Journal of the New Zealand Medical Association, 23-June-2006, Vol 119 No 1236
Proceedings of the Waikato Clinical School Research Seminar, Wednesday 22 March 2006
Stability of the harm avoidance personality trait in late-life depression. G Cheung, C Todd-Oldehaver, Mental Health Services for Older People, Waikato District Health Board, Hamilton
Abstract: Research in the personality trait of harm avoidance using the Temperament and Character Inventory (TCI) in older people with depression is very limited. One of the properties of a personality trait is that it should be relatively stable over time. The aim of this study is to investigate whether the personality trait of harm avoidance is stable over a 12 months period in a group of older people with depression. 32 (86%) of the initial 37 older people with depression with their harm avoidance personality trait measured 12 months ago were interviewed to have this personality trait re-measured using the TCI. There is no statistically significant difference between the initial mean harm avoidance score of 17.3 and the repeated mean score of 17.1 (p=0.85). This study provided evidence for harm avoidance being a stable personality trait as proposed in the Cloninger’s psychobiological model of personality.
Comparison of suture ligation and clip ligation for the treatment of patent ductus arteriosus. Parkash Mandhan, Udaya Samarakkody—Spencer Beasley, Stuart Brown, Kiki Maoate, Askar Kukkady and Russell Blakelock. Department of Paediatric Surgery, Waikato Hospital, Hamilton—Department of Paediatric Surgery, Christchurch Hospital, Christchurch
Purpose: We reviewed the experience of the two centres with the surgical treatment of patent ductus arteriosus (PDA), and compared the two techniques, suture ligation (SL) and clip ligation (CL).
Material and Methods: Retrospective review of the clinical and operative records of 63 newborn patients who had surgical closure of PDA at two centers, Hamilton and Christchurch, from 2000 to 2005. Thirty-two patients had SL and thirty-one CL. All patients had open thoractomy for PDA ligation. A two-tailed Student’s t test was used to calculate the 95% confidence intervals for length of operation, intra and postoperative problems.
Results: The diagnosis was made by echocardiography in 58 (93%) patients and all procedures were performed semi-urgently. Both groups were similar in age and gender. The average length of procedure was 55.78 ± 13.7 minutes for SL and 30.83 ± 8.7 for CL. Six neonates had intra-operative bleeding in SL group. In the SL group, 4 patients had significant post-operative complications (pneumothoracies and chylothorax) in comparison to one in the CL group (pneumothorax). The differences in the operative time was statistically significant (p value <0.05), however there were no differences in the intra-operative and postoperative complications between the two groups because of the relatively small numbers of patients in each study group.
Conclusion: This study demonstrates that there is a significant reduction in the operative time in using the method of CL as opposed to the SL in the surgical closure of PDA in neonates.
Quality of life in the elderly. Dr PSDV Prasadarao, Dr Gary Cheung & Weibo Sun, Mental Health Services for Older People (MHSOP), Waikato Hospital, Hamilton
Abstract: New Zealand population is ageing. Research exploring quality of life (QOL) among older people may have implications in developing and delivering services and in enhancing their QOL. Enhancing QOL can promote subjective well-being in the Elderly, may prevent deterioration of physical and mental health, and reduce the need for more intensive and expensive health care. Efforts in enhancing QOL may lead to positive health gains through better treatment adherence and positive outlook towards life and illness that in turn may postpone functional decline. There is a paucity of research in this area, prompting the present pilot study to explore quality of life among older people.
The present research was a cross-sectional exploratory study utilising convenience samples. The aims were to: 1) assess the QOL among older people who are living a) on their own and b) in the retirement villages with supported environment, and to find out if there is any difference between these two groups; 2) assess the role of life satisfaction on QOL among older people; and 3) assess the role of perceived health status on QOL among older people. Individuals over 65 years with adequate cognitive functioning were included. Subjects included: Group-I (N=49) : individuals living in a supportive environment and with structured group activities; Group-II (N=54) : individuals living on their own with no exposure to supportive activities. Variables, namely, health status (Health conditions Checklist of the Multilevel Assessment Instrument; Lawton, 1972), life satisfaction (The Life Satisfaction Index-A; Neugarten et al., 1961) and quality of life (QuiLL Questionnaire; Evans et al., 2005) were studied. Findings and implications were discussed.
Expression of Sonic Hedgehog cascade during hindgut development. Parkash Mandhan, Spencer Beasley, Tracy Hale, Leigh Ellmers, Justin Roake, Michael Sullivan, Children’s Developmental & Cancer Genetic Research Group, Department of Surgery and Paediatrics, University of Otago, Christchurch
Purpose: In normal hindgut development, sonic hedgehog (shh) cascade is required to play a crucial role in anorectal morphogenesis in vertebrates. The aim of this study was to determine the expression pattern of shh and its downstream genes during hindgut development in ETU exposed embryos with anorectal malformations (ARM).
Material and Methods: Pregnant Sprague-Dawley females were administered 1% ETU (125 mg/kg) on the tenth day of gestation (D10). Embryos were collected between D12 and D16 from experimental and control group. Developing hindgut was dissected from each embryo and dissected tissues were immediately frozen in liquid nitrogen. RNA was isolated using Trizol method and first strand cDNA was synthesised using Random hexamer primers. Reverse transcriptase polymerase chain reaction (RT-PCR) was done to determine the expression of shh and its downstream genes.
Results: Reverse transcriptase (RT) polymerase chain reaction (PCR) was done to determine the transcripts of Shh in each sample and quantitative real-time PCR was carried out to show relative quantitative expression of Shh at each time point. Shh was detected in all samples confirming that Shh is active during the process of hindgut development in fetal rats. Relative quantitation demonstrated that Shh expression shows time-dependent changes in the developing hindgut of ETU-exposed rat embryos, and when results were compared with control samples, there was significant decrease in expression on gD14 and 15, when the cloaca normally separates into the rectum and urethra occurs in the rat fetus.
Conclusion: Our preliminary data shows that shh plays vital role during the process of hindgut development, and on D14 and D15, when there is time of separation of cloaca into hindgut and urogenital tract, shh is down regulated thus possibly contribute for the ARM.
Isolation of myostatin in human volunteers and age related correlation of serum levels. TM Vasudevan, R Kambadur#, J Conaglen*, K Foulkes. Department of Vascular Surgery, *Endocrinology, Waikato Hospital, #Human Genomics, AgResearch, Ruakura
Background: Myostatin is a TGF beta super family member produced in normal skeletal muscles in animals. It is a negative regulator of skeletal muscle mass. Following isolation of the mostatin gene, myostatin knock out animals show significant increase in muscle bulk without changes in body weight.
Aim: To estimate myostatin levels in normal human volunteers in various decades of life and correlate the levels to lean body mass (LBM) and serum creatinine levels.
Methodology: 120 healthy volunteers were recruited following approval from the local ethics committee. 10mls of venous blood was extracted after overnight fasting for estimation of serum lipids, creatinine and myostatin levels. Volunteers performing vigorous physical exercises were excluded along with people on medications and pre-existing diseases or disabilities. Serum myostatin levels were measured by ELISA. standardisation.
Results: 60 samples were analysed to date. Myostatin was present in measurable quantities in all volunteers. Mean levels were maximal in the 5th decade (14.47mMol/L). Peak levels of myostatin was more prominent in men (14.97 vs 14.12mMol/L) although not statistically significant. There was no significant correlation of serum myostatin with age, BMI, LBM.
Conclusion: Serum myostatin is present in measurable quantities in humans The role of myostatin in disease processes like muscular dystrophy and muscle wasting due to malignant illnesses is being determined in an ongoing study.
Chlamydia trachomatis in New Zealand. Geoff Spencer, Jane Morgan
Aims: To make crude regional and national estimates of Chlamydia prevalence in New Zealand, based on Chlamydia diagnoses for the year 2003.
Methods: A survey of all accredited medical-testing laboratories in New Zealand was carried out.
Results: Fifty of 53 laboratories responded; 10 were unable or unwilling to provide testing data for the survey. Of the data provided, 7.57 % of all Chlamydia tests in 2003 were positive. Because of data limitations, we were unable to calculate regional or national Chlamydia population-based figures. Data limitations and issues included lack of ethnicity data, issues of duplicate testing, centralised testing, non-standardised testing methodologies, funding and commercial sector reluctance to share data in a competitive environment.
Conclusions: New Zealand lacks robust epidemiological prevalence data for sexually transmitted infections and urgent improvements to the national surveillance framework are needed. The issues identified in our survey suggest such improvements will only occur if bacterial sexually transmitted infections become notifiable conditions.
An investigation into the medication usage and cost for diabetic patients in a rural town in New Zealand. Antonia Zechner1, Grace Joshy2, David Simmons2. 1Dept of Economics, University of Waikato, Hamilton; 2Waikato Clinical School, University of Auckland, Hamilton
Improvements in diabetes care due to a multi-faceted intervention in a rural Waikato town will be monitored and costed over the next 2 years. Medicine costs are both an expense to patients and the government as subsidies. A mail survey was undertaken to provide insight into the range of medicine costs faced by diabetes patients. The information collected was: name of medication, dosage of that medication, number of doses taken, and frequency of dose taken. The Pharmac database covering a three month period was used to access the medication costs of those patients who filled in the survey.
204 (63%) patients responded (57% European, 31% Maori, 52% Female). 246 different medications were identified as being used within the rural cohort. There was however an overlap of medication listed under both generic and brand name. The medication covers prescription drugs, over-the-counter (OTC) medication, supplements, herbal and traditional medication. Antihyperglycaemic medications (AHM) were taken by 64% of patients and medications for non glycaemic risk factors and cardiovascular disease medications (NGRFCVDM) were taken by 87% of patients. Twelve patients (5.9%) took no medication. The average number of different medications was 4.4± 3.1. The most common drugs used were: Lipex 96 (47.1%), Accupril 89 (43.6%), and Metformin 68 (33.3%). The median (interquartile range) AHM costs were: out-of-pocket $3.00(0-9), subsidies $64.38 ($33-271) and total costs $67.54 (40-274). The cost for NGRFCVDM were $6.00(0-15), subsidies $221.88(112-393) and total costs $215.38(105-385). The median (interquartile range) costs for all drugs were: out-of-pocket $52.10 (29-76), subsidies $525 ($264-1003) and total costs $583 (323-1179).
We conclude that in this rural town, out of pocket expenses for medications are a small fraction of the total costs, and that AHM are a quarter of the cost of NGRFCVDM.
Glycaemic control and antibody status among patients with newly diagnosed Type 1 diabetes. Doron Hickey, Grace Joshy, Peter Dunn, David Simmons, Ross Lawrenson
Abstract: The aim of the study was to compare the risk of admission to hospital and poor glycaemic control by antibody status among newly diagnosed patients with Type 1 diabetes in the Waikato. A cohort of patients under the age of 25 at diagnosis were identified from the Waikato Diabetes Service diabetes database. Patient information extracted included: gender, date of birth, ethnicity, year of diagnosis, age at diagnosis, initial and current treatment, height, weight, lipids and HbA1c. The primary outcomes of interest were: admission to hospital, admission for DKA and most recent HbA1c. A total of 164 people were diagnosed with diabetes between 1997 and 2002. 133 (81%) were diagnosed with type 1 diabetes and 27 (16%) with type 2 diabetes. Of the 133 type 1 patients, 85 (64%) had an anti-GAD measurement and 65/85 (76%) were positive. 24 patients had one or more admissions for DKA. Logistic regression suggested gender and IA2 positivity but not anti-GAD were related to the latest HbA1c but there was no association between level of antibodies at diagnosis and subsequent risk of admission to hospital. Our follow study up shows that admission to hospital with DKA was a relatively rare event and only occurred in 18% of patients. Because of the small number of admissions with DKA we did not show any statistically significant associations with antibody status at diagnosis but high levels of anti-IA2 are associated with improved glycaemic control suggesting it is a good prognostic indicator.
High dose oxygen therapy in vascular surgery. PJ Puckridge, H Saleem, C Holdaway, TM Vasudevan, D Ferrar
The administration of high dose oxygen therapy (FiO2 80%) intra-operatively and immediately post operatively has been successful in halving wound infections in colorectal surgical patients1 through increasing tissue oxygenation. This high dose oxygen therapy has been administered safely without worsening respiratory function2.
Infra-inguinal bypass surgical patients have high rates of wound infections with potential disastrous consequences. These patients have baseline tissue oxygen tension that is reduced below normal3-10. This pathological hypoxaemia worsens during surgery, which may make the tissue defences unable to control bacterial lodgement within the surgical wound. However it is unknown whether delivery of high dose oxygen will change the tissue oxygenation in the vascular patient.
Consequently we commenced a pilot project with the hypothesis that high dose intra-operative oxygen administration to patients undergoing infra-inguinal arterial surgery will result in increased tissue p02 as evidenced by TcpO2 measurements.
Method: Consecutive non-randomised patients undergoing infra-inguinal arterial surgery were recruited. Relevant demographic information was collected. Transcutaneous partial pressure of oxygen (TcpO2) was measured using A TCM3 monitoring system (Radiometer, Copenhagen) attached to the foot. A baseline measurement was recorded pre-operatively.
Intraoperatively with arterial clamps in place FiO2 was set at 30% and after equilibration complete a measurement obtained. FiO2 then changed to 80% and further measurement obtained. Post operatively the patients had TcpO2 once again measured with FiO2 at 30% and 80% while in recovery. A final reading was taken prior to discharge. For comparison arterial blood gases were taken at the same times. Induction of anaesthesia and surgery was performed in the usual manner. Analysis of the results was performed using standard statistical methodology.
Results: Nine patients have been recruited at this time. There were significant differences in arterial oxygen concentration intra-operatively and postoperatively between FiO2 30% and FiO2 80%. Tissue oxygenation showed no difference intraoperatively while arterial clamps in place. A trend towards higher results with use of high dose oxygen (FiO2 80%) postoperatively was seen with P value approaching significance (P=0.10).
Conclusion: The administration of high dose oxygen to vascular surgical patients undergoing lower limb arterial surgery results in a non-significant trend for increased oxygen concentrations in the tissue of the foot. These results suggest the administration of high dose oxygen intra-operatively in patients with peripheral vascular disease may be beneficial but further research is required.
Initiating oral medication for erection problems: changes couples experience. Amy Williamson (Psychology Department, University of Waikato); John V Conaglen (Waikato Clinical School, University of Auckland); Helen M Conaglen (University of Waikato)
Background: Understanding how a couple’s sexual function dynamics alter with the initiation of oral medication treatment is important for the ongoing use of such treatments by couples with erection problems.
Method: This study investigated how couples were affected by the man’s erectile dysfunction (ED) and the impact on both the men and women of subsequent medical treatment of the ED. Following a medical screening process, 30 couples were randomised to receive either Viagra or Cialis oral medication for the man’s erectile problems.
Questionnaires rating the men’s (International index of Erectile Function, IIEF), and women’s sexual functioning (Female Sexual Function Inventory, FSFI), sexual desire (Sexual Desire Inventory, SDI-2), relationship factors (Psychological and Interpersonal Relationship Scales, PAIRS), and adjustment (Dyadic Adjustment Scale, DAS) and quality of life (Comprehensive Quality of Life, COMQoL), were completed at baseline and following treatment.
Results: On the quality of life measure the men showed a significant increase in satisfaction with all areas of life (material, health, productivity, intimacy, safety, place in community and emotional wellbeing.) The women however showed a decrease in their satisfaction regarding level of productivity. The men’s IIEF scores showed improvements in erectile function, orgasmic function, intercourse satisfaction and overall satisfaction, while the women improved levels of arousal, orgasm and satisfaction. Both men and women showed significant increases in levels of confidence within their sexual relationship on the PAIRS measure. The women also showed improvement in their GSI and PST scales of the SCL-90-R, indicating a decrease in the breadth, level and intensity of symptoms of psychopathology.
These changes in quality of life, sexual function, psychopathology and relationship scales will be discussed.
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