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Biomedical subjects

R Beaglehole

Publications and source records attributed to R Beaglehole.

At least 19 recordsLinked to original sources
PubMed1992

Does recent alcohol consumption reduce the risk of acute myocardial infarction and coronary death in regular drinkers?

This study, conducted in Auckland, New Zealand, over 2 years from March 1986, used a case-control design to investigate the hypothesis that alcohol acutely increases the risk of both nonfatal myocardial infarction and coronary death in the 24 hours after drinking, among regular drinkers. The nonfatal myocardial infarction analyses included 278 male and 60 female cases identified from a population-based coronary heart disease surveillance program and 458 male and 266 female controls randomly selected from the same population matched by age and sex. In the coronary death analyses, 172 male and 16 female coronary death cases from the same surveillance program and a population-based sample of 294 males and 165 females who were age and sex matched were examined. Information on alcohol consumption in the 24 hours before the coronary event in cases and a comparable 24-hour period in controls was collected. Study subjects all drank alcohol regularly at least once per month and were aged 25-64 years. Controls were more likely than cases to report a drinking episode in the 24-hour period examined in both sexes and for fatal and nonfatal disease. After controlling for possible confounding, the authors found that drinkers had a consistently lower estimated risk of both fatal and nonfatal coronary heart disease than participants reporting no alcohol in the previous 24 hours. The odds ratios ranged from 0.75 (95% confidence interval 0.62-0.90) for nonfatal myocardial infarction in men to 0.46 (95% confidence interval 0.19-1.10) for coronary death in women. There were no clear differences in estimated acute risk among those who drank one or two drinks, three or four drinks, or more than four drinks in the 24-hour period. These findings suggest that, contrary to previous speculation, alcohol consumption may acutely reduce coronary heart disease risk.

Adult↗
PubMed1992

Does physical activity lower blood pressure: a critical review of the clinical trials.

This review critically appraises 22 recent articles of trials of physical activity, as a means of reducing blood pressure. The quality of the literature remains poor and of the 13 controlled trials of habitual activity only one did not have a major design fault. Overall, blood pressure was reduced by physical activity in both hypertensive and normotensive persons. This effect was independent of weight loss and in some studies blood pressure reduction occurred in the presence of weight gain. The average reduction in the better designed studies was approximately 6-7 mmHg for both systolic and diastolic blood pressure which compares favourably with studies of pharmacological treatment. The better designed studies reported smaller reductions than studies with poorer design. All activities, including circuit weight training, lowered blood pressure and daily activity produced greater blood pressure reduction than when performed three times per week. It is concluded that physical activity has an independent capacity to lower blood pressure.

Adolescent↗
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↗
PubMed1992

Setting national health goals and targets in the context of a fiscal crisis: the politics of social choice in New Zealand.

The setting of national health goals and targets in New Zealand has taken place in the context of fiscal crisis. The mandate for State intervention for social goals has also been under a sustained ideological challenge. These circumstances, together with other developments within the New Zealand health service, prepared the way for the development of the first set of health goals and targets. Six criteria were used to identify health problems for which goals and targets could be set. Ten areas were included, and specific, timed and quantified targets were set in each area for the year 2000 with shorter term targets for 1995. The Minister of Health gave priority to three areas: tobacco control, secondary prevention of cervical cancer, and reduction of road accident injury and death. An important aspect of the program is that the goals and targets are to be the focus of the annual contract between the Minister of Health (the primary funder of health care) and the Area Health Boards (the primary providers of health care). A matrix of policy options is presented for resource allocation and public health. The case study described represents one solution to the set of policy choices presented by fiscal and ideological challenge; the "new managerialism" has been allied with the "new public health." The authors argue that a combination of ideological renewal and fiscal probity has preserved a vigorous role for the State in health and health care. This matrix of policy options also underlines the necessity to consider health outcomes, as well as organizational goals, in the evaluation of the performance of health systems.

Cost Control↗
PubMed1991

Mortality from coronary heart disease and incidence of acute myocardial infarction in Auckland, Newcastle and Perth.

OBJECTIVE: To confirm the existence of regional differences in coronary death rates in Australia and New Zealand and to determine whether or not these are associated with parallel differences in the incidence of acute myocardial infarction. DESIGN: Descriptive epidemiological study. SETTING: Community based study. SUBJECTS: Residents of Auckland, Newcastle and Perth aged 25-64 years admitted to hospital for acute myocardial infarction or dying from coronary heart disease between 1983 and 1987. MAIN OUTCOME MEASURES: Definite acute myocardial infarction or coronary death classified according to the criteria of the World Health Organization MONICA project. RESULTS: This study confirms the marked variation, evident from official statistics, in mortality rates from ischaemic heart disease between Newcastle (high), Auckland and Perth (low). A different pattern is observed for the incidence of acute myocardial infarction and there are also obvious differences between centres in the case fatality ratios for all acute coronary events combined. Newcastle has the highest rate for all coronary events, particularly in women. Auckland is characterised by substantially higher case fatality ratios compared with the two Australian cities. This is due especially to higher rates of coronary death outside hospital. Perth, which has the lowest mortality rates and case fatality ratios in both men and women, has rates for admission to hospital for acute myocardial infarction and all cases of ischaemic heart disease that are disproportionately high in relation to the corresponding mortality rates. CONCLUSION: The differences in case fatality ratios between these three centres are not readily explained by artefacts related to enumeration or classification. Rather, they are most likely related to differences in the natural history of ischaemic heart disease in the three populations. Differences in medical management may also contribute to the substantial variation in mortality rates.

Adult↗
PubMed1991

Alcohol consumption and risk of coronary heart disease.

OBJECTIVE: To investigate the hypothesis that the apparent protective effect of habitual alcohol consumption on coronary heart disease is due to drinkers at high risk of coronary heart disease becoming non-drinkers. DESIGN: Case-control population based study. Data were obtained from interviews with patients with non-fatal myocardial infarction and their controls and with the next of kin of those who had died of coronary heart disease and their controls. SETTING: Auckland, New Zealand. SUBJECTS: Two groups of cases were studied. The first comprised 227 men and 72 women with non-fatal myocardial infarction identified from a population based surveillance programme for coronary heart disease; controls were 525 men and 341 women randomly selected from the same population group and matched for age and sex. The second group comprised 128 men and 30 women who had died of coronary heart disease and had been identified from the surveillance programme; controls were a sample of the previous control group and comprised 330 men and 214 women matched for age and sex. All participants were aged 25-64 years and without diagnosed coronary heart disease. MAIN OUTCOME MEASURES: Regular alcohol consumption; high density lipoprotein cholesterol and low density lipoprotein concentrations. RESULTS: Men with myocardial infarction and men who had died of coronary heart disease were more likely to have been never drinkers (had never drunk more than once a month) than controls (18% v 12% and 23% v 13% respectively). After possible confounding factors had been controlled for, people in all categories of drinking (up to more than 56 drinks per week) had at least a 40% reduction in risk of fatal and non-fatal coronary heart disease compared with never drinkers. Former drinkers also had a lower risk of non-fatal myocardial infarction than never drinkers (relative risks 0.41 and 0.10 in men and women respectively) but a similar risk of death from coronary heart disease. The reduction in risk was consistently greater in women than in men in all drinking categories but there was no clear dose-response effect in either sex. CONCLUSIONS: The results support the hypothesis that light and moderate alcohol consumption reduces the risk of coronary heart disease. This protective effect in this population was not due to the misclassification of former drinkers with a high risk of coronary heart disease as non-drinkers.

Adult↗
PubMed1991

The diet of Auckland men and women aged 25-64 years.

The dietary intake of a sample of 537 men and 372 women aged 25-64 years, randomly selected from the Auckland general electoral rolls, was assessed in order to describe current nutritional patterns in Auckland and to compare dietary intakes between men and women. A 118 item food frequency questionnaire was given to each participant to recall usual intake over the previous three months. After adjusting for energy intake, men consumed significantly more fat and cholesterol than women, consistent with their increased intake of red meat (median serves per month = 28 for men, 23 for women) and their greater tendency to eat fried meat (80.3% v 71.7%) and to drink full cream milk (82.7% v 70.7%). In contrast, women consumed more carbohydrate and fibre than men after adjusting for energy, consistent with their increased intake of vegetables (median serves per month = 136 for women, 116 for men) and fruit (median serves per month = 71 for women, 39 for men). These dietary differences between men and women may partly explain the increased coronary heart disease rates in men.

Adult↗
PubMed1991

Coronary heart disease mortality in Auckland Maori and Europeans.

This paper investigates the differential between Maori and European coronary heart disease mortality in Auckland by analysing data from an Auckland register of coronary heart disease. The age standardised coronary heart disease mortality rate for Maori men is 1.6 times higher than for European men, and the rate for Maori women is 4.2 times higher than that of European women. Maori mortality is disproportionately high for women, and for the younger age groups. Maori and European who died of definite myocardial infarction in Auckland between 1983-86 showed little difference in severity of coronary artery occlusion at post mortem, and the likelihood of cardiomyopathy contributing a major part to Maori heart disease mortality is small.

Adult↗
PubMed1991

The Auckland diet: results from a seven day food diary.

Dietary intakes of 113 men and women aged 50-66 years, sampled from the Auckland electoral roll, were measured by a prospective seven day dietary diary. The mean intakes of percentage of energy due to fat and saturated fat were 32% and 16% in men and 34% and 15% in women. Compared with earlier New Zealand dietary studies, which used different methods, there has been an apparent decrease in both the absolute amount and proportion of cholesterol and saturated fat. The absolute and relative amount of protein consumed appears to have remained stable while carbohydrate intake has increased. In comparison with current guidelines for dietary fat intake there remains a need for further improvement in the typical New Zealand adult diet.

Aged↗