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Biomedical subjects

R Bonita

Publications and source records attributed to R Bonita.

At least 73 records · Page 4Linked to original sources
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

Cigarette smoking and risk of stroke in middle-aged women.

It is known that cigarette smoking is associated with increased risk of both thrombotic and hemorrhagic stroke among men. To test for such an association among women, we examined the incidence of stroke in relation to cigarette smoking in a prospective cohort study of 118,539 women 30 to 55 years of age and free from coronary heart disease, stroke, and cancer in 1976. During eight years of follow-up (908,447 person-years), we identified 274 strokes, comprising 71 subarachnoid hemorrhages, 26 intracerebral hemorrhages, 122 thromboembolic strokes, and 55 strokes about which information was insufficient to permit classification. The number of cigarettes smoked per day was associated positively with the risk of stroke. Compared with the women who had never smoked, those who smoked 1 to 14 cigarettes per day had an age-adjusted relative risk of 2.2 (95 percent confidence interval, 1.5 to 3.3), whereas those who smoked 25 or more cigarettes per day had a relative risk of 3.7 (95 percent confidence interval, 2.7 to 5.1). For women in this latter group, the relative risk of subarachnoid hemorrhage was 9.8 (95 percent confidence interval, 5.3 to 17.9), as compared with those who had never smoked. Adjustment for the effects of relative weight, hypertension, diabetes, history of high cholesterol, previous use of oral contraceptives, postmenopausal estrogen therapy, and alcohol intake did not appreciably alter the association between cigarette use and incidence of stroke. These prospective data support a strong causal relation between cigarette smoking and stroke among young and middle-aged women.

Adult↗
PubMed1988

Is the pharmacological treatment of mild to moderate hypertension cost effective in stroke prevention?

Pooled data from clinical trials show that the incidence of fatal and nonfatal strokes combined is reduced by approximately 39% (95% CI: -48% to -28%) with antihypertensive treatment. However, given the relatively low incidence of stroke, it can be calculated that about 530 to 1375 mild to moderate hypertensive patients would need to be treated per year to prevent one stroke. Applying these results to the health service costs, both public and private, of treating mild to moderate hypertension in New Zealand we have estimated that the cost of preventing one stroke in those aged 35-64 years at between $110,900 and $285,400 in 1982 dollars. The offsetting hospital and community care costs to the health services of treating a stroke, was approximately $6500 giving a net cost of between $104,000 and $279,000 per stroke prevented. The cost of preventing a death from stroke was estimated to be between $356,000 and $1,822,000. Per year of life saved, this appears to be well in excess of such costly interventions as coronary artery bypass, heart transplantation and renal dialysis. Greater use should be made of inexpensive diuretics and nonpharmacological methods for the management of hypertension. A population strategy, rather than the present expensive high risk approach, could be far more cost effective in stroke prevention.

Adult↗
PubMed1988

Cigarette smoking as a risk factor for stroke. The Framingham Study.

The impact of cigarette smoking on stroke incidence was assessed in the Framingham Heart Study cohort of 4255 men and women who were aged 36 to 68 years and free of stroke and transient ischemic attacks. During 26 years of follow-up, 459 strokes occurred. Regardless of smoking status and in each sex, hypertensive subjects had twice the incidence of stroke. Using the Cox proportional hazard regression method, smoking was significantly related to stroke after age and hypertension were taken into account. Even after pertinent cardiovascular disease risk factors were added to the Cox model, cigarette smoking continued to make a significant independent contribution to the risk of stroke generally and brain infarction specifically. The risk of stroke increased as the number of cigarettes smoked increased. The relative risk of stroke in heavy smokers (greater than 40 cigarettes per day) was twice that of light smokers (fewer than ten cigarettes per day). Lapsed smokers developed stroke at the same level as nonsmokers soon after stopping. Stroke risk decreased significantly by two years and was at the level of nonsmokers by five years after cessation of cigarette smoking.

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

Predicting survival after stroke: a three-year follow-up.

We examined characteristics associated with a high risk of mortality within 3 years after a stroke. Analyses are based on data from a population-based register of stroke events that occurred in Auckland (total population 829,545), New Zealand during a 1-year period in 1981-1982 and a 3-year follow-up study of all survivors (97% complete). Statistical techniques that allow for the simultaneous evaluation of multiple factors indicated that retention of consciousness, decreasing age, and place of residence at the onset of the stroke were the strongest predictors of survival over 3 years. The survival rate for those living at home at the onset of the stroke who did not lose consciousness was 58% compared with 5% for people in institutional care who lost consciousness. Marital status, history of stroke, and ethnic group also predicted survival. Most of the important prognostic factors we identified in our study cannot be modified, testifying to the importance of the prevention of stroke in the first place.

Adolescent↗
PubMed1987

The pattern of management after stroke.

A large population-based study of stroke is used to describe the pattern of management and the relative contribution of hospital care and community care in the year following an acute stroke episode. Two thirds of the 680 patients registered in the study were admitted to a public hospital during the acute stage of their illness, while almost one quarter of all patients were managed entirely at home. One month after the initial episode the majority of patients admitted to hospital had either died or had been discharged. Overall, four-fifths of the care during the first year after the onset of the stroke took place out of hospital, either at home or in private long-term institutions.

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

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↗
PubMed1984

Myocardial infarction and sudden death in Auckland.

A population-based register of definite myocardial infarction and sudden death was established in Auckland for the twelve months from 1 March 1981. Data were collected on 905 myocardial infarctions and 300 sudden deaths that occurred in people under the age of 70 years. The age standardised event rates were more than three times higher in men than in women. The rates of myocardial infarction were comparable in Maoris and non-Maoris but the sudden death rate was almost three times higher in Maoris than in the other ethnic groups. The age standardised 28 day myocardial infarction case fatality rates were 27% and 21% for men and women respectively. Overall, 42% of patients who reached hospital were transported by a life support unit, and 59% of patients who reached a coronary care unit did so within four hours of onset.

Adult↗
PubMed1984

Deaths from strokes.

Explore the source record for details and available documents.

Cerebrovascular Disorders↗
PubMed1984

Trends in coronary heart disease event rates in New Zealand.

To examine the reasons for the recent decline in coronary heart disease death rates in New Zealand, a register of definite myocardial infarction and sudden death was established in the Auckland region (1981 population 829,464). Both routine and nonroutine case finding sources were used and event rates for the 12 months from March 1, 1981, were compared with estimates from an earlier study conducted in 1974. In 1981, 1,093 myocardial infarction and/or sudden death events in people 25-69 years of age were registered. The age standardized event rates for the total of myocardial infarction and sudden death were 506/100,000 and 139/100,000 for men and women, respectively. Over the seven-year period from 1974 there was no change in the event rate or 28-day case fatality of definite myocardial infarction, but a significant decline in the rate of sudden death occurred from 139/100,000 to 117/100,000. The decline in the sudden death rate was particularly marked in people under the age of 50 years and in subjects with a prior history of myocardial infarction.

Adult↗