Adoption of direct oral anticoagulants for stroke prevention in atrial fibrillation.

BACKGROUND: Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter. AIMS: To analyse the adoption and application of these drugs in a regional hospital inpatient cohort and compare with national prescribing data. METHODS: Digital medical records identified prescribed anticoagulants for patients admitted with AF and atrial flutter during 2013-2014. Analysis of patient demographics and stroke risk identified trends in prescribing DOAC versus warfarin. For broader comparison, data from the Pharmaceuticals Benefits Scheme were sourced to determine the nation-wide adoption of DOAC. RESULT: Of the 615 patients identified, 505 (255 in 2013, 250 in 2014) had sufficient records to include in the study. From 2013 to 2014, DOAC prescriptions increased from 9 to 28% (P < 0.001), warfarin and aspirin remained comparatively stable (38-34%, 22-20%), and those prescribed no medication declined (17-8%, P < 0.001). DOAC were prescribed to patients with lower CHA2 DS2 VASc scores than warfarin (3.6 vs 4.4; P = 0.005), lower HAS-BLED scores (1.7 vs 2.3; P < 0.01), higher glomerular filtration rates; 70 vs 63 ml/min; P = 0.002) and younger age (74 vs 77 years; P = 0.006). Nationally, warfarin prescriptions are higher in total numbers but increasing at a slower rate than DOAC, which increased 10-fold (101 158 in 2013, 1 095 985 in 2014). CONCLUSION: DOAC prescribing grew rapidly from 2013 to 2014, regionally and nationally. Warfarin prescriptions have remained stable, indicating that more patients are being appropriately anticoagulated for AF who previously were not. DOAC were found to be prescribed to patients with lower CHA2 DS2 VASc and HAS-BLED scores, younger age and higher glomerular filtration rates. Aspirin therapy remains over utilised in AF.

Sleep, blood pressure and obesity in 22,389 New Zealanders.

AIM: To determine the relationship of sleep disorders with blood pressure and obesity in a large, relatively healthy, community-based cohort. METHODS: A cross-sectional study was undertaken using data from 22,389 volunteer blood donors in New Zealand aged 16-84 years. Height, weight, neck circumference and blood pressure were measured directly, and data on sleep and other factors were ascertained using a validated self-administered questionnaire. RESULTS: Even in a relatively young, non-clinical cohort, lack of sleep (34%), snoring (33%), high blood pressure (20%) and obesity (19%) are common. After adjusting for relevant confounders, participants at high risk of sleep apnoea had double the odds of having high blood pressure but only in participants over 40 years. Very low and high quantities of sleep are also associated with high blood pressure. Even after controlling for neck circumference, self-reported sleep apnoea, sleep dissatisfaction and low amounts of sleep are associated with a higher body mass index. CONCLUSIONS: Obesity and hypertension have significant associations with a variety of sleep disorders, even in those less than 40 years of age and after adjusting for a wide range of potential confounders.

Shift work and work injury in the New Zealand Blood Donors' Health Study.

OBJECTIVE: To investigate associations between work patterns and the occurrence of work injury. METHODS: A cross sectional analysis of the New Zealand Blood Donors Health Study conducted among the 15 687 (70%) participants who reported being in paid employment. After measurement of height and weight, a self-administered questionnaire collected information concerning occupation and work pattern, lifestyle behaviour, sleep, and the occurrence of an injury at work requiring treatment from a doctor during the past 12 months. RESULTS: Among paid employees providing information on work pattern, 3119 (21.2%) reported doing shift work (rotating with nights, rotating without nights, or permanent nights) and 1282 (8.7%) sustained a work injury. In unadjusted analysis, work injury was most strongly associated with employment in heavy manual occupations (3.6, 2.8 to 4.6) (relative risk, 95% CI), being male (1.9, 1.7 to 2.2), being obese (1.7, 1.5 to 2.0), working rotating shifts with nights (2.1, 1.7 to 2.5), and working more than three nights a week (1.9, 1.6 to 2.3). Snoring, apnoea or choking during sleep, sleep complaints, and excessive daytime sleepiness were also significantly associated with work injury. When mutually adjusting for all significant risk factors, rotating shift work, with or without nights, remained significantly associated with work injury (1.9, 1.5 to 2.4) and (1.8, 1.2 to 2.6), respectively. Working permanent night shifts was no longer significantly associated with work injury in the adjusted model. CONCLUSION: Work injury is highly associated with rotating shift work, even when accounting for increased exposure to high risk occupations, lifestyle factors, and excessive daytime sleepiness.

Ventilatory changes in heat-stressed humans with spinal-cord injury.

STUDY DESIGN: Single trial using matched subjects under tightly-controlled experimental conditions. OBJECTIVE: Humans with spinal-cord injury have a reduced ability to dissipate heat. The current project examined the possibility that, in such people, an elevated ventilatory response (panting) may act as a supplementary avenue for heat loss. SETTING: Australia, New South Wales. METHODS: Breathing frequency was measured during a resting heat exposure (

Whole-body pre-cooling does not alter human muscle metabolism during sub-maximal exercise in the heat.

Muscle metabolism was investigated in seven men during two 35 min cycling trials at 60% peak oxygen uptake, at 35 degrees C and 50% relative humidity. On one occasion, exercise was preceded by whole-body cooling achieved by immersion in water during a reduction in temperature from 29 to 24 degrees C, and, for the other trial, by immersion in water at a thermoneutral temperature (control, 34.8 degrees C). Pre-cooling did not alter oxygen uptake during exercise (P > 0.05), whilst the change in cardiac frequency and body mass both tended to be lower following pre-cooling (0.05 < P < 0.10). When averaged over the exercise period, muscle and oesophageal temperatures after pre-cooling were reduced by 1.5 and 0.6 degrees C respectively, compared with control (P < 0.05). Pre-cooling had a limited effect on muscle metabolism, with no differences between the two conditions in muscle glycogen, triglyceride, adenosine triphosphate, creatine phosphate, creatine or lactate contents at rest, or following exercise. These data indicate that whole-body pre-cooling does not alter muscle metabolism during submaximal exercise in the heat. It is more likely that thermoregulatory and cardiovascular strain are reduced, through lower muscle and core temperatures.

Clinical and immunological responses of ewes following vaccination with an experimental formalin-inactivated Chlamydia psittaci (ovis) vaccine and subsequent challenge with the live organism during pregnancy.

The protection afforded by an experimental, killed, adjuvanted vaccine derived from the A22 strain of Chlamydia psittaci (ovis) against ovine enzootic abortion was studied. The vaccine was used undiluted (group A), at a dilution of 10(-3) (group B) and at a dilution of 10(-6) (group C). A fourth control group (group D) was inoculated with all components of the vaccine except the chlamydial antigen. A group of rams (group R) was also vaccinated with the chlamydial antigen diluted to 10(-3). Animals were challenged 70 days after mating with the A22 strain of C. psittaci (ovis) and were studied throughout pregnancy and the subsequent lambing period. Their cell-mediated immune responses were examined using a skin test and their humoral immune responses were studied using an ELISA. Tests for excretion of chlamydiae in their faeces and genital tract during pregnancy and after parturition and in the faeces of their lambs were made. The reproductive performance of the ewes was assessed by calculating the average weight of lambs produced per ewe in each group. The experimental vaccine protected the ewes in groups A and B against challenge with C. psittaci (ovis) as none showed clinical signs of OEA or excreted chlamydiae. The average weight of lambs produced per ewe in both groups was greater than 4 kg. Both groups seroconverted after vaccination but not all of them were positive to the skin test. The experimental vaccine at 10(-6) dilution of antigen did not protect the ewes as three of 10 ewes displayed clinical OEA and excreted chlamydiae in the products of parturition.(ABSTRACT TRUNCATED AT 250 WORDS)

Protection of ewes vaccinated with A22 strain Chlamydia psittaci (ovis) against challenge in pregnancy with homologous and heterologous strains of the organism.

Fifty ewes were randomly divided into four groups. Groups A and B were vaccinated with an experimental vaccine derived from the A22 isolate of Chlamydia psittaci (ovis), an isolate known to cause ovine enzootic abortion (OEA). Groups C and D were unvaccinated controls. In mid-pregnancy, animals in group A and C were challenged with live A22 C. psittaci (ovis) and those in B and D were challenged with a field isolate of the organism (BS) against which the commercially available A22 vaccine appeared to offer poor protection. In group A, three animals showed clinical signs of OEA and six excreted chlamydiae. In group B, five ewes showed clinical signs of OEA and excreted chlamydiae. In group C, three ewes had clinical signs of OEA but seven excreted chlamydiae. In group D, all 11 ewes showed clinical signs of OEA and excreted chlamydiae in the products of parturition. This group produced only four live lambs with an average weight of viable lamb per ewe of 1.4 kg, whereas the other groups each produced 12 or 13 lambs with an average weight of viable lamb per ewe of more than 4 kg. The BS isolate was much more virulent than the A22 isolate for unvaccinated, pregnant ewes. However, the A22 vaccine offered significant protection against the heterologous BS isolate although on this occasion it did not appear to alter the course of disease produced by the less pathogenic A22 isolate.