUND: Antenatal betamethasone treatment is widely used for the prevention of neonatal respiratory distress syndrome in preterm infants and substantially reduces neonatal mortality and morbidity. Fetal exposure to excess glucocorticoids has been proposed as one of the core mechanisms of the fetal origins of adult disease hypothesis. We assessed whether antenatal exposure to betamethasone for the prevention of neonatal respiratory distress syndrome affects cardiovascular risk factors at 30 years of age. METHODS: We followed up at age 30 years 534 individuals whose mothers participated in a double-blind, placebo-controlled, randomised trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome. Mothers received two doses of betamethasone or placebo given by intramuscular injection 24 h apart. Follow-up assessments included anthropometry; measurement of blood pressure, blood lipids (after overnight fasting), and early morning cortisol levels; and a 75 g oral glucose tolerance test. FINDINGS: There were no differences between those exposed to betamethasone and to placebo in body size, blood lipids, blood pressure, plasma cortisol, prevalence of diabetes, or history of cardiovascular disease. After a 75 g oral glucose tolerance test, participants exposed to betamethasone had higher plasma insulin concentrations at 30 min (60.5 vs 52.0 mIU/L; ratio of geometric means 1.16 [95% CI 1.03 to 1.31], p=0.02) and lower glucose concentrations at 120 min (4.8 vs 5.1 mmol/L; difference -0.26 mmol/L [-0.53 to 0.00], p=0.05) than did those exposed to placebo. INTERPRETATION: Antenatal exposure to betamethasone might result in insulin resistance in adult offspring, but has no clinical effect on cardiovascular risk factors at 30 years of age. Thus, obstetricians should continue to use a single course of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome.

Adult↗
PubMedDate not supplied

Efficacy and tolerability of finasteride 1 mg in men aged 41 to 60 years with male pattern hair loss.

A 24-month double-blind, randomized, placebo-controlled, parallel-group, multicenter study of 424 men was conducted to determine the efficacy and tolerability of finasteride 1 mg on hair growth/loss in men aged 41 to 60 years with mild-to-moderate, predominantly vertex male pattern hair loss. Efficacy was evaluated by review of global photographs of the vertex scalp taken at baseline and at Months 6, 12, 18, and 24 and by patient self-assessments and investigator clinical assessments of change from baseline in hair growth/loss collected at Months 6, 12, 18, and 24. Safety analyses included assessment of clinical and laboratory adverse experiences, including sexual adverse experiences. Analysis of global photographic assessment data showed significant improvement in hair growth for men in the finasteride group compared with those taking placebo beginning at Month 6 (p < 0.001) and maintained through Month 24 (p < 0.001). Results of the patient self-assessment and investigator assessments were consistent with those from the global photographic assessment. Finasteride 1 mg improved scalp hair growth in men aged 41 to 60 years with predominantly vertex male pattern hair loss compared with results seen with placebo. Improvement was evident by 6 months of treatment and continued through 24 months. Treatment with finasteride 1 mg was generally well tolerated.

Adult↗