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Biomedical subjects

Patrick J Phillips

Publications and source records attributed to Patrick J Phillips.

15 recordsLinked to original sources
PubMed2006

The North West Adelaide Health Study: detailed methods and baseline segmentation of a cohort for selected chronic diseases.

The North West Adelaide Health Study is a population-based biomedical cohort study investigating the prevalence of a number of chronic conditions and health-related risk factors along a continuum. This methodology may assist with evidence-based decisions for health policy makers and planners, and inform health professionals who are involved in chronic disease prevention and management, by providing a better description of people at risk of developing or already diagnosed with selected chronic conditions for more accurate targeting groups for health gain and improved health outcomes. Longitudinal data will provide information on progression of chronic conditions and allow description of those who move forward and back along the continuum over time. Detailed methods are provided regarding the random recruitment and examination of a representative sample of participants (n = 4060), including the rationale for various processes and valuable lessons learnt. Self-reported and biomedical data were obtained on risk factors (smoking, alcohol consumption, physical activity, family history, body mass index, blood pressure, cholesterol) and chronic conditions (asthma, chronic obstructive pulmonary disease, diabetes) to classify participants according to their status along a continuum. Segmenting this population sample along a continuum showed that 71.5% had at least one risk factor for developing asthma, chronic obstructive pulmonary disease or diabetes. Almost one-fifth (18.8%) had been previously diagnosed with at least one of these chronic conditions, and an additional 3.9% had at least one of these conditions but had not been diagnosed. This paper provides a novel opportunity to examine how a cohort study was born. It presents detailed methodology behind the selection, recruitment and examination of a cohort and how participants with selected chronic conditions can be segmented along a continuum that may assist with health promotion and health services planning.

Journal Article↗
PubMed2006

Health status assessed by the SF-36 along the diabetes continuum in an Australian population.

OBJECTIVE: To examine the association of health status with stage along the diabetes continuum. DESIGN, SETTING AND PARTICIPANTS: Self-reported health status (SF-36) was assessed in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Impaired fasting glucose (IFG), undiagnosed diabetes, diagnosed diabetes, glycaemic control and cardiovascular disease were determined from fasting blood and self-reported data. RESULTS: The prevalence of diagnosed diabetes was 5.6% (95% CI: 4.9-6.3), with an additional 1.0% (95% CI: 0.7-1.4) previously undiagnosed. When compared to those with normal glucose, those with diabetes were significantly impaired on all SF-36 dimensions except Mental Health, and those with IFG (4.3%) were significantly impaired in terms of Physical Functioning and Bodily Pain when controlling for the effects of age, sex and cardiovascular disease. Poor glycaemic control (HbA1c >or= 7.0%) was also associated with impaired health status. CONCLUSIONS: Health status is impaired not only among those with diagnosed diabetes but also those with IFG and undiagnosed diabetes.

Adolescent↗
PubMed2006

Neglected nephropathy.

BACKGROUND: Diabetic nephropathy is a significant contributor to the morbidity, mortality and health care cost among patients with diabetes. With increasing understanding of this problem, the natural progression of diabetic nephropathy can potentially be changed. OBJECTIVE: This article examines the natural history of diabetic nephropathy and provides guidelines on detection, management and future treatment possibilities of this complication. DISCUSSION: Prevention and slowing progression are the most important aspects of the management of diabetic nephropathy. This involves monitoring renal function and risk factors for renal damage and early active intervention. The angiotensin converting enzyme inhibitors and receptor antagonists are important components of therapy, both for controlling hypertension and for slowing the progression of micro and macroalbuminuria. When microalbuminuria occurs, intensive intervention on a range of risk factors can halve the number of those suffering a cardiovascular event or progressing to macroalbuminuria. When renal insufficiency occurs, particularly when creatinine clearance is >30 mL/minute, referral to an nephrologist should be considered.

Australia↗
PubMed2006

High protein diets and diabetes.

Higher protein diets are currently 'hot'. The CSIRO total wellbeing diet book has been on the bestseller list in Australia and internationally. Various other high protein diets have also had, or are getting, media attention. However, high protein diets, particularly for people with diabetes, are controversial. There are questions about effectiveness and safety, especially in the long term. As a general practitioner people will look to you for advice about what to eat. This article summarises the pros and cons of two of the popular higher protein diets--the Atkins diet and the CSIRO total wellbeing.

Australia↗
PubMed2006

Gestational diabetes--worth finding and actively treating.

Gestational diabetes affects around 5% of pregnant women, however the value of screening women for gestational diabetes has been hotly debated. On the positive side there has been potential benefits for the baby and, on the negative side, the costs of managing gestational diabetes to the mother. This controversy has largely been settled with the publication of the Australasian Carbohydrate Intolerance Study (ACHOIS). This article reviews the implications of ACHOIS for Australian women and their general practitioners.

Adult↗
PubMed2006

Endocrinology and the skin.

CASE STUDY: 'I've got these ugly red blotches on my legs and they are getting worse?' Lisa, 32 years of age, is an accountant who always presents herself meticulously. You can understand why she doesn't like the raised red brown blotches on her shins. The lesions are raised, indurated with follicular accentuation. They are an uneven red-brown colour that doesn't fade with pressure, nor does the tissue pit. Lisa seems more upset and agitated than you expected. When you ask if she's under stress at work she breaks down in tears and says she feels 'agitated and on edge all the time and can't sit still for a minute'.

Adult↗
PubMed2006

Innovative insulins--where do analogues fit?

BACKGROUND: Problems with traditional bolus insulins include delayed time to onset and offset, and with basal insulins, an overnight peak and poor reproducibility. Analogue insulins have been formulated to better emulate physiologic insulin secretion and improve glycaemic control without increasing hypoglycaemia. OBJECTIVE: This article discusses analogue insulins and outlines their role in current diabetes management. DISCUSSION: Analogue insulins do offer some advantages over traditional insulins. The bolus and basal analogues offer flexibility, and basal analogues reduce nocturnal hypoglycaemia. However, there is limited evidence supporting improved glycaemic control with analogue insulins. No study has looked at long term outcomes and hard endpoints. Rapid acting analogues are widely used, generally in type 1 diabetes. The basal analogues glargine and detemir are significantly more expensive compared to traditional basal insulins, but were listed on the Pharmaceutical Benefits Scheme on 1 October 2006. Glargine is available for patients with type 1 and insulin requiring type 2 diabetes, while detemir has been recommended only for patients with type 1 diabetes. Patients with type 1 diabetes, particularly those with hypoglycaemic unawareness, may be expected to derive most benefit from the new basal analogues.

Diabetes Mellitus↗
PubMed2005

A1C--frequently asked questions.

BACKGROUND: Routine clinical measurements of glycated haemoglobin first became available during the early 1970s and are now accepted as the standard for estimated overall glycaemic exposure and risk of microvascular complications in diabetes. OBJECTIVE: This article attempts to answer frequently asked questions concerning A1C, and provide guidance on how to make best use of A1C measurements in clinical practice. DISCUSSION: Blood glucose gives immediate day-to-day information and A1C usually gives a reliable estimate of the average glycaemic exposure over the past 6-8 weeks. Both are important components of glycaemic monitoring. Discrepancies between these two estimates of glycaemia can usually be resolved by checking blood glucose and A1C techniques. Target A1C is less than 7%, but encouraging patients to aim slightly lower (eg. by 0.5%) on A1C can result in significant reduction in complication risk. There is a clear relationship between glycaemic control reflected by A1C and the progression of microvascular complications in both type 1 and type 2 diabetes.

Blood Glucose↗
PubMed2004

Pesticides in surface water runoff in south-eastern New York State, USA: seasonal and stormflow effects on concentrations.

Samples from two streams (Kisco River and the Middle Branch of the Croton River) in the Croton Reservoir system in south-eastern New York State, USA were sampled from May 2000 through to February 2001 in order to document the effect of land use, streamflow and seasonal patterns of application on pesticide concentrations in runoff from developed watersheds. Many of the pesticides detected most commonly in this study are generally used in developed areas, and particularly on turfgrass. Pesticide concentrations were generally higher, and the numbers of compounds were generally larger, in samples from the Kisco River than in samples from the Middle Branch, probably because the Kisco River drainage has a greater population density and is more extensively developed. Four pesticides (2,4-D, 2,4-D-methyl, dicamba and metalaxyl) were detected in at least one sample from the Kisco River at a concentration >1 microg litre(-1), and no pesticides were detected at concentrations >0.4 microg litre(-1) in Middle Branch samples. No human-health-based water-quality standards were exceeded by samples from either site in this study, but samples from the Kisco River contained four insecticides (carbaryl, chlorpyrifos, diazinon and malathion) and one herbicide (2,4-D) in concentrations that exceeded water quality criteria for the protection of aquatic life. The highest concentrations of most compounds occurred during stormflows in both streams in June, September and December, 2000. The lowest concentrations of most compounds at both sites occurred during baseflows from October 2000 through February 2001, even though the concentrations of many compounds increased substantially at the Kisco River site during stormflows in November and December. Detailed data on the variability of pesticide concentrations during stormflows indicate that there may be two sources of pesticides in the Kisco River watershed: (1) elevated concentrations of pesticides during peak flows that occur early in stormflows likely reflect runoff from paved areas, and (2) elevated concentrations during peak flows that occur later in stormflows from areas with lesser amounts of pavement. Data from the Kisco River indicate that the relation between storm discharge and pesticide concentrations varies among compounds, in part because of variation in seasonal application patterns. These variations in the timing of application result in not all stormflows producing increased concentrations of pesticides. Overall, these results indicate the importance of stormflow sampling throughout the year in assessing pesticide fate and transport in urbanized, developed areas.

Agriculture↗