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Biomedical subjects

N Pearce

Publications and source records attributed to N Pearce.

At least 127 records · Page 7Linked to original sources
PubMed1993

Descriptive epidemiology of primary cancer of the brain, cranial nerves, and cranial meninges in New Zealand, 1948-88.

We used New Zealand data on occurrence of different types of brain cancer to investigate: (i) a possible secular increase which has been seen worldwide and has generated considerable debate; (ii) possibly higher rates among Maori; and (iii) possibly higher risks related to social class and occupation. Data from the NZ Cancer Registry on the 5,684 brain cancers diagnosed among NZ residents from 1948-88 were used to study the pattern of occurrence by gender, age, race, calendar year, social class, occupation, and histology. Age-standardized brain-cancer incidence rates per 100,000 more than doubled over the 41-year period (from 2.9 to 6.9 in males and from 2.1 to 5.1 in females). A strong trend of increasing incidence with increasing social class is seen in males (Ptrend = 0.01). Among Maori, the proportion of all brain cancer that is medulloblastoma is four times that among non-Maori, and the proportion of all brain cancers that lack histologic confirmation is about 40 percent higher. Elevated risks are seen among: dairy farmers (odds ratio [OR] = 3.4, 95 percent confidence interval [CI] = 1.9-6.0); sheep handlers (OR = 2.7, CI = 1.4-5.3); livestock workers (OR = 3.8, CI = 1.7-8.4); and farm managers (OR = 3.2, CI = 1.4-7.2); as well as among electrical engineers (OR = 8.2, CI = 20-34.7); electricians (OR = 4.6, CI = 1.7-12.2); and other electrical workers. Brain cancer rates in NZ have increased steadily since 1948, but this increase has leveled off in the most recent five-year period. Although brain cancer rates are likely to be underestimated among the Maori, an excess of medulloblastoma is evident in this group.

Adolescent↗
PubMed1993

Moderate maternal drinking and outcome of pregnancy.

The adverse effect of light or moderate maternal drinking during pregnancy on the well being of the newborn has been investigated. The study group included 2145 live births in the obstetric units of 11 Italian cities between February 1989 and July 1990. A detailed life style questionnaire was administered to the mothers. Information on the newborn was collected from clinical records as well as from a clinical examination. Both univariate and multivariate analyses were suggestive of a decrease in mean birth weight associated with maternal drinking pregnancy, especially in women who also smoked during pregnancy. This effect was higher in male newborns. The occurrence of low birth weight (< 2500 g.) was more frequent in women drinking during pregnancy in both smokers and non-smokers (for this latter group an effect is suggested only for a daily consumption of more than 10 grams of absolute alcohol). Maternal alcohol drinking of more than 20 grams of absolute alcohol per day also increased the risk of preterm delivery (OR = 2.35; 95% CI: .98-5.59). Finally, an increase in the rate of early jaundice was found, also associated with maternal drinking (OR = 3.30; 95% CI: 1.03-10.54).

Adult↗
PubMed1993

Pathology of asthma and its clinical implications.

Although detailed histopathologic studies have described the inflammatory processes present in fatal asthma, until recently the pathology of less severe forms of the disease has been less well understood. Now a series of important studies has extended our understanding of the pathophysiology of mild asthma. Studies that examine sputum or fluid obtained by bronchoalveolar lavage from mildly asthmatic subjects revealed findings consistent with an active inflammatory process within the airways. The histopathologic examination of endobronchial biopsy specimens from stable asthmatic patients has shown that inflammatory cell infiltration of the mucosa is a distinctive feature of mildly asthmatic subjects requiring only intermittent inhaled beta-agonist therapy. These studies have also shown that marked tissue disruption may occur early in the natural history of mild asthma. These investigations have demonstrated that asthma is a disease characterized by acute and chronic inflammatory changes within the airways and that in many respects the histopathologic features of mild allergic asthma are similar to those observed in fatal asthma. The therapeutic implications of these findings are that management of mild asthma should be directed toward resolving this inflammatory process. There is now sufficient evidence to suggest that anti-inflammatory drugs such as cromolyn sodium, inhaled corticosteroids, and nedocromil sodium be used earlier in the course of the disease and that the use of these therapeutic agents should not be limited to patients with severe forms of asthma. This may be particularly important in view of the increasing awareness of the potential problems associated with the overreliance on beta-agonist therapy in patients with asthma.

Asthma↗
PubMed1993

Social class differences in mortality from diseases amenable to medical intervention in New Zealand.

Social class differences in mortality from causes of death amenable to medical intervention were examined. All deaths in New Zealand males aged 15-64 years during the periods 1975-1977 and 1985-1987 were identified. Strong social class gradients in mortality from causes of death amenable to medical intervention were observed during both periods. Furthermore, social class inequalities were more pronounced for amenable causes of mortality than for non-amenable causes. However, a marked decline in the age-standardized mortality rate from amenable causes was observed, with the rate falling by 30% over the 10-year study period. This decline was twice as large as the drop in the non-amenable mortality rate. Despite the fall in the death rate from amenable causes, social class inequalities in mortality persisted among New Zealand men, with the lowest socioeconomic group experiencing a death rate from amenable causes of mortality that was 3.5 times higher than men in the highest socioeconomic group.

Adolescent↗
PubMed1993

What does the odds ratio estimate in a case-control study?

The use of the term 'odds ratio' in reporting the findings of case-control studies is technically correct, but is often misleading. The meaning of the odds ratio estimates obtained in a case-control study differs according to whether controls are selected from person-time at risk (the study base), persons at risk (the base-population at risk at the beginning of follow-up), or survivors (the population at risk at the end of follow-up). These three methods of control selection correspond to estimating the rate ratio, risk ratio, or the odds ratio respectively, by means of calculating the odds ratio in the subjects actually studied. None of these estimation procedures depends on any rare disease assumption. Where the rare disease assumption is relevant is whether the effect which is estimated (e.g. the odds ratio) is approximately equal to some other effect measure of interest (e.g. the risk ratio or rate ratio) in the underlying study base. To avoid confusion on this issue, authors should be encouraged to not only specify the manner in which controls have been selected (e.g. by density sampling) but also the corresponding effect measure which is being estimated (e.g. the rate ratio) by the 'odds ratio' which is obtained in a case-control analysis.

Case-Control Studies↗
PubMed1993

A comparative study of the efficacy of beclomethasone dipropionate delivered from a breath activated and conventional metered dose inhaler in asthmatic patients.

In order to overcome the problem of poor co-ordination with the use of the conventional press and breathe metered dose inhaler, a breath-activated inhaler ('Autohaler' inhalation device) has been developed. The clinical response to equal doses of beclomethasone dipropionate administered from the 'Autohaler' device and the conventional metered dose inhaler was compared in 36 stable asthmatic patients receiving regular inhaled beclomethasone dipropionate. The study was performed using a double-blind, double-dummy crossover design. Each treatment was given for 4 weeks. Objective and subjective measures of asthma severity were compared in the second 14 days of each treatment period, with clinical equivalence defined as a difference of 20% or less in the adjusted mean values for the 30 patients with data from both treatment periods. Equivalence at the +/- 5% level was found in the objective measures of pre-bronchodilator FEV1 (p < or = 0.001); post-bronchodilator FEV1 (p < 0.001); morning and evening peak expiratory flow rate (both p < or = 0.001). Patient diary cards established there was equivalent usage of inhaled bronchodilator, and equivalent symptom scores for daytime disability and daytime and night-time breathlessness. The results show that, in stable asthmatics, treatment with beclomethasone dipropionate is clinically equivalent when delivered by the 'Autohaler' device or the conventional metered dose inhaler used efficiently.

Adult↗
PubMed1993

Goal planning, needs assessment & advocacy.

The White Paper, Health of the Nation, and the Patients' Charter both seek to emphasise the importance of fully involving and informing patients about the treatment they receive. Much work on implementation of these documents has concentrated on achieving specific targets which, although essential, ignore the key managerial theme of changing behaviour, approach and attitudes in the staff/patient relationship and ensuring that patients are empowered through this relationship. Paul Kennedy and Nigel Pearce suggest that carefully planned and managed change through the use of a comparatively simple and well established approach has a major impact on the achievement of these initiatives.

England↗
PubMed1993

A comparison of the cardiovascular and metabolic effects of formoterol, salbutamol and fenoterol.

The cardiovascular and metabolic effects of the long-acting beta 2-agonist formoterol were compared with those of salbutamol, fenoterol and placebo in 12 healthy volunteers, using a randomised, double-blind, cross-over design. On the study days, the subjects inhaled either formoterol (24 micrograms), salbutamol (400 micrograms), fenoterol (400 micrograms) or placebo, at 30 min intervals for five doses. Heart rate (HR) total electromechanical systole (Q-S2I) (a measure of inotropy), the corrected QT interval (QTc), systolic and diastolic blood pressure, plasma glucose and plasma potassium (K+) were measured prior to drug administration, 10 min after each inhalation and at 30 min intervals for 3 h after the last inhalation. All of the active agents significantly increased HR, QTc and plasma glucose, and decreased Q-S2I, diastolic blood pressure and plasma K+ compared to placebo. Fenoterol had a significantly greater maximum effect on HR, QTc and Q-S2I than either salbutamol or formoterol. Formoterol and fenoterol caused a similar maximum reduction in plasma K+, greater than that due to salbutamol. We conclude that formoterol is a more selective beta 2-agonist than fenoterol, and has similar cardiovascular effects to salbutamol when inhaled repeatedly by normal volunteers.

Administration, Inhalation↗
PubMed1993

Self-reported prevalence of asthma symptoms in children in Australia, England, Germany and New Zealand: an international comparison using the ISAAC protocol.

There is a need for a standardized approach to international and regional comparisons of the prevalence and severity of asthma, and for the monitoring of asthma morbidity over time. In 1991, standardized written and video questionnaires were developed and administered in surveys of schoolchildren, aged 12-15 yrs, in five regions in four countries: Adelaide, Australia (n = 1,428); Sydney, Australia (n = 1519); West Sussex, England (n = 2,097); Bochum, Germany (n = 1928); and Wellington, New Zealand (n = 1863). The self-reported prevalence of wheezing during the previous 12 months was similar in West Sussex (29% using the written questionnaire and 30% using the video questionnaire), Wellington (28 and 36%), Adelaide (29 and 37%), and Sydney (30 and 40%), but was lower in Bochum (20 and 27%). The one year prevalence of severe wheezing limiting speech was greater in Wellington (11%), Adelaide (10%) and Sydney (13%), than in West Sussex (7%) and Bochum (6%). The self-reported one year prevalences of frequent attacks, frequent nocturnal wheezing, and doctor diagnosed asthma, were also higher in the Australasian centres than in the European centres. We conclude, that an international comparison of asthma symptom prevalence in childhood, using simple standardized instruments, is feasible. Possible explanations for the differences in reported asthma severity between the Australasian and European centres include differences in exposure to risk factors and differences in the management of asthma.

Adolescent↗
PubMed1992

Increasing incidence of non-Hodgkin's lymphoma: occupational and environmental factors.

The incidence of non-Hodgkin's lymphoma (NHL) has been increasing steadily for the last 30 years, and attention is being focused on the possible causes of this increase. Possible explanations have included the exposure to viruses, radiation, nutrition, and pesticides, and these issues are addressed by other presentations in this workshop. The interest in a possible role of pesticides stems from the observation that farmers have an increased risk of NHL. However, farmers may also be exposed to oncogenic viruses carried by farm animals, and studies of abattoir workers and meat inspectors have found increased risks of NHL; although these findings are unlikely to be directly relevant to the general population, they do complement other suggestions that exposure to oncogenic viruses may be a factor in the general increase in NHL. Farmers may also be exposed to chronic antigenic stimulation which may increase the risk of NHL. This latter observation is consistent with the observation that NHL is associated with several autoimmune diseases which involve chronic antigenic stimulation. NHL has also been associated with a number of occupational exposures but these are generally rare and the findings are inconsistent, although a number of studies have found an increased risk of NHL in work involving exposure to wood, solvents, or related chemicals. Perhaps the strongest evidence of an association with an environmental exposure comes from two studies showing that use of hair dyes increases the risk of NHL. This exposure is relatively common in women, and hair dye use may account for approximately 20% of all NHL cases in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1992

A study of New Zealand wood workers: exposure to wood dust, respiratory symptoms, and suspected cases of occupational asthma.

A randomly selected group of 50 New Zealand wood workers was studied. The level of airborne wood dust to which they were exposed ranged from 1.0-24.5 mg/m3. The wood workers reported experiencing higher rates of both lower and upper respiratory tract symptoms than a control group of office workers. Inhaled wood dust, in particular from rimu (Dacrydium cupressinum), was frequently cited by workers as being associated with respiratory tract symptoms. The wood workers' responses to the respiratory symptom questionnaire, and serial recordings of peak expiratory flow rate were used to screen the group for suspected cases of occupational asthma. Five cases fulfilled the study's criteria for suspected occupational asthma. In four of these, further evidence was found to support this diagnosis. We conclude that exposure to wood dust may cause occupational asthma in the woodworking industry in New Zealand.

Adult↗