Asthma, the general practitioner and the divisions.
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Asthma↗
Biomedical subjects
J Beilby
Publications and source records attributed to J Beilby.
Vitamin A and cancer prevention I: observations in workers previously exposed to asbestos at Wittenoom, Western Australia.
Our aim was to describe a vitamin A-based cancer prevention program for former asbestos workers and to check for possible harmful effects by comparing rates of disease and death in study subjects with subjects who chose not to join. All subjects had been occupationally exposed to crocidolite at Wittenoom Gorge between 1943 and 1966; 1,677 subjects indicated interest in the program and 1,203 joined between June 1990 and May 1995. Comparison subjects consisted of 996 former workers known to be alive in Western Australia in 1990 who did not join the program. Program subjects were provided with annual supplies of vitamin A (either synthetic beta-carotene or retinol), help in quitting smoking and dietary advice. The comparison group received only mail contact. Both groups were followed up to December 1994 for vital status and cancer information, and rates of cancer and death from various causes were compared. Mortality in both groups was higher than expected (standardised mortality ratio 1.23 in program subjects and 1.67 in comparison subjects). After adjustment for age, smoking and asbestos exposure, the relative rates in participants compared with non-participants was below I for all examined cancers and causes of death. For mesothelioma and lung cancer, group differences increased with time from entry, whereas other differences dissipated with time. No significant side effects were reported. In conclusion, program participants had significantly lower mortality than non-participants, but the rates of the 2 groups converged with time.
Adult↗
Vitamin A and cancer prevention II: comparison of the effects of retinol and beta-carotene.
Former blue asbestos workers known to be at high risk of asbestos-related diseases, particularly malignant mesothelioma and lung cancer, were enrolled in a chemo-prevention program using vitamin A. Our aims were to compare rates of disease and death in subjects randomly assigned to beta-carotene or retinol. Subjects were assigned randomly to take 30 mg/day beta-carotene (512 subjects) or 25,000 IU/day retinol (512 subjects) and followed up through death and cancer registries from the start of the study in June 1990 till May 1995. Comparison between groups was by Cox regression in both intention-to-treat analyses and efficacy analyses based on treatment actually taken. Median follow-up time was 232 weeks. Four cases of lung cancer and 3 cases of mesothelioma were observed in subjects randomised to retinol and 6 cases of lung cancer and 12 cases of mesothelioma in subjects randomised to beta-carotene. The relative rate of mesothelioma (the most common single cause of death in our study) for those on retinol compared with those on beta-carotene was 0.24 (95% CI 0.07-0.86). In the retinol group, there was also a significantly lower rate for death from all causes but a higher rate of ischaemic heart disease mortality. Similar results were found with efficacy analyses. Our results confirm other findings of a lack of any benefit from administration of large doses of synthetic beta-carotene. The finding of significantly lower rates of mesothelioma among subjects assigned to retinol requires further investigation.
Adult↗
In vitro growth inhibition of Plasmodium falciparum by retinol at concentrations present in normal human serum.
To assess the in vitro effect of retinol on Plasmodium falciparum, the standard isolates 3D7, D10, W2 and K1 in continuous culture were exposed to retinol added in concentrations ranging from 10(-7) to 0.1 mumol/l. Parasite growth inhibition was assessed from 3H-hypoxanthine incorporation. Triplicate experiments were performed at physiological pH and in the case of D10, additional experiments were performed at pH 7.2 and 7.6. Final media retinol concentrations were assayed using high performance liquid chromatography. Retinol inhibited growth of both asynchronous and synchronous cultures of 3D7 and D10 and asynchronous cultures of W2 and K1. IC50 values determined from assayed media concentrations ranged from 0.2 to 3.9 mumol/l and were comparable to concentrations in normal human serum (1.0-3.0 mumol/l). IC50 values for asynchronous D10 cultures at pH 7.2 were lower than at pH 7.4 or 7.6 (0.5, 3.9 and 5.0 mumol/l, respectively); results from synchronous cultures were similar. These data suggest that P. falciparum is a retinol-sensitive parasite, especially at pH levels equivalent to those in an acidotic patient. Adjunctive retinol therapy may have a role in clinical management of malaria.
Animals↗
Diabetes complications and risk factors in an Australian population. How well are they managed?
BACKGROUND: This study aimed to explore the relationship between complications and risk factors in the type 2 diabetes population, and to assess the level of assistance people with diabetes receive in controlling their risk factors. METHODS: Participants were recruited from representative population surveys of South Australians aged over 18 years. Participants were asked a series of questions about their risk factors and the advice and assistance they received from their general practitioner (GP) in modifying their risk factors. Additionally, participants were clinically tested for a number of macro and microvascular complications. RESULTS: South Australians with type 2 diabetes have a high prevalence of risk factors, with the majority being overweight or obese, doing no vigorous exercise and having high blood pressure. They also have a high prevalence of complications, with 53% having at least one macrovascular complication and 66% having at least one microvascular complication. Additionally, participants reported high levels of GP advice and assistance on the risk factors where pharmacological controls were available, but low levels of assistance where non-pharmacological interventions were needed to control the risk factor. CONCLUSIONS: The prevalence of diabetes risk factors and complications among South Australians with type 2 diabetes is a cause for concern, as is the lack of assistance offered by GPs to modify risk factors. Multi-disciplinary approaches to the control of risk factors and patient self-management and education are critical to the progression and success of diabetes care.
Adult↗
Economic analysis and general practice.
At this time innovation in general practice service delivery is being extensively explored and critically examined as a means of improving efficiency. It is important that general practitioners are actively involved in the debate and utilise techniques that allow detailed, logical and robust judgments to be formulated. Economic analysis is one important tool that can contribute to these judgments. The aim of this article is to provide a brief overview of the concepts and methods used.
Costs and Cost Analysis↗
The national asthma audit. Bridging the gap between guidelines and practice.
OBJECTIVE: This pilot study was undertaken to assess the need and acceptability of a theoretically based audit model to assist GPs improve their asthma care. METHOD: Seventeen GPs from two GP divisions conducted a chart audit and patient survey of asthma patients presenting during the 8 week audit period. Audit results were discussed at a workshop providing a forum for GP peer groups to review their asthma care against current guidelines. This workshop allowed the GPs to develop strategies to improve their asthma care in the context of the resources of their individual practice, GP division, local community and health services. RESULTS: Of the 243 asthma patients audited 177 (72.8%) had a review of their asthma recorded in the past 12 months, 138 (56.8%) were prescribed regular preventive therapy and 118 (48.2%) had been given an asthma action plan. Despite the time commitment required to participate in the activity, 16 respondents who answered the audit evaluation questionnaire reported that the audit was a useful process and 15 (93.8%) stated that it had motivated them to change their practice. CONCLUSION: The results confirmed the need for improved asthma care in general practice and demonstrated the feasibility of the GP-peer led, regionally coordinated, audit-workshop model.
Adult↗
Risk factors for repeat attendance at hospital emergency departments among adults and children with asthma.
BACKGROUND: Acute asthma attacks are frequent causes of attendance at hospital Emergency Departments (EDs) and a subgroup of these patients repeatedly present for such treatment. AIMS: This study sought to characterise patients who were repeat attenders at EDs, to assist the targetting of appropriate future interventions aimed at reducing avoidable presentation. METHODS: A cross-sectional survey was undertaken of patients presenting with an asthma attack to the EDs of six teaching hospitals in Adelaide, South Australia between 14 May and 30 June 1994. Patients were interviewed within six weeks of their attendance about aspects of their asthma history, severity, medications, self-management, attitudes and environment. Repeat attenders, defined as two or more visits over the course of the preceding year, were compared with those who reportedly attended on one occasion only, using logistic regression analyses. RESULTS: Sixty-two per cent of 272 patients aged under 15 years and 40% of 165 patients aged 15 years or more reported having attended two or more times over the course of the preceding year. Among adults, the variables independently associated with repeat attendance principally related to asthma severity. Among children, repeat attendance was associated with parental attitudinal variables relating to appraisal of their child's asthma severity, management of asthma attacks and parental worry. CONCLUSIONS: The factors underlying repeated presentations at EDs differ between adults and children and interventions to minimise avoidable presentation will require different emphasis for these patient subgroups.
Adolescent↗
A risk screening questionnaire for adult asthmatics to predict attendance at hospital emergency departments. South Australian Asthma Reference Panel.
STUDY OBJECTIVES: To develop a practical screening tool that could identify adult patients highly likely to attend a hospital emergency department (ED) in a 1-year period. DESIGN: Retrospective case-control study of patients who did and did not attend a hospital ED for asthma in the past year. SETTING: Adelaide, South Australia. PARTICIPANTS: One hundred sixty-five adults attending an ED for asthma were compared with 260 adults with asthma from a community survey who had not attended an ED in the previous year. MEASUREMENTS AND RESULTS: The following variables were independently related to ED attendance: having been woken from sleep by asthma in past month; having been admitted to hospital because of asthma in the past year; having seen more than one general practitioner for asthma in the last 12 months; a moderate or severe self-rating of asthma in the last month; and having taken oral steroid medication for asthma in past month. A risk screening questionnaire using the weighted responses to these five variables with a cutoff score of 30/100 demonstrated a sensitivity of 90% and specificity of 88%. CONCLUSIONS: These findings agree with those of previous studies that markers of asthma severity and discontinuity of care are risk factors for adverse asthma outcomes. Validation of the risk screening questionnaire is required in a prospective study.
Adolescent↗
Biochemical and ultrastructural indices of muscle damage after a twenty-one kilometre run.
Increased serum concentrations of intracellular proteins are generally accepted as good indicators of muscle damage. The mechanism of this damage is, however, poorly understood. Twenty male runners completed a 21 km run in as fast a time as possible. Blood samples were obtained from each subject just prior to, immediately after, and 24 hr after the run. Samples were analysed for haemoglobin, haematocrit, creatine kinase (CK), myoglobin (Mb) and malondialdehyde (MDA) concentrations and corrected for percentage change in plasma volume (PV). Percutaneous muscle biopsies were taken from the lateral gastrocnemius muscle of 6 of the subjects 24 hr before and 24 hr after the run and examined by electron microscopy. Mb levels in the serum increased significantly (p < 0.001) immediately post-exercise, while CK levels increased significantly (p < 0.001) at 24 hours post-exercise. The PV corrected serum MDA levels were very close (p = 0.06) to a significant increase immediately post-exercise. Ultrastructural examination of pre-exercise samples revealed evidence of muscle changes consistent with endurance exercise training, but no further damage was evident at 24 hr post-exercise. It is thus suggested that the increased serum levels of CK and Mb after the 21 km run may be a result of free radical induced cell membrane damage and increased permeability, as evidenced by elevated serum MDA levels, and not due to mechanical muscle damage.
Adult↗
Risk factors for ill-health in a remote desert-dwelling aboriginal community in Western Australia.
BACKGROUND: Living in small, isolated groups may promote health for Aborigines if traditional lifestyles are followed, but overall health risks in such communities are inadequately documented. AIM: To document health status of a remote Aboriginal community with reference to nutrition, cardiovascular risks, renal disease and infections and to identify areas where health might be improved. METHODS: All residents of a small community in the Great Sandy Desert underwent medical examinations, anthropometry and measurement of blood pressure. Investigations included cholesterol, triglycerides, glucose, insulin, creatinine, lipoprotein (a), apolipoprotein E phenotype, angiotensin-converting enzyme genotype, urinalysis, stool microscopy (children), liver function tests and full blood examination. RESULTS: Children (n = 26) were undernourished while 14% of adults (n = 51) were underweight, 22% overweight and 40% of women and 13% of men were obese with central obesity in 90% of women and 48% of men. Fifteen per cent of the group were hypertensive. Insulin levels were increased in 55% of subjects, total cholesterol in 21% and triglycerides in 56%, while HDL was decreased in 78%. Angiotensin-converting enzyme and apolipoprotein E typing and lipoprotein (a) did not suggest increased cardiovascular risk. Proteinuria was present in 39% of subjects, haematuria in 49% and definite or possible urinary tract infections in 30%. Faecal parasites were prevalent and a history of infections, including sexually transmitted diseases, was common. CONCLUSIONS: Increased cardiovascular risk, nutritional disorders, renal disease and infections are major problems in this community which had relocated several years previously from a mission environment closer to western influences, including alcohol.
Adolescent↗
General practitioners' knowledge and use of living wills.
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Attitude of Health Personnel↗
Effect of indomethacin on blood pressure control during treatment with nitrendipine.
This study tested the hypothesis that treatment with a nonsteroidal anti-inflammatory drug will not alter the hypotensive effect of a dihydropyridine calcium channel antagonist. Fifteen essential hypertensives (ages 58-80 years) had a supine diastolic blood pressure (DBP) < 100 mmHg after 4 weeks monotherapy with nitrendipine 5-20 mg twice daily. They entered a double-blind randomised crossover study in which the addition of indomethacin 25 mg three times daily was compared with placebo in treatment phases each of 4 weeks duration. Subjects were seen weekly and measurements in the last 2 weeks of each phase were compared. Supine blood pressure (mean +/- SE) was higher in the indomethacin phase (158 +/- 4/80 +/- 2) than in the placebo phase (154 +/- 4/76 +/- 3) (p < 0.01 for DBP). In 6/15 (40%) of subjects the increase in supine diastolic blood pressure with indomethacin was > 5 mmHg. Plasma urea was also increased in the indomethacin phase: 7.6 +/- 0.6 mmol/l compared with placebo: 6.3 +/- 0.5 mmol/l (p < 0.001). The study has demonstrated that concurrent treatment with the NSAID indomethacin impairs the blood pressure lowering effect of the dihydropyridine calcium channel antagonist nitrendipine. This increase in blood pressure with indomethacin in subjects treated with nitrendipine may represent either an independent pressor effect of indomethacin or a reduced vasodilator prostanoid contribution to the hypotensive effect of nitrendipine. This blood pressure increase may be sufficient to interfere significantly with clinical blood pressure control in some subjects.
Aged↗
Improving diagnosis of Huntington's disease by analysis of an intragenic trinucleotide repeat expansion.
OBJECTIVE: To develop an accurate presymptomatic test for Huntington's disease. METHOD: An improved polymerase chain reaction method was used to investigate the pattern of expansions of a CAG repeat sequence located in the 5' region of a gene recently found to produce the protein called Huntingtin. We documented the range of trinucleotide repeat expansions in the responsible gene in 82 affected individuals compared with 80 control subjects from a Western Australian population. RESULTS: The number of expanded repeats ranged from 40 to 73 in affected individuals and from 13 to 38 in normal controls. CONCLUSIONS: Polymerase chain reaction analysis of a CAG repeat sequence in the Huntington's disease gene clearly differentiated between normal and mutated alleles, providing an accurate diagnostic test for the disorder in individuals at risk. This predictive test has met with greater acceptance and demand than methods using family based linkage studies.
Base Sequence↗
Screening for colorectal cancer. Knowledge, attitudes and practices of South Australian GPs.
OBJECTIVE: To examine knowledge, attitudes and practices of South Australian general practitioners (GPs) in relation to screening for colorectal cancer. DESIGN: A descriptive study in which data were collected by means of postal questionnaires. MAIN OUTCOME MEASURES: Use of screening tests for colorectal cancer, knowledge in relation to colorectal cancer prevention, opinions on organisation and delivery of colorectal cancer screening. RESULTS: The response rate to the survey was 66.3%. GPs showed considerable variability in screening practices, particularly for individuals who are at no increased risk of colorectal cancer. Mass screening with the faecal occult blood test (FOBT), particularly if it is centrally coordinated, was not widely endorsed, in contrast with strategies which provide a central role for the GP. On the whole, GPs preferred patient-initiated, rather than doctor-initiated, screening. We found a number of knowledge deficits in relation to FOBT screening; many GPs felt they had inadequate training in this area. CONCLUSION: Clear and consistent guidelines for colorectal cancer screening are required. Medical education about colorectal cancer should also be addressed.
Colorectal Neoplasms↗
Reported diabetes mellitus management among South Australian general practitioners.
Diabetes mellitus is a chronic disease commonly managed in general practice. This article reviews the findings of a questionnaire survey of 173 randomly chosen South Australian general practitioners and their reported management in the areas of detection, diagnosis, assessment, monitoring and GP knowledge. Substantial differences between respondents were found in all areas, suggesting the need for improved educational methods aimed at all general practitioners.
Adult↗
Knowledge of and reported asthma management among South Australian general practitioners.
AIM: This study, carried out in 1989, set out to assess general practitioners' knowledge of asthma management and their reported management practices. METHOD: Of 153 randomly selected South Australian general practitioners 127 (83%) completed a questionnaire designed to explore issues relating to the management of asthma. RESULTS: The survey revealed substantial differences between general practitioners in their knowledge and management practices including the assessment of the severity of asthma, the need for objective monitoring, that is by the use of spirometry and peak flow meters, and the use of medication. Overall, the sampled general practitioners believed that patient-related factors were the main barriers to effective treatment of asthma. CONCLUSION: The findings of this study suggest that ideal asthma management was not being attained. More research is required to ascertain why such variability among practitioners exists and how best to remedy these differences.
Adult↗