ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93832.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93833.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93834.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93835.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93836.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To assess the efficacy of simvastatin in a large patient cohort.Design:In an open multicentre study, after a four week placebo phase, patients were treated with simvastatin for 24 weeks; a subgroup continued therapy for a further 24 weeks. Efficacy of simvastatin (a) with prolonged use over three years, and (b) in combination with bezafibrate was assessed in an open single site study.Setting:Lipid or cardiology specialist hospital outpatient clinics.Patients:For the open multicentre study, 228 patients with primary hypercholesterolaemia (total cholesterol level>6.5 mmol/L) were recruited, of whom 224 met entry criteria and completed the study. Forty‐seven of these patients continued therapy for one year. In the open single site study, 22 patients (with low density lipoprotein [LDL] cholesterol levels>4.3 mmol/L) participated in studies of long term use (n= 9) or of combined therapy (n= 13).Intervention:Therapy in the open multicentre study began with 10 mg of simvastatin per day, doubling to 20 mg after six weeks and then 40 mg after 12 weeks of therapy if total cholesterol levels persisted above 5.2 mmol/L. In the study of long term use, simvastatin (40 mg daily) was taken continuously over three years. In the study of combination therapy, bezafibrate (600 mg daily) was taken in addition to simvastatin (40 mg daily) for 10 months.Main outcome measures:Plasma lipid and lipoprotein concentrations.Results:In the multicentre study, total plasma cholesterol levels were reduced by 32.8% from 9.11 ± 1.84 (in mmol/L, mean ± SD) to 6.12 ± 1.25 (P<0.001), and LDL cholesterol levels by 41.4% from 6.90 ± 1.92 to 4.04±0.31 (P<0.001). The effect of therapy was sustained in those patients continuing therapy to 48 weeks. The study of long term use found no significant attenuation of effect over three years of monotherapy. Combined simvastatin/bezafibrate therapy reduced the LDL cholesterol concentration by a further 19.9% (P<0.001) from levels achieved on simvastatin alone.Conclusions:Simvastatin is an effective, well tolerated lipid lowering drug, without significant attenuation of effect with prolonged use. Simvastatin plus bezafibrate appears to be a potentially useful drug combination.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93837.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

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.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93838.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To determine the characteristics of victims killed by firearms, whether they died by suicide, homicide or accident, and the types of firearms involved.Design:A retrospective and descriptive study.Setting and subjects:Coronial autopsy data were obtained from the Brisbane Laboratory of Pathology and Microbiology. All 587 firearm deaths during the period 1980–1989 were included.Main outcome measures:The proportions of deaths by suicide, homicide, accident or undetermined cause. In cases of homicide, we sought to define the relationship of the perpetrator to the victim.Results:The types of death were suicide 76%, homicide 18%, accidents 3% and undetermined 3%. Most homicides were of a domestic nature as opposed to crime. Small calibre rifles were the most common weapon; handguns were rarely used.Conclusions:Recent debate regarding firearm legislation has failed to recognise the predominance of interpersonal and psychological issues in the causation of firearm deaths. Crime is a motive for only a minority. Medical practitioners may reduce firearm deaths both by organisational representation and individual efforts in clinical practice. In particular, attention should be given to the identification of individuals or families at risk, the detection and treatment of psychological disorder and advice regarding firearm disposal.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93839.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To describe where deaths occur in Victoria and to determine to what extent the probability of dying in certain institutions is associated with cause of death and socio‐demographic variables.Design:Descriptive study of death certificates and multivariate analysis of 7697 deaths that occurred in a three‐month period in 1988.Setting:The State of Victoria.Main outcome measures:Cause of death, age, sex, marital status, and socioeconomic status.Results:Most deaths occurred in public hospitals (48%) followed by private homes (21%), nursing homes (14%) and private hospitals (9%). Only 2% of all deaths (90% from cancer) occurred in hospices. Women were more likely to die in a nursing home than were men (21 % v. 8%) and less likely to die at home (17% v. 24%). The proportion of deaths increased with age in nursing homes and declined in private homes. Significant predictors of death in a public hospital were age and socioeconomic status; the probability diminished with increasing age and was lower for those in the upper third for socioeconomic status. Predictors for dying in a private home were age and marital status; the probability diminished with age and in the absence of a spouse.Conclusions:Death as a hospice inpatient is comparatively rare in Victoria and the impart of hospice outpatient or domiciliary care on dying at home has yet to be established. Should death at home become a preferred option, the presence and ability of a spouse or other caregiver will be a significant factor.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93840.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93841.x

出版商:Wiley    

年代:1991

数据来源: WILEY