ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03018.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03019.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

Summary:The relative importance of the major risk factors in atherosclerotic and other diseases.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03020.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

Summary:Alcohol usage as a possible explanation for socio‐economic and occupational differentials in mortality from hypertension and coronary heart disease in England and Wales.In England and Wales in 1949‐53, those socio‐economic and occupational groups with high death rates for cirrhosis also had high death rates for hypertension and stroke. Alcohol exposure appeared to be the factor common to the 15 occupational groups with the highest death rates for cirrhosis. Although deaths certified to hypertension and stroke were relatively more frequent in these “high cirrhosis” occupations, deaths from coronary heart disease (CHD) were decreased relative to deaths from all causes. These observations suggest that although alcohol use is associated with an increased risk of hypertension, there may be a lesser increase in the risk of CHD. These observations could be of causal significance; if so, a study of the effects of alcohol should help dissociate those causal mechanisms unique to hypertension from those uniq

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03021.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

Summary:The rate of initiation of treatment for hypertension in a community, 1971–1975.In 1971 persons aged 50–59 in a community were screened for hypertension and those with diastolic BP ≤ 110 mmHg were notified. On reviewing the sample in 1975 the treatment rate had doubled to 22%. Screening in 1971 was followed by an immediate rise in numbers starting treatment, most being notified cases. Thereafter initiation of treatment at a rate of 3–8 cases per 100 persons per year chiefly reflected identification of subjects deemed to need treatment in the ordinary course of medical practice. Of those starting treatment during the four years 25% had stopped it by 1975. The influence of screening and other factors on the rate of initiation of treatment and adherence to it are discussed. With an already high attendance rate at doctors, regular screening of this whole age group seems feasible within the framework of general practice. The high treatment rate found in 1975 underlines the urgent need for the indications currently used for starting treatment to be va

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03022.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

Summary:Community control of hypertension.The adequacy of treatment of hypertension in a community was monitored at triennial mass health examinations. Hypertensives were not adequately retained on treatment until a disease register was developed and a practice nurse given responsibility for maintaining contact with patients on the register. The advent of newer therapeutic agents and intensification of the interest of both doctor and patient in the results of treatment were associated with progressive improvement in the adequacy of control of blood pressure.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03023.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

Summary:The Australian National Blood Pressure Study: A test of the effectiveness of antihypertensive therapy on the incidence of ischaemic heart disease.Although hypertension is an acknowledged risk factor in ischaemic heart disease (IHD) the question remains whether antihypertensive therapy is necessarily beneficial. A priori, because coronary atherosclerosis is probably irreversible, the time for effective intervention would seem to be well before the development of clinical manifestations. The Australian National Blood Pressure Study, a long term clinical trial of the treatment of mild hypertension, is in principle better suited than previous trials to answer the question because the trial population selected (4000 subjects aged 30–69) contains substantial proportions ui yuunycr dye groups (26% below 45) and of females (37%) and none had manifest IHD at entry. Sensitivity to the emergence of IHD in the trial population is increased by including as diagnostic indices angina and ischaemic ECG changes, using suitably objective methods, as well as myocardial infarction and sudden death. Thus morbidity and mortality from IHD which currently accounts for 71% of trial end points (cf 19% for stroke) will effectively determine the outcome of the trial. The occurrence of a substantial proportion of subjects withdrawn from randomised treatment will mean that the question will be answered necessarily in two ways: firstly in respect of those subjects remaining on their assigned treatments and secondly in terms of all subjects initially assigned one treatment or other irrespective of the subsequent need to change treatment on ethical grounds or of the degree of complianc

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03024.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

Summary:Rationalisation of hospital services for stroke patients.Over a six month period, the Royal Melbourne Hospital admitted 25% of the stroke patients expected from the north‐west region of Melbourne. When the private sector and Mount Royal Hospital were included, a total of 57% of expected demand was met by the hospital services of the region. The natural history of stroke in hospital consisted of an early “active” phase with a high death rate and a high investigation rate. Three weeks after admission this activity had largely subsided and it is suggested that the acute general hospital was no longer providing the most appropriate care. Transfer of patients with stroke three weeks after admission to a lower cost care situation with more appropriate use of staff would enable the Royal Melbourne Hospital to meet the demand for hospitalisation from its r

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03025.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

Summary:Prospects for prevention of atherosclerosis in the young.There appears to be a need to protect our young from an atherogenic way of life. The average male child today has one chance in three of a cardiovascular catastrophe before age 60. Atherosclerosis and the conditions which predispose appear to have their onset in childhood. Correctable precursors of cardiovascular disease have been identified, and their contribution to risk has been estimated not only for adults but for college students as well. An analysis of the combined impact of atherogenic risk factors indicates that they exert greater force early in life than later. Although the optimal time to begin prophylaxis is not established, there is evidence to suggest that measures instituted late in life when lesions are advanced is of only limited value. Prevention of atherosclerosis is best viewed as a family affair since the propensity to disease and contributing factors tend to be shared by family members.It is also difficult to implement effectively preventive measures which include dietary changes, weight control, exercise and restriction of cigarettes for one family member without involving the rest of the family.Optimal levels of the correctable precursors of cardiovascular disease are not established for children. However, the rise in serum lipids, blood pressure, weight and blood sugar observed in transition from childhood to adult life is not inevitable, or desirable. Paediatricians can alter the appalling cardiovascular mortality statistics by not allowing the process or the habits and conditions which promote it to reach an irreversible stage.Cardiovascular disease may well begin in childhood with “medical trivia” such as a tendency to obesity, moderate cholesterol and blood pressure elevations, lack of exercise and the cigarette habit. In some respects a heart attack at age 45 can be regarded as a failure of the paediatrician.Awaiting proof of the efficacy of the indicated prophylactic measures is not acceptable since this will be a long time in coming. We must learn how to correct risk factors effectively in childhood as soon as they appear. We must establish goals based on optimal as distinct fromusuallevels of risk factors. Paediatricians' resolve about prevention of atherosclerosis in childhood needs to be strengthened and we must develop a sense of urgency about t

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03026.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

Summary:Comparison of plasma lipids at birth and in second year of life.The value of measuring plasma lipids at birth as a guide to hyperlipidaemia in the future has been studied in 230 infants. There was a weak overall correlation between the cholesterol concentration at birth and during the second year of life (r=+0–215, P<005). There was no such relationship for triglyceride concentration. Not one of seven infants showing hypercholesterolemia at birth had a raised level at follow‐up. By contrast, all seven infants whose cholesterol levels exceeded two standard deviations at follow‐up had normal values at birth.This discrepancy may reflect the influence of diet on plasma lipids. The mean plasma cholesterol and triglyceride concentrations during the second year were significantly lower in those infants being fed diets that contained increased amounts of unsaturated fat. The likelihood of hyperlipidaemia being found during the second year of life therefore depended more on the nature of the infant's food than on the presence of hyperlipidaemia at birth. The added influence of genetic components was suggested by the finding of a greater prevalence of early cardiovascular events in the families of infants showing hyperlipidaemia at one to two years o

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1976.tb03027.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY