Getting the fat tax on the table.
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Coronary Disease↗
Biomedical subjects
O Mansoor
Publications and source records attributed to O Mansoor.
[Effect of bronchial drainage on the improvement in gas exchange observed in ventral decubitus in ARDS].
OBJECTIVES: A bronchial secretion draining effect is frequently suggested as a mechanism for oxygenation improvement during prone positioning (PP) in patients with acute respiratory distress syndrome (ARDS). Nevertheless, it has never really been evaluated. The aim of this study was to search for an interrelationship between the volume of the bronchial secretion and the improvement of the PaO2/FIO2 ratio during prone positioning, with NO inhalation or not. STUDY DESIGN: Open prospective clinical study. PATIENTS: The study included 15 consecutive patients with severe ARDS (PaO2/FIO2 < 200 after alveolar recruitment, Murray score > 2.5). METHODS: They were returned to the prone position for 4 hours (h0-h4) combined with an inhalation of 5 ppm NO during 1 hour (h2-h3). Tracheal suction were performed hourly between h-2 and h6 and weighed on a precision scale from h-1 to h6. Haemodynamic, blood gas and respiratory compliance were recorded at h0, h2, h3, h4 and h6. RESULTS: No significant haemodynamic changes were observed in the various phases. Compared with the baseline condition at h0, PP and PP + NO respectively improved PaO2/FIO2 by 102 +/- 62% at h2 (P < 0.005) and 156 +/- 79% at h3 (P < 0.005/h0 and < 0.01/h2). 14/15 patients responded to PP and 15/15 to PP + NO (gain in PaO2/FIO2 > 10%). Concerning secretions, we collected 3.0 +/- 7.5 g, 4.4 +/- 6.1 g, 1.7 +/- 1.4 g and 1.7 +/- 1.6 between h-2 and h0, h0 and h2, h2 and h4, h4 and h6. Individual assessments showed no relationship between the PaO2/FIO2 evolution at any time and the quantity of secretions obtained during the first 2 hours in the prone position. Six patients presented secretions of less than 1 g between h0 and h2, and for whom the improvement in oxygenation was higher than average (115 +/- 53% at h2). CONCLUSION: In patients with little or moderate secretions, the improvement observed in oxygenation, with or without NO, does not depend on their volume.
Aged↗
Developing an immunization safety surveillance system in the Philippines.
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Adverse Drug Reaction Reporting Systems↗
Pneumococcal infections in New Zealand.
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Adolescent↗
Diabetes in New Zealand--better information needed.
AIMS: To review the availability and quality of data on the epidemiology of diabetes in New Zealand. METHODS: A search was undertaken for all Medline-indexed publications on diabetes in New Zealand. Hospitalisation and mortality data (ICD9 code 250) from the New Zealand Health Information Service (NZHIS) were examined. RESULTS: Information on diabetes in New Zealand has come from community surveys, national surveys, diabetes registers, hospitalisation data and mortality data. Much of this information has been valuable, but there is still inadequate national information on diabetes prevalence, incidence and time trends. CONCLUSION: Information technology provides an opportunity to couple the surveillance of diabetes with improved diabetes care. Medical practitioners need to support the development of their own practice-based registers/recall systems and to contribute to the development of district-based diabetes registers where these have a central focus on improving diabetes care.
Diabetes Mellitus↗
The 1996 pertussis epidemic in New Zealand: vaccine effectiveness.
AIM: To assess if reduced vaccine effectiveness may have accounted for increased hospitalisations in the 1996 pertussis epidemic. METHODS: Vaccine effectiveness was estimated by comparing vaccine coverage of the population (derived from a literature review) with that of cases (from notification data available from 1 June 1996) -- the screening method. Only three doses of pertussis vaccine were in the immunisation schedule until 1996, so vaccine effectiveness was calculated for three or more doses. RESULTS: Most likely estimates of vaccine effectiveness for Europeans were 88% (95% confidence interval 71 to 95%) for 5- to 14-month-olds, 80% for 15-month to 4-year-olds (66 to 88%) but lower for children aged 5 years and older with confidence limits including zero. Vaccine effectiveness estimates for Maori were less for each age group but based on few observations. CONCLUSIONS: The increase in hospitalisations for young children in the 1996 epidemic cannot be directly attributed to a reduced vaccine effectiveness, as vaccine effectiveness estimates for preschool Europeans are in line with international evidence. Additionally, the vaccine effectiveness estimates in this study are likely to be underestimates due to bias. The lower estimates for vaccine effectiveness among Maori are likely to reflect increased pressure of these biases, although a biological basis for the difference or clustering of factors that cause failure are also possible. The vaccine effectiveness estimates decrease with age, a likely combination of waning vaccine immunity and the cross-sectional nature of the screening method itself for determining vaccine effectiveness.
Child↗
The future of the immunisation schedule: recommendations of a workshop.
The Ministry of Health convened a workshop in June 1998 on the future of the immunisation schedule. Your comments are invited on the recommendations of the workshop. PRINCIPLES BEHIND THE SCHEDULE: Improve on-time immunisation coverage as the priority. Reaching the last 20% will cost at least as much as the first 80% and is vital to achieve the aims of the immunisation programme (disease elimination and improved control). Obtain regular secure coverage data, derived from a tracking system that ensures children are followed up. Assess compliance with early childhood centre immunisation checks at entry and improve if necessary. Establish an expert committee to advise on the immunisation schedule and policies. Keep the schedule as simple as possible. Accept that vaccines are not generic and future schedule recommendations may be vaccine-specific. Involve providers in the process of change. PROPOSED CHANGES: Move the second dose of measles-mumps-rubella vaccine from age 11 years to around five years. Consider moving the third visit from five to four months to achieve earlier protection against pertussis. Consider adding a fifth dose of pertussis vaccine. Change to acellular pertussis vaccine, once suitable vaccines are available. Change to inactivated polio vaccine, once suitable vaccines are available. Consider omitting the fourth dose of polio vaccine. Consider introducing an adult immunisation schedule with fewer adult tetanus-diphtheria boosters.
Adult↗
The 1996 pertussis epidemic in New Zealand: descriptive epidemiology.
AIM: To describe the 1996 pertussis epidemic. METHODS: Hospitalisation, notification and laboratory data were used to describe the 1996 pertussis epidemic and compare it with previous epidemics. RESULTS: The 1996 epidemic spanned 24 months. The crude hospitalisation rate from 1 June 1995 to 31 May 1997, was 10.1 per 100,000 person years, being highest for children aged six weeks to two months (42 to 90 days old inclusive; 1402 per 100,000). The 1996 epidemic involved more hospitalisations than the 1991 and 1986 epidemics, and a greater proportion for children under the age of one year (77%), compared to previous epidemics (60-70%). There were no deaths. Pertussis only became notifiable from 1 June 1996. The crude notification rate for the following twelve months was 19.8 per 100,000 (equivalent hospitalisation rate 6.7 per 100,000); children aged six weeks to two months of age had the highest notification rate (531 per 100,000; equivalent hospitalisation rate 1021 per 100,000). In 1996-97, children aged under 15 months accounted for 21% of notifications, but 82% of hospitalisations. Europeans tended to have higher rates of notifications than non-Europeans, but lower rates of hospitalisation. CONCLUSIONS: New Zealand continues to experience high rates of pertussis as a result of inadequate immunisation coverage. The increase in hospitalisations during the 1996 epidemic may reflect a real increase in the population-based incidence, or other changes (e.g. hospitalisation practice, increase in vulnerable children with poor access to primary care). Improved rates, accuracy and completeness of pertussis notifications will improve the ability of notification data to accurately describe future epidemics and estimate vaccine effectiveness. Further debate is required regarding the aims of pertussis immunisation; accelerating the timing of the first three doses and adding further doses of pertussis vaccine on the national immunisation schedule; and the role of acellular pertussis vaccines. In the meantime, the priority must be increasing on-time immunisation coverage.
Adolescent↗
Food ads on TV: a health hazard for children?
OBJECTIVE: To examine the nutritional quality of food in television food advertisements that are targeted at children. METHOD: We videotaped 42 hours of children's programs and analysed the food advertisements' content and nutrient composition using the New Zealand Food Composition Database. RESULTS: Of 269 food advertisements, 63% were for foods 'high in fat and/or sugar'. Children who ate only the advertised foods would eat a diet too high in fat, saturated fat, protein, free sugars and sodium. Furthermore, their diets would have suboptimal levels of fibre and suboptimal intakes of a number of important micronutrients (depending on age), including magnesium, selenium and vitamin E. The food products advertised on this channel rarely included nutritious low-cost foods that are necessary for food security in low-income groups. There were also no food advertisements that included any of the healthy foods consumed by Maori and Pacific peoples. CONCLUSIONS: Food advertisements targeted at children generally reflect the dietary pattern associated with an increased risk of obesity and dental caries in childhood; and cardiovascular disease, diabetes and cancers in adulthood.
Adolescent↗
A measles epidemic controlled by immunisation.
AIM: In 1997, an immunisation campaign, using measles-mumps-rubella vaccine, was planned for children aged 2-10 years to prevent a measles epidemic predicted by mathematical modelling. The epidemic started before the campaign and is described here. METHOD: Measles hospitalisation, notification and laboratory data were combined. RESULTS: The epidemic started in April 1997 and was largely over by January 1998. No deaths were identified and only one hospitalisation was coded as measles encephalitis, compared to seven deaths and ten cases of measles encephalitis in the 1991 epidemic. For the 12 months from 1 March 1997 there were 2,169 (60 per 100,000) measles cases identified, 314 (9 per 100,000) of whom were hospitalised. Two-thirds of hospitalised cases were notified. The age-standardised measles incidence rates were 33, 34, and 174 per 100,000 for Europeans, Maori and Pacific people, respectively. The respective age-standardised hospitalisation rates were 4, 9 and 32 per 100,000. Measles incidence was highest for under one-year-olds (904 per 100,000) and low for 11-16 year-olds (27 per 100,000)--the cohort previously offered a second vaccine dose. Most cases were aged 10 years and under, and this group were the main drivers of virus transmission. CONCLUSIONS: The immunisation campaign prevented 90-95% of predicted cases. The campaign was appropriately targeted at children aged 10 years and under.
Adult↗
Is confidence in immunisation declining?
There is no regular immunisation coverage information in New Zealand that is reliable. Immunisation benefit data do provide an indication of trends. The benefit data show a decline in coverage in 1997, after several years of improving coverage. The reasons for the decline are not known, but media reports which dented public and professional confidence in immunisation may have played a role.
Diphtheria-Tetanus-Pertussis Vaccine↗
Combined nitric oxide inhalation, prone positioning and almitrine infusion improve oxygenation in severe ARDS.
PURPOSE: To determine the efficacy and side effects of prone positioning (PP) and nitric oxide (NO) inhalation, alone, associated, or combined with i.v. almitrine for the treatment of hypoxaemia in severe acute respiratory distress syndrome (ARDS). METHODS: Over a period of 20 months, 27 consecutive critically ill patients with severe ARDS (Murray score > 2.5, PaO2/FiO2 < 170 after alveolar recruitment) were prospectively and randomly included. They inhaled NO for two hours at concentrations of 5 and 10 ppm for one hour each (H0-H2). One hour later, they were returned to the prone position for four hours (H3-H7). During the last two hours in this position (H5-H7), they were assigned to further inhalation of 10 ppm NO (Group B, n = 9) or to no further inhalation (Group A, n = 9). In group C (n = 9), the procedure for group B was combined with perfusion of 16 mg.kg-1.min-1 almitrine throughout the study. RESULTS: Compared with control values, two hours NO inhalation improves PaO2/FiO2 and shunt effect by +28% and -9%, PP by +88% and -27%, PP + almitrine by +132% and -28%, NO + almitrine by +153 and -28%, PP + NO by +94% and -29%, NO + PP + almitrine by +327 and -48%. NO inhalation reduces pulmonary vascular resistance. Other haemodynamic parameters remain unchanged, whatever the treatment. NO inhalation improves PaO2/FiO2 by over 20% in 50% of the patients and PP is effective in 78% of the cases. CONCLUSION: Prone Position improves PaO2/FiO2 significantly more than NO alone but less than PP + almitrine or NO + almitrine. The best results are obtained with the association of NO + Prone position + Almitrine.
Administration, Inhalation↗
[Catabolic aspects of cranial trauma].
During their stay in the intensive care unit, head-trauma patients develop a hypermetabolic and a hypercatabolic status. Their nitrogen balance is highly negative and the muscular proteolysis is largely increased. The nitrogen losses originate mainly in muscles, resulting in muscle wasting and weakness. The whole protein synthesis remains quite normal, but this does not reflect the reality, as muscular protein synthesis is decreased, while hepatic protein synthesis is increased. The increased proteolysis seems to be due to the activation of the three proteolytic pathways, particularly the ATP-ubiquitin-dependent pathway. The causes of the increased muscle proteolysis in head trauma patients remain unclear. The increased glucocorticoid release, which is integrated in the acute phase response to injury, could be one of them. Glutamin, vitamin or zinc supplementation has been proposed in head trauma patients. The use of glucocorticoid antagonists, recombinant growth hormone or anti-cytokines are our fields of research.
Craniocerebral Trauma↗
Can New Zealand eliminate measles?
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Child↗
Vaccine adverse events reported in New Zealand 1990-5.
AIM: New Zealand monitors vaccine safety through vaccinator reports of adverse events following immunisation. The rate of reporting for the commonly used vaccines during 1990-5 are presented. During this time new vaccines were added to the immunisation schedule, enabling comparison of reporting rates. METHOD: The number of events were obtained from the CARM database and a rate calculated based on estimated vaccine use. RESULTS: Injection site reaction with adult tetanus-diphtheria vaccine was most commonly reported (68/100,000); a rate five times higher than with tetanus vaccine. There were also more reported reactions from diphtheria-tetanus-pertussis-Haemophilus influenzae type b (DTPH) than DTP vaccine, with 'abnormal crying' the commonest reaction reported after 29/100,000 doses of DTPH and 3/100,000 doses of DTP. The next commonest reaction for DTPH was injection site reaction (25/100,000) which compares to 17/100,000 doses of DTP. For the other inactivated vaccines, more reports were made for fever following Hib (16/100,000), than for hepatitis B (2/100,000) or influenza (1/100,000). The most common reports following measles-mumps-rubella (MMR) vaccine were rash (17/100,000), fever (12/100,000), and injection site inflammation (5/100,000). There were very few reports following polio vaccine, with rash, fever and headache all reported at less than 1/100,000 doses. CONCLUSION: Although only a proportion of events are reported, the picture presented here confirms the overall safety of vaccines and the value of the adverse event monitoring system. Monitoring vaccine adverse events is an essential part of the immunisation programme.
Adult↗
Albumin and fibrinogen syntheses increase while muscle protein synthesis decreases in head-injured patients.
The effect of trauma on protein metabolism was investigated in the whole body, muscle, and liver in severely head-injured patients presenting an acute inflammatory response by comparison to fed control subjects receiving a similar diet. Nonoxidative leucine disposal (an index of whole body protein synthesis) and muscle, albumin, and fibrinogen synthesis were determined by means of a primed, continuous infusion of L-[1-13C]leucine. Nonoxidative leucine disposal increased by 28% in the patients (P < 0.02). Fractional muscle protein synthesis rate decreased by 50% (P < 0.01) after injury. Fractional and absolute fibrinogen synthesis rates were multiplied by two and nine, respectively, after injury (P < 0.001). Albumin levels were lower in patients (25.2 +/- 1.2 g/l, means +/- SE) than in controls (33.7 +/- 1.2 g/l, P < 0.001). However, fractional albumin synthesis rates were increased by 60% in patients (11.4 +/- 1.0%/day) compared with controls (7.3 +/- 0.4%/day, P < 0.01). Therefore, 1) head trauma induces opposite and large changes of protein synthesis in muscle and acute-phase hepatic proteins, probably mediated by cytokines, glucocorticoids, and other stress hormones, and 2) in these patients, hypoalbuminemia is not due to a depressed albumin synthesis.
Blood Proteins↗
New Zealand immunisation schedule history.
The first formal immunisation schedule for the delivery of triple (DTP) vaccine was drawn up in November 1960. Since 1960 there have been many changes to the immunisation schedule, with a further change proposed for 1996. These changes have been in response to new vaccine development and better understanding of vaccine immunology. Further changes are certain.
History, 20th Century↗
Increased mRNA levels for components of the lysosomal, Ca2+-activated, and ATP-ubiquitin-dependent proteolytic pathways in skeletal muscle from head trauma patients.
The cellular mechanisms responsible for enhanced muscle protein breakdown in hospitalized patients, which frequently results in lean body wasting, are unknown. To determine whether the lysosomal, Ca2+-activated, and ubiquitin-proteasome proteolytic pathways are activated, we measured mRNA levels for components of these processes in muscle biopsies from severe head trauma patients. These patients exhibited negative nitrogen balance and increased rates of whole-body protein breakdown (assessed by [13C]leucine infusion) and of myofibrillar protein breakdown (assessed by 3-methylhistidine urinary excretion). Increased muscle mRNA levels for cathepsin D, m-calpain, and critical components of the ubiquitin proteolytic pathway (i.e., ubiquitin, the 14-kDa ubiquitin-conjugating enzyme E2, and proteasome subunits) paralleled these metabolic adaptations. The data clearly support a role for multiple proteolytic processes in increased muscle proteolysis. The ubiquitin proteolytic pathway could be activated by altered glucocorticoid production and/or increased circulating levels of interleukin 1beta and interleukin 6 observed in head trauma patients and account for the breakdown of myofibrillar proteins, as was recently reported in animal studies.
Adult↗