Mortality attributable to smoking in New Zealand

Relative risks for mortality due to various smoking related diseases were derived from a review of the literature on the epidemiology of smoking related illness. These were used, together with the New Zealand 1976 census data on smoking habits and the National Health Statistics mortality data, to derive the proportion of deaths which can be attributed to cigarette smoking. The results indicate that about 15 percent of deaths in New Zealand (3693 deaths annually) are attributable to smoking. This is comprised of 19 percent of all male deaths and 8 percent of all female deaths in 1976.     

Mortality and social class in New Zealand. I: overall male mortality

Social class differences in New Zealand male mortality are investigated using two different systems of social class classification. In each case it is found that the lower social classes have mortality rates significantly higher than those of the upper social classes with the mortality rate of the lowest class being approximately twice that of the highest class on a six-category scale. The relative risk is higher in the younger age-groups. When the British Registrar-General's scale is used New Zealand exhibits a social class mortality gradient similar to that previously found in England and Wales, but the lowest social class experiences a particularly high mortality rate.     

Mortality patterns in acute coronary heart disease in New Zealand.

An analysis has been made of death certificate information from 4885 persons classified as having died from acute myocardial infarction or other acute or subacute forms of ischaemic heart disease. One-third of non-Maori deaths occur in a public hospital and half the deaths occur at home. One-third of the deaths occur within five minutes, half within one hour, and by 24 hours, two-thirds of all those who die within two months of an acute coronary heart attack, have already died. Sudden death is more common in the elderly and far more common in those who die outside hospital. Post-mortems were performed in approximately a quarter of the patients. In public hospitals, 36 percent of non-Maoris had a post-mortem examination and 10 percent of Maoris.     

Hip fracture incidence in New Zealand, revisited

AIM: Earlier predictions of the incidence of hip fractures in the older adult population suggested that by 2011 the rate would rise to epidemic proportions. The purpose of this study was to compare the number hip fractures occuring in New Zealand from 1988 to 1999 with the hip fracture rate predicted in 1990 by Rockwood, Horne and Cryer. METHODS: Data on the number of patients admitted to New Zealand hospitals with a diagnosis of fractured neck of femur were obtained, and compared with weighted regression and baseline predictions of Rockwood et al. RESULTS: The numbers of hip fractures for females, from 1988 to 1993, were similar to the number predicted, yet have been significantly lower than stated predictions since 1995. For males, hip fracture numbers since 1995 were less than the weighted regressions predicted (NS). CONCLUSIONS: Numbers of hip fractures since 1995 have been fewer than predicted. Possible reasons for maintaining the rates of hospitalisation due to fractured neck of femur at pre-1995 levels, are discussed.     

Mortality and social class in New Zealand II: male mortality by major disease groupings

Social class differences in male mortality in New Zealand were investigated for each major disease grouping. The patterns found were similar to those for England and Wales with the lower social classes having mortality rates significantly higher than those of the upper social classes for each major cause of death. The strongest social class mortality gradients were found for deaths from accidents, poisonings and violence; diseases of the respiratory system; endocrine, nutritional and metabolic diseases; diseases of the genito-urinary system; and diseases of the digestive system. The gradients for coronary heart disease and neoplasms were weaker, but in the same direction as those found for other disease groupings.     

Mortality and cancer incidence in New Zealand pulp and paper mill workers

AIMS: To evaluate mortality and cancer incidence in a cohort of workers employed in the New Zealand pulp and paper industry, and to identify the exposures responsible for any increased risk. METHODS: A total of 8456 workers employed for at least one year in three pulp and paper mills between 1978 and 1990 were followed up until 1992. The observed number of deaths and cancer cases was compared with expected numbers calculated using five-year age-specific rates for the New Zealand population. RESULTS: Vital status was determined for 81% of the cohort, and for 93% of the total person-years at risk. Mortality from all causes (standardised mortality ratios (SMR) = 0.80, 95% confidence intervals [CI] 0.71-0.89; 314 deaths), and from all malignant neoplasms (SMR = 0.95, 95% CI 0.78-1.15, 103 deaths), was lower than expected. Mortality from lung cancer (SMR = 1.33, 95% CI 0.94-1.83, 37 deaths) was marginally increased. CONCLUSIONS: No overall increase in mortality from cancer or other causes was observed in this cohort. A small increase in lung cancer risk is suggested, although this was not statistically significant. Numbers of cases were too small for detailed analyses of associations between disease and specific exposures.     

New horizons for zoledronic acid: results of the HORIZON trials in postmenopausal women with osteoporosis and after hip fracture

Nearly 2 million hip fractures occur each year in the US as a result of osteoporosis. After hip fracture, people are at an increased risk of a further fracture. The HORIZON-PFT (Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly Pivotal Fracture Trial), investigated the effect of zoledronic acid on fractures in women with osteoporosis, whereas the HORIZON-RFT (Recurrent Fracture Trial), studied the effect of zoledronic acid after hip fracture. In the HORIZON-PFT, after 3 years the incidence of new vertebral fractures in postmenopausal women, who were not taking any medication for osteoporosis at randomisation, was 10.9% in the placebo group and this was significantly lower in the once-yearly intravenous zoledronic acid group (3.3%). In the second of the HORIZON trials, the RFT, the effect of a single intravenous injection of zoledronic acid within 90 days of fracture on the recurrence of fracture was tested. The primary endpoint was a new clinical fracture, and after a median follow-up of 1.9 years, there were 139 fractures in the placebo group of 1062 and this was significantly reduced to 92 out of 1065 in the zoledronic acid group. Thus, this second HORIZON trial has demonstrated that zoledronic may have a role in preventing recurrent fractures in those who have a recent hip fracture.     

The smoking habits of New Zealand doctors: a review after ten years.

A second survey of New Zealand doctors' smoking habits in 1972 elicited an 83 percent response from 3113 doctors. 38.5 percent had never smoked compared with 23.8 percent in a 1963 survey; 29.2 had given up smoking, and 33.3 percent still smoked. Only 21.3 percent smoked cigarettes compared with 35.3 percent in 1963. There has been a sustantial increase in non-smokers among recent graduates. Both sexes now smoke cigarettes less frequently but pipe and cigar smoking by male doctors has risen sharply. Obstetricians smoke cigarettes more often than other groups of doctors, while pathologists, medical administrators and academics smoke the least. Giving up smoking was not difficult for most former smokers except for the heavy smokers who now make up most of the persistent smoker group.     

全髋关节置换术后股骨假体周围骨折的治疗

目的 探讨全髋关节置换术后股骨假体周围骨折的治疗方法.方法 选择全髋关节置换术后假体周围骨折患者9例.按照Vancouver分型:A型1例,B1型5例,B2型2例,C型1例.采用保守治疗1例,8例行手术治疗,5例行切开复位记忆合金环抱器内固定加髂骨块植骨治疗,3例行髋关节长柄假体翻修钢丝捆扎髂骨植骨术.结果 8例患者获随访,随访时间8 ～21个月,平均14.2个月,除1例假体松动外,均无骨折不愈合、感染、畸形愈合、内固定断裂等并发症.结论 全髋关节置换术后股骨假体周围骨折,Vancouver分型方法包括了骨折的位置,骨折稳定性,假体松动情况,股骨近段的骨量对于临床治疗有很好的指导意义.对于A型骨折,假体稳定,可以采用保守治疗,B1型、B2型和C型骨折在身体条件允许的情况下则应尽量采用积极的手术治疗.如果伴有假体松动最好能一期行长柄假体置换.     

Rural hospitals in New Zealand.

AIM: To produce a list of New Zealand rural hospitals, including information on acute bed numbers, population served, average driving time to base hospital, and number and payment of rural hospital doctors. METHODS: Information about rural hospitals was obtained from local doctors and/or administrators, and reflected conditions at June 15, 1998. A 'rural hospital' was defined as a facility with no resident medical specialists, where acutely ill patients are admitted and cared for solely by generalist doctors, either general practitioners or medical officers of special scale. RESULTS: Varying definitions for acute 'facilities' and 'beds' made analysis difficult. There were a total of 36 'rural hospitals' in New Zealand at June 15, 1998 containing 293 acute beds and serving a population of about 340000. Patient care was provided by a total of 131 generalists (general practitioners or medical officers of special scale) equivalent to 40 full-time rural hospital doctors. CONCLUSIONS: Approximately 10% of the New Zealand population are served by rural hospitals. Discrepancies exist between the list of rural hospitals provided in this study and that provided by the Government's recent 'Hospital Services Plan'.