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R Beaglehole

Publications and source records attributed to R Beaglehole.

At least 109 records · Page 6Linked to original sources
PubMed1988

Validation of coronary heart disease death certificate diagnoses.

Data from a coronary heart disease register in Auckland have been used to validate routine death certificate data produced by the National Health Statistics Centre. The register used current World Health Organisation criteria for definite or possible coronary heart disease and identified all suspected events in people aged less than 65 years for the years 1983 and 1984. During this period 768 coronary heart disease cases were included in the register and in the same population 772 death certificates were coded 410-414 (coronary heart disease), according to the ninth revision of the International Classification of Diseases, by the National Health Statistics Centre. Ninety one percent of deaths meeting the register's criteria for definite or possible coronary heart disease were coded 410-414 in the official data. Conversely of all death certificates coded 410-414, 93% were registered as due to coronary heart disease. The validity of subcategories was considerably lower; only 49% of deaths coded 410 (acute myocardial infarction) were categorised as definite myocardial infarction by the register. These findings suggest that the broad official statistics for the category coronary heart disease mortality (codes 410-414) are accurate to within approximately 10% in New Zealand; the validity of the subcategory myocardial infarction (code 410) is considerably lower.

Aged↗
PubMed1988

Hospital bed use by stroke patients: the Auckland stroke study.

This paper examines the use of hospital beds by stroke patients utilising data from a study of a 50% sample of stroke events which occurred in Auckland in a one-year period during 1981-82. Two-thirds of all stroke patients registered in the study were admitted to a public hospital. Patients less than 65 years were twice as likely to be admitted than those over the age of 65 and men were 60% more likely to be admitted than women. Two-thirds died or were discharged within the first month. The average length of stay during the first six months was 38 days (median 21 days) and was influenced by the severity of the motor deficit but not by age or sex. Extrapolation from the study to the total Auckland population indicates that 46 acute and 67 geriatric beds respectively were occupied daily in 1981-82 by stroke patients. This represented 2% and 15% of all acute and geriatric beds respectively in the general public hospitals and suggests that the use of public hospital beds by acute stroke patients is relatively low.

Adolescent↗
PubMed1988

What should be done about hypercholesterolaemia?

Recent developments have given new impetus to the prevention of coronary heart disease through the control of hypercholesterolaemia and there is increasing pressure to identify and treat individuals with high serum cholesterol levels. It is now imperative that we develop a rational and cost-effective management policy. Epidemiological considerations indicate that although various strategies exist, the most cost-effective method of reducing the burden of hypercholesterolaemia in New Zealand would be by changing the nations diet as a whole. We cannot afford a strategy based primarily on treating high risk individuals.

Adult↗
PubMed1988

Prevention and control of hypertension in New Zealand: a reappraisal.

A new national policy for the prevention and control of hypertension is required in New Zealand. The first priority is the prevention of hypertension with the development of a population strategy directed at encouraging healthy nutritional and exercise habits. Pharmacological management or specific nonpharmacological treatment of individuals is the second priority and decisions about treatment levels have important logistic and cost implications. Given the limited absolute benefits of treatment to individuals, the current policy of initiating treatment at a diastolic blood pressure of greater than or equal to 95 mmHg should be revised upwards. A population approach to the prevention of hypertension is essential in New Zealand because the majority (57%) of excess deaths due to raised blood pressure occur in people with diastolic blood pressure in the range 80-94 mmHg. A fall in the population mean diastolic blood pressure of 2 mmHg would have the same effect on total mortality rates as the successful treatment of everyone with a diastolic blood pressure greater than or equal to 100 mmHg. A national multidisciplinary group should be established to formulate strategies for preventing hypertension in New Zealand and to review current treatment guidelines.

Adult↗
PubMed1988

Cardiovascular disease mortality trends in the western Pacific, 1968-1984.

Much attention has been paid in recent years to the declining cardiovascular disease mortality rates in western industrialised countries; far less attention has been paid to other countries. A comparison of 1984 age standardised mortality rates in five western Pacific countries indicates a wide variation for all cause mortality and all cardiovascular disease mortality, with Singapore having rates twice as great as Japan which has the lowest rates. New Zealand has the highest rate of coronary heart disease, and with Australia the lowest rate of stroke mortality. Mortality rates for each disease category studied were lower among women than men for each country. In the period 1968-1984 all countries experienced a decline in all cause mortality. All cardiovascular disease mortality rates have declined in all countries except Singapore; coronary heart disease mortality rates have increased in Singapore. The improvements in stroke mortality in Japan have been dramatic in comparison with the other four countries. These marked variations in absolute levels and secular trends raise intriguing research questions and indicate the potential for prevention in all countries.

Adult↗
PubMed1988

Diet, serum cholesterol and the prevention of coronary heart disease in New Zealand.

A combination of the population strategy and the high risk strategy has been recommended for the prevention and control of coronary heart disease in New Zealand. In this paper, using data from a variety of sources, we estimate the potential relative benefits of these two strategies to reduce the contribution of diet and high blood cholesterol to coronary heart disease mortality in New Zealand. It is estimated that diet is responsible, at a minimum for between 22% (1600 deaths) and 39% (2800 deaths) of the coronary heart disease mortality in New Zealand each year. Achievement of the suggested short term dietary goals for the New Zealand population would have at least the same benefit as the identification and successful treatment of all people in the top 10% of the serum cholesterol distribution. This indicates that the population strategy should have higher priority in efforts to prevent and control coronary heart disease. Decisions concerning the level at which elevated blood cholesterol levels are treated pharmacologically will have important logistic and cost implications; national guidelines are required for the management of people with high blood cholesterol levels.

Adult↗
PubMed1988

Comparison of event rates among three MONICA centres.

Data from three MONICA centres in Auckland (New Zealand) and Newcastle and Perth (Australia) are used to explore some of the issues involved in comparing event rates and case fatality among MONICA centres. Auckland and Newcastle follow the "hot pursuit" method of identifying and interviewing patients while they are still in hospital. Perth follows the "cold pursuit" method, in which patients are identified by search of computerized hospital records after discharge and all data are abstracted retrospectively from case notes. Fatal cases are identified by the same method in the three centres. The distribution of events by MONICA diagnostic classification varied among centres, with Perth having the highest proportion of definite myocardial infarction events and the lowest proportion of possible myocardial infarction events. These differences appear to be due to the different methods of event ascertainment and data collection, and to variations in post mortem rates between centres. For comparisons among these three centres, the categories of non-fatal definite myocardial infarction and of all coronary heart disease deaths (that is those in the MONICA categories fatal definite myocardial infarction, fatal possible myocardial infarction, and fatal cases with insufficient data) appear to be the most useful.

Adult↗
PubMed1988

Recovery of motor function after stroke.

The natural history of recovery of motor function after stroke is described using data from a 1-year community-based study in Auckland, New Zealand. Of 680 patients, 88% presented with a hemiparesis; the proportion of survivors with a persisting deficit declined to 71% at 1 month and 62% at 6 months after the onset of the stroke. At onset, there were equal proportions of people with mild, moderate, and severe motor deficits, but the majority (76%) of those who survived 6 months had either no or only a mild deficit. Recovery of motor function was associated with the stroke severity but not with age or sex; patients with a mild motor deficit at onset were 10 times more likely to recover their motor function than those with a severe stroke. Our results confirm the reasonably optimistic outcome for survivors of stroke and further suggest that recovery of motor function is confined to patients whose motor deficit at onset is either mild or moderate.

Adolescent↗
PubMed1988

International trends in asthma mortality: 1970 to 1985.

Recent international trends in asthma mortality among people aged five to 34 years were examined as a follow-up to an epidemic of asthma deaths in the late 1970s which appeared to be confined to New Zealand. Mortality rates were compared in 14 countries with suitable statistics; Australia, Canada, England and Wales, Finland, France, Japan, Israel, the Netherlands, New Zealand, Singapore, Sweden, Switzerland, the United States, and West Germany, for the period 1970 to 1984/5. In New Zealand, asthma mortality in this age group more than trebled from 1.3 per 100,000 in 1974 to 4.2 per 100,000 in 1979 and since then has declined substantially to 1.85 per 100,000 in 1985. Asthma death rates vary more than six-fold among the other countries examined, and although the New Zealand experience has not been seen to the same degree elsewhere, a gradual increase in reported asthma mortality has occurred since the mid to late 1970s in the majority of countries studied. The increase and subsequent decline in asthma mortality in New Zealand could not be explained by changes in diagnostic fashions or in the International Classification of Disease coding rules. Similarly, the US data do not suggest there is diagnostic transfer among diseases of airway obstruction. However, part of the differences in asthma mortality among the countries examined and the recent increases in asthma death rates, could be due to changing diagnostic fashions rather than true differences in mortality. International studies on the validity of asthma death statistics and on asthma prevalence are required to clarify these issues.

Adult↗
PubMed1987

Lessons from the national asthma mortality study: deaths in hospital.

The circumstances surrounding 38 deaths from asthma in hospital in New Zealanders under 70 years of age between August 1981 and July 1983 have been analysed. Twelve deaths did not appear to be preventable, all but one occurring in chronic severe asthmatics despite apparently optimal therapy. Critical delays by patients or relatives in seeking medical help occurred in six cases, and inadequate assessment of severity and undertreatment by medical practitioners prior to the patient reaching hospital was a major contributing factor in a further six deaths. In four cases, insufficient speed and indecisive treatment in the accident and emergency department appeared to contribute to death. Ten patients died after many hours or days in hospital wards in circumstances where assessment, monitoring and treatment were deficient. There were no deaths in intensive care units. Urgent expert assessment is necessary in A & E departments, and more severe cases should be managed in intensive care units. Patients with acute severe asthma may need continuous oxygen, intravenous therapy and close objective assessment for a week or more after hospitalisation.

Adolescent↗