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Hartvigsen J.,University of Southern Denmark | Hartvigsen J.,Nordic Institute of Chiropractic and Clinical Biomechanics | Natvig B.,University of Oslo | Ferreira M.,George Institute for Global Health
Best Practice and Research: Clinical Rheumatology | Year: 2013

Multisite musculoskeletal pain is common among people suffering from low back pain. Although the mechanisms behind co-occurrence of multiple somatic symptoms and musculoskeletal pain are still unknown, patients with co-morbidities and co-occurring musculoskeletal symptoms tend to have worse functional status, a poorer prognosis and respond less favourably to treatment. Evidence also suggests that the more pain sites a patient reports, the more reduced their physical and mental function will be regardless of location of pain. At the same time, evidence suggests that strategies for diagnosis and treatment of low back pain and other musculoskeletal disorders such as neck pain and lower limb osteoarthritis are very similar. In this chapter, we discuss the prevalence, consequences, and implications of commonalities between low back pain, pain in other sites and co-occurring pain. In addition, we propose a conceptual framework for a common stepwise approach to the diagnosis and management of back and musculoskeletal pain. © 2013 Elsevier Ltd. All rights reserved.


Celermajer D.S.,University of Sydney | Celermajer D.S.,Royal Prince Alfred Hospital | Chow C.K.,University of Sydney | Chow C.K.,George Institute for Global Health | And 5 more authors.
Journal of the American College of Cardiology | Year: 2012

Over the past decade or more, the prevalence of traditional risk factors for atherosclerotic cardiovascular diseases has been increasing in the major populous countries of the developing world, including China and India, with consequent increases in the rates of coronary and cerebrovascular events. Indeed, by 2020, cardiovascular diseases are predicted to be the major causes of morbidity and mortality in most developing nations around the world. Techniques for the early detection of arterial damage have provided important insights into disease patterns and pathogenesis and especially the effects of progressive urbanization on cardiovascular risk in these populations. Furthermore, certain other diseases affecting the cardiovascular system remain prevalent and important causes of cardiovascular morbidity and mortality in developing countries, including the cardiac effects of rheumatic heart disease and the vascular effects of malaria. Imaging and functional studies of early cardiovascular changes in those disease processes have also recently been published by various groups, allowing consideration of screening and early treatment opportunities. In this report, the authors review the prevalences and patterns of major cardiovascular diseases in the developing world, as well as potential opportunities provided by early disease detection. © 2012 American College of Cardiology Foundation.


Dunford E.,George Institute for Global Health
Food Chemistry | Year: 2013

Excess energy, saturated fat, sugar and salt from processed and fast foods are a major cause of chronic disease worldwide. In 2010 The Food Monitoring Group established a global branded food composition database to track the nutritional content of foods and make comparisons between countries, food companies and over time. A protocol for the project was agreed and published in 2011 with 24 collaborating countries. Standardised tools and a website have been developed to facilitate data collection and entry. In 2010 data were obtained from nine countries, in 2011 from 12 and in 2012 data are anticipated from 10 additional countries. This collaborative approach to the collation of food composition data offers potential for cross-border collaboration and support in developed and developing countries. The project should contribute significantly to tracking progress of the food industry and governments towards commitments made at the recent UN high level meeting on chronic disease. © 2013 Elsevier Ltd. All rights reserved.


Ramachandran R.,Jawaharlal Institute of Postgraduate Medical Education & Research | Jha V.,Jawaharlal Institute of Postgraduate Medical Education & Research | Jha V.,George Institute for Global Health
PLoS ONE | Year: 2013

Kidney transplantation (KT) is only viable renal replacement option for most patients in India. Most patients do not have health insurance and meet treatment expenditure from their own resources. We prospectively evaluated the expenses associated with KT and its impact on the socioeconomic status of families in a public hospital. All direct and indirect expenses incurred by the patients from the time of diagnosis of chronic kidney disease to KT were recorded. Direct expenses included physician fees, cost of drugs and disposables, dialysis, and expenses on investigations and hospitalization. Indirect expenses included travel, food, stay, and loss of income suffered by the family. Educational dropout and financial loss were also recorded. There were 43 males and 7 females between the ages of 12 and 57 years. Direct expenses ranged from US$ 2,151-23,792 and accounted for two-thirds of the total expenses. Pre-referral hospitalization, dialysis and medication accounted for majority of direct expense. Indirect expenses ranged from US$ 226-15,283. Travel expenses and loss of income accounted for most of indirect expense. About 54%, 8%, and 10% of families suffered from severe, moderate, and some financial crisis respectively. A total of 38 families had job losses, and 1 patient and 12 caregivers dropped out of studies. To conclude, KT is associated with catastrophic out-of-pocket expenditure and pushes a majority of the patients who come for treatment to public hospitals into severe financial crisis. Educational dropout and loss of jobs are other major concerns. Systematic efforts are required to address these issues. © 2013 Ramachandran, Jha.


Groop P.-H.,Folkhalsan Institute of Genetics | Groop P.-H.,University of Helsinki | Groop P.-H.,Baker IDI Heart and Diabetes Institute | Cooper M.E.,Baker IDI Heart and Diabetes Institute | And 4 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-Preclinical data suggest that linagliptin, a dipeptidyl peptidase-4 inhibitor, may lower urinary albumin excretion. The ability of linagliptin to lower albuminuria on top of reninangiotensin- aldosterone system(RAAS) inhibition in humans was analyzed by pooling data from four similarly designed, 24-week, randomized, double-blind, placebo-controlled, phase III trials. RESEARCH DESIGN AND METHODSdA pooled analysis of four completed studies identified 217 subjects with type 2 diabetes and prevalent albuminuria (defined as a urinary albumin-to-creatinine ratio [UACR] of 3023,000mg/g creatinine) while receiving stable doses of RAAS inhibitors. Participants were randomized to either linagliptin 5 mg/day (n = 162) or placebo (n = 55). The primary end point was the percentage change in geometric mean UACR from baseline to week 24. RESULTS-UACR at week 24 was reduced by 32% (95% CI 242 to 221; P < 0.05) with linagliptin compared with 6% (95% CI 227 to +23) with placebo, with a between-group difference of 28% (95% CI 247 to 22; P = 0.0357). The between-group difference in the change in HbA1c from baseline to week 24 was 20.61% (26.7 mmol/mol) in favor of linagliptin (95% CI 20.88 to 20.34% [29.6 to 23.7 mmol/mol]; P < 0.0001). The albuminuria-lowering effect of linagliptin, however, was not influenced by race or HbA1c and systolic blood pressure (SBP) values at baseline or after treatment. CONCLUSIONS-Linagliptin administered in addition to stable RAAS inhibitors led to a significant reduction in albuminuria in patients with type 2 diabetes and renal dysfunction. This observation was independent of changes in glucose level or SBP. Further research to prospectively investigate the renal effects of linagliptin is underway. © 2013 by the American Diabetes Association.


Sundstrom J.,Uppsala University | Arima H.,George Institute for Global Health | Jackson R.,University of Auckland | Turnbull F.,George Institute for Global Health | And 4 more authors.
Annals of Internal Medicine | Year: 2015

Background: Effects of blood pressure reduction in persons with grade 1 hypertension are unclear. Purpose: To investigate whether pharmacologic blood pressure reduction prevents cardiovascular events and deaths in persons with grade 1 hypertension. Data Sources: Trials included in the BPLTTC (Blood Pressure Lowering Treatment Trialists' Collaboration) and trials identified from a previous review and electronic database searches. Study Selection: Patients without cardiovascular disease with blood pressures in the grade 1 hypertension range (140 to 159/90 to 99 mm Hg) who were randomly assigned to an active (antihypertensive drug or more intensive regimen) or control (placebo or less intensive regimen) blood pressure-lowering regimen. Data Extraction: Individual-patient data from BPLTTC trials and aggregate data from other trials were extracted. Risk of bias was assessed for all trials. Data Synthesis: Individual-patient data involved 10 comparisons from trials where most patients had diabetes, and aggregate data involved 3 comparisons from trials of patients without diabetes. The average blood pressure reduction was about 3.6/2.4 mm Hg. Over 5 years, odds ratios were 0.86 (95% CI, 0.74 to 1.01) for total cardiovascular events, 0.72 (CI, 0.55 to 0.94) for strokes, 0.91 (CI, 0.74 to 1.12) for coronary events, 0.80 (CI, 0.57 to 1.12) for heart failure, 0.75 (CI, 0.57 to 0.98) for cardiovascular deaths, and 0.78 (CI, 0.67 to 0.92) for total deaths. Results were similar in secondary analyses. Withdrawal from treatment due to adverse effects was more common in the active groups. Limitation: Blood pressure reductions and numbers of events were small. Conclusion: Blood pressure-lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension. © 2015 American College of Physicians.


Chalmers R.L.,Clinical Trial Consultant | Keay L.,George Institute for Global Health | McNally J.,Cooper Vision | Kern J.,Alcon
Optometry and Vision Science | Year: 2012

PURPOSE.: To evaluate the association of symptomatic soft contact lens (SCL)-related corneal infiltrative events (CIEs) with SCL material, lens care products (LCPs), and other risk factors. METHODS.: Cases with symptomatic CIEs were identified in a retrospective, multicenter case-control study at five academic eye care centers. Each case was matched to three controls each who had received eye care near the time of the case's last full examination at that center but were not matched for demographic or other factors. Infiltrate status was established by an expert panel who were masked to sponsor, SCL, and LCP brand. Stratified analyses were conducted removing all daily disposable (DD) and all extended wear (EW) cases. RESULTS.: Clinical records from 166 patients with symptomatic CIEs and known EW status were included. Cases used >50 SCL brands and >10 LCP brands. Increased risk in univariate analysis for LCP was not significant after adjustment for other factors. In the multivariate analysis of all cases, use of reusable SCLs (4.03×; 95% C.I. 1.12 to 14.67) and EW (3.98×; 2.32 to 6.84) increased risk and patient age (per year older) was protective (0.96×; 0.94 to 0.98). Among daily wear cases (n = 102 cases), use of reusable SCLs (12.46×; 1.54 to 100.62) and silicone hydrogel (SiHy) (1.99×; 1.06 to 3.75) and age (0.95×: 0.92 to 0.97) were associated. Without DD cases (n = 162), EW (4.42×; 2.53 to 7.70), SiHy use (1.84×; 1.03 to 3.29), and patient age (0.96× 0.94 to 0.98) were significant factors. No specific SCL or LCP brands were associated with increased risk. CONCLUSIONS.: In this community-based trial, younger patients were at increased risk of infiltrative events. DD lenses were protective relative to reusable lenses. Overnight use increased risk in all analyses and silicone hydrogels increased risk in daily wearers, regardless of LCP brand. Improvements in lens storage case hygiene and environment may be a mechanism for reducing risk of CIEs related to SCL use. Copyright © 2012 American Academy of Optometry.


Kwah L.K.,Australian Catholic University | Pinto R.Z.,George Institute for Global Health | Diong J.,George Institute for Global Health | Herbert R.D.,Neuroscience Research Australia
Journal of Applied Physiology | Year: 2013

Ultrasound imaging is widely used to measure architectural features of human skeletal muscles in vivo. We systematically reviewed studies of the reliability and validity of two-dimensional ultrasound measurement of muscle fascicle lengths or pennation angles in human skeletal muscles. A comprehensive search was conducted in June 2011. Thirty-six reliability studies and six validity studies met the inclusion criteria. Data from these studies indicate that ultrasound measurements of muscle fascicle lengths are reliable across a broad range of experimental conditions [intraclass correlation coefficient (ICC) and r values were always > 0.6, and coefficient of variation values were always < 10%]. The reliability of measurements of pennation angles is broadly similar (ICC and r values were always > 0.5 and coefficient of variation values were always < 14%). Data on validity are less extensive and probably less robust, but suggest that measurement of fascicle lengths and pennation angles are accurate (ICC > 0.7) under certain conditions, such as when large limb muscles are imaged in a relaxed state and the limb or joint remains stationary. Future studies on validity should consider ways to test for the validity of twodimensional ultrasound imaging in contracted or moving muscles and the best method of probe alignment. Copyright © 2013 the American Physiological Society.


Grant
Agency: Cordis | Branch: FP7 | Program: CP-FP | Phase: HEALTH-2009-3.1-4 | Award Amount: 4.15M | Year: 2010

Cardiovascular disease is the focus of this proposal as it is the leading cause of mortality worldwide. People with established vascular disease represent a target for secondary prevention using combination therapy that addresses multiple risk factors. Barriers to effective delivery of proven secondary preventative treatments create important gaps in the uptake. These gaps vary in different countries. Complexity and cost of treatment confer particularly difficult barriers; typically an individual recovering from a stroke or heart attack might be advised to take multiple medications to address cholesterol, blood pressure and platelet function. A combination once daily polypill may address these issues. Such a pill, the Red Heart Pill, has been formulated by Dr Reddys Laboratories in India. It is remarkably inexpensive with a projected annual cost in India of about 15. Evidence of safety and efficacy of this low-cost fixed-dose, once-daily polypill derived from a carefully conducted clinical trial will support its use in resource-poor countries and internationally. This project aims to evaluate whether provision of a cardiovascular polypill compared with usual medications improves adherence to therapies and clinical outcomes among high-risk patients. Further aims are to measure prescription of combination therapy, barriers to adherence, quality of life, safety, cardiovascular events, and healthcare resource consumption. The results will be used to develop recommendations for equitable access relevant to both Europe and India. India has been chosen as an ICPC partner as it is the home of a large global generic pharmaceutical company Dr Reddys and about 1 in 4 heart attacks globally occur in India. Parallel polypill projects running in Australia and New Zealand will afford the opportunity of pooling data to assess effects on cardiovascular outcomes. This synergy will enhance the generalisable impact of the UMPIRE trial.


News Article | August 29, 2016
Site: www.techtimes.com

Millions of people in the United States suffer from obstructive sleep apnea, a condition that causes those afflicted to briefly stop breathing during sleep, sometimes several times at night. The disorder, which happens when the throat muscles relax during sleep and block the airway, has been linked to a range of health problems including high blood pressure, heart disease, stroke and type 2 diabetes. The standard treatment given to patients with the condition is continuous positive airway pressure (CPAP) therapy, which makes use of a machine. The CPAP machine works by pumping a stream of air through the nostril of the patient during sleep to keep the airway open. There are drawbacks with this therapy, one of which is non-compliance. Many people give up on using the machine because they find the air mask and hose uncomfortable. Some users bear with the discomfort because the therapy is believed to reduce potentially fatal health risks associated with the condition. A new study, however, challenges this idea. The Sleep Apnea Cardiovascular Endpoints (SAVE) study found that CPAP does not prevent heart attacks, strokes, hospitalizations or deaths in sleep apnea sufferers with existing cardiovascular disease. Craig Anderson, from the George Institute for Global Health in Sydney, and colleagues monitored sleep apnea patients with pre-existing vascular disease over a period of four years in 89 hospitals to determine if the use of the CPAP machine would prevent major cardiovascular events such as stroke and heart attack. Earlier studies suggest that CPAP has a positive impact on these health problems but the result of the study, which is by far the largest to look into the condition and involved 2,687 participants, revealed otherwise. The findings revealed that although the use of the CPAP machine reduces daytime sleepiness plaguing sleep apnea patients — reducing anxiety and depression and boosting mood and work productivity — the use of the CPAP machine does not appear to be helpful in reducing risk of heart attack and stroke in sleep apnea sufferers. In patients under the CPAP group, the rate of cardiovascular events was 17 percent, while the rate in the control group was 15.4 percent. "At the moment, we could not recommend, on the basis of our study findings, that CPAP be used for the prevention of cardiovascular disease in patients, particularly those who are asymptomatic from sleep apnea," said study lead Dr. Doug McEvoy from the Adelaide Institute for Sleep Health. The research was presented at a cardiology conference held in Rome, Italy on Sunday, Aug. 28 and published in the New England Journal of Medicine. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.

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