10 results for Parag, V

  • Incidence of Transient Ischemic Attack in Auckland, New Zealand, in 2011 to 2012

    Barber, PA; Krishnamurthi, R; Parag, V; Anderson, NE; Ranta, A; Klifoyle, D; Wong, E; Green, G; Arroll, B; Bennett, DA; Witt, E; Rush, E; Suh, FM; Theadom, A; Rathnasabapathy, Y; Te Ao, B; Parmar, P; Feigin, V; for the ARCOS IV study group

    Journal article
    Auckland University of Technology

    Background and Purpose—There have been few recent population-based studies reporting the incidence (first ever) and attack rates (incident and recurrent) of transient ischemic attack (TIA). Methods—The fourth Auckland Regional Community Stroke study (ARCOS IV) used multiple overlapping case ascertainment methods to identify all hospitalized and nonhospitalized cases of TIA that occurred in people ≥16 years of age usually resident in Auckland (population ≥16 years of age is 1.12 million), during the 12 months from March 1, 2011. All first-ever and recurrent new TIAs (any new TIA 28 days after the index event) during the study period were recorded. Results—There were 785 people with TIA (402 [51.2%] women, mean [SD] age 71.5 [13.8] years); 614 (78%) of European origin, 84 (11%) Māori/Pacific, and 75 (10%) Asian/Other. The annual incidence of TIA was 40 (95% confidence interval, 36–43), and attack rate was 63 (95% confidence interval, 59–68), per 100 000 people, age standardized to the World Health Organization world population. Approximately two thirds of people were known to be hypertensive or were being treated with blood pressure–lowering agents, half were taking antiplatelet agents and just under half were taking lipid-lowering therapy before the index TIA. Two hundred ten (27%) people were known to have atrial fibrillation at the time of the TIA, of whom only 61 (29%) were taking anticoagulant therapy, suggesting a failure to identify or treat atrial fibrillation. Conclusions—This study describes the burden of TIA in an era of aggressive primary and secondary vascular risk factor management. Education programs for medical practitioners and patients around the identification and management of atrial fibrillation are required.

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  • 30-year trends in stroke rates and outcome in Auckland, New Zealand (1981-2012): a multi-ethnic population-based series of studies

    Feigin, VL; Krishnamurthi, RV; Barker-Collo, S; McPherson, KM; Barber, PA; Parag, V; Arroll, B; Bennett, DA; Tobias, M; Jones, A; Witt, E; Brown, P; Abbott, M; Bhattacharjee, R; Rush, E; Suh, FM; Theadom, A; Rathnasabapathy, Y; Te Ao, B; Parmar, PG; Anderson, C; Bonita, R; ARCOS IV Group

    Journal article
    Auckland University of Technology

    Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years.

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  • STUB IT: randomised controlled trial of a theory-based video messaging mobile phone smoking cessation intervention.

    Whittaker, Robyn; Dorey, E; Bramley, D; Bullen, C; Denny, S; Elley, CR; Maddison, R; McRobbie, H; Parag, V; Rodgers, A; Salmon, P (2011)

    Journal article
    The University of Auckland Library

    Background: Advances in technology allowed the development of a novel smoking cessation program delivered by video messages sent to mobile phones. This social cognitive theory-based intervention (called “STUB IT”) used observational learning via short video diary messages from role models going through the quitting process to teach behavioral change techniques. Objective: The objective of our study was to assess the effectiveness of a multimedia mobile phone intervention for smoking cessation. Methods: A randomized controlled trial was conducted with 6-month follow-up. Participants had to be 16 years of age or over, be current daily smokers, be ready to quit, and have a video message-capable phone. Recruitment targeted younger adults predominantly through radio and online advertising. Registration and data collection were completed online, prompted by text messages. The intervention group received an automated package of video and text messages over 6 months that was tailored to self-selected quit date, role model, and timing of messages. Extra messages were available on demand to beat cravings and address lapses. The control group also set a quit date and received a general health video message sent to their phone every 2 weeks. Results: The target sample size was not achieved due to difficulty recruiting young adult quitters. Of the 226 randomized participants, 47% (107/226) were female and 24% (54/226) were Maori (indigenous population of New Zealand). Their mean age was 27 years (SD 8.7), and there was a high level of nicotine addiction. Continuous abstinence at 6 months was 26.4% (29/110) in the intervention group and 27.6% (32/116) in the control group (P = .8). Feedback from participants indicated that the support provided by the video role models was important and appreciated. Conclusions: This study was not able to demonstrate a statistically significant effect of the complex video messaging mobile phone intervention compared with simple general health video messages via mobile phone. However, there was sufficient positive feedback about the ease of use of this novel intervention, and the support obtained by observing the role model video messages, to warrant further investigation.

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  • Reducing recurrent stroke: methodology of the motivational interviewing in stroke (MIST) randomized clinical trial

    Krishnamurthi, R; Witt, E; Barker-Collo, S; McPherson, K; Davis-Martin, K; Bennett, D; Rush, E; Suh, F; Starkey, N; Parag, V; Rathnasabapathy, Y; Jones, A; Brown, P; Te Ao, B; Feigin, VL; ARCOS IV Programme Group

    Journal article
    Auckland University of Technology

    Recurrent stroke is prevalent in both developed and developing countries, contributing significantly to disability and death. Recurrent stroke rates can be reduced by adequate risk factor management. However, adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor, leading to a large number of preventable recurrent strokes. Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke.

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  • Cardiovascular treatment gaps: closing, but slowly

    Selak, Vanessa; Rafter, N; Parag, V; Tomlin, A; Vander Hoorn, S; Dovey, S; Rodgers, Anthony (2009)

    Journal article
    The University of Auckland Library

    Aim To measure trends in the cardiovascular preventive medication prescribing in New Zealand primary care during 2000???2003. Methods Demographic, risk factor, and prescribing data from the Dunedin Royal New Zealand College of General Practitioners Research Unit database were analysed. The data set consisted of men aged at least 45 years and women at least 55 years, who consulted a doctor in 2000???2003 in a practice that supplied electronic clinical notes (total number varied by year from 24,292 to 30,842). Results Cardiovascular risk (as calculated by the Framingham-based [Anderson] risk equation) could only be estimated for one-third of the study population due to missing risk factor information. In 2000, prescription of both blood pressure- and cholesterollowering medications occurred in 28% of people with established vascular disease and 14???16% of people without vascular disease but with a 5-year cardiovascular risk over 5%. From 2000 to 2003, the treatment of all patient groups with a 5-year cardiovascular risk of >10% (vascular history or not) increased by about 4% per year. Those in the 5???10% cardiovascular risk bracket increased treatment by about 3% per year. Conclusions Cardiovascular medicine treatment gaps in primary care reduced between 2000 and 2003 but a significant gap persisted. There is only modest evidence that treatment rates are targeted to estimated cardiovascular risk. Data on the prescription of these medications by cardiovascular risk needs to be collected, analysed, and disseminated on an ongoing basis to enable close monitoring of strategies to improve cardiovascular risk assessment and management.

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  • Cardiovascular risk factors at age 30 following pre-term birth

    Dalziel, SR; Parag, V; Rodgers, A; Harding, Jane (2007-08)

    Journal article
    The University of Auckland Library

    Background Recent epidemiological evidence has shown increased rates of cardiovascular mortality and associated risk factors in those born small. However, scarce information exists concerning cardiovascular risk factors in adulthood following pre-term birth, or distinguishing the relative contributions of length of gestation and fetal growth to small size at birth.Methods Prospective follow-up of 458 30-year-olds whose mothers took part in a randomized controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome (147 born at term, 311 born pre-term). Follow-up assessments included anthropometry, blood pressure, blood lipids, early morning cortisol levels and 75 g oral glucose tolerance test.Results Gestational age at birth, pre-term birth, and birth weight z-score were not associated with serum cholesterol, triglyceride or cortisol at age 30 (P > 0. 1 for all). However, pre-term birth was associated with increased systolic blood pressure (3.5 mmHg, 95% CI 0.9-6.1 mmHg, P = 0.009) and insulin resistance at age 30 [Log (Insulin area under the curve) = 0.17, 95% CI 0.05-0.28, P=0.006]. Low gestational age at birth was also associated with these outcomes, whereas birth weight, adjusted for gestational age, was not.Conclusions Adults who were born moderately pre-term have increased blood pressure and insulin resistance at 30 years of age. Pre-term birth rather than poor fetal growth is the major determinant of this association. As both the incidence of pre-term birth and survival amongst those born pre-term are increasing, this group may contribute an increasing proportion to overall cardiovascular disease burden.

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  • Auckland Stroke Outcomes study. Part 2: Cognition and functional outcomes 5-years post-stroke.

    Barker-Collo, Suzanne; Feignin, VL; Parag, V; Lawes, CMM; Senior, H (2010)

    Journal article
    The University of Auckland Library

    Background: Understanding the extent of long-term neuropsychological deficits poststroke and their contribution to functional outcomes is essential for evidence-based rehabilitation and resource planning, and could improve stroke outcomes. However, most existing neuropsychological stroke data are not population-based, examine limited outcomes, and have short-term follow-up. Methods: This population-based long-term stroke follow-up study examined associations between neuropsychological deficits (memory, executive function, information processing speed [IPS], visuoperceptual/construction ability, language), depression, and a range of functional outcomes and their interrelationships 5 years poststroke. Results: The greatest proportion of the 307 participants exhibited neuropsychological functioning within the average range, and about 30%???50% performed at lower levels on most measures; few performed above the average range. Deficits were most common in executive functioning and IPS, and 30.4% of participants were depressed. While correlation analyses indicate all cognitive domains are significantly related to functional outcomes, multiple regression analyses showed that only IPS and visuoperceptual ability made significant independent contributions to functional outcomes over and above age, depression, and current Barthel Index. Depression also made a significant and independent contribution to functional outcomes. Conclusion: A considerable proportion of 5-year stroke survivors experience neuropsychological deficits, with these being more likely to involve IPS and executive functioning. Visuoperceptual/construction abilities, visual memory, and IPS were independently associated with handicap, disability, and health-related quality of life over and above contributions made by age, depression, and stroke severity, suggesting these areas are important targets for rehabilitation to improve overall stroke recovery and should be evaluated in future randomized controlled trials.

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  • Randomized clinical trial of honey-impregnated dressings for venous leg ulcers

    Jull, Andrew; Walker, NK; Parag, V; Molan, PC; Rodgers, A (2008)

    Journal article
    The University of Auckland Library

    BACKGROUND: The efficacy of honey as a treatment for venous ulcers has not been evaluated, despite widespread interest. This trial aimed to evaluate the safety and effectiveness of honey as a dressing for venous ulcers. METHODS: This community-based open-label randomized trial allocated people with a venous ulcer to calcium alginate dressings impregnated with manuka honey or usual care. All participants received compression bandaging. The primary outcome was the proportion of ulcers healed after 12 weeks. Secondary outcomes were: time to healing, change in ulcer area, incidence of infection, costs per healed ulcer, adverse events and quality of life. Analysis was by intention to treat. RESULTS: Of 368 participants, 187 were randomized to honey and 181 to usual care. At 12 weeks, 104 ulcers (55.6 per cent) in the honey-treated group and 90 (49.7 per cent) in the usual care group had healed (absolute increase 5.9 (95 per cent confidence interval (c.i.) -4.3 to 15.7) per cent; P = 0.258). Treatment with honey was probably more expensive and associated with more adverse events (relative risk 1.3 (95 per cent c.i. 1.1 to 1.6); P = 0.013). There were no significant differences between the groups for other outcomes. CONCLUSION: Honey-impregnated dressings did not significantly improve venous ulcer healing at 12 weeks compared with usual care. Registration number: ISRCTN 06161544 (http://www.controlled-trials.com).

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  • Long term effects of antenatal betamethasone on lung function: 30 year follow up of a randomised controlled trial

    Dalziel, SR; Rea, Harold; Walker, NK; Parag, V; Mantell, C; Rodgers, A; Harding, Jane (2006-08)

    Journal article
    The University of Auckland Library

    Background: Antenatal betamethasone is routinely used for the prevention of neonatal respiratory distress syndrome in preterm infants. However, little is known of the long term effects of exposure to antenatal betamethasone on lung function in adulthood.Methods: Five hundred and thirty four 30 year olds whose mothers had participated in the first and largest randomised controlled trial of antenatal betamethasone were followed. Lung function was assessed by portable spirometric testing. The prevalence of asthma symptoms was assessed using the European Community Respiratory Health Survey questionnaire.Results: Fifty (20%) betamethasone exposed and 53 (19%) placebo exposed participants met the criteria for current asthma ( relative risk 0.98 (95% CI 0.74 to 1.30), p = 0.89). 181 betamethasone exposed and 202 placebo exposed participants had acceptable spirometric data. There were no differences in lung function between betamethasone and placebo exposed groups (mean (SD) forced vital capacity in the betamethasone and placebo groups 105.9 (12.0) v 106.6 (12.6)% predicted, difference = 20.7 ( 95% CI 23.2 to 1.8), p = 0.59; mean ( SD) forced expiratory volume in 1 second in the betamethasone and placebo groups 98.9 (13.4) v 98.5 (13.6)% predicted, difference = 0.3 ( 95% CI 22.4 to 3.1, p = 0.80)).Conclusions: Antenatal exposure to a single course of betamethasone does not alter lung function or the prevalence of wheeze and asthma at age 30.

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  • Sports-related brain injury in the general population: An epidemiological study

    Theadom, Alice; Starkey, NJ; Dowell, T; Hume, PA; Kahan, M; McPherson, K; Feigin, V; Barker-Collo, Suzanne; Kydd, R; Parag, V; Brown, P; Ameratunga, Shanthi; Christey, G; Jones, K; Jones, A; Hardaker, N; Te Ao, B (2014-11)

    Journal article
    The University of Auckland Library

    Objectives: To determine the incidence, nature and severity of all sports-related brain injuries in the general population. Design: Population-based epidemiological incidence study. Methods: Data on all traumatic brain injury events sustained during a sports-related activity were extracted from a dataset of all new traumatic brain injury cases (both fatal and non-fatal), identified over a one-year period in the Hamilton and Waikato districts of New Zealand. Prospective and retrospective case ascertainment methods from multiple sources were used. All age groups and levels of traumatic brain injury severity were included. Details of the registering injuries and recurrent injuries sustained over the subsequent year were obtained through medical/accident records and assessment interviews with participants. Results: Of 1369 incident traumatic brain injury cases, 291 were identified as being sustained during a sports-related activity (21% of all traumatic brain injuries) equating to an incidence rate of 170 per 100,000 of the general population. Recurrent injuries occurred more frequently in adults (11%) than children (5%). Of the sports-related injuries 46% were classified as mild with a high risk of complications. Injuries were most frequently sustained during rugby, cycling and equestrian activities. It was revealed that up to 19% of traumatic brain injuries were not recorded in medical notes. Conclusions: Given the high incidence of new and recurrent traumatic brain injury and the high risk of complications following injury, further sport specific injury prevention strategies are urgently needed to reduce the impact of traumatic brain injury and facilitate safer engagement in sports activities. The high levels of ???missed??? traumatic brain injuries, highlights the importance in raising awareness of traumatic brain injury during sports-related activity in the general population.

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