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J A Malcolm

Publications and source records attributed to J A Malcolm.

32 records · Page 2Linked to original sources
PubMed1991

Lessons from Oregon.

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Acquired Immunodeficiency Syndrome↗
PubMed1990

Death from myocardial infarction: what are the benefits of early arrival at hospital and thrombolysis?

The potential benefits of early hospital care in the event of myocardial infarction were investigated in a community-based study of all suspected cases of heart attack among people aged under 70 years in the Hunter Region of New South Wales. Between August 1984 and December 1985 acute care data were collected for 1029 cardiovascular events classified as definite myocardial infarction or sudden coronary death; 516 (50%) resulted in death within 28 days from the onset of symptoms and 325 of these deaths (63%) occurred outside hospital. Of 703 people who are known to have reached hospital alive 205 (29%) did so more than four hours after the onset of symptoms. At the time of the study fewer than 1% of patients received streptokinase. To estimate the potential benefits of increased medical care an optimistic scenario was considered in which patients who arrived at hospital more than four hours after the onset of symptoms received medical attention earlier and all eligible patients received thrombolysis. Based on the results of the Second International Study of Infarct Survival (ISIS-2), if streptokinase and aspirin had been used 14% of deaths would have been averted. If, in addition, patients had arrived at hospital earlier and received optimal benefit from thrombolysis another 13% of deaths could have been avoided. These results provide a broader perspective of the potential benefits of improved medical care than can be obtained from hospital-based studies that deal only with those heart attack victims who survive long enough to reach hospital alive.

Adult↗
PubMed1990

Length of hospital stay after acute myocardial infarction.

A number of trials show that long stay in hospital after an acute myocardial infarction (AMI) is not necessary for many patients and that stays of three-ten days may be adequate. All patients aged under 70 years with a diagnosis of AMI admitted to the seven public hospitals in the Lower Hunter Region of New South Wales are monitored as part of the WHO MONICA Study. Between August 1984 and December 1985 of 438 hospitalised patients with a 'definite' AMI according to MONICA criteria and a clinical discharge diagnosis of AMI, 386 (88%) patients were discharged alive from hospital. Four patients had lengths of stay between 46 and 77 days and have been omitted from further analysis. The mean length of hospital stay was 13.6 days (95% confidence intervals 12.9 to 14.3 days); 74% of all patients stayed in hospital for more than ten days. The mean length of stay in the Coronary Care Unit (CCU) was 4.5 days (95% confidence intervals 4.2 to 4.8 days) with 60% staying longer than three days. Mean hospital stay varied from 10.5 to 17.4 days among the seven hospitals, although most of this variation was accounted for by three hospitals with few patients. Restricting analysis to the four hospitals with 90% of all the patients, multiple regression analysis showed that the CK enzyme levels, the evolution of Q waves on ECG, the presence of an anterior AMI and the use of nitrates and digoxin during hospitalisation were all associated with increased length of stay in hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Methodological issues in interpreting trends in MONICA event rates.

Before looking at the trends in coronary event rates and case fatality rates in the WHO MONICA Project, it is necessary to assess the consistency and validity of the data. In the Newcastle MONICA Collaborating Centre, two methods have been used. One involves monitoring data quality by comparisons with external data systems such as hospital discharge data and official mortality records. The other is to examine the internal consistency of MONICA diagnostic findings. For fatal myocardial infarction (MI) or coronary death, there is consistent evidence of a decline, but the MONICA data are not adequate to assess relative changes in sudden compared to non-sudden death rates. For non-fatal definite MI there was an increase early in the study, possibly due to a change in methods, but rates have now stabilized. For non-fatal possible MI there has been a steady increase in rates for events which may be becoming less severe. This is consistent with increasing hospital admissions for subacute ischaemic heart disease (IHD) and angina. This paper exemplifies the importance of maintaining internal and external surveillance of the quality of the data.

Adult↗
PubMed1989

Marriage is associated with a lower risk of ischaemic heart disease in men.

Comparison between subjects who were identified from a register of cases of myocardial infarction and a random sample of the same community showed that in the Lower Hunter region of New South Wales men who currently are not married are at higher risk of acute myocardial infarction or of sudden coronary death than are married men of the same age. While there are indications that unmarried men have a life-style that is different from that of currently married men, their increased risk of ischaemic heart disease is greater than can be accounted for by differences in factors such as age, the previous history of heart disease, their alcohol and tobacco consumption and various socioeconomic factors.

Adult↗
PubMed1989

Social effects of a history of ischaemic heart disease.

The consequences of ischaemic heart disease include adverse personal and social effects as well as morbidity and mortality. This study describes these affects among people registered in a community-based study of all suspected heart attacks. Two groups were compared, those with and those without a previous history of ischaemic heart disease, using information about the subjects' lives before the event which caused them to be registered. Men with a history were more likely to be retired or permanently unable to work (64% compared with 47%). Despite some modification of risk factors, such as reductions of cigarette smoking, men (but not women) with a history were more likely to die from the registered event especially within one hour from onset of symptoms. These results emphasize the need for prevention of heart disease before it causes the effects and disabilities reported here.

Adult↗
PubMed1988

Coronary events in the Hunter region of New South Wales, Australia: 1984-1986.

The results of coronary event registration using the protocol of the World Health Organization MONICA Project are reported for two years for the Hunter Region, the area in and around Newcastle in New South Wales, Australia. The Newcastle MONICA Project monitors all suspected cases of heart attack by identifying patients from hospital admissions and obtaining information while they are still in hospital. For people who die out of hospital, the initial source of information is usually the death certificate. Rates for the most robust MONICA diagnostic categories, non-fatal definite myocardial infarction and all coronary deaths, differed for the two years reported here. Monthly rates suggested possible seasonal effects, and the possible influence of lower respiratory infections including an epidemic of influenza A. The results demonstrate that consistent monitoring over several years will be necessary to establish clear trends in coronary heart disease.

Adult↗
PubMedDate not supplied

Heart attacks and the Newcastle earthquake.

OBJECTIVE: To test the hypothesis that stress generated by the Newcastle earthquake led to increased risk of heart attack and coronary death. DESIGN: A natural experiment. SUBJECTS: People living in the Newcastle and Lake Macquarie local government areas of New South Wales, Australia. INTERVENTION: At 10.27 a.m. on 28 December 1989 Newcastle was struck by an earthquake measuring 5.6 on the Richter scale. OUTCOME MEASURES: Myocardial infarction and coronary death defined by the criteria of the WHO MONICA Project and hospital admissions for coronary disease before and after the earthquake and in corresponding periods in previous years. Well established, concurrent data collection systems were used. RESULTS: There were six fatal myocardial infarctions and coronary deaths among people aged under 70 years after the earthquake in the period 28-31 December 1989. Compared with the average number of deaths at this time of year this was unusually high (P = 0.016). Relative risks for this four-day period were: fatal myocardial infarction and coronary death, 1.67 (95% confidence interval [Cl]: 0.72, 3.17); non-fatal definite myocardial infarction, 1.05 (95% Cl: 0.05, 2.22); non-fatal possible myocardial infarction, 1.34 (95% Cl: 0.67, 1.91); hospital admissions for myocardial infarction or other ischaemic heart disease, 1.27 (95% Cl: 0.83, 1.66). There was no evidence of increased risk during the following four months. CONCLUSION: The magnitude of increased risk of death was slightly less than that previously reported after earthquakes in Greece. The data provide weak evidence that acute emotional and physical stress may trigger myocardial infarction and coronary death.

Adult↗