ORCID Profile
0000-0002-4384-8226
Current Organisations
George Institute for Global Health
,
University of Sydney School of Public Health
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Publisher: Springer Science and Business Media LLC
Date: 12-01-2016
DOI: 10.1007/S00296-015-3419-6
Abstract: The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
DOI: 10.2215/CJN.03330414
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.SPINEE.2016.08.010
Abstract: A previous study has shown that transient physical and psychosocial activities increased the risk of developing low back pain. However, the link between these factors in triggering nonpersistent or persistent episodes remains unclear. We aimed to investigate the association of transient exposures to physical and psychosocial activities with the development of nonpersistent or persistent low back pain. This was a case-crossover study with 12 months follow-up. We included 999 consecutive participants seeking care for a sudden onset of low back pain. Development of low back pain was the outcome measure. At baseline, participants reported transient exposures to 12 predefined activities over the 4 days preceding pain onset. After 12 months, participants were asked whether they had recovered and the date of recovery. Exposures in the 2-hour period preceding pain onset (case window) were compared with the 2-hour period, 24 hours before pain onset (control window) in a case-crossover design for all participants. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CI), and interaction analyses were used to compare estimates of nonpersistent (i.e., <6 weeks duration) and persistent cases. This study received funding from Australia's National Health and Medical Research Council (APP1003608). There were 832 participants (83%) who completed the 12 months follow-up successfully. Of these, 430 participants had nonpersistent low back pain (<6 weeks duration), whereas 352 reported persistent symptoms (≥6 weeks duration). Exposure to several transient activities, such as manual tasks involving heavy loads, awkward postures, live people or animals, moderate or vigorous physical activity, and being fatigued or tired during a task or activity, significantly increased the risk of both nonpersistent and persistent low back pain, with ORs ranging from 2.9 to 11.7. Overall, the risk of developing a persistent or a nonpersistent episode of low back pain associated with the included physical factors did not differ significantly. Our results revealed that previously identified triggers contribute equally to the development of both nonpersistent and persistent low back pain. Future prevention strategies should focus on controlling exposure to these triggers as they have the potential to decrease the burden associated with both acute and chronic low back pain.
Publisher: Wiley
Date: 09-06-2015
DOI: 10.1111/NEP.12488
Abstract: While patients with chronic kidney disease have reduced health-related quality of life (HRQOL), long-term HRQOL of survivors of severe acute kidney injury (AKI) remains unclear. We analysed HRQOL from the Prolonged Outcomes Study of the Randomized Evaluation of Normal versus Augmented Level Replacement Therapy (POST-RENAL) study and compared findings with those from a general Australian adult population enrolled in the Australian Diabetes, Obesity and Lifestyle (AusDiab) study. We used a multivariate analysis adjusted for baseline characteristics along with sensitivity analysis using age and sex-matched case controls. In the POST-RENAL study, 282 participants had HRQOL data collected using the SF-12 questionnaire. This was compared with 6330 participants from the AusDiab study. Unadjusted analyses showed that POST-RENAL participants had lower physical component scores (PCS, mean score 40.0 vs 49.8, P<0.0001) and lower mental component scores (MCS, mean score 49.8 vs 53.9, P<0.0001) than the AusDiab group. After age and sex matching, the difference in PCS and MCS remained statistically significant (P<0.0001). Advanced age, reduced renal function and albuminuria (all P ≤ 0.01) were all strongly associated with lower PCS values but not MCS values. After matching subsets of the cohorts on the basis of age, sex and renal function, PCS and MCS were lower in the POST-RENAL group (P<0.0001). Survivors of severe AKI in the POST-RENAL study had lower physical and mental components of HRQOL compared with general population, even after adjustment for their reduced renal function. Increasing age and reduced renal function were associated with poorer physical QOL.
Publisher: American Diabetes Association
Date: 10-04-2014
DOI: 10.2337/DC13-2727
Abstract: Moderate alcohol consumption has been associated with a reduced risk of mortality and coronary artery disease. The relationship between cardiovascular health and alcohol use in type 2 diabetes is less clear. The current study assesses the effects of alcohol use among participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial. The effects of alcohol use were explored using Cox regression models, adjusted for potential confounders. The study end points were cardiovascular events (cardiovascular death, myocardial infarction, and stroke), microvascular complications (new or worsening nephropathy or retinopathy), and all-cause mortality. During a median of 5 years of follow-up, 1,031 (9%) patients died, 1,147 (10%) experienced a cardiovascular event, and 1,136 (10%) experienced a microvascular complication. Compared with patients who reported no alcohol consumption, those who reported moderate consumption had fewer cardiovascular events (adjusted hazard ratio [aHR] 0.83 95% CI 0.72–0.95 P = 0.008), less microvascular complications (aHR 0.85 95% CI 0.73–0.99 P = 0.03), and lower all-cause mortality (aHR 0.87 96% CI 0.75–1.00 P = 0.05). The benefits were particularly evident in participants who drank predominantly wine (cardiovascular events aHR 0.78, 95% CI 0.63–0.95, P = 0.01 all-cause mortality aHR 0.77, 95% CI 0.62–0.95, P = 0.02). Compared with patients who reported no alcohol consumption, those who reported heavy consumption had dose-dependent higher risks of cardiovascular events and all-cause mortality. In patients with type 2 diabetes, moderate alcohol use, particularly wine consumption, is associated with reduced risks of cardiovascular events and all-cause mortality.
Publisher: American Medical Association (AMA)
Date: 11-2017
Publisher: American Diabetes Association
Date: 12-07-2014
DOI: 10.2337/DC13-2625
Abstract: We investigated microvascular event risk in people with type 2 diabetes and assessed whether N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hsTnT) improved prediction. We performed a case-cohort study, including 439 incident cases of microvascular events (new or worsening nephropathy or retinopathy) and 2,946 noncase subjects identified from participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. NT-proBNP and hsTnT were measured in stored plasma s les using automated commercial assays. After adjustment for age, sex, and randomized treatment, the hazard ratios for microvascular events per 1-SD increase in the log-transformed hsTnT and NT-proBNP were 1.67 (95% CI 1.51–1.85) and 1.63 (1.44–1.84), respectively. After further adjustment for classical and diabetes-related cardiovascular disease risk factors, the hazard ratios attenuated to 1.40 (1.24–1.58) and 1.41 (1.24–1.60), respectively. While the C statistic did not improve on addition of hsTnT or NT-proBNP for the total microvascular end point, a combination of both markers improved the prediction of nephropathy (P = 0.033) but not retinopathy (P = 0.72). The corresponding net reclassification indices in a three–risk category model (& %, 10–15%, and & % 5-year risk) for all microvascular events were 7.31% (95% CI 2.24–12.79) for hsTNT addition, 6.23% (1.74–11.5) for NT-proBNP addition, and 7.1% (1.5–12.9) for both markers together. These data suggest that cardiac biomarkers moderately improve microvascular event risk prediction, in particular the risk of nephropathy. Further studies examining the value of this approach for trial design and clinical use are warranted.
Publisher: Wiley
Date: 30-09-2021
DOI: 10.1002/HPJA.413
Abstract: We describe the reach of the scale‐up of Stepping On , a fall prevention program targeting community‐dwellers aged ≥65 years in NSW, along with fall‐related ambulance service use and fall‐related hospitalisations after scale‐up. Data on program provision were received from Local Health Districts. Routinely collected fall‐related ambulance usage and hospital admissions in NSW residents aged ≥65 years between 2009 and 2015 were compared within Statistical Local Areas prior to and following the implementation of Stepping On using multilevel models. Between 2009 and 2014 the program was delivered in 1077 sites to 10 096 older adults. Rates of fall‐related ambulance use and hospital admissions per 100‐person‐years were 1‐2 in people aged 66‐74, 4‐5 in people aged 75‐84 and 12‐13 in people aged ≥85. These rates increased over time ( P .001). The interaction between time and program delivery was not significant for fall‐related ambulance use or hospital admissions. The time‐related increase in fall‐related ambulance usage in people aged 75‐84 years may have been moderated by the Stepping On program (rate ratio 0.97, 95% CI 0.93‐1.00, P = .045). There was no indication of a reduced rate of fall‐related ambulance use or hospital admissions across the entire s le. Ambulance call‐outs for falls in people aged 75‐84 years may have reduced following program participation. Program scale‐ups need to reach a large proportion of the target population with a focus on those groups contributing most to fall‐related health service utilisation. Linking in idual participants’ health data as part of large‐scale evaluations may provide better insights into program outcomes.
Publisher: The Sax Institute
Date: 2017
Abstract: Objective and importance of study: To describe characteristics and temporal trends of fall-related ambulance service use and hospital admission in older adults in New South Wales (NSW), Australia. Such information will facilitate a more targeted approach to planning and delivery of health services to prevent falls and their adverse sequelae in different groups of older adults. Retrospective population-based descriptive study. Fall-related ambulance use and hospital admissions for all falls and injurious falls in NSW residents aged ≥65 years between 2006 and 2013 were obtained from two discrete sources of routinely collected data. Rates of use are presented descriptively. There were 314 041 occasions of fall-related ambulance use by older adults and 331 311 fall-related hospitalisations, of which 69% (n = 227 753) were for injurious falls. Fractures accounted for 57% of injurious hospitalisations. Slips and trips were the most common mechanism of falls requiring hospitalisation (52%). Residents of aged care facilities had a greater proportion of fall injury hospitalisations compared with people living in the community (85% and 65%, respectively). Rates of fall-related ambulance use and hospitalisation were similar and continued to increase over time. Increased effort is needed to prevent falls and associated injury among older people in NSW, particularly among people living in aged care facilities. Ongoing monitoring of rates and the characteristics of people who fall are needed to determine the long-term impact of fall prevention interventions.
Publisher: Public Library of Science (PLoS)
Date: 09-02-2016
Publisher: SAGE Publications
Date: 09-07-2016
Abstract: There is limited information regarding return to driving after stroke. To determine the frequency and predictors of return to driving within 1 month of acute stroke in younger (age 18–65 years) adults. POISE (Psychosocial Outcomes In StrokE) was a cohort study conducted in Australia between October 2008 and June 2010. Consecutive patients (age 18–65 years) with a recent (≤28 days) acute stroke were recruited. Validated demographic, clinical, mental health, cognitive, and disability measures including return to driving were obtained. Multivariable logistic regression was used to determine factors associated with return to driving within 1 month of stroke. Among 359 participants who were legally able to drive before stroke, 96 (26.7%) returned to driving within 1 month. Compared to those without an early return to driving ( n = 263), drivers were more often male, the main income earner, in paid work before stroke and without symptoms of depression or fatigue. Independence in activities of daily living (odds ratio (OR) 30.05, 95% confidence interval (CI) 3.85–234.45), not recalling receiving advice on driving cessation (OR 5.55, 95% CI 2.86–11.11), and having returned to paid work (OR 3.93, 95% CI 1.94–7.96) were associated with early return to driving. One in four young adults resumed driving within a month, contrary to guideline recommendations. These data reinforce the importance of deciding who is responsible for determining fitness to drive after stroke, when, and whether it is reasonable to enforce driving restrictions on those with minimal disability who are fit to return to work. Australian New Zealand Clinical Trials Registry ANZCTRN 12608000459325.
Publisher: American Diabetes Association
Date: 27-09-2016
DOI: 10.2337/DC16-1594
Abstract: The burden of vascular diseases remains substantial in patients with type 2 diabetes, requiring identification of further risk markers. We tested the absence of dorsalis pedis and posterior tibial pulses as predictors of major macrovascular and microvascular events, death, and cognitive decline in this population. Data were derived from 11,120 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study. Absent peripheral pulses at baseline were defined as absence of at least one dorsalis pedis or posterior tibial pulse. Absent compared with present peripheral pulses (n = 2,218) were associated with increased 5-year risks for major macrovascular events (hazard ratio 1.47 [95% CI 1.28–1.69], P & 0.0001), myocardial infarction (1.45 [1.13–1.87], P = 0.003), stroke (1.57 [1.23–2.00], P = 0.0003), cardiovascular death (1.61 [1.33–1.95], P & 0.0001), heart failure (1.49 [1.21–1.84], P = 0.0002), all-cause mortality (1.48 [1.29–1.71], P & 0.0001), major microvascular events (1.17 [1.00–1.36], P = 0.04), nephropathy (1.24 [1.00–1.54], P = 0.04), end-stage renal disease or renal death (2.04 [1.12–3.70], P = 0.02), and peripheral neuropathy (1.13 [1.05–1.21], P = 0.0008) after multiple adjustment. Participants with absent dorsalis pedis or posterior tibial pulses had comparable hazard ratios. Risks increased proportionally with the number of absent peripheral pulses, with the highest risks observed in patients with three or four absent pulses. Every additional absent pulse increases the risk of all outcomes. Absent dorsalis pedis and/or posterior tibial pulses are independent predictors of major vascular outcomes in patients with type 2 diabetes. These simple clinical indicators should be used to improve risk stratification and treatment of these patients.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2018
DOI: 10.1007/S00586-017-5178-4
Abstract: Limited evidence exists on secular trends of analgesics for spinal pain. We investigated general practitioner's (GP) recommendations of analgesic medicines for spinal pain and investigated characteristics associated with their recommendation. We accessed data on spinal pain consultations from the Bettering the Evaluation and Care of Health (BEACH) database, a nationally representative database on GP activity in Australia. Data extracted included consultation details and management provided. Medicines recommended were grouped as simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics or neuropathic pain medicines. Multivariate logistic regression determined if patient characteristics and GP characteristics were associated with medication recommendations. We analysed BEACH data for 9100 GPs who managed 39,303 patients with spinal pain between 2004 and 2014. Over the decade, analgesic recommendations increased. After accounting for patient and GP characteristics, there was a significant increase in the rate single-ingredient opioid analgesics [annual relative increase of 6% (RR 1.06 (95% CI 1.05-1.07), P < 0.001)] and neuropathic pain medicines [annual relative increase of 19% (RR 1.19 (95% CI 1.16-1.22), P < 0.001)] were recommended and a significant decrease in the rate NSAIDs were recommended [annual relative decrease of 4% (RR 0.96 (95% CI 0.95-0.97), P < 0.001)]. Logistic regression identified several patient and GP characteristics associated with medicine recommendations, e.g. stronger opioids were less likely recommended for Indigenous patients [odds ratio 0.15 (95% CI 0.04-0.56)]. GP's analgesic recommendations for spinal pain have become increasingly ergent from guideline recommendations over time.
Publisher: Springer Science and Business Media LLC
Date: 17-09-2014
DOI: 10.1007/S00125-014-3369-7
Abstract: Data are inconsistent regarding the associations between age, age at diagnosis of diabetes, diabetes duration and subsequent vascular complications. The associations between age (or age at diagnosis), diabetes duration and major macrovascular events, all-cause death and major microvascular events were examined in 11,140 patients with type 2 diabetes randomly allocated to intensive or standard glucose control in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Rates were calculated by 5 year baseline age (or age at diagnosis) and diabetes duration strata. Risks were estimated using Cox models adjusted for treatment assignment and HbA1c. The mean age (±SD) was 65.8 ± 6.4 years, age at diagnosis was 57.8 ± 8.7 years and diabetes duration was 7.9 ± 6.4 years. Diabetes duration was associated with the risk of macrovascular events (HR 1.13 [95% CI 1.08, 1.17]), microvascular events (1.28 [1.23, 1.33]) and death (1.15 [1.10, 1.20]) whereas age (or age at diagnosis) was only associated with the risk of macrovascular events (1.33 [1.27, 1.39]) and death (1.56 [1.48, 1.64]). No interaction was observed between diabetes duration, age and the risk of macrovascular events or death (both p > 0.4). However, an interaction was observed between diabetes duration, age and the risk of microvascular events (p = 0.002), such that the effects of increasing diabetes duration were greatest at younger rather than older age. In patients with type 2 diabetes, age or age at diagnosis and diabetes duration are independently associated with macrovascular events and death whereas only diabetes duration is independently associated with microvascular events and this effect is greater in the youngest patients.
Publisher: American Diabetes Association
Date: 22-03-2016
DOI: 10.2337/DC15-2322
Abstract: The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial reported that intensive glucose control prevents end-stage kidney disease (ESKD) in patients with type 2 diabetes, but uncertainty about the balance between risks and benefits exists. Here, we examine the long-term effects of intensive glucose control on risk of ESKD and other outcomes. Survivors, previously randomized to intensive or standard glucose control, were invited to participate in post-trial follow-up. ESKD, defined as the need for dialysis or kidney transplantation, or death due to kidney disease, was documented overall and by baseline CKD stage, along with hypoglycemic episodes, major cardiovascular events, and death from other causes. A total of 8,494 ADVANCE participants were followed for a median of 5.4 additional years. In-trial HbA1c differences disappeared by the first post-trial visit. The in-trial reductions in the risk of ESKD (7 vs. 20 events, hazard ratio [HR] 0.35, P = 0.02) persisted after 9.9 years of overall follow-up (29 vs. 53 events, HR 0.54, P & 0.01). These effects were greater in earlier-stage CKD (P = 0.04) and at lower baseline systolic blood pressure levels (P = 0.01). The effects of glucose lowering on the risks of death, cardiovascular death, or major cardiovascular events did not differ by levels of kidney function (P & 0.26). Intensive glucose control was associated with a long-term reduction in ESKD, without evidence of any increased risk of cardiovascular events or death. These benefits were greater with preserved kidney function and with well-controlled blood pressure.
Publisher: American Diabetes Association
Date: 07-08-2015
DOI: 10.2337/DC15-0925
Abstract: This study explored whether activation of the receptor for advanced glycation end products (RAGE) is implicated in the development of diabetes complications. A case-cohort study was performed in 3,763 participants with prevalent diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. The hazard ratios (HRs) for death, major cardiovascular events, and new or worsening nephropathy were derived using Cox regression models, and the ability of sRAGE and AGE levels to reclassify the risk of nephropathy was assessed. After adjustment for a range of possible confounders and other risk factors, sRAGE levels were associated with all-cause mortality (HR 1.11 for a 1-SD increase of log sRAGE [95% CI 1.00–1.22] P = 0.045) and new or worsening nephropathy (HR 1.20 for a 1-SD increase of log sRAGE [95% CI 1.02–1.41] P = 0.032). Circulating AGE levels were also independently associated with new or worsening nephropathy (HR 1.21 for a 1-SD increase [95% CI 1.08–1.36] P = 0.001). Both markers also significantly improved the accuracy with which the 5-year risk of new or worsening nephropathy could be predicted (net reclassification index in continuous model, 0.25 for sRAGE and 0.24 for AGE levels). In adults with type 2 diabetes, increased levels of sRAGE are independently associated with new or worsening kidney disease and mortality over the next 5 years. Higher levels of AGE are also associated with an increased risk of adverse renal outcomes. The AGE/RAGE axis may be of importance in the prevention and management of diabetes complications.
Publisher: S. Karger AG
Date: 16-12-2015
DOI: 10.1159/000442532
Abstract: b i Background: /i /b This study aimed at identifying the determinants and prognostic significance of a sedimentation level (fluid-blood level) in the hematoma among patients with acute intracerebral hemorrhage (ICH) who participated in the main Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). b i Methods: /i /b Post-hoc analysis of the INTERACT2 dataset, a randomized controlled trial of patients with acute ICH with elevated systolic blood pressure (SBP), randomly assigned to intensive (target SBP mm Hg) or guideline-based ( mm Hg) BP management. Patients with a sedimentation level at baseline assessment on CT, and modified Rankin Scale score at 90-day, were included in these analyses. Factors associated with a sedimentation level and its significance in relation to 90-day clinical outcomes were assessed in univariable and multivariable logistic regression models. b i Results: /i /b Of 2,065 participants, 19 (1%) had sedimentation level on baseline CT, which was independently associated with warfarin use (p = 0.006) and lobar ICH (p = 0.025). Sedimentation level was also associated with death or major disability at 90-day in both crude (84 vs. 53% p = 0.014) and multivariable analyses adjusted for age, gender, Chinese region, warfarin use, baseline National Institutes of Health Stroke Scale score, onset to CT time, volume and location of ICH, intraventricular extension, and randomized intensive BP lowering (OR 3.94, 95% CI 1.01-15.37 p = 0.049). b i Conclusions: /i /b The presence of hematoma sedimentation level on baseline CT is associated with warfarin use and lobar location of ICH, and predicts a worse outcome. Although uncommon, sedimentation level is an easily detectable prognostic factor in acute ICH.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.JPAIN.2017.03.004
Abstract: The presence of bimodal outcome distributions has been used as a justification for conducting responder analyses, in addition to, or in place of analyses of the mean between-group difference, in clinical trials and systematic reviews of interventions for pain. The aim of this study was to investigate the distribution of participants' pain outcomes for evidence of bimodal distribution. We sourced data on participant outcomes from a convenience s le of 10 trials of nonsurgical interventions (exercise, manual therapy, medication) for spinal pain. We assessed normality using the Shapiro-Wilk test. When the Shapiro-Wilk test suggested non-normality we inspected distribution plots visually and attempted to classify them. To test whether responder analyses detected a meaningful number of additional patients experiencing substantial improvements we also calculated the risk difference and number needed to treat to benefit. We found no compelling evidence suggesting that outcomes were bimodally distributed for any of the intervention groups. Responder analysis would not meaningfully alter our interpretation of these data compared with the mean between group difference. Our findings suggest that bimodal distribution of outcomes should not be assumed in interventions for spinal pain and do not support the automatic prioritization of responder analysis over the between group difference in the evaluation of treatment effectiveness for pain. Secondary analysis of clinical trials of nonsurgical interventions for spinal pain found no evidence for bimodally distributed outcomes. The findings do not support the automatic prioritization of responder analyses over the average between group difference in the evaluation of treatment effectiveness for spinal pain.
Publisher: Elsevier BV
Date: 10-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Oxford University Press (OUP)
Date: 15-12-2016
DOI: 10.1093/PM/PNW126
Abstract: To investigate the influence of various weather parameters on the risk of developing a low back pain (LBP) episode. Case-crossover study. Primary care clinics in Sydney, Australia. 981 participants with a new episode of acute LBP. Weather parameters were obtained from the Australian Bureau of Meteorology. Odds ratios (OR) and 95% confidence intervals (95% CI) were derived comparing two exposure variables in the case window-(1) the average of the weather variable for the day prior to pain onset and (2) the change in the weather variable from 2 days prior to 1 day prior to pain onset-with exposures in two control windows (1 week and 1 month before the case window). The weather parameters of precipitation, humidity, wind speed, wind gust, wind direction, and air pressure were not associated with the onset of acute LBP. For one of the four analyses, higher temperature slightly increased the odds of pain onset. Common weather parameters that had been previously linked to musculoskeletal pain, such as precipitation, humidity, wind speed, wind gust, wind direction, and air pressure, do not increase the risk of onset for LBP.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-01-2018
DOI: 10.1161/CIRCULATIONAHA.117.032038
Abstract: Canagliflozin is a sodium glucose cotransporter 2 inhibitor that significantly reduces the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke in patients with type 2 diabetes mellitus and elevated cardiovascular risk. The comparative effects among participants with and without a history of cardiovascular disease (secondary versus primary prevention) were prespecified for evaluation. The CANVAS Program (Canagliflozin Cardiovascular Assessment Study) randomly assigned 10 142 participants with type 2 diabetes mellitus to canagliflozin or placebo. The primary prevention cohort comprised in iduals ≥50 years of age with ≥2 risk factors for cardiovascular events but with no prior cardiovascular event, and the secondary prevention cohort comprised in iduals ≥30 years of age with a prior cardiovascular event. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Secondary outcomes included heart failure hospitalization and a renal composite (40% reduction in estimated glomerular filtration rate, renal replacement therapy, or renal death). Primary prevention participants (N=3486 34%) were younger (63 versus 64 years of age), were more often female (45% versus 31%), and had a longer duration of diabetes mellitus (14 versus 13 years) compared with secondary prevention participants (N=6656 66%). The primary end point event rate was higher in the secondary prevention group compared with the primary prevention group (36.9 versus 15.7/1000 patient-years, P .001). In the total cohort, the primary end point was reduced with canagliflozin compared with placebo (26.9 versus 31.5/1000 patient-years hazard ratio [HR], 0.86 95% confidence interval [CI], 0.75–0.97 P .001 for noninferiority, P =0.02 for superiority) with no statistical evidence of heterogeneity (interaction P value=0.18) between the primary (HR, 0.98 95% CI, 0.74–1.30) and secondary prevention (HR, 0.82 95% CI, 0.72–0.95) cohorts. Renal outcomes (HR, 0.59 95% CI, 0.44–0.79 versus HR, 0.63 95% CI, 0.39–1.02 interaction P value=0.73) and heart failure hospitalization (HR, 0.68 95% CI, 0.51–0.90 versus HR, 0.64 95% CI, 0.35–1.15 interaction P value=0.91) were similarly reduced in the secondary and primary prevention cohorts, respectively. Lower extremity utations were similarly increased in the secondary and primary prevention cohorts (HR, 2.07 95% CI, 1.43–3.00 versus HR, 1.52 95% CI, 0.70–3.29 interaction P value=0.63). Patients with type 2 diabetes mellitus and prior cardiovascular events had higher rates of cardiovascular outcomes compared with the primary prevention patients. Canagliflozin reduced cardiovascular and renal outcomes with no statistical evidence of heterogeneity of the treatment effect across the primary and secondary prevention groups. Additional studies will provide further insights into the effects of canagliflozin in these patient populations. URL: www.clinicaltrials.gov . Unique identifiers: NCT01032629 and NCT01989754.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-11-2017
Publisher: BMJ
Date: 20-10-2016
Publisher: American Medical Association (AMA)
Date: 06-2015
DOI: 10.1001/JAMADERMATOL.2014.3593
Abstract: The total cost of psoriasis in the United States is unknown. Defining the US economic burden of psoriasis is needed because it provides the foundation for research, advocacy, and educational efforts. To determine the US economic burden of psoriasis from a societal perspective. PubMed and MEDLINE databases were searched between January 1, 2008, and September 20, 2013, for economic investigations on the direct, indirect, intangible, and comorbidity costs of adult psoriasis in the United States. The base year costs were adjusted to 2013 US dollars using the Consumer Price Index for All Urban Consumers and multiplied by the estimated number of US patients with psoriasis in 2013 to determine the 2013 psoriasis cost burden. Among 100 identified articles, 22 studies were included in the systematic review. The direct psoriasis costs ranged from $51.7 billion to $63.2 billion, the indirect costs ranged from $23.9 billion to $35.4 billion, and medical comorbidities were estimated to contribute $36.4 billion annually in 2013 US dollars. Patients with psoriasis would pay a lifetime cost of $11,498 for relief of physical symptoms and emotional health however, intangible cost data are limited. The annual US cost of psoriasis amounted to approximately $112 billion in 2013. The economic burden of psoriasis is substantial and significant in the United States.
Publisher: Massachusetts Medical Society
Date: 20-07-2017
DOI: 10.1056/NEJMC1703337
Publisher: S. Karger AG
Date: 03-02-2017
DOI: 10.1159/000455751
Abstract: b i Background: /i /b Insomnia symptoms are common in the population and have negative psychosocial and functional sequelae. There are no prospective studies of the course of such symptoms and their impact, if any, in stroke survivors. This prospective cohort study investigated insomnia after stroke in working-age adults and evaluated its impact on psychological and functional outcomes over the subsequent year. b i Methods: /i /b We prospectively recruited 441 young (& #x3c years) consecutive stroke survivors from 20 public hospitals in the New South Wales Stroke Service network. Participants were assessed by self-report and interview at 28 days, 6 months, and 12 months after stroke. Insomnia was defined using a common epidemiological measure of sleep disturbance and daytime consequences. Depression, anxiety, disability, and return to work were assessed through standardized measures. b i Results: /i /b The point prevalence of insomnia at each time point in the year after stroke was stable at 30–37% and more common in females. Fifty-eight (16%) of all participants reported “chronic” insomnia, with symptoms at both baseline and 6 months later. At 12 months, this group was more likely to be depressed (OR 6.75, 95% CI 2.78–16.4), anxious (OR 3.31, 95% CI 1.54–7.09), disabled (OR 3.60, 95% CI 2.07–6.25), and not have returned to work, compared to those without insomnia over the same period. b i Conclusions: /i /b Chronic insomnia has a negative effect on disability and return to work 1 year after stroke even after adjusting for demographic, psychiatric, and disability factors. Identifying and appropriately targeting insomnia through known effective treatments may improve functional outcomes after stroke.
Publisher: Massachusetts Medical Society
Date: 09-10-2014
Publisher: Oxford University Press (OUP)
Date: 27-03-2014
Abstract: Most in iduals at high cardiovascular disease (CVD) risk worldwide do not receive any or optimal preventive drugs. We aimed to determine whether fixed dose combinations of generic drugs ('polypills') would promote use of such medications. We conducted a randomized, open-label trial involving 623 participants from Australian general practices. Participants had established CVD or an estimated five-year CVD risk of ≥15%, with indications for antiplatelet, statin and ≥2 blood pressure lowering drugs ('combination treatment'). Participants randomized to the 'polypill-based strategy' received a polypill containing aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide 12.5 mg. Participants randomized to 'usual care' continued with separate medications and doses as prescribed by their doctor. Primary outcomes were self-reported combination treatment use, systolic blood pressure and total cholesterol. After a median of 18 months, the polypill-based strategy was associated with greater use of combination treatment (70% vs. 47% relative risk 1.49, (95% confidence interval (CI) 1.30 to 1.72) p < 0.0001 number needed to treat = 4.4 (3.3 to 6.6)) without differences in systolic blood pressure (-1.5 mmHg (95% CI -4.0 to 1.0) p = 0.24) or total cholesterol (0.08 mmol/l (95% CI -0.06 to 0.22) p = 0.26). At study end, 17% and 67% of participants in polypill and usual care groups, respectively, were taking atorvastatin or rosuvastatin. Provision of a polypill improved self-reported use of indicated preventive treatments. The lack of differences in blood pressure and cholesterol may reflect limited study power, although for cholesterol, improved statin use in the polypill group counter-balanced use of more potent statins with usual care.
Publisher: American Diabetes Association
Date: 11-12-2013
DOI: 10.2337/DC13-1165
Abstract: Current methods of risk stratification in patients with type 2 diabetes are suboptimal. The current study assesses the ability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) to improve the prediction of cardiovascular events and death in patients with type 2 diabetes. A nested case-cohort study was performed in 3,862 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Seven hundred nine (18%) patients experienced a major cardiovascular event (composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) and 706 (18%) died during a median of 5 years of follow-up. In Cox regression models, adjusting for all established risk predictors, the hazard ratio for cardiovascular events for NT-proBNP was 1.95 per 1 SD increase (95% CI 1.72, 2.20) and the hazard ratio for hs-cTnT was 1.50 per 1 SD increase (95% CI 1.36, 1.65). The hazard ratios for death were 1.97 (95% CI 1.73, 2.24) and 1.52 (95% CI 1.37, 1.67), respectively. The addition of either marker improved 5-year risk classification for cardiovascular events (net reclassification index in continuous model, 39% for NT-proBNP and 46% for hs-cTnT). Likewise, both markers greatly improved the accuracy with which the 5-year risk of death was predicted. The combination of both markers provided optimal risk discrimination. NT-proBNP and hs-cTnT appear to greatly improve the accuracy with which the risk of cardiovascular events or death can be estimated in patients with type 2 diabetes.
Publisher: Massachusetts Medical Society
Date: 16-06-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-10-2017
Abstract: We evaluated a multifaceted, computerized quality improvement intervention for management of cardiovascular disease ( CVD ) risk in Australian primary health care. After completion of a cluster randomized controlled trial, the intervention was made available to both trial arms. Our objective was to assess intervention outcomes in the post‐trial period and any heterogeneity based on original intervention allocation. Data from 41 health services were analyzed. Outcomes were (1) proportion of eligible population with guideline‐recommended CVD risk factor measurements and (2) the proportion at high CVD risk with current prescriptions for guideline‐recommended medications. Patient‐level analyses were conducted using generalized estimating equations to account for clustering and time effects and tests for heterogeneity were conducted to assess impact of original treatment allocation. Median follow‐up for 22 809 patients (mean age, 64.2 years 42.5% men, 26.5% high CVD risk) was 17.9 months post‐trial and 35 months since trial inception. At the end of the post‐trial period there was no change in CVD risk factor screening overall when compared with the end of the trial period (64.7% versus 63.5%, P =0.17). For patients at high CVD risk, there were significant improvements in recommended prescriptions at end of the post‐trial period when compared with the end of the trial period (65.2% versus 56.0%, P .001). There was no heterogeneity of treatment effects on the outcomes based on original randomization allocation. CVD risk screening improvements were not observed in the post‐trial period. Conversely, improvements in prescribing continued, suggesting that changes in provider and patient actions may take time when initiating medications. URL : www.anzctr.org.au . Unique identifier: 12611000478910.
Publisher: Wiley
Date: 24-02-2015
DOI: 10.1002/ACR.22533
Abstract: To investigate a range of transient risk factors for an episode of sudden-onset, acute low back pain (LBP). This case-crossover study recruited 999 subjects with a new episode of acute LBP between October 2011 and November 2012 from 300 primary care clinics in Sydney, Australia. Each participant was asked to report exposure to 12 putative triggers over the 96 hours preceding the onset of back pain. Conditional logistic regression was used to estimate odds ratios (ORs) expressing the magnitude of increased risk with exposure to each trigger. Exposure to a range of physical and psychosocial triggers significantly increased the risk of a new onset of LBP ORs ranged from 2.7 (moderate or vigorous physical activity) to 25.0 (distracted during an activity or task). Age moderated the effect of exposure to heavy loads and sexual activity. The ORs for heavy loads for people ages 20, 40, or 60 years were 13.6, 6.0, and 2.7, respectively. The risk of developing back pain was greatest between 7:00 AM and noon. Transient exposure to a number of modifiable physical and psychosocial triggers substantially increases risk for a new episode of LBP. Triggers previously evaluated in occupational injury studies, but never in LBP, have been shown to significantly increase risk. These results aid our understanding of the causes of LBP and can inform the development of new prevention approaches.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2016
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.OPHTHA.2014.05.014
Abstract: To measure the change in quality of life and economic circumstances after cataract surgery and identify the predictors of an improvement in these outcomes. A multicenter, prospective, longitudinal cohort study. Participants aged 18 years were recruited to the study if the clinical assessment of their best uncorrected vision was <= 6/18 in the better eye because of cataract [Corrected]. Cataract surgery. Data were collected on quality of life and a multidimensional assessment of household economic circumstances (work status, income, asset ownership, household economic hardship, and catastrophic health expenditure). At 12 months follow-up, 381 of 480 participants were re-interviewed, and all had undergone surgery. There was a significant improvement in quality of life. Household economic circumstances also improved (mean change paid work participation/month: 44.5 hours, P < 0.0001 mean change unpaid work participation/month: 89.5 hours, P < 0.0001 change in proportion with hardship: -17%, P < 0.0001 and change in proportion with catastrophic health expenditure: -7%, P = 0.02). Improvements were most likely in near-poor households and were related to the type of surgery and complications after surgery. This research showed that cataract surgery is associated with meaningful improvements in quality of life and household economic circumstances that are indicative of positive transitions out of poverty. Given the unmet need for cataract surgery in low- and middle-income countries where cataract impairment is substantial, this research demonstrates the potential of a relatively simple, low-cost health intervention to greatly improve household economic circumstances.
Publisher: Wiley
Date: 16-02-2017
DOI: 10.1111/NEP.12749
Abstract: The aim is to explore (i) the relationship between quality of life and physical parameters (muscle strength and mobility) among people undergoing maintenance haemodialysis (ii) changes in strength and mobility over time and predictors of changes and (iii) whether strength and mobility were associated with falls. We recruited 51 maintenance haemodialysis patients to a prospective longitudinal study. Baseline quality of life was assessed using the SF-36 physical component summary and mental component summary scores. Muscle strength (ankle dorsiflexion strength measured with a hand-held dynamometer), mobility (short physical performance battery) and falls history were assessed at baseline, 12 and 36 months. Associations between variables at baseline were assessed with linear regression models. Changes in physical parameters were evaluated with paired t-tests and prediction of falls assessed by negative binominal regression. Fifty and 34 patients completed 12 and 36 month follow-ups, respectively. Baseline mobility but not muscle strength correlated with physical component summary (P = 0.01 and P = 0.23, respectively). Neither baseline mobility nor muscle strength correlated with mental component summary. At 12 months, muscle strength and mobility had significantly deteriorated (mean ankle dorsiflexion strength 11.0 lb (SD 1.5) from 14.0 lb (SD 2.2), P < 0.01 short physical performance battery 8.5 (SD 2.8) from 9.3 (SD 2.6), P < 0.01). Falls at 12 and 36 months were predicted by baseline mobility (P = 0.06 and P = 0.02, respectively) but not muscle strength. Physical parameters appear to be associated with meaningful patient outcomes and showed measurable deterioration over relatively short time frames. Interventions, with the potential to slow physical decline in people receiving maintenance dialysis, such as exercise programmes, warrant further investigation.
Publisher: Wiley
Date: 24-11-2014
DOI: 10.1002/ACR.22378
Abstract: To investigate the influence of various weather conditions on risk of low back pain. We conducted a case-crossover study in primary care clinics in Sydney, Australia. A total of 993 consecutive patients with a sudden, acute episode of back pain were recruited from October 2011 to November 2012. Following the pain onset, demographic and clinical data about the back pain episode were obtained for each participant during an interview. Weather parameters (temperature, relative humidity, air pressure, wind speed, wind gust, wind direction, and precipitation) were obtained from the Australian Bureau of Meteorology for the entire study period. Weather exposures in the case window (time when participants first noticed their back pain) were compared to exposures in 2 control time windows (same time duration, 1 week and 1 month before the case window). Temperature, relative humidity, air pressure, wind direction, and precipitation showed no association with onset of back pain. Higher wind speed (odds ratio [OR] 1.17 [95% confidence interval (95% CI) 1.04-1.32], P = 0.01 for an increase of 11 km/hour) and wind gust (OR 1.14 [95% CI 1.02-1.28], P = 0.02 for an increase of 14 km/hour) increased the odds of pain onset. Weather parameters that have been linked to musculoskeletal pain such as temperature, relative humidity, air pressure, and precipitation do not increase the risk of a low back pain episode. Higher wind speed and wind gust speed provided a small increase in risk of back pain, and although this reached statistical significance, the magnitude of the increase was not clinically important.
Publisher: BMJ
Date: 2016
No related grants have been discovered for Qiang Li.