Trends in cardiovascular risk factors in Australia, 1966-1986: evidence from prevalence surveys.
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Adult↗
Biomedical subjects
A J Dobson
Publications and source records attributed to A J Dobson.
Mucosal immunocompetence in man--the first five years.
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Age Factors↗
Hypertension and the risk of ischaemic heart disease.
The magnitude of the effect of hypertension as a risk factor for acute myocardial infarction (AMI) was estimated in 250 patients who presented with a first AMI who were aged 35-64 years (199 survivals and 51 deaths within 24 h), whose names were obtained from a community-based register of myocardial infarctions in the Hunter Region of New South Wales. The cases were matched by sex, age and residential area, and control subjects were obtained from a random population sample from the same region. A history of hypertension (odds ratio, 5.5; 95% confidence limits, 3.4 and 8.9) and treatment for hypertension (odds ratio, 4.2; 95% confidence limits, 2.5 and 7.2) were each significantly (P less than 0.0001) associated with an increased risk of AMI--persons with treated or untreated hypertension were four to five times more likely to develop AMI than were persons without hypertension. Adjustment for smoking did not affect the association between hypertension and the incidence of AMI. Cigarette smoking appears to have had less influence on the incidence of AMI (odds ratio, 1.7; 95% confidence limits, 1.1 and 2.4; P less than 0.01) than did a history of hypertension. Twenty-four per cent of the first AMIs that occurred in the study population were attributable to hypertension (after adjustment for smoking) and twenty-seven per cent were attributable to smoking (after adjustment for hypertension).
Adult↗
Risk factors and heart disease mortality. A regional perspective.
The mortality rates from ischaemic heart disease in the Hunter Region of New South Wales are among the highest in Australia. Within the Region substantial differences occur in death rates from heart disease among the five urban local government areas, the highest being in the coal-mining district of Cessnock and the lowest in the resort and dormitory area of Port Stephens. A recent survey in the Region of risk factors for heart disease has revealed prevalence patterns for high blood pressure, serum cholesterol levels, smoking and overweight and obesity which largely parallel the pattern of heart disease mortality. This suggests that changes in life-style in the communities could reduce the intraregional differences in mortality. In addition, the widespread prevalence of an unhealthy diet and a lack of exercise may explain the Region's high death rates from heart disease and suggests that mortality could be reduced by effective preventive measures.
Adult↗
Peptic ulcer and non-steroidal anti-inflammatory agents.
Aspirin is generally regarded as a cause of gastric ulcer but the role of non-steroidal anti-inflammatory agents and paracetamol in the aetiology of peptic ulcer is unclear. To investigate this we conducted a case control study of 180 matched pairs of peptic ulcer patients and controls obtained from surgical and dermatology outpatient clinics. There were 95 gastric ulcer and 85 duodenal ulcer patients. A statistically and clinically association (relative risk = 5) was found between the regular use of non-steroidal anti-inflammatory agents and gastric ulcer. There was also evidence of positive associations between gastric ulcer and aspirin containing preparations with or without non-steroidal anti-inflammatory agents. By contrast, duodenal ulcer was unrelated to these drugs. Too few patients used paracetamol for any conclusion to be drawn on its role.
Acetaminophen↗
Breast feeding conditions a differential developmental pattern of mucosal immunity.
A prospective study of 146 children was conducted to evaluate the influence of infant feeding patterns on the development of mucosal immunity. First, there was a trend towards lower IgG concentrations in the breast-fed neonate, indicating a possible earlier 'closure' mechanism of membrane permeability. Second, the post-natal increase in IgA was earlier and greater in formula-fed infants. Third, IgM was detected earlier, more frequently, and at higher levels in formula-fed infants.
Aging↗
Effects of random breath testing on hospital admissions of traffic-accident casualties in the Hunter Health Region.
During the period of six years from 1977 to 1982, the number of admissions of victims of traffic accidents to public hospitals in the Hunter Health Region of New South Wales fell from 2099 to 1734, a decline of 21%. About three-quarters of these patients were male; one-quarter were in the 15-20 year age group. Since the introduction of random breath testing (RBT) in 1982, there has been a further decline in admissions of traffic accident victims to hospitals of nearly 20%, attributable to the introduction of RBT. The initial decline of 30% appears to have stabilized at 20% after 12 months. The decline in admissions occurred in the urban hospitals (31%), and not in the rural hospitals; it was greater among male (31%) than among female (8%) accident victims. In the Hunter region, it is estimated that RBT has resulted in a saving of more than 3000 hospital bed-days in its first year.
Accidents, Traffic↗
Occupational differences in ischemic heart disease mortality and risk factors in Australia.
Mortality rates from ischemic heart disease in Australia declined by about 25% over the period 1969-1978. The greatest declines were experienced by the professional occupations, while lower socioeconomic groups had higher mortality rates at the beginning of the period and experienced smaller declines. From a national survey in 1980, significantly and consistently lower risk levels of blood pressure, triglyceride, cigarette smoking, body mass and exercise were found among higher status occupation groups. This suggests that there is a pattern of coronary prevention behavior spanning multiple risk factors that is associated with a reduction in ischemic heart disease.
Adult↗
Coronary heart disease mortality trends and related factors in Australia.
Coronary heart disease (CHD) has been the greatest single cause of mortality in Australia over the past 30 years. For most age and sex groups CHD mortality rates peaked in 1965-67. Since that time, rates have decreased by nearly 40% and are currently the lowest for 30 years. CHD mortality rates are highest in the eastern areas of Australia, among those who were born in Australia, and among lower socio-economic groups. Changes in CHD mortality have been accompanied by changes in life-style (particularly recent decreases in the prevalence of cigarette smoking, large reductions in tar content of cigarettes and a large change in preference for margarine over butter) and changes in treatment (especially in the control of hypertension and surgical interventions). Concurrent studies of the incidence and case fatality rates in two population centres (Perth and Newcastle) coupled with periodic surveys of changes in treatment and population risk factor levels are being undertaken over a 10-year period to try to understand the current and future trends in CHD mortality.
Adult↗
Antihypertensive treatment, body mass, and survival after myocardial infarction.
In a community-based study of heart attack, which was conducted in the Hunter Region of New South Wales in 1979, the prognosis was found to be poorer for patients who had received therapy with diuretic agents before the index attack, compared with those who either had received no treatment or were treated with other antihypertensive agents. There was also some evidence of a better prognosis for overweight people or those of normal weight, compared with those whose body weight was below normal.
Age Factors↗
Dietary compliance among insulin-dependent diabetics.
An education program to improve dietary compliance in insulin-dependent diabetics was evaluated from 1978 to 1980 at the Royal North Shore Hospital of Sydney. Dietary intake, biochemical status, health beliefs, knowledge, anthropometric and other measurements were made on 140 diabetics and their family members before and, where possible, 6 months after the program. Four aspects of compliance were assessed: dietary composition, body weight, carbohydrate spacing among meal periods and carbohydrate variation between days. There was a significant increase in the proportion of subjects who achieved the recommended goal of a high carbohydrate/low fat diet. Diabetics who complied with this recommendation were significantly more likely to have adequate glycemic control. Most of the participants were initially near ideal weight and there were few substantial weight changes. The proportions of diabetics with acceptable scores for carbohydrate spacing and variation did not change significantly. Subjects who complied with one aspect of the dietary regimen did not necessarily comply with other aspects. Dietary compliance was related to initial patterns of dietary intake but could not be predicted from any other factors such as demographic characteristics, duration of disease, knowledge or health beliefs, although this could have been due to small sample sizes.
Adolescent↗
Differences and comparative declines in ischaemic heart disease mortality among subpopulations in Australia, 1969-1978.
Mortality rates from ischaemic heart disease (IHD) in Australia for the period 1969-78 have been analysed by place of residence, occupation and country of birth. Large variations were found among subpopulations. Throughout the period IHD mortality was lowest among professional and farming occupations and highest among workers in mining, transport and communications. Geographically, mortality from IHD was highest on the east coast and lowest in Western Australia. Mortality among immigrants was lower than among people born in Australia, with death rates for those born in Greece, Italy and Yugoslavia about half the average rates. Mortality from IHD in Australia has declined by about 25% over the last decade. However, the decline has not occurred uniformly. By occupation, the professional, technical and related workers showed the largest decline, while administrative, executive and managerial workers experienced the smallest decline. By place of residence in Australia, the largest declines occurred in the Hunter and Geelong regions, although the Hunter region still has the highest rate. Western Australia, excluding Perth, and rural Victoria did not show any marked decline. The remaining regions particularly the capital cities all experienced similar declines. When analysed by country of birth, Australian born residents showed a greater decline, while men born in Greece and Italy may have had an increase in IHD mortality. There is every indication that the decline will continue. Even those subpopulations with low initial IHD mortality experienced the decline, thus Perth and Adelaide (with low rates) had similar declines to Brisbane and Sydney (with high rates) and the professional occupation group which had the lowest rate also experienced the greatest decline.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Declining mortality rates from ischemic heart disease in Australia.
Ischemic heart disease is the major cause of death in Australia. Australian attack and mortality rates from this disease are high compared with most other countries. Over the last thirty years there have been remarkable changes in heart disease death rates which rose from the 1950's until around 1965-7 and then declined by about 40% over the period 1965-7 to 1980-81. Although the pattern of this decline was similar for most age groups and both sexes it varied among subgroups of the population defined by country of birth, geographic region and occupation. For example, Australian-born men initially had higher death rates than immigrants and they experienced relatively greater declines; Perth and Adelaide (with low initial rates) had similar declines to Sydney and Brisbane (with high rates); professionals (with the lowest rates) had the greatest decline among occupational groups. While the decline in mortality is encouraging the cause is still unclear so control programmes must proceed, to some extent, by guesswork. If the subpopulations with high mortality can achieve rates comparable with subpopulations with low rates further substantial decline in heart disease mortality is possible.
Adult↗
The role of clinical epidemiology in medical practice.
Epidemiological research has been carried out traditionally in the field on non-clinical populations and has sought to reveal the aetiology of disease. But in the 1960's a possible role for epidemiology in the study of clinical practice emerged. A series of articles on scientific methodology and clinical medicine argued that much of the reasoning underpinning clinical practice might be expressed in numerical terms. This numerical expression would require the counting of diseases and events in groups of patients and would thus employ similar methods to traditional epidemiology where diseases are counted in populations. Although the term 'clinical epidemiology' was introduced as early as 1938, Sackett was instrumental in promoting the concept in 1969 as the 'application by a physician... of epidemiologic and biometric methods to the study of the diagnostic and therapeutic process in order to effect an improvement in health'. The management of individual patients involves the clinician in a multitude of decisions, concerned with making a diagnosis, ordering tests, prescribing treatment and estimating prognosis. Decisions are often made in a state of uncertainty because no reasonably objective information is available to indicate the best decision in the given circumstances, or because the most appropriate sequence of decisions for an individual patient is not apparent. Although the state of the art does not allow us to do this completely, the role of clinical epidemiology is, by way of clinical research, to provide clinicians with the information to make decisions that are most appropriate for the welfare of their patients, and in combination with information derived from decision theory to make these decisions rapidly and logically.(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical Competence↗
Cigarette smoking and drug use in schoolchildren: III--evaluation of a smoking prevention education programme.
A one year randomized controlled trial was used to evaluate the effectiveness of a smoking prevention programme designed by health educationalists for 10-12 year old primary schoolchildren. The study was carried out in the Hunter Region of New South Wales, Australia, using a sample of over 6000 children which would be large enough to detect, with high probability, differences of about 5% in smoking prevalence between the treatment and control groups. We report the results from the children surveyed in 1979 and 1980, before and after the programme was implemented. It was found that there were no significant differences in smoking behaviour between treatment and control groups. The changes that the programme did bring about were very small compared with the overall increases in smoking prevalence which occurred during the study period. The programme's effectiveness varied with both the age and sex of the children. It was most successful among older girls, aged 11-12 years, for whom smoking prevalence rates increased from 10.7% in 1979 to 22.6% in 1980 in the treatment group compared with 6.2% to 26.8% in the control group. It was least successful for younger boys, aged 10-11 years, for whom smoking increased from 9.4% to 14.5% in the treatment group compared with 10.3% to 11.8% in the control group. Attitudes changed in parallel with changes in smoking behaviour. Changes in knowledge differed only slightly between treatment and control groups. Inadequate implementation of the programme by some teachers may have been associated with adverse effects on the children's behaviour, attitudes and knowledge.
Age Factors↗
Cigarette smoking and drug use in schoolchildren: IV--factors associated with changes in smoking behaviour.
Factors associated with changes in the smoking behaviour of approximately 6000 schoolchildren (two cohorts aged between 10 and 12 years in 1979) over 12 months are described. They were measured twice as part of a randomized controlled trial of a smoking prevention programme. Four groups were defined: (a) those who became smokers (adopters); (b) those who remained non-smokers; (c) those who became non-smokers (quitters), and, (d) those who remained smokers. Personal and social variables were ordered using a logistic regression model according to the strength of their association with adopting and quitting smoking. Factors distinguishing adopters from children who remained nonsmokers were, being a member of the older cohort, having friends who smoke, having siblings who smoke, approving of cigarette advertising and having a relatively large amount of money to spend each week. Factors distinguishing quitters from children who continued to smoke were, having siblings who do not smoke, being a member of the younger cohort, disapproving of cigarette advertising and having a relatively small amount of money to spend each week. Initial attitude scores were indicative of future smoking behaviour and where smoking behaviour changed, attitudes also changed so that the two remained congruent. The younger cohort improved their knowledge of smoking hazards over the year irrespective of their smoking behaviour. The older cohort showed significant differences in knowledge which were dependent upon smoking category, with 1980 smokers having lower knowledge scores than non-smokers and showing an apparent decrement in their previous knowledge.
Attitude↗
The role of the statistician.
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Computers↗
Death certification and coding for ischemic heart disease in Australia.
Trends in ischemic heart disease mortality are of current interest because death rates have declined rapidly in the United States, Australia, and some other countries during the last decade, although they have risen elsewhere. There is a need to assess the quality of the data from which such trends are calculated and to consider what information will be required to monitor accurately future patterns of incidence and mortality for this disease. This paper describes two investigations of routinely collected mortality data for ischemic heart disease in Australia. First, information obtained from a heart attack surveillance study was compared with officially recorded causes of death for a defined population during 1979. Second, mortality trends from 1969 to 1978 were compared between the major Australian states. Both studies showed that mortality data were accurate to within about 10%. However, for acute myocardial infarction and other subcategories of ischemic heart disease, the data were neither valid nor reliable. New diagnostic and coding practices are required before it will be possible to monitor accurately long-term trends in subcategories of ischemic heart disease.
Adult↗