Risk factors for injuries and other health problems sustained in a marathon.
OBJECTIVES: To identify risk factors for injuries and other health problems occurring during or immediately after participation in a marathon. METHODS: A prospective cohort study was undertaken of participants in the 1993 Auckland Citibank marathon. Demographic data, information on running experience, training and injuries, and information on other lifestyle factors were obtained from participants before the race using an interviewer-administered questionnaire. Information on injuries and other health problems sustained during or immediately after the marathon were obtained by a self administered questionnaire. Logistic regression analyses were undertaken to identify significant risk factors for health problems. RESULTS: This study, one of only a few controlled epidemiological studies that have been undertaken of running injuries, has identified a number of risk factors for injuries and other health problems sustained in a marathon. Men were at increased risk of hamstring and calf problems, whereas women were at increased risk of hip problems. Participation in a marathon for the first time, participation in other sports, illness in the two weeks before the marathon, current use of medication, and drinking alcohol once a month or more, were associated with increased self reported risks of problems. While increased training seemed to increase the risk of front thigh and hamstring problems, it may decrease the risk of knee problems. There are significant but complex relations between age and risk of injury or health problem. CONCLUSIONS: This study has identified certain high risk subjects and risk factors for injuries and other health problems sustained in a marathon. In particular, subjects who have recently been unwell or are taking medication should weigh up carefully the pros and cons of participating. (+info
A comparative analysis of surveyors from six hospital accreditation programmes and a consideration of the related management issues.
PURPOSE: To gather data on how accreditors manage surveyors, to compare these data and to offer them to the accreditors for improvement and to the scientific community for knowledge of the accreditation process and reinforcement of the credibility of these processes. DATA SOURCE: The data were gathered with the aid of a questionnaire sent to all accreditors participating in the study. RESULTS: An important finding in this comparative study is the different contractual relationships that exist between the accreditors and their surveyors. CONCLUSION: Surveyors around the world share many common features in terms of careers, training, work history and expectations. These similarities probably arise from the objectives of the accreditors who try to provide a developmental process to their clients rather than an 'inspection'. (+info
A comparison of the use, effectiveness and safety of bezafibrate, gemfibrozil and simvastatin in normal clinical practice using the New Zealand Intensive Medicines Monitoring Programme (IMMP).
AIMS: Because of the importance of treating dyslipidaemia in the prevention of ischaemic heart disease and because patient selection criteria and outcomes in clinical trials do not necessarily reflect what happens in normal clinical practice, we compared outcomes from bezafibrate, gemfibrozil and simvastatin therapy under conditions of normal use. METHODS: A random sample of 200 patients was selected from the New Zealand Intensive Medicines Monitoring Programme's (IMMP) patient cohorts for each drug. Questionnaires sent to prescribers requested information on indications, risk factors for ischaemic heart disease, lipid profiles with changes during treatment and reasons for stopping therapy. RESULTS: 80% of prescribers replied and 83% of these contained useful information. The three groups were similar for age, sex and geographical region, but significantly more patients on bezafibrate had diabetes and/or hypertension than those on gemfibrozil or simvastatin. After treatment and taking the initial measure into account, the changes in serum lipid values were consistent with those generally observed, but with gemfibrozil being significantly less effective than expected. More patients (15.8%S) stopped gemfibrozil because of an inadequate response compared with bezafibrate (5.4%) and simvastatin (1.6%). Gemfibrozil treatment was also withdrawn significantly more frequently due to a possible adverse reaction compared with the other two drugs. CONCLUSIONS: In normal clinical practice in New Zealand gemfibrozil appears less effective and more frequently causes adverse effects leading to withdrawal of treatment than either bezafibrate or simvastatin. (+info
Feasibility of finding an unrelated bone marrow donor on international registries for New Zealand patients.
Allogeneic bone marrow transplantation is the treatment of choice for several hematological conditions. Unfortunately, for the majority (70%) of patients an HLA-matched sibling donor is not available and a matched unrelated donor must be found if they are to proceed to allogeneic transplantation. Most of the donors on international registries are of Caucasian ethnic origin. It has been recognized that patients from certain racial groups have a reduced chance of finding an unrelated donor. This study reports the feasibility of finding an unrelated donor for our local New Zealand patients of Caucasian, New Zealand Maori and Pacific Islander ethnic origin presenting with transplantable hematological conditions at a single center. The search was performed on international registries using HLA-A,B and DR typings for our patients. Six of six and five of six matches were evaluated. We have shown that Maori and Pacific Islanders have significantly lower hit rates than Caucasians when searched for 6/6 antigen matches, but there was no significant difference between the three ethnic groups in finding a 5/6 antigen matched donor. This study supports the policy of the New Zealand Bone Marrow Donor Registry in recruiting New Zealand Maori and Pacific Islanders. (+info
Priority points and cardiac events while waiting for coronary bypass surgery.
OBJECTIVE: To assess the risk of important cardiac events while waiting for coronary artery bypass surgery (CABG) in relation to the New Zealand priority scoring system; to compare clinical characteristics of patients referred for CABG in New Zealand with those in Ontario, Canada; and to compare the New Zealand priority scoring system for CABG with the previously validated Ontario urgency score. DESIGN: Analysis of outcomes in a consecutive case series of patients referred for CABG. SETTING: University hospital. PATIENTS: All 324 patients from Christchurch Hospital wait listed for isolated CABG between 1 January 1994 and 31 December 1995. MAIN OUTCOME MEASURES: Death, myocardial infarction, and unstable angina while waiting for CABG; waiting time to surgery. RESULTS: Clinical characteristics at referral were very similar, but median waiting time was longer in New Zealand than in a large Canadian case series (212 days v 17 days). While waiting for elective CABG, 44% (114/257) of New Zealand patients had cardiac events: death 4% (13/257), non-fatal myocardial infarction 6% (16/257), readmission with unstable angina 34% (87/257). Priority scores did not predict cardiac events while waiting for CABG. Indeed, death or non-fatal myocardial infarction occurred in 4% (3/76) and 8% (6/76), respectively, of those with priority scores < 35. These people are no longer eligible for publicly funded surgery in New Zealand. CONCLUSIONS: Very long waiting times for CABG are associated with frequent cardiac events, at considerable cost to both patients and health care providers. Priority scores may facilitate comparison between countries but such scores did not predict clinical events while waiting. (+info
Twins and maternal smoking: ordeals for the fetal origins hypothesis? A cohort study.
OBJECTIVE: To assess the direct and indirect effects of being a twin, maternal smoking, birth weight, and mother's height on blood pressure at ages 9 and 18 years. DESIGN: Longitudinal study. SUBJECTS: Cohort born in 1972-3. SETTING: Dunedin, New Zealand. MAIN OUTCOME MEASURE: Blood pressure at ages 9 and 18 years. RESULTS: Compared with singletons, twins had a systolic blood pressure 4.55 (95% confidence interval 1.57 to 7.52) mm Hg lower at age 9 after adjustment for direct and indirect effects of sex, maternal smoking, mother's height, socioeconomic status, and birth weight, as well as concurrent height and body mass index. Blood pressure in children whose mothers had smoked during pregnancy was 1.54 (0.46 to 2.62) mm Hg higher than in those whose mothers did not. The total effect of birth weight on systolic blood pressure at age 9 was -0.78 (-1.76 to 0.20) mm Hg and that for mother's height was 0.10 (0.06 to 0.14) mm Hg. Similar results were obtained for systolic blood pressure at age 18. The total effect of twins, maternal smoking, and birth weight on diastolic blood pressure was not significant at either age. CONCLUSIONS: Twins had lower birth weight and lower systolic blood pressure at ages 9 and 18 than singletons. This finding challenges the fetal origins hypothesis. The effect of maternal smoking was consistent with the fetal origin hypothesis in that the infants of smokers were smaller and had higher blood pressure at both ages. This may be explained by pharmacological rather than nutritional effects. The total effect of birth weight on systolic blood pressure, after its indirect effect working through concurrent measures of height and body mass index was taken into account, was small. (+info
In-vitro antimicrobial susceptibility of Neisseria gonorrhoeae in New Zealand.
Four hundred and forty-two isolates of Neisseria gonorrhoeae were tested by an agar dilution method for their susceptibility to penicillin, ampicillin, tetracycline, cephaloridine, and spectinomycin. Of these isolates, 295 were tested for their susceptibility to sulphamethoxazole and to trimethoprim by the same method, using Oxoid diagnostic sensitivity test agar plus 7.5% laked horse blood instead of Proteose No. 3 agar plus 1% IsoVitaleX and 1% haemoglobin. One hundred (22.6%) of the isolates were found to be relatively resistant to penicillin (minimum inhibitory concentration (MIC) less than 0.1 iu/ml), but only 1.1% had a MIC of 1 iu/ml or higher. Ampicillin was slightly more active than penicillin in that all isolates were inhibited by 0.5 microgram/ml or less. For 3.7% of isolates the MIC of tetracycline was 2 microgram/ml or higher. All isolates were sensitive to spectinomycin. By calculating the Spearman rank correlation coefficient (rs), a high correlation (rs greater than 0.5) was found between susceptibility to penicillin and susceptibility to ampicillin, tetracycline, and cephaloridine. Low correlation (rs less than 0.2) was found between susceptibility to penicillin and susceptibility to spectinomycin, sulphamethoxazole, and trimethoprim. (+info
Where young people with multiple sexual partners seek medical care: implications for screening for chlamydial infection.
OBJECTIVE: To investigate among young people the relation between the number of sexual partners and use of medical services in order to guide planning of sexually transmitted disease screening. DESIGN: Cross sectional study within a birth cohort using a questionnaire presented by computer. SETTING: Dunedin, New Zealand in 1993-4. SUBJECTS: 477 men and 458 women aged 21 enrolled in the Dunedin Multidisciplinary Health and Development Study, comprising 91.7% of survivors of the cohort. RESULTS: Men with multiple sexual partners in the previous year were less likely to have a general practitioner than men with one or no partners (76.2% v 88.5%, p < 0.01). Among the women the respective proportions (83.1% and 88.4%) were not significantly different. Significantly more women than men (75.8% v 50.7%, p = 0.03) with five or more partners in the previous year had visited their own general practitioner over that period. Among the sexually experienced, more women than men attended any setting appropriate for sexually transmitted disease screening (93.6% v 71.6%, p < 0.001). CONCLUSIONS: In New Zealand a screening programme for sexually transmitted diseases among young adults reliant on invitation by their own general practitioner would be biased towards those at less risk. Opportunistic screening in general practice would potentially include only about half the most sexually active men and three quarters of such women over a 12 month period. The extension of opportunistic screening to other settings considered appropriate for discussion of sexual health issues could potentially engage the vast majority of women, but not men, at most risk. Any screening programme should incorporate an effective method of finding and treating the sexual partners of infected women. (+info