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R Beaglehole

Publications and source records attributed to R Beaglehole.

At least 127 records · Page 7Linked to original sources
PubMed1987

Lessons from the national asthma mortality study: circumstances surrounding death.

The circumstances surrounding all deaths from asthma in New Zealanders under 70 years of age between August 1981 and July 1983 have been analysed from information recorded or recalled by doctors or relatives of the deceased. Factors which may have reduced the time available for effective treatment of these severe attacks are described to draw attention to ways in which mortality might be reduced. For almost half of the 271 deaths medical help had not been called before the patient was in extremis. When medical help was summoned in sufficient time doctors commonly did not give corticosteroids or used them inadequately. Difficulties in using medical care and noncompliance with asthma management were common particularly in Polynesian patients. In 38% of patients some medical inadequacy appeared to contribute to poor long-term care and education. Failure of patients to attend for ongoing medical care, education and preventative treatment, or a medical failure to deliver these may have led to chronically reduced lung function. Any further deterioration may then have more rapidly led to a fatal outcome. Lack of patient or family awareness about how to detect and cope with an unusually severe attack was found and contributed to avoidable fatalities.

Asthma↗
PubMed1987

Comparability of old and new World Health Organization criteria for definite myocardial infarction.

New epidemiological criteria for definite myocardial infarction are now in use as part of the international study of trends and determinants of cardiovascular disease coordinated by the World Health Organization (MONICA Project). In this paper we use data from a myocardial infarction register to assess the comparability of the old and new World Health Organization criteria for definite myocardial infarction. The new criteria were applied to 905 cases who had been categorized as definite myocardial infarction on the old criteria. 739 (82%) of these cases met the new criteria for definite myocardial infarction; a further 157 cases (17%) met the new criteria for possible myocardial infarction. This study indicates that the two sets of criteria produce results that are too dissimilar for reliable comparisons to be made between studies using different criteria for definite myocardial infarction.

Adult↗
PubMed1987

Trends in dietary fat and cigarette smoking and the decline in coronary heart disease in New Zealand.

Coronary heart disease (CHD) mortality declined by approximately 23.5% in New Zealand men aged 35-64 years between 1968 and 1980. The contributions of secular trends in dietary fat and tobacco consumption to this decline were examined using data from national consumption statistics and population based studies of risk factor levels. Per capita saturated fat and dietary cholesterol consumption fell by approximately 12% and 10% respectively during this period while polyunsaturated fat consumption increased by 73%. Per capita tobacco consumption fell by approximately 15%. Using equations developed by Keys and Hegsted it was calculated that the mean serum cholesterol level declined by between 6.6 and 10.3 mg/dl (2.9%-4.4%) during this period. The potential impact of these risk factor changes on CHD mortality was estimated using a Framingham multivariate logistic risk function. Between 38% and 51% of the observed decline in CHD mortality in men aged 35-64 years in New Zealand between 1968 and 1980 could be accounted for by the calculated changes in serum cholesterol and tobacco consumption. If serum cholesterol and cigarette smoking were reduced further to meet current recommendations, it is estimated that CHD mortality would decline by a further 26%-30% from the 1980 level.

Adult↗
PubMed1987

Underestimation of relative weight by use of self-reported height and weight.

Self-reported and measured height and weight were obtained from a representative sample of 1,598 persons in Auckland, New Zealand during 1982. The accuracy of the self-reported data and its effect on the misclassification of relative weight, as measured by Quetelet index, were examined. The finding that for most participants (75%), self-reported measures were no more than 3.5 cm from their measured height and 2.4 kg from their measured weight indicates that self-reports have a high degree of accuracy. However, the participants consistently overestimated their height and underestimated their weight, resulting in an underestimation of relative weight. This would have little effect on analyses using the self-reported relative weight measures as a continuous covariate, but misclassification would occur when using relative weight as a categorical variable. The sensitivities and specificities associated with categorized self-reported relative risks that have been calculated from relative weight derived from self-reported height and weight.

Adult↗
PubMed1987

Alcohol and exercise in myocardial infarction and sudden coronary death in men and women.

The relation of alcohol consumption and regular leisure time physical activity with nonfatal myocardial infarction and sudden coronary death in men and women of Auckland, New Zealand, was examined in a large population-based case-control analysis. Within each sex, alcohol drinkers had decreased relative risks of both myocardial infarction and sudden coronary death compared with nondrinkers. Similarly, physical activity was associated with decreased relative risks of myocardial infarction and sudden coronary death in both women and men, but only in those subjects who had been exercising for five or more years. After controlling for hypertension, cigarette smoking, and alcohol consumption, 43% (95 confidence interval (CI) = 26-60) of coronary events could be explained by lack of exposure to physical activity. This compares with the per cent of coronary events in the study population attributable to hypertension (22%; 95% CI = 17-27) or cigarette smoking (31%; 95% CI = 25-38). Although the estimation of the attributable risk for a continuous variable is affected by the cut-point used to define exposure, from a public health viewpoint, regular leisure time physical activity may be as important as the above-mentioned major coronary heart disease risk factors.

Adult↗
PubMed1987

Validation of coronary heart disease hospital discharge data.

Data from a 1983 Auckland coronary heart disease register applying current World Health Organization criteria have been used to validate routine hospital discharge data. The register contained 905 patients under 65 years admitted to hospital and 858 of these patients were matched with hospital discharge records. Of the registered definite myocardial infarction cases 86% received the International Classification of Diseases code 410 (acute myocardial infarction); 9% of these cases received a code 411-414 (other forms of coronary heart disease or angina) and 5% received other codes. Only 405 of the 604 cases (67%) coded 410 in the hospital discharge data were true definite myocardial infarctions according to the World Health Organization criteria. The routine hospital International Classification of Diseases data do not provide diagnostic groups sufficiently close to World Health Organization categories for them to be used alone to monitor trends in coronary heart disease morbidity rates.

Adult↗
PubMed1986

Asthma mortality: comparison between New Zealand and England.

Causes for the high mortality from asthma in New Zealand were investigated by comparing deaths from asthma in caucasian subjects aged 15-64 in New Zealand with those from asthma in the same age group in two regions in England. There were no significant differences in the accuracy of death certification. The verified asthma mortality in New Zealand (4.2/100,000) was over twice that in England. Many characteristics of patients and management, including poor compliance with treatment and deficiencies in long term and emergency care, were qualitatively similar in the two countries. New Zealand had an apparently higher rate of non-preventable deaths from asthma, suggesting a greater severity of asthma in New Zealand. In both countries, however, most deaths were associated with poor assessment, underestimation of severity and inappropriate treatment (over-reliance on bronchodilators and underuse of systemic corticosteroids), and delays in obtaining help. A greater frequency of some of these deficiencies in management remains a possible additional explanation for part of the excess mortality in New Zealand.

Adolescent↗
PubMed1986

Cigarette smoking and risk of premature stroke in men and women.

A case-control study was carried out of the relation between cigarette smoking and hypertension and stroke. A total of 132 cases of stroke (79 in men, 53 in women) identified as a part of a population based register were compared with 1586 controls (1017 men, 569 women) from a survey of cardiovascular risk factors conducted in the same population. Cigarette smokers had a threefold increase in the risk of stroke compared with current non-smokers. This association remained significant after adjusting for hypertension. Those who both smoked and had hypertension had an increased risk of stroke of almost 20-fold compared with those who neither smoked nor had hypertension. Overall, in this population roughly 37% of stroke events may be attributed to cigarette smoking and 36% to hypertension.

Adult↗
PubMed1986

Has the long term prognosis following myocardial infarction improved?

Coronary heart disease mortality in New Zealand has declined by 25% in the 15 years since 1968. One possible explanation for this decline is lower case-fatality rates resulting from improvements in the management of myocardial infarction. This paper tests this hypothesis by examining trends in three year survival following a definite myocardial infarction for the population aged 35-69 in Auckland. The data were obtained from two methodologically identical population-based registers of myocardial infarction compiled in Auckland in 1974 and 1981. The three year survival rates were 59% and 65% for the two time periods respectively and this difference did not reach statistical significance. However, as the survival curves appear to be diverging, there may have been a small improvement in long term outcome after myocardial infarction.

Actuarial Analysis↗
PubMed1986

Serum lipids, body mass, and exercise levels in Auckland, 1982.

The level of coronary heart disease risk factors was examined in a random sample of 1598 people aged 35 to 64 years in Auckland during 1982. Data on serum total cholesterol and high density lipoprotein cholesterol, height, weight, body mass index and exercise patterns, are reported. The mean serum cholesterol was 5.71 mmol/l in men and 5.81 mmol/l in women with 22% and 24% of men and women respectively having a serum cholesterol of 6.5 mmol/l or more. Total cholesterol levels were lower than in previous New Zealand studies at all ages and in both sexes. Approximately 54% of men and 48% of women in the sample were overweight or obese and only 37% of men and 30% of women reported taking regular exercise each week. These data indicate that there is considerable potential for the primary prevention of coronary heart disease in New Zealand.

Adult↗
PubMed1986

Cardiovascular mortality in New Zealand and Australia 1968-1983: how can the diverging trends be explained?

Cardiovascular diseases are responsible for almost 50% of all deaths in New Zealand and Australia. In 1968 death rates were higher in Australia than in New Zealand for all causes of death, all cardiovascular disease, coronary heart disease and cerebrovascular disease. Over the period 1968-1983 death rates declined in both countries but at a significantly greater rate in Australia. By 1983 death rates for all categories were higher in New Zealand than Australia. The decline in cardiovascular disease accounted for approximately 90% and 70% of the decline in all causes of death in New Zealand and Australia respectively. Life expectancy has increased more rapidly for Australian middle aged men and women. From the limited cardiovascular morbidity and risk factor data available, it is not possible to identify the reasons for the differential rates of improvements in the two countries. Both nations require comprehensive and complementary studies which monitor changes in health practices such as diet, smoking and exercise, as well as surveys that allow differences in the patterns of medical and surgical practices to be determined.

Adult↗
PubMed1986

Does treatment of hypertension explain the decline in mortality from stroke?

Mortality from stroke has been declining in New Zealand since 1950 and at an accelerating rate since the early 1970s. Hypertension is the single most important risk factor for stroke. The temporal association between the recent decline in mortality and an increase in the proportion of patients with hypertension detected and treated led to the assumption of a cause and effect relation. Data from studies of the prevalence of blood pressure carried out in the community and from therapeutic trials of the treatment of hypertension were used to estimate the proportion of the decline in mortality from stroke that could be accounted for by increased treatment of hypertension during 1973-82 in New Zealand. Treatment of hypertension was estimated to account for roughly 10% of the observed reduction in deaths from stroke. Greater understanding of the reasons for the decline in mortality from stroke is required.

Adult↗
PubMed1986

Medical management and the decline in mortality from coronary heart disease.

The contribution of resuscitation before admission to hospital, coronary care units, treatment with beta blockers after myocardial infarction, coronary artery bypass surgery, and the treatment of hypertension to the decline in mortality from coronary heart disease in Auckland between 1974 and 1981 was assessed by using data from several population based studies. There were 126 fewer deaths from coronary heart disease in Auckland in 1981 than expected from the 1974 rates among people less than 70 years. The specific medical interventions probably accounted for about 51 (40%) of the 126 fewer deaths. Local data indicate that resuscitation before admission to hospital was responsible for 20 (16%) of the 126 fewer deaths. Projections based on local data and trials carried out overseas suggest that up to 15 (12%) of the 126 fewer deaths were due to the treatment of hypertension. Coronary care units and the use of beta blockers after myocardial infarction were estimated to be responsible for six (5%) and three (2%) of the 126 fewer deaths, respectively. The impact of coronary surgery was especially difficult to determine in the absence of appropriate randomised controlled trial data. Estimates of its contribution ranged from seven to 23 (5% to 18%) of the 126 fewer deaths.

Adrenergic beta-Antagonists↗