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Biomedical subjects

R Bonita

Publications and source records attributed to R Bonita.

At least 55 records · Page 3Linked to original sources
PubMed1993

Stroke trends in Australia and New Zealand: mortality, morbidity, and risk factors.

Stroke death rates are declining in Australia and New Zealand as in many other industrialized countries. An explanation for the decline in mortality requires information from population-based incidence studies. Two studies that meet the criteria for well-designed stroke studies have been conducted, one in Auckland, New Zealand, in 1991 and the other in Perth, Western Australia, in 1988 to 1989. Comparisons between the two studies reveal similar incidence and case-fatality rates for both men and women, reflecting the similar mortality rates. The Auckland study repeats one carried out 10 years earlier and allows an insight into the changes in incidence, case fatality, and severity of stroke in a large urban population. Between the two study periods there was no overall change in the incidence rates but case-fatality rates improved in both men and women. Although there have been significant improvements in the level of smoking in both Australia and New Zealand during the 1980s, only marginal improvements in mean population blood pressure have occurred, despite efforts and resources directed at identification of individuals with raised blood pressure. This high-risk strategy has apparently had only a very limited impact on reducing the incidence of stroke in the population.

Aged↗
PubMed1992

The development and evaluation of Basic Epidemiology: Student's Text.

This paper describes the development and evaluation of a World Health Organization book Basic Epidemiology: Student's Text. This book was a response to a need identified by members of the WHO Global Environmental Epidemiology network. A draft was commented on by members of the Network and then at an editorial meeting. Two thousand copies of a pre-publication version were prepared and this version was formally evaluated by 13 teachers of introductory courses of epidemiology and less formally by members of the Epidemiology Network. A high response was received to the evaluation questionnaires; 45% of the students rated the test overall as 'very useful' and another 54% as 'useful'; many useful comments were received and were incorporated into the final version which will be published by WHO in 1993.

Attitude of Health Personnel↗
PubMed1991

The extent of cervical screening in New Zealand women.

To estimate the extent of cervical screening coverage of New Zealand women, a national survey of 1000 randomly selected women with a supplement of 200 Maori women was carried out by the National Research Bureau in August 1990 for the Department of Health. The results indicate a high level of screening in women aged 20-64 and improvements in coverage over the last three years, probably in response to the Cartwright inquiry. Overall, 77% of women reported having had a smear test within the previous three years and after adjustment for hysterectomy, this proportion increased to 82%. Screening coverage, however, was unevenly spread according to ethnic group, age and household income. Only 15% of European women reported no smear test in the last three years compared with 27% of Maori and Pacific Island women. The likelihood of having had a smear test in the last three years increased with increasing income. The survey confirms a high level of very frequent screening throughout New Zealand (2.4 smear tests per woman in the previous three years); the most frequent screening occurred in women 20-24 years of age (2.9 smears). Because an organised national screening programme has the potential to maintain and extend screening coverage to all age and ethnic groups, as well as reduce the number of unnecessary smears, it is likely to be more cost effective than the current screening practice.

Adolescent↗
PubMed1991

Young disabled residents in old people's homes.

A survey of the status of residents in aged care facilities in the Auckland region conducted in 1988 indicated that almost 9% (645) of the 7516 people studied were under 65 years of age. Rates were markedly higher for people of Maori descent than for those of European descent in this age group. For nonMaori, the rate for men was higher than that for women, but for Maori the opposite was the case. The majority of these young residents (94%) were being cared for in commercial old people's homes. One half were cared for in just 29 of the 223 homes in the region. While most (59%) were admitted after the age of 50, 15% were admitted before they were 40 and must expect to liver their lives out in institutions primarily housing elderly residents. Almost half of those in old people's homes had been admitted from a psychiatric hospital. The authors are concerned that so many young people appear to be in old people's homes because of a lack of alternative accommodation which is more suited to their care.

Activities of Daily Living↗
PubMed1991

1991 cervical screening recommendations: a working group report.

The Department of Health and the Cancer Society invited a working group to review the 1985 recommendations on cervical screening. Minor modifications have been made to the earlier recommendations in the light of more information about the effectiveness of different screening policies, and in the expectation that comprehensive cytology registers to ensure recall and follow up of abnormalities will be in place shortly. All women from the age of 20 up to 70 years should be offered cervical screening every three years. Any woman who has never had sexual intercourse or who has had a hysterectomy with complete removal of the cervical epithelium for a benign condition need not be screened. Women should have a second smear within one year if they have never had a smear before or if more than five years have passed since their last smear. But recall through the register should not be more frequently than three yearly for women with a history of normal smears.

Adult↗
PubMed1991

Functional disability in residents of Auckland rest homes.

OBJECT: to measure the extent of disability in residents of Auckland rest homes and to document any differences between religious and welfare homes and commercial homes. METHODS: analysis of a 36 item questionnaire on 2087 residents in 32 religious and welfare homes and 3126 residents in 191 commercial homes (98.7% response rate). RESULTS: residents in commercial homes were significantly more disabled than those in religious and welfare homes: 24% compared with 12% were incontinent, 62% and 31% confused, and 78% and 49% respectively needed assistance with mobility and selfcare. Of special concern were 7% and 3% who were doubly incontinent, 7% and 2% confused to the point of disturbing other residents, and 4% and 2% who met the criteria for hospital care. CONCLUSIONS: a significant number of residents were disabled and required help in important aspects of simple self care. Informed advice, variety, and choice in type of care are mandatory before entering a rest home. Homes must employ trained staff who can identify and minimise problems so as to ensure optimal quality of life for residents.

Aged↗
PubMed1991

Boom in rest homes in Auckland: implications for the future.

Available beds for frail elderly people in the rest home sector in Auckland increased from 44 to 67 per 1000 population over 65 years between 1981 and 1988. This expansion is partly explained by the financial incentives provided by various government subsidies including an open-ended number of rest home subsidies available subject only to an assessment by a geriatric team and a means and assets test. Four estimates of the number of beds required in the Auckland region for the year 2001 indicate that as few as 3414 beds or as many as 7450 beds will be required depending on the assumptions used. The best estimate suggests that approximately 5200 beds are required for the population 65 years and over in the year 2001, 800 fewer than the 6000 currently available. This estimate does not include an allowance for the provision of care for people less than 65 years of age, nor for a proportion of beds to remain vacant and nor for seasonal fluctuations in the demand for rest home beds. These projections have important policy implications for the future funding and provision of rest home care.

Aged↗
PubMed1991

Hypertension, cigarette smoking, and the decline in stroke incidence in eastern Finland.

Finland has high rates of both cardiovascular disease and cardiovascular disease risk factors. We studied random samples of the population 30-59 years of age for risk factors in two provinces of eastern Finland in 1972 and 1977. We then followed both cohorts until 1985 through linkage with national hospital discharge and death certificate registers. The prevalence of hypertension and smoking in both provinces declined between 1972 and 1977, as did the stroke incidence in the 8-year period of follow-up of each cohort. We observed no differences in stroke incidence between the two provinces. The relative risk of stroke in the later period (1977-1985) was 0.71 and 0.58 for men and women, respectively, when compared with the earlier period (1972-1980). Overall, 28% of all stroke events could be attributed to hypertension, 17% to smoking, and 43% to these two factors jointly. The decrease in the prevalence of hypertension and smoking accounted for about 29% of the decline.

Adult↗
PubMed1990

A profile of the 7500 people in aged-care institutions in Auckland.

A study was carried out in 1988 to describe the residents and patients of aged-care institutions in Auckland against which future measures, including planned changes in licensing and funding, could be made. Information was collected for each patient in every hospital (public and private) and each resident in all old people's homes in the Auckland region between January and June 1988. Of the 7516 people surveyed (99.4% response rate), 70% were residents in old people's homes, 25% were patients in private hospitals and 6% were cared for in the public hospital sector. Of the people surveyed, 71% were women. The average age of women, 82 years, was 6.5 years older than that of men. Three-quarters of all women and 44% of men in care were widowed. Women had a higher rate of admission to institutions than did men with almost one in two women and one in four men in the age group 85 years and over being in long term care. Rates of institutionalisation for Maoris and Pacific Islanders were the same as for Europeans. The majority of elderly people received regular contact and concern from family members. This study has demonstrated that Auckland has a higher proportion of the elderly population (7.6% of the population 65 years and over) in long term care compared with other areas of New Zealand.

Aged↗
PubMed1990

Dependency levels of people in aged care institutions in Auckland.

Between January and June 1988, a survey of 7516 people in aged care facilities in the Auckland region (99.4% response rate) was undertaken to ascertain the extent and provision of care for elderly people requiring ongoing care in order to make comparisons with other centres in New Zealand. Information was gathered about their ability to perform various activities of daily living by staff members who completed a structured precoded and pretested questionnaire for each resident or patient. Overall levels of dependency were also assessed as part of the questionnaire: 13% were assessed as requiring long stay hospital care, 48% had moderate or appreciable dependency, and the remainder had some dependency (23%) or none at all (16%). Almost one quarter (23%) of the 5213 residents in old people's homes were rated as apparently independent. Of people in religious and welfare residential homes, 38% were rated as independent whereas in commercial rest homes 12% of people were classified in this way. This high level of apparent independence in religious and welfare homes is the main aspect in which the Auckland long term care scene is distinct from other regions in the country.

Activities of Daily Living↗
PubMed1990

International trends in stroke mortality: 1970-1985.

We compared the pattern of cerebrovascular disease (stroke) mortality in men and women aged 40-69 years in 27 countries during 1970-1985 with the decline in coronary heart disease mortality during the same period. Stroke mortality rates declined in 21 and 25 countries for men and women, respectively. In 23 countries the decline in stroke mortality in women was greater than that in men. Countries with the highest rates of stroke mortality are also those with the least favorable secular trend. The rate of decline for stroke mortality is greater than that for coronary heart disease mortality in those countries that experienced a decline in both categories. International comparisons of risk factor levels over time are required to explain the striking differences between countries.

Adult↗
PubMed1989

Increased treatment of hypertension does not explain the decline in stroke mortality in the United States, 1970-1980.

The steady decline in mortality from stroke in the United States accelerated markedly in the 1970s. It has been widely assumed that an increase in the rate of treatment of hypertension is the most likely explanation for this major public health achievement. An analysis of available information, however, suggests that improvements in the community control of hypertension in the United States in the period 1970-1980 have contributed in only a minor way. There were 45,357 fewer deaths from stroke in 1980 among those aged 35-74 years than might have been expected if the death rates had stayed the same as in 1970. Data from the National Health and Nutrition Surveys indicate that six million more people received antihypertensive medication in 1980 than in 1970. Results from a pooled analysis of randomized controlled trials of the treatment of hypertension suggest that between 6% and 16% of the reduction in stroke mortality was due to the increased treatment of hypertension. Epidemiological observations indicate that between 16% and 25% of the overall decline in stroke mortality can be attributed to the treatment of hypertension, suggesting that clinical trials probably underestimate the community-wide benefits of treatment. These results also suggest that at least three quarters of the decline in stroke mortality in the United States in the period 1970-1980 is due to factors other than antihypertensive treatment.

Adult↗
PubMed1988

Rehabilitation services received by stroke patients: the Auckland stroke study.

A study of the pattern of use of rehabilitation services by stroke survivors in the Auckland region (total population 829,545) found that in 1981-82 the majority of patients with functional motor deficit received, after early referral, a wide range of rehabilitation services. Patients with severe stroke, as measured by motor deficit, were more likely to be referred to rehabilitation services than patients with mild or moderate deficits; four-fifths of all patients with a persisting severe motor deficit were still receiving physiotherapy six months after the stroke. Up to one-third of patients who received rehabilitation did not find the service helpful. The proportion of patients receiving rehabilitation has probably improved since 1982 because of an increase in the number of therapists and a decrease in the number of new strokes each year. A formal evaluation of the quality, effectiveness and acceptability of the services provided to stroke patients should be an urgent priority.

Attitude to Health↗
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↗