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Biomedical subjects

S R Leeder

Publications and source records attributed to S R Leeder.

At least 55 records · Page 3Linked to original sources
PubMed1995

Social support, marital status and living arrangement correlates of cardiovascular disease risk factors in the elderly.

Marital status and indices of social support are associated with mortality due to coronary heart disease and stroke. This association seems not entirely due to differences in recognised cardiovascular disease risk factors. The Western Sydney Stroke risk in the Elderly Study examined the relationship between marital status, living arrangements, widowhood and extent of social support, and risk factors for cardiovascular disease in men and women aged over 65 years. Unmarried men had the lowest mean HDL-C levels. Men living alone had the highest mean systolic blood pressures. The lower mean HDL-C levels and higher DBP levels seen among widows were not statistically significant after adjustment for differences in past medical history and education levels. The extent of social support was not associated with any significant differences in cardiovascular risk factor levels among men or women. We conclude that some of the increased risk of cardiovascular disease associated with socio-demographic factors among men in this age-group may be due to differences in primary cardiovascular disease risk factors. However, some of the mechanisms underlying risk of cardiovascular disease in this age-group remains obscure.

Activities of Daily Living↗
PubMed1995

The contribution of epidemiology to the definition of health goals and targets for Australia.

Health goals and targets may be used to improve the efficiency of investment of resources for health care and the promotion of health the better to fulfil the values and expectations of society. Australia has been developing health goals and targets since 1985. The first step was the establishment of the Better Health Commission that year. Its proposals led to the states and territories undertaking concerted health promotion activities through the National Better Health Program. Subsequently the health-care system as a whole, through the 1993 Medicare agreement, endorsed the goals and targets approach. Epidemiology has played a major role in every step in this process. Initially it was used to establish health status baselines or to point to serious data deficits which stopped a baseline being set. It provided data about the burden and distribution of illness in the community. It was used critically to appraise evidence about aetiology and the fraction of illness attributable to modifiable risk factors and the effectiveness of interventions, and to provide estimates of potential years of life lost through illness and injury. This has contributed, along with economic analysis which is a critically important corollary, to the definition of health care priorities. Epidemiology, while being necessary for these developments, however, has not been sufficient. This 'insufficiency' has three elements. First, existing epidemiological knowledge and methods have been inadequately applied or the data have been missing, or distorted by inappropriate interpretation. Second, there are now goals and targets in health literacy, the health care system, and the environment where epidemiological methods (and hence data) are poorly developed or non-existent.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed1994

Changing prevalence of asthma in Australian children.

OBJECTIVE: To investigate whether prevalence of asthma in children increased in 10 years. DESIGN: Serial cross sectional studies of two populations of children by means of standard protocol. SETTING: Two towns in New South Wales: Belmont (coastal and humid) and Wagga Wagga (inland and dry). SUBJECTS: Children aged 8-10 years: 718 in Belmont and 769 in Wagga Wagga in 1982; 873 in Belmont and 795 in Wagga Wagga in 1992. MAIN OUTCOME MEASURES: History of respiratory illness recorded by parents in self administered questionnaire; airway hyperresponsiveness by histamine inhalation test; atopy by skin prick tests; counts of house dust mites in domestic dust. RESULTS: Prevalence of wheeze in previous 12 months increased in Belmont, from 10.4% (75/718) in 1982 to 27.6% (240/873) in 1992 (P < 0.001), and in Wagga Wagga, from 15.5% (119/769) to 23.1% (183/795) (P < 0.001). The prevalence of airway hyperresponsiveness increased twofold in Belmont to 19.8% (173/873) (P < 0.001) and 1.4-fold in Wagga Wagga to 18.1% (P < 0.05). The prevalence of airway hyperresponsiveness increased mainly in atopic children only, but the prevalence of atopy was unchanged (about 28.5% in Belmont and about 32.5% in Wagga Wagga). Numbers of house dust mites increased 5.5-fold in Belmont and 4.5-fold in Wagga Wagga. CONCLUSIONS: We suggest that exposure to higher allergen levels has increased airway abnormalities in atopic children or that mechanisms that protected airways of earlier generations of children have been altered by new environmental factors.

Allergens↗
PubMed1994

A profile of asthma and its management in a New South Wales provincial centre.

OBJECTIVE: To describe aspects of the manifestations and management of asthma in a community setting. DESIGN: Cross-sectional survey. SETTING: A NSW provincial centre in October 1991. PARTICIPANTS: Ninety-eight adults, identified from a population survey, with wheeze, shortness of breath, or cough, in the past year, and either airway hyperresponsiveness (AHR) or a reported doctor's diagnosis of asthma. MAIN OUTCOME MEASURES: Histamine challenge test to measure AHR; asthma quality of life questionnaire (AQLQ) score (with the maximum score of 10 corresponding with lowest quality of life); need for medical attention or time off work; medical management and self-management of asthma; and the extent of beta 2-agonist use. RESULTS: Of the 98 participants, 74 had had asthma diagnosed by their doctor, 34 had perennial asthma, and 30 had required medical attention or had missed work because of asthma in the preceding year. The median AQLQ score was 1.0 (interquartile range, 0.6-1.8). Inhaled steroids were used by 17 participants who accounted for 23% of those with medically diagnosed asthma, 32% of those with perennial asthma, 17% of those with moderate or severe AHR, 40% of those who had required medical attention or missed work because of asthma in the preceding year, and 31% of those with AQLQ scores in the top quartile. Only 18 participants owned a peak flow meter; seven had a written self-management plan; 18 stated they would respond to worsening asthma by starting or increasing treatment with inhaled steroids, and six would start therapy with orally administered steroids. Twelve had never used beta 2-agonists and only five had purchased more than 12 beta 2-agonist inhalers in the preceding year. CONCLUSIONS: The spectrum of asthma in this community sample included many adults with mild disease and few with severe disease. Many were not managed in accordance with the recommendations of the Asthma Management Plan, but overuse of beta 2-agonists was not an important public health problem in this community.

Adrenergic beta-Agonists↗
PubMed1994

The Western Sydney Stroke Risk in the Elderly Study. A 5-year prospective study.

Aging of the Australian population, as in other developed nations, will ensure that stroke remains one of the most important causes of death and disability. The Stroke Risk in the Elderly (SITE) study aims to measure prospectively the independent contribution of dietary, sociodemographic, blood lipid, blood pressure, and hemostatic factors to risk of stroke and other cardiovascular outcomes. The target population included all independently living men and women aged 65 years and over, residents in several retirement villages in western metropolitan Sydney, New South Wales, Australia. The study cohort consists of 225 men and 787 women, selected as a convenience sample from all eligible residents in the local government areas (LGAs) adjacent to Westmead Hospital. Participants attended a baseline session to complete dietary, life-style, medical, and sociodemographic questionnaires. Anthropomorphic variables and blood pressure were measured. Blood was taken for measurement of serum lipid, glucose, and hemostatic factors. Questionnaire results were compared with an age/sex-stratified, randomly selected sample drawn from the community (in the same LGAs), in order to quantify potential sampling and selection biases. The study cohort will be followed for a minimum of 5 years. The attendance rate of eligible residents for a baseline medical, dietary, life-style, and sociodemographic assessment was 72% for males and 69% for females. The study cohort was older, better educated, less ethnically diverse, and among women, less likely to have ever been married compared to people aged over 65 years in the comparison group. The baseline results suggest that hemostatic factors may be of importance in assessing risk of cardiovascular disease, (CVD), particularly in older men.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1994

Differences in airway responsiveness between children and adults living in the same environment: an epidemiological study in two regions of New South Wales.

The aim of the present study was to compare the severity of asthma in children and adults living in the same home environments. In winter 1991 and 1992, we studied two large random samples of children living in two different regions; and, three months later, we conducted a study of adults who lived with enrolled children. A total of 805 children and 814 adults attended in Lismore, and 850 children and 711 adults in Wagga Wagga. Questionnaires were used to measure symptom history, histamine inhalation challenge to measure airway hyperresponsiveness (AHR) and skin-prick tests to measure allergy. There was a higher prevalence of asthma in children than in adults: recent wheeze was 1.5 times higher; asthma medication use was 1.5 times higher; diagnosed asthma was 1.6 times higher; and AHR was two times higher. Current asthma (AHR and recent wheeze) was 9.5-11.3% in children and 5.4-5.6% in adults. These differences were statistically significant. In both regions, airway responsiveness was more severe in children who were sensitized to common allergens than in similarly sensitized adults. These results suggests that airways can develop protective mechanisms with age, or that recent environmental changes in factors such as allergen levels, diet or treatment practices have led to immunological changes and to increased airway responsiveness in this generation of children.

Adolescent↗
PubMed1993

Importance of house dust mite and Alternaria allergens in childhood asthma: an epidemiological study in two climatic regions of Australia.

The relation of house dust mite allergen levels to asthma and allergy was examined in two population samples of children aged 8-11 years in northern New South Wales. We studied 805 children in Lismore (a hot, humid, coastal region) and 770 in Moree/Narrabri (a hot, dry inland region). Respiratory symptoms were measured by questionnaire, bronchial hyperresponsiveness (BHR) by histamine inhalation test, and allergy by skin-prick tests. Current asthma was defined as the presence of both wheeze in last 12 months and BHR. Der p I levels were measured in dust from the bed and floors in the homes of 57 randomly selected children in the coastal region and of 74 inland children. Der p I levels were significantly higher by the coast (83.0 vs 11.2 microg/g, P < 0.001). House dust mite sensitivity was of similar prevalence in both regions (28.6 vs 26.4%, n.s.) but Alternaria sensitivity was higher inland (4.0 vs 15.2% P<0.001). Bronchial responsiveness was more severe in coastal children sensitized to house dust mites and in inland children who were sensitized to Alternaria. The adjusted odds ratios for current asthma in children sensitized to house dust mites were 21.3 (95% CI 10.5, 43.2) by the coast and 2.7 (95% CI 1.3, 5.4) inland, and in children sensitized to Alternaria were 3.4 (95% CI 1.3, 9.1) in the coastal region and 5.6 (95% CI 3.1, 10.1 inland. These studies suggest that high house dust mite allergen levels in a humid, subtropical region act to significantly increase bronchial responsiveness in sensitized children, and that Alternaria allergens have a similar but less potent action in a dry, rural region.

Allergens↗