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Biomedical subjects

D Simmons

Publications and source records attributed to D Simmons.

At least 19 recordsLinked to original sources
PubMed2006

Is grand multiparity associated with an increased risk of dysglycaemia?

AIMS/HYPOTHESIS: We sought to determine the risk of diabetes and IGT/IFG with grand multiparity. SUBJECTS, MATERIALS AND METHODS: Women, aged > or =25 years, from the Australian Diabetes, Obesity and Lifestyle Study and the Crossroads Undiagnosed Disease Study (a rural study in Victoria, Australia), participated in a household census (response 67 and 70%, respectively), subsequently attending a biomedical examination that included an oral glucose tolerance test (58% [6198] and 69% [819]). RESULTS: After adjusting for age, obesity and socio-economic status, diabetes, but not IGT/IFG, was less common among women with a parity of 1 to 2 (odds ratio [OR]=0.64 [0.48-0.84]) and 3 to 4 (OR=0.72 [0.53-0.96]) than in grand multiparous women. This relationship was unrelated to past hysterectomy, use of the oral contraceptive pill or menopausal status. CONCLUSIONS/INTERPRETATION: Grand multiparity is associated with an increased risk of diabetes but not of IGT/IFG. We postulate that parity accelerates transition from IGT/IFG to diabetes, more than it does transition from normal glucose tolerance to IGT/IFG.

Adult↗
PubMed2006

Comparison of international and New Zealand guidelines for the care of pregnant women with diabetes.

OBJECTIVE: To compare international guidelines for the care of women with diabetes and pregnancy with reported current practice among New Zealand tertiary centres. RESEARCH DESIGN AND METHODS: A literature review of national and international guidelines for the care of women with diabetes in pregnancy was undertaken. Guideline activities were placed within nine facets of care, from preconception advice, through pregnancy from screening to follow-up. New Zealand tertiary centres guidelines were obtained and placed in the same framework. RESULTS: International guideline consensus was inconsistent across most facets of care. Those for the detection and diagnosis of gestational diabetes mellitus (GDM) were particularly discordant internationally, although intranational agreement has occurred. CONCLUSIONS: International guidelines for the care of women with diabetes in pregnancy remain fragmented. The development of one set of guidelines based on the consensus of international best practice could overcome many of the misconceptions associated with diabetes in pregnancy.

Consensus↗
PubMed2006

Mortality in individuals with Type 2 diabetes and heart disease in a unique New Zealand population.

AIMS: To determine rate and predictors of mortality in patients with Type 2 diabetes living in a population with a large proportion of Maori and Pacific peoples who were admitted to hospital with myocardial infarction (MI) or congestive cardiac failure (CCF). METHODS: The study population included 4193 individuals with Type 2 diabetes who lived in South Auckland and who participated in a primary care audit between 1994 and 1999. We studied a subgroup of 319 patients who subsequently had a hospital admission for MI or CCF between 1999 and 2001. We examined their demographics, drug treatment, vascular risk factors and mortality up to 2003. RESULTS: Following discharge, the prescription of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, aspirin and statins had all increased significantly. Vascular risk factors including total cholesterol, high-density lipoprotein (HDL) cholesterol, systolic blood pressure and glycated haemoglobin (HbA(1c)) improved significantly. Nevertheless, mortality remained high with individuals admitted because of an MI 7.2-fold more likely to die early and those with a CCF admission 5.9-fold more likely to die early than other individuals with Type 2 diabetes. Maori patients have an 80% excess mortality. CONCLUSIONS: Patients with past admission for MI and/or CCF remain at exceptionally high risk of death for at least 4 years after hospital admission, even with improvements in management of cardiovascular risk factors. Maori individuals are at particular risk.

Aged↗
PubMed2006

Dental health in rural Victoria: the Crossroads Household Survey.

BACKGROUND: The aims of this study were to describe dental health and perceived barriers to dental care in a regional centre and surrounding smaller towns in rural Victoria. METHODS: A stratified, randomized, face-to-face household survey was undertaken to assess levels of edentulism and access to oral health services. A study response rate of 70.3 per cent (6316/9260) was achieved. RESULTS: When compared with those in the regional centre, people living in the shire capitals were more likely to travel greater distances to see a dentist and were less likely to have seen a dentist within the past 12 months. While there was little difference in the edentulous proportion living in shire capitals compared with the regional centre, the level of edentulousness over the entire region was greater than overall Australian estimates. Differences in perceived barriers to care within the region were less than expected. Existing perceived barriers were lack of need, time until available appointments, attitudes of dentists and lack of public dental facilities. Differences in these barriers existed between socio-economic groups. CONCLUSIONS: This study shows that the prevalence of edentulism was higher in the areas studied relative to the Australian population. Significant patient perceived barriers to care exist which may contribute to the problem.

Adolescent↗
PubMed2005

Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia.

OBJECTIVES: To establish whether choice and availability of takeaway and restaurant food consumption are associated with increased obesity. DESIGN: Crossroads Undiagnosed Disease Study: a cross-sectional study undertaken between June 2001 and March 2003. SETTING: A regional centre and six shire capitals of variables size in rural Victoria, Australia. PARTICIPANTS: In total, 1454 residents of randomly selected households. MEASUREMENTS: Obesity (by body mass index (BMI) or waist circumference), weekly recreational activity, self-reported frequency of takeaway consumption, number of local takeaway and restaurant food outlets in the area. RESULTS: The prevalence of obesity ranged from 25.5-30.8% and was higher than the general Australian population among both men and women. Those in the regional centre were less likely than those in large and small shire capitals to participate in recreational activity of 150 min or more (39.7 vs 48.4%, 46.0% respectively, P=0.023) and yet reported better access to facilities and amenities for physical activity. Recreational activity of > or =150 min/week was associated with 0.75 (0.58-0.97) fold less risk of obesity. BMI was unrelated to takeaway consumption. Waist circumference was significantly lower among those eating no takeaways, but similar whether takeaways were consumed <1/month or > or =1/week. Increased takeaway consumption was associated with increased consumption of higher fat preparations of dairy and meat products. Availability of takeaway outlets and restaurants was unrelated to obesity. CONCLUSION: The obesity epidemic exists among those without significant consumption of or availability to takeaway foods. In a setting of easy availability of food, the obesity epidemic relates strongly to reduced physical activity, but not to consumption of takeaway food.

Age Factors↗
PubMed2005

Controlling the diabetes epidemic: how should we screen for undiagnosed diabetes and dysglycaemia?

AIMS: To compare the detection of undiagnosed diabetes and dysglycaemia (impaired glucose tolerance, impaired fasting glucose, diabetes) using risk factors and laboratory measures of glycaemia. METHODS: Casual blood glucose samples were taken from 1899 (69.4% of 2737 invited) European, Maori and Pacific Islands subjects aged 40-79 years from randomly selected households in South Auckland, New Zealand. Of these, 534 attended for a 75-g oral glucose tolerance test (OGTT) if an elevated result was identified [327/478 (68.4%)] or if randomly selected with a 'normal' screening result [207/308 (67.2%)]. RESULTS: Several Europeans with undiagnosed diabetes (25.0%) and dysglycaemia (31.4%) had no diabetes risk factors. Most Maori and Pacific Islanders had at least one risk factor. The area under the receiver operating curve (ROC) for the detection of undiagnosed diabetes was 0.92 (0.89-0.95) using fasting glucose, 0.86 (0.82-0.90) using HbA1c, 0.75 (0.69-0.80) using random glucose, but 0.60 (0.55-0.66) using risk factor screening. The ROC for detecting any dysglycaemia was 0.88 (0.85-0.90), 0.68 (0.64-0.71), 0.72 (0.69-0.75), 0.61 (0.58-0.65), respectively. Screening using fasting glucose (the best test) detected 90.4% of new diabetes and 78.4% of dysglycaemia; risk factor screening followed by fasting glucose detected significantly less cases [88 (82-93)% and 86 (82-89)%, respectively] with 9.2% less OGTTs. CONCLUSIONS: Using risk factors for the identification of who should receive a blood test for dysglycaemia adds little to direct screening with the risk of missing some with significant hyperglycaemia. Screening for dysglycaemia may best be undertaken using blood tests without initial risk factor symptom screening.

Adult↗
PubMed2005

In-hospital breast feeding rates among women with gestational diabetes and pregestational Type 2 diabetes in South Auckland.

AIM: To describe the uptake of breast feeding in mothers with either Type 2 diabetes or gestational diabetes (GDM) in a hospital serving a multiethnic community in South Auckland, New Zealand. RESEARCH DESIGN AND METHODS: A retrospective study of all women attending the Diabetes in Pregnancy clinic over a 4-year period was undertaken: 30 women had Type 2 diabetes and 373 GDM. RESULTS: Compared with mothers with GDM, mothers with Type 2 diabetes were less likely to breast feed in any way as the first feed (41.4% vs. 68.0%, P = 0.011) or at discharge (69.0% vs. 84.0%, P = 0.039). In the combined group, there were no differences in uptake of breast feeding by ethnicity, age, parity, body mass index, smoking or antenatal glycaemia, use of insulin or presence of hypertension. Breast feeding on discharge was associated with a higher APGAR score, breast feeding as the first feed (78.2% vs. 19.4%, P < 0.001) and lower rates of delivery by Caesarean section (17.0% vs. 31.8%, P = 0.006). Logistic regression showed breast feeding as the first feed, the major determinant for breast feeding on discharge. CONCLUSIONS: Factors delaying breast feeding as the first feed are the major determinant of breast feeding on discharge. Strategies to increase breast feeding as the first feed among women with Type 2 diabetes, and those having a Caesarean section, may be useful in increasing the uptake of breast feeding in the longer term.

Adult↗
PubMed2004

Tale of two churches: differential impact of a church-based diabetes control programme among Pacific Islands people in New Zealand.

AIMS: To compare the impact on weight and exercise of a 2-year church-based diabetes risk reduction programme in four churches in South Auckland, New Zealand. METHODS: A prospective non-randomized controlled study of a modular lifestyle and diabetes awareness intervention programme applying community development principles. The study involved four complete church congregations, two Samoan and two Tongan, with 516 participants at commencement. Risk of Type 2 diabetes is high among both ethnic groups. RESULTS: Overall, 285 subjects were available for their second assessment. In one intervention church, weight gain was controlled (vs. control 0 +/- 4.8 vs. +3.1 +/- 9.8 kg, respectively; P=0.05), diabetes knowledge (+46 +/- 26% vs. +4 +/- 17%; P<0.001) and regular exercise (at least 3 days per week: +22% vs. -8%; P=0.032) increased and readiness to change weight (P=0.007) shifted towards maintenance (e.g. maintenance +41% vs. +8%, respectively). The other intervention church increased diabetes knowledge (+19 +/- 24 vs. +8 +/- 25; P<0.024), but no other significant personal changes occurred. Attendance and perceived utility of the programme were greater in the first intervention church. CONCLUSIONS: A moderate intensity, community-based, structured diabetes awareness and lifestyle programme can reduce diabetes risk, but increasing diabetes knowledge alone is not necessarily associated with healthier lifestyle choices. Continuous and detailed monitoring of penetration of interventions may be essential to help guide the timing of interventions and identify the need for additional strategies to increase participation and motivation.

Adolescent↗
PubMed2004

The New Zealand Diabetes Passport Study: a randomized controlled trial of the impact of a diabetes passport on risk factors for diabetes-related complications.

AIMS: To assess the efficacy (change in HbA1c) of a patient-held communication, self-empowerment and educational device for people with diabetes (the New Zealand Diabetes Passport) in patients with poor glycaemic control. RESEARCH DESIGN AND METHODS: A 12-month, multicentre, general practice-based randomized controlled trial in urban, provincial and rural New Zealand involving 398 people with poorly controlled Type 1 or Type 2 diabetes. The intervention included a specifically designed and piloted New Zealand Diabetes Passport including information relating to diabetes knowledge, self-assessments, and guidance concerning how to engage with diabetes health professionals. The primary end point was change in HbA1c. Assessments were made at 0, 6 and 12 months. RESULTS: Two hundred and twenty-two patients received the Passport, 176 the control booklet, coming from 69 and 66 general practitioners, respectively. Use of the Passport was associated with a relative reduction in HbA1c of 0.4% (P = 0.017) and a relative increase in weight of 1.0 kg/m2 (P = 0.028), but no changes in diabetes knowledge, attitudes to diabetes or risk factors for diabetic tissue damage. CONCLUSIONS: The dissemination of the New Zealand Diabetes Passport, in isolation, was not associated with improvements in either diabetes knowledge or self-empowerment. While a small improvement in glycaemic control occurred, this was probably due to changes in insulin therapy in the intervention group. It is possible that linking the use of the Passport with other behavioural and educational interventions may make the Passport more useful. Further study is required to confirm the effect of such multifaceted interventions.

Body Weight↗
PubMed2003

Impact of an integrated approach to diabetes care at the Rumbalara Aboriginal Health Service.

AIMS: To describe the effectiveness of an integrated primary-secondary care diabetes clinic on metabolic control among indigenous patients in a rural community. METHODS: A retrospective audit of attendance to the clinic over 2 years (2 August 1999 to 31 August 2001). The service included a weekly specialist diabetes clinic integrated with the primary care team at the Rumbalara Aboriginal Health Service, Mooroopna, Victoria, Australia. Between clinics, follow up was provided by the Aboriginal health worker and other members of the integrated care team. Of the 47 patients seen, 20 had an HbA1c persistently > or =9.0% (of 21 patients identified in the community) and seven had gestational diabetes. RESULTS: Among 40 patients without gestational diabetes, microalbuminuria or proteinuria were present in 62%, retinopathy was present in 50%, neuropathy was present in 50% and at least one past cardiac or vascular event/surgical procedure had occurred in 25%. Of these, the 30 patients seen more than once increased their self glucose monitoring (baseline (53.3%) vs. last visit (90%); P = 0.003) and reduced their HbA1c (10.4 +/- 2.2%vs. 7.9 +/- 1.9%; P < 0.001), systolic blood pressure (138 +/- 20 vs. 127 +/- 18 mmHg; P = 0.003) and diastolic blood pressure (78 +/- 11 vs. 73 +/- 12 mmHg; P = 0.037) and total cholesterol (6.1 +/- 1.7 vs. 5.1 +/- 1.6 mmol/L; P = 0.002), but not their weight, smoking or triglycerides. CONCLUSION: The introduction of an integrated diabetes care service in an Aboriginal health service can overcome many of the pre-existing barriers to achieving metabolic targets. Poor metabolic control in Aboriginal patients is often due to lack of resources and inappropriateness of approach, rather than "compliance".

Aged↗
PubMed2002

Genomic organization and localization of mouse Nma/BAMBI: possible implications related to ameloblastoma formation.

Our laboratory has determined the DNA sequence and transcriptional expression pattern of a mouse cDNA clone termed Nma/BAMBI. This clone encodes a highly conserved protein with 89% identity to the human homologue (termed Nma) and 78% similarity to the Xenopus homologue (termed BAMBI) at the predicted amino acid level. Nma/BAMBI encodes a 260-amino-acid transmembrane protein that has homology to the transforming growth factor (TGF) beta type I receptor family. This protein contains an extracellular ligand binding domain, a 24-amino-acid transmembrane domain, and a short intracellular domain that lacks a functional serine/threonine kinase domain. It is believed that Nma/BAMBI is important in the negative regulation of TGF beta signal transduction pathways during development and has implications in tumor progression. We have determined the genomic organization of the mouse Nma/BAMBI gene and confirmed the chromosomal mapping to human chromosome 10 and mouse chromosome 2. Furthermore, we report the production and utilization of an anti-peptide antibody in preliminary immunohistochemical analysis of an ameloblastoma.

Ameloblastoma↗
PubMed2001

CD antigens 2001.

Explore the source record for details and available documents.

Antigens, CD↗
PubMed2001

Heart disease and diabetes risk factors in Pacific Islands communities and associations with measures of body fat.

AIMS: To describe the prevalence of obesity and other coronary heart disease and Type 2 diabetes risk factors by age and ethnic group in Pacific Island communities and to determine the associations between these risk factors and body mass index. METHODS: Cross-sectional data from commuity-based intervention projects were combined to provide anthropometric, blood sample and blood pressure data on 1,175 Pacific Islands people (467 men, 708 women) aged 20 years and over from church communities in South, Central and West Auckland. Self-reported data on diabetes status and leisure-time physical activity were also collected. RESULTS: Based on an ethnic-specific mass index (BMI) cut-off (> 32 kg/m2), 45% of men and 66% of women were obese. The age-standardised prevalence of known diabetes was 12%. Men and women aged 40-60 years had the highest risk factor levels and were the most sedentary. Tongans had higher risk factor levels than Samoans. In men, BMI and waist circumference were associated (p<0.05), in the direction of greater disease risk, with blood pressure and concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and blood glucose. In women, these associations were similar but less consistent. CONCLUSIONS: While these data are not representative for all Pacific people living in New Zealand, they do show an extremely high prevalence of obesity and significant associations between obesity and other cardiovascular risk factors. These communities warrant a very high priority as part of public health efforts to address New Zealand's growing obesity epidemic.

Adolescent↗