Prevention of infective endocarditis associated with dental treatment: a report by a committee of the National Heart Foundation of New Zealand.
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Biomedical subjects
Publications and source records attributed to D R Hay.
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In all major occupational groups the proportion of smokers has fallen in the intercensal period from 1976 to 1981. Half as many male professional workers are smokers (21%) compared with service workers (42%) and production workers (43%). Women have shown an increase or little change in the percentage of smokers in many occupations. The unemployed have the highest proportion of smokers (56% men, 52% women). More than half of those receiving sickness and domestic purposes benefits are smokers as are 57% of men and women living in a de facto relationship. Higher rates of income are in general correlated with a lower proportion of smokers. Smoking rates are high for members of the Ratana religion (58% men and 65% women). For other denominations, rates in men vary from 5% for Jehovah's Witnesses to 39% for Roman Catholics. The proportion of smokers is higher with lower levels of educational attainment. Those who had attended both university and training college have low rates of smoking (19% men, 16% women).
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The 1981 New Zealand census has shown that since 1976 the proportion of cigarette smokers has fallen from 40% to 35% in men and from 32% to 29% in women. In men, there has been a reduction in smoking in every age group, but in women smoking has increased in those aged 20-24 and 70-74 years. More girls aged 15-19 years are smokers than boys. Maori rates of smoking are much higher than other ethnic groups but since 1976 there has been a considerable reduction in the proportion of Maori men and women who smoke. The important exception is that smoking by Maori women aged 20-24 years has increased to very high levels (70%). Almost half the men and a third of the women who smoke consume 20 or more cigarettes a day. The average number of cigarettes smoked per day has fallen since the 1976 census to 18 for men and 14 for women. From 1976 to 1981, the prevalence of smoking in New Zealand has shown a considerable reduction in non-Maori and Maori men and women of most ages, except for younger women.
The proportion of cigarette smokers has fallen in male doctors from 20% in 1976 to 15% in 1981 and in female doctors from 17% to 13%. The same trends have also occurred in nurses with a reduction from 49% to 39% in men and from 36% to 31% in women. Smoking rates remain high among female psychiatric nurses (46%) and male general nurses (48%). Only 10% of all doctors under 24 years are smokers. Among general practitioners, the proportion of smokers has fallen from 21% to 14% and among surgeons from 22% to 13%. If present trends continue, a generation of non-smoking doctors may be expected by the year 2000. Both doctors and nurses have accepted their role as exemplars and made significant reductions in their level of smoking.
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Two patients developed cirrhosis of the liver following therapy with perhexiline maleate. Liver failure and polyneuropathy caused death in one patient who had received 300 mg daily for three years. Cirrhosis was an unexpected finding in the other patient whose perhexiline dose was 200 mg daily for five years. Perhexiline should be prescribed cautiously and discontinued if liver function tests become abnormal. Monitoring of blood levels may lead to a reduction of toxicity.
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Coronary heart disease mortality declined by 17 percent and 14 percent for New Zealand European men and women respectively between 1968 and 1978. The fall occurred in all age groups and in Maoris and cannot be attributed to change in diagnostic fashions. The decline has been associated with a decrease in the consumption of diary products and more recently with a levelling off of cigarette smoking, an increased awareness of the importance of treating hypertension, and an apparent increase in habitual physical activity in the community. There have also been improvements in the medical management of patients with coronary heart disease which may be contributing to the continuing decline in mortality rates. A programme to monitor trends in CHD incidence and case fatality and the level of risk factors in the community is required to elucidate the reasons for the decline in CHD mortality.
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97% of the New Zealand population 15 years and over (2.1 million persons) responded to a question on cigarette smoking in the 1976 population census. 38% of New Zealand men and 30% of women other than Maoris or Pacific Islanders were cigarette smokers. 56% of Maori men and 59% of Maori women smoked regularly; the corresponding figures for Pacific Islanders, a relatively recent migrant population, were 46% and 24%. In all age groups more Maoris smoked than non-Maoris. More than two-thirds of Maori women aged 20-24 were smokers. Cigarette consumption rates were high; the men and over one third of the women smokers smoked more than 20 cigarette a day. Smoking was higher then expected among Roman Catholics and among those who objected to stating their religion. Those who were divorced or separated had smoking rates 38% to 56% higher than expected. Smoking was inversely related to the level of education attained. Those in the professions were least likely to be smokers (average 27%) whereas at least half those in labouring or unskilled occupations were smokers.