Rheumatic heart disease.
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Catheterization↗
Biomedical subjects
D A North
Publications and source records attributed to D A North.
Analysis of costs of acute rheumatic fever and rheumatic heart disease in Auckland.
AIM: This analysis aims to identify the direct costs of rheumatic fever and its sequelae to the Auckland Area Health Board and to describe the indirect and intangible costs to patients. METHODS: The annual cost was estimated using primarily 1987 data costed in 1991 dollars. The cost analysis was undertaken in five sections: (1) acute rheumatic fever admissions; (2) surgical admissions; (3) rheumatic heart disease related admissions (nonsurgical); (4) outpatient clinic appointments; and (5) secondary prophylaxis programme. Non hospital board direct costs and indirect and intangible costs are described. Ethnic distribution and subsequent economic burden were analysed for each section. RESULTS: The total cost to the health board was estimated to be $3.60M. The management of chronic rheumatic heart disease accounts for 71% of the cost. Rheumatic heart disease related nonsurgical admissions cost $1,228,495 (34%), surgical admissions $846,235 (23%) and outpatient clinic appointments $490,060 (14%) respectively. Both Maori (30% of costs, $1.1M) and Pacific Island people (36% of costs, $1.3M) are disproportionately affected by this largely preventable disease. Of the total cost 13% is spent on coordinated secondary prevention programmes. CONCLUSION: An energetic secondary prevention programme over 10 years to prevent recurrences and the development of carditis has only partially reduced the rate of rheumatic heart disease. A targeted primary prevention pilot programme should be actively considered.
Acute Disease↗
Benzodiazepine use in general practice--is it a problem?
AIMS: The aim of this study was to describe benzodiazepine use in a general practice. METHODS: A prevalence study in an Auckland general practice was undertaken to describe the benzodiazepines prescribed, patterns of use and compliance. An associated case control study compared benzodiazepine users and nonusers. RESULTS: The age standardised prevalence rate of benzodiazepine use in this Auckland general practice was 3.4% for patients over 20 years of age. The benzodiazepine users described were predominantly elderly (70% over 60 years of age) and female (62.5%). They had significantly more medical and psychiatric complaints than matched controls. Triazolam and diazepam accounted for 60.9% of the benzodiazepines prescribed. Over one-third of the patients using benzodiazepines were concurrently prescribed other psychotropic medications, primarily tricyclic antidepressants. CONCLUSION: This rate suggests an overall decline in benzodiazepine use since previous studies. Benzodiazepines continue to be prescribed predominantly in the elderly, a group at considerable risk from side effects. Doctors should continue to inform their patients about the side effects of benzodiazepines, the risks of dependence and difficulties of withdrawal.
Adult↗
Trends in the contraceptive practices of women seeking abortions in the 1980s.
The demographic features and contraceptive practices of 1000 women attending Parkview clinic of Wellington Hospital for termination of pregnancy were studied over an eight month period in 1988-9. Comparisons were made with a previous study at the same clinic in 1980-1. The overall abortion rate has increased from 6.8/1000 women in the Wellington statistical area in 1981 to 9.8 in 1989. The proportion of Pacific Island and Asian women presenting for abortions is high and has increased disproportionately between 1981 and 1989. The abortion rate has also increased in lower socioeconomic groups in 1989. The proportion of women using contraception at the time of conception increased from 50% in 1981 to 68.5% in 1989. The methods used by women presenting for abortion have changed significantly. There has been an increase in the proportion of women using condoms (from 13.3% to 36.2%) and the oral contraceptive pill from (14% to 21.4%).
Abortion Applicants↗