Air quality and seasonal variations in consultations for respiratory, allergic, dermatological and gastrointestinal diseases in Bahrain, 2007.

Environmental health data in Bahrain are scarce. This study in 4 governorates of Bahrain aimed to establish baseline data on the seasonal prevalence of certain disease groups that are sensitive to climate (respiratory, allergic, dermatological and non-specific gastrointestinal diseases) over a 1-year period and to record local climate and air pollutant data for the same year. A 5% sample of medical records for those who attended primary health-care centres during 2007 was taken. Visit rates for all 4 diseases had peaks, in spring and in autumn, with the lowest rates in the summer season when the average temperatures were highest and average humidity was lower. Respiratory-related visits were highest when the air concentrations of SO2 were highest. An ongoing surveillance system for climate-sensitive diseases should be initiated to monitor and relate health and environmental trends.

Air quality and seasonal variations in consultations for respiratory, allergic, dermatological and gastrointestinal diseases in Bahrain, 2007

إن البيانات حول الصحة البيئية شحيحة في البحرين. وقد أجرى الباحثان هذه الدراسة في 4 محافظات في البحرين بهدف توطيد بيانات خط الأساس حول معدل الانتشار الفصلي لبعض مجموعات الأمراض ذات الحساسية الفصلية [أمراض تنفسية، وأليرجية، وجلدية، وأمراض هضمية غير نوعية]، وذلك على مدى سنة كاملة، مع تسجيل البيانات حول المناخ المحلي وملوثات الهواء في السنة ذاتها. وقد أخذت عينة مقدارها 5% من السجلات الطبية لمن حصر إلى مراكز الرعاية الصحية الأولية خال عام 2007 . وقد اتضح أن الزيارات للأمراض الأربعة تبلغ ذروتها في فصلي الربيع وفي الخريف وتصل إلى حضيضها في فصل الصيف عندما تبلغ درجات الحرارة ذروتها وتكون الرطوبة أقل. وقد كانت الزيارات ذات الصلة بالأمراض التنفسية في ذروتها عندما بلغ تركيز ثنائي أكسيد الكبريتSO[2]، ذروته، مما يدل على وجوب إنشاء نظام ترصد مستمر للأمراض الحساسة للمناخ لرصد الاتجاهات البيئية والصحية ذات الصلة بها

ABSTRACT Environmental health data in Bahrain are scarce. This study in 4 governorates of Bahrain aimed to establish baseline data on the seasonal prevalence of certain disease groups that are sensitive to climate (respiratory, allergic, dermatological and non-specific gastrointestinal diseases) over a 1-year period and to record local climate and air pollutant data for the same year. A 5% sample of medical records for those who attended primary health-care centres during 2007 was taken. Visit rates for all 4 diseases had peaks, in spring and in autumn, with the lowest rates in the summer season when the average temperatures were highest and average humidity was lower. Respiratory-related visits were highest when the air concentrations of SO2 were highest. An ongoing surveillance system for climate-sensitive diseases should be initiated to monitor and relate health and environmental trends.

RÉSUMÉ Les données sur la salubrité de l'environnement sont rares à Bahreïn. La présente étude menée dans quatre gouvernorats de Bahreïn visait à recueillir des données initiales sur la prévalence saisonnière de certains groupes de maladies qui sont sensibles au climat (maladies respiratoires, allergiques, dermatologiques et troubles gastrointestinaux non spécifiques) sur une période d'un an et à enregistrer les données sur le climat local et les polluants atmosphériques pour la même année. Un échantillon de 5 % des dossiers médicaux des patients ayant consulté dans des centres de soins de santé primaires en 2007 a été sélectionné. Les fréquences de consultation pour les quatre groupes de maladies avaient des pics, au printemps et en automne, et des creux pendant la saison d'été, lorsque les températures moyennes étaint les plus élevées et que le taux d'humidité était le plus faible. Les consultations pour un motif respiratoire étaient plus nombreuses lorsque la concentration atmosphérique en dioxyde de soufre était la plus élevée. Un système de surveillance permanent pour les maladies sensibles au climat devrait être instauré pour surveiller et corréler les tendances sanitaires et environnementales.

Undergraduate medical education in the Gulf Cooperation Council: a multi-countries study (Part 2).

BACKGROUND: The Gulf Cooperation Council (GCC) countries have witnessed over the last 40 years a rapid and major social, cultural, and economic transformation. The development of medical education in the region is relatively new, dating from the late 1960s. An important goal among the medical colleges in the region is to graduate national physicians who can populate the healthcare service of each country. AIM: The aim of this study is to provide understanding of undergraduate medical education in each of the six GCC countries and the challenges that each face. METHODS: This is a descriptive cross-sectional study. Fourteen senior medical faculty were requested to submit information about undergraduate medical education in their own countries, focusing on its historical background, student selection, curriculum, faculty, and challenges. RESULTS: The information provided was about 27 medical colleges: 16 from the Kingdom of Saudi Arabia (KSA), five from the United Arab Emirates, two from the Kingdom of Bahrain, two from Sultanate of Oman, one from Kuwait and one from the State of Qatar. It was found that older colleges are reviewing their curriculum while new colleges are developing their programs following current trends in medical education particularly problem-based learning and integrated curricula. The programs as described 'on paper' look good but what needs to be evaluated is the curriculum 'in action'. Faculty development in medical education is taking place in most of the region's medical colleges. CONCLUSION: The challenges reported were mainly related to shortages of faculty, availability of clinical training facilities, and the need to more integration with the National Health Care services. Attention to quality, standards, and accreditation is considered essential by all colleges.

Undergraduate medical education in the Gulf Cooperation Council: a multi-countries study (Part 1).

BACKGROUND: The Gulf Cooperation Council (GCC) countries have witnessed over the last 40 years a rapid and major social, cultural, and economic transformation. The development of medical education in the region is relatively new, dating from the late 1960s. An important goal among the medical colleges in the region is to graduate national physicians who can populate the healthcare service of each country. AIM: The aim of this study is to provide understanding of undergraduate medical education in each of the six GCC countries and the challenges that each face. METHODS: This is a descriptive cross-sectional study. Fourteen senior medical faculty were requested to submit information about undergraduate medical education in their own countries, focusing on its historical background, student selection, curriculum, faculty, and challenges. RESULTS: The information provided was about 27 medical colleges: 16 from the Kingdom of Saudi Arabia (KSA), five from the United Arab Emirates (UAE), two from the Kingdom of Bahrain, two from Sultanate of Oman, one from Kuwait, and one from the State of Qatar. It was found that older colleges are reviewing their curriculum while new colleges are developing their programs following current trends in medical education, particularly problem-based learning and integrated curricula. The programs as described 'on paper' look good but what needs to be evaluated is the curriculum 'in action'. Faculty development in medical education is taking place in most of the region's medical colleges. CONCLUSION: The challenges reported were mainly related to shortages of faculty, availability of clinical training facilities and the need to more integration with the National Health Care services. Attention to quality, standards, and accreditation is considered essential by all colleges.

Anticonvulsant therapy for status epilepticus.

BACKGROUND: Status epilepticus is a medical emergency associated with significant mortality and morbidity, which requires immediate and effective treatment. OBJECTIVES: (1) To determine whether a particular anticonvulsant is more effective or safer to use in status epilepticus compared to another and compared to placebo.(2) To delineate reasons for disagreement in the literature regarding recommended treatment regimens and to highlight areas for future research. SEARCH STRATEGY: We searched the following electronic databases using the highly sensitive search strategy for identifying published randomised controlled trials: (1) Cochrane Epilepsy Group Specialized Register (July 2005); (2) Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2,2005); (3) MEDLINE (1966 - August 2004); (4) EMBASE (1966 - January 2003). SELECTION CRITERIA: Randomised controlled trials of participants with premonitory, early, established or refractory status epilepticus using a truly random or quasi-random allocation of treatments were included. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. MAIN RESULTS: Eleven studies with 2017 participants were included. Few studies used the same interventions. Diazepam was better than placebo in reducing the risk of non-cessation of seizures (RR 0.73, 95% CI 0.57 to 0.92), requirement for ventilatory support (RR 0.39, 95% CI 0.16 to 0.94) or continuation of status epilepticus requiring use of a different drug or general anaesthesia (RR 0.73, 95% CI 0.57 to 0.92). Lorazepam was better than placebo for risk of non-cessation of seizures (RR 0.52, 95% CI 0.38 to 0.71) and for risk of continuation of status epilepticus requiring a different drug or general anaesthesia (RR 0.52, 95% CI 0.38 to 0.71). Lorazepam was better than diazepam for reducing risk of non-cessation of seizures (RR 0.64, 95% CI 0.45 to 0.90) and had a lower risk for continuation of status epilepticus requiring a different drug or general anaesthesia (RR 0.63, 95% CI 0.45 to 0.88). Lorazepam was better than phenytoin for risk of non-cessation of seizures (RR 0.62, 95% CI 0.45 to 0.86). Diazepam (30 mg intrarectal gel) was better than a lower dose (20 mg intrarectal gel) in premonitory status epilepticus for the risk of seizure continuation (RR 0.39, 95% CI 0.18 to 0.86). AUTHORS' CONCLUSIONS: Lorazepam is better than diazepam or phenytoin alone for cessation of seizures and carries a lower risk of continuation of status epilepticus requiring a different drug or general anaesthesia. Both lorazepam and diazepam are better than placebo for the same outcomes. In the treatment of premonitory seizures, diazepam 30 mg in an intrarectal gel is better than 20 mg for cessation of seizures without a statistically significant increase in adverse effects. Universally accepted definitions of premonitory, early, established and refractory status epilepticus are required.

Obesity among adult Bahraini population: impact of physical activity and educational level.

BACKGROUND: In the populations of the Arabian Peninsula, obesity has emerged as the leading cause of morbidity and mortality over a 25-year period of swift socioeconomic progress. The objective of this study was to determine the body weight distribution, prevalence and risk factors for the overweight and obese in the native adult Bahraini population. SUBJECTS AND METHODS: A cross-sectional national epidemiological community survey was conducted involving 2013 Bahraini subjects aged 40-69. The males were aged 40-59 years, with a mean age of 49 years, while the females were aged 50-69 years, with a mean age of 59. The sample was adjusted for gender, age, and area of residence distribution. A questionnaire describing the demographic, social, educational status and income status was completed. Measurements were made of height and weight, and body mass index (BMI) was calculated for each subject. WHO classification was used for defining overweight (BMI 25-29.9 kg/m 2) and obesity (BMI > or =30 kg/m(2)) categories. RESULTS: The age-standardized prevalence rate among native Bahraini men and women was high. Approximately 32% of women and 25% of men were obese (BMI > or =30.0 kg/m(2)). The prevalence of obesity was significantly higher among female subjects than males throughout all the age groups. Overweight and obesity were more prevalent among those with higher levels of education and people with high incomes. A significant relationship was found between obesity and education, physical inactivity and TV watching of 16 hours a week or more. Subjects' self-appraisal and their report of physicians' diagnosis of health disorders revealed a significantly higher prevalence of ill health among obese subjects. There was a progressive decrease of BMI for male and female subjects with age. Although 28% of participants (564) had body mass index > or =30 kg/m(2), only 42% (267) of these obese individuals rated themselves as overweight. In addition, obesity was inversely related to physical activity at work in men. CONCLUSION: We conclude that the prevalence of obesity among the native middle-aged and elderly Bahraini population is high. We noted that the prevalence of obesity increased as the level of education increased, which reflects the perception of obesity being a sign of affluence among Bahraini population. There is a necessity to develop an action plan for controlling obesity and its metabolic consequences among the populations of the Arabian Gulf.

Relation of high blood pressure to glucose intolerance, plasma lipids and educational status in an Arabian Gulf population.

BACKGROUND: In Bahrain and other populations of the Arabian Peninsula, glucose intolerance is associated with raised plasma total cholesterol, postmenopausal status and low educational status. These associations are not generally seen in other populations with high diabetes prevalence. A study was undertaken in order to determine if hypertension in Bahrainis is associated with the same factors as those related to glucose intolerance. METHODS: A cross-sectional survey of 2120 Bahrainis aged 40-69 years. RESULTS: The age-adjusted prevalence of hypertension (defined as current treatment for hypertension, systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg) rose with increasing degrees of glucose intolerance. Age- and sex-standardized prevalence of hypertension was 21% (95% CI: 19-24%) in those with normal glucose tolerance, 31% (95% CI: 27-36%) in those with impaired glucose tolerance, and 38% (95% CI: 34-42%) in those with diabetes. In a multivariate analysis adjusting for age and sex, raised blood pressure was independently associated with waist girth, plasma cholesterol, glucose intolerance, family history of hypertension and (in women) postmenopausal status. There was an inverse relationship between blood pressure and educational status that was independent of other variables. This association parallels the inverse relationship of diabetes to educational level and is consistent with low educational level being a marker for socioeconomic deprivation in early life in this population. CONCLUSION: The high prevalence rates of hypertension and diabetes in Bahrainis are manifestations of a pattern of metabolic disturbances that includes raised plasma cholesterol levels. Both hypertension and diabetes are associated with low educational status, which in this population is a marker for socioeconomic deprivation in early life. This suggests that the risk of hypertension may be set by environmental factors in early life.

Overweight and obesity in the Arabian Peninsula: an overview.

Obesity greatly increases the risks of developing diseases, including diabetes mellitus, hypertension, dyslipidaemia, coronary artery disease, and some cancers. At least one-third of Arabs are obese, as defined by body mass index (BMI) more than 30 kg/m2 and this figure is rising steadily despite increased interest in fitness. Women have particularly high rates of obesity. Obesity is clearly associated with increased risk for mortality, but there has been controversy regarding optimal weight with respect to mortality risk. A review of recent studies on the prevalence of obesity among population of the Arabian Peninsula and the evaluation of the health risk of obesity is presented in this paper. The prevalence of obesity ranges between 16-25% in men and 17-43% in women. The most prevalent chronic diseases related to obesity in these populations are diabetes, hypertension and coronary heart disease (CHD).

Prevalence of risk factors for cardiovascular diseases among men and women in an Arab Gulf community.

A cross-sectional study was conducted to estimate the prevalence of major risk factors for cardiovascular diseases (CVD) among the adult population in Bahrain, an Arab Gulf country. A total sample of 516 subjects aged 30-79 years was selected proportionally from all geographical areas of Bahrain. Findings revealed that current smokers represented 32% of men and 20% of women (P < 0.001). However, a relatively high percentage of women were exposed to inhalation of other family member tobacco smoking compared to men (29% and 44% among men and women, respectively). Obesity, hypertension and diabetes were highly prevalent and significantly more reported among women than men. Of women, 79.6% were overweight or obese compared to 56% of men. Sedentary lifestyle patterns (Lack of physical exercise and daily watching of television) were also highly reported. About 12.1% of men and 15.7% of women did not consume fresh fruits. The corresponding percentages for fresh vegetables were 8.4% and 5.5%, respectively. The prevalence of well established risk factors for CVD such as smoking, obesity, inactivity, diabetes and hypertension were high and indicates the need for a national health policy to prevent and control the CVD.

Lifestyle and the risk of acute myocardial infarction in a Gulf Arab population.

BACKGROUND: Recent statistics indicate that acute myocardial infarction (AMI) is becoming very common in the State of Bahrain. A population-based case-control study was carried out to explore the importance of lifestyle in the occurrence of AMI in Bahrain among those aged 30-79 years. METHODS: Seventy consecutive cases with a first episode of AMI were identified from a register, which included all hospital admissions, during the period 1 February 1992 to 31 July 1992, and compared with 516 subjects obtained from a random sample of the same community. Multiple logistic regression was used to control for demographic variables as well as for the mutual confounding effects of the investigated risk factors. RESULTS: Of the patients with first-time AMI, 64% did not walk regularly for exercise compared with 34% of community controls (adjusted odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.24-5.15). In all, 12% of community controls has a history of hypertension and 9% had diabetes. The comparative figures for AMI patients were 44% for hypertension (adjusted OR = 5.04, 95% CI: 2.82-9.00) and 22% for diabetes (adjusted OR = 3.28, CI: 1.73-6.20). Cigarette smoking and infrequent consumption of fruits and vegetables also appeared to be associated with an increased risk of AMI. CONCLUSION: There is scope for lifestyle change in reducing AMI risk, by changes in physical activity, smoking and dietary habits. In addition, measures to control hypertension and diabetes should be given a high priority in any national health policy to prevent AMI.

The importance of hypertension in the aetiology of infarctive and haemorrhagic stroke. The Lower Hunter Stroke Study.

OBJECTIVE: To determine the importance of hypertension in the aetiology of infarctive and haemorrhagic stroke in persons aged 35-69 years. DESIGN: A population-based case-control study. SETTING: Lower Hunter Region community. SUBJECTS: One hundred and ninety patients with a first stroke were identified from a register, including all hospital admissions and death certificates in the Region, and compared with 496 control subjects obtained from a random population sample of the same community. MAIN OUTCOME MEASURE: First event of stroke (fatal or non-fatal). RESULTS: Twenty-seven per cent of those with a haemorrhagic stroke, compared with 2% of those with infarctive stroke, died before hospital admission; the in-hospital mortality was 15% and 9%, respectively. Twenty-one per cent of control subjects, compared with 51% of those with stroke, were currently receiving treatment for hypertension. By logistic regression analysis the odds ratio for receiving current treatment for hypertension in those with haemorrhagic stroke was 5.5 (95% confidence interval [CI], 2.36-12.8), compared with 2.53 (95% CI, 1.48-4.34) in those with infarctive stroke. Other differences between haemorrhagic and infarctive stroke included no excess risk in men for haemorrhagic stroke but an odds ratio of 3.51 (95% CI, 1.83-6.74) for infarctive stroke; and a steep risk gradient for obesity in haemorrhagic but not in infarctive stroke. Cigarette smoking carried a non-significant odds ratio of around 1.5, with no difference between stroke type. Among those who had ever been told that they had hypertension, 75% and 71% of patients with infarctive stroke and haemorrhagic stroke, respectively, and 61% of control subjects, were currently receiving treatment for hypertension. In those stroke patients who were currently being treated for hypertension, 63% had a pre-admission diastolic blood pressure of 90 mmHg or more. The mean diastolic blood pressure levels on admission were 10 mmHg higher than the latest recorded pre-hospital measurements and fell to 10 mmHg lower than the levels recorded before hospital admission by the time of discharge. CONCLUSION: Hypertension is important in the aetiology of both infarctive and haemorrhagic strokes, although it may be more important in haemorrhagic stroke, and there appear to be other aetiological differences between stroke types. Most of the patients with a history of hypertension were currently receiving treatment for hypertension, although blood pressure control before admission was not optimal.

Hypertension control and the risk of myocardial infarction and stroke: a population-based study.

A population-based case-control study was performed to determine the importance of the presence of hypertension and the control of blood pressure level during treatment for hypertension on the occurrence of acute myocardial infarction (AMI) and stroke in persons aged 35-69 years in the Hunter Region community. Patients with a first episode of AMI or stroke were identified from community-based heart attack and stroke registers and compared with control subjects obtained from a random population sample from the same community. Twenty per cent of control subjects were currently receiving treatment for hypertension compared with 37% of patients with myocardial infarction (odds ratio adjusted for age, sex and several other possible confounding variables, 2.6; 95% confidence interval (CI), 1.9-3.4) and 51% of patients with stroke (adjusted odds ratio, 3.5; 95% CI, 2.3-54). Among those who had ever been told they had hypertension, 71%, 73% and 59% of patients with AMI, patients with stroke and control subjects, respectively, were receiving treatment at the time of the AMI or the stroke or at the time of the survey (control subjects). For those receiving treatment for hypertension, blood pressure levels were obtained from the records of their general practitioner. Despite similar pretreatment levels the last recorded blood pressure level (either before the survey of the development of AMI or stroke) was higher among those who developed AMI or stroke than those in the control group. Those with a treated diastolic blood pressure of less than 80 mmHg appeared to be at a higher risk of both AMI and stroke than those with a treated diastolic blood pressure level of 80-89 mmHg, but the difference was not statistically significant. Randomised controlled trials do not show a reduction in rates of AMI in response to a reduction of blood pressure. Nevertheless our findings suggest that the presence of hypertension and poor control of blood pressure levels despite treatment may be important aetiologically both for AMI and stroke occurrence.

Length of hospital stay after acute myocardial infarction.

A number of trials show that long stay in hospital after an acute myocardial infarction (AMI) is not necessary for many patients and that stays of three-ten days may be adequate. All patients aged under 70 years with a diagnosis of AMI admitted to the seven public hospitals in the Lower Hunter Region of New South Wales are monitored as part of the WHO MONICA Study. Between August 1984 and December 1985 of 438 hospitalised patients with a 'definite' AMI according to MONICA criteria and a clinical discharge diagnosis of AMI, 386 (88%) patients were discharged alive from hospital. Four patients had lengths of stay between 46 and 77 days and have been omitted from further analysis. The mean length of hospital stay was 13.6 days (95% confidence intervals 12.9 to 14.3 days); 74% of all patients stayed in hospital for more than ten days. The mean length of stay in the Coronary Care Unit (CCU) was 4.5 days (95% confidence intervals 4.2 to 4.8 days) with 60% staying longer than three days. Mean hospital stay varied from 10.5 to 17.4 days among the seven hospitals, although most of this variation was accounted for by three hospitals with few patients. Restricting analysis to the four hospitals with 90% of all the patients, multiple regression analysis showed that the CK enzyme levels, the evolution of Q waves on ECG, the presence of an anterior AMI and the use of nitrates and digoxin during hospitalisation were all associated with increased length of stay in hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Death from myocardial infarction: what are the benefits of early arrival at hospital and thrombolysis?

The potential benefits of early hospital care in the event of myocardial infarction were investigated in a community-based study of all suspected cases of heart attack among people aged under 70 years in the Hunter Region of New South Wales. Between August 1984 and December 1985 acute care data were collected for 1029 cardiovascular events classified as definite myocardial infarction or sudden coronary death; 516 (50%) resulted in death within 28 days from the onset of symptoms and 325 of these deaths (63%) occurred outside hospital. Of 703 people who are known to have reached hospital alive 205 (29%) did so more than four hours after the onset of symptoms. At the time of the study fewer than 1% of patients received streptokinase. To estimate the potential benefits of increased medical care an optimistic scenario was considered in which patients who arrived at hospital more than four hours after the onset of symptoms received medical attention earlier and all eligible patients received thrombolysis. Based on the results of the Second International Study of Infarct Survival (ISIS-2), if streptokinase and aspirin had been used 14% of deaths would have been averted. If, in addition, patients had arrived at hospital earlier and received optimal benefit from thrombolysis another 13% of deaths could have been avoided. These results provide a broader perspective of the potential benefits of improved medical care than can be obtained from hospital-based studies that deal only with those heart attack victims who survive long enough to reach hospital alive.

Methodological issues in interpreting trends in MONICA event rates.

Before looking at the trends in coronary event rates and case fatality rates in the WHO MONICA Project, it is necessary to assess the consistency and validity of the data. In the Newcastle MONICA Collaborating Centre, two methods have been used. One involves monitoring data quality by comparisons with external data systems such as hospital discharge data and official mortality records. The other is to examine the internal consistency of MONICA diagnostic findings. For fatal myocardial infarction (MI) or coronary death, there is consistent evidence of a decline, but the MONICA data are not adequate to assess relative changes in sudden compared to non-sudden death rates. For non-fatal definite MI there was an increase early in the study, possibly due to a change in methods, but rates have now stabilized. For non-fatal possible MI there has been a steady increase in rates for events which may be becoming less severe. This is consistent with increasing hospital admissions for subacute ischaemic heart disease (IHD) and angina. This paper exemplifies the importance of maintaining internal and external surveillance of the quality of the data.

Declining mortality from ischemic heart disease and cerebrovascular disease in Australia.

The authors examined the patterns of mortality from ischemic heart disease and cerebrovascular disease in Australia for men and women aged 30-84 years during the period 1950-1986 to assess the relative contributions of period and cohort effects on changes in the mortality rates. Death rates for ischemic heart disease increased from 1950 to the late 1960s and then declined. Although the relative magnitude of the decline was greater among younger age groups, decreasing mortality rates were experienced in all age groups, including the oldest. The period effect was dominant so that each successive cohort experienced lower age-specific mortality rates after the late 1960s. Death rates for cerebrovascular disease for both sexes and all age groups have declined since the early 1950s, although the rate of change was less in 1961-1971 and greater before and after this period. No cohort effect was demonstrated for either disease. Changes in diet, decreasing prevalence of cigarette smoking, and increasing treatment of hypertension throughout the period and improved coronary care from the late 1960s onward are all consistent with the mortality trends.

Coronary events in the Hunter region of New South Wales, Australia: 1984-1986.

The results of coronary event registration using the protocol of the World Health Organization MONICA Project are reported for two years for the Hunter Region, the area in and around Newcastle in New South Wales, Australia. The Newcastle MONICA Project monitors all suspected cases of heart attack by identifying patients from hospital admissions and obtaining information while they are still in hospital. For people who die out of hospital, the initial source of information is usually the death certificate. Rates for the most robust MONICA diagnostic categories, non-fatal definite myocardial infarction and all coronary deaths, differed for the two years reported here. Monthly rates suggested possible seasonal effects, and the possible influence of lower respiratory infections including an epidemic of influenza A. The results demonstrate that consistent monitoring over several years will be necessary to establish clear trends in coronary heart disease.

Blood pressure measurement in an Australian population.

A postal survey of a random sample of 1200 persons who lived in the Hunter Region of New South Wales was undertaken in order to determine their experiences of blood pressure measurement and treatment for hypertension. The corrected response rate was 89%. Ninety per cent of the 962 respondents had visited a doctor in the previous year and 69% of them reported a blood pressure measurement at their last visit. Eighty-nine per cent of the 962 respondents reported that they had undergone a blood pressure measurement in the past three years. Although 79% of the respondents reported a blood pressure measurement in the past year, only 59% of men who were aged 45 years or less had experienced such a measurement during that period. Women were more likely than were men to have had their blood pressure measured and to report a knowledge of and treatment for hypertension. As these findings suggest that a large proportion of the population has experienced a blood pressure measurement in the past three years, it appears that most of the hypertension in the community has already been detected. The value of blood pressure screening is questioned, although it would appear that a need remains for an improvement in the detection of hypertension in men under 45 years of age. The prevalence of hypertension in the community remains high in spite of the degree of attention that is paid to it by the medical profession. It is imperative to explore the possibilities for the primary prevention of hypertension.