Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men.

In a community based, prospective study to determine risk factors for falls, 465 women and 296 men 70 years and over were followed for 1 year and 507 falls were documented. A greater proportion of women (32.7%) than men (23.0%) experienced at least one fall in which there was no or minimal external contribution. Using unconditional logistic regression models we investigated the effect of physical and sociological variables on the sex difference in fall rate. Controlling for the variables age, use of psychotropic drugs, inability to rise from a chair without using arms, going outdoors less than daily and living alone decreased the relative risk of women falling compared to men from 2.02 (95% CI, 1.40-2.92) to 1.55 (95% CI 1.04-2.31). Some of the increased risk of falling associated with being a women was able to be explained and is potentially correctable. But even after controlling for the physical and social variables which we had assessed, women compared to men still had a significantly increased relative risk of falling.

Alcohol use in a community-based sample of subjects aged 70 years and older.

The usual alcohol intake in a community-based sample of subjects aged 70 years and over was investigated. A sample of 825 subjects was drawn from the records of five general practices in a rural township and 774 subjects (93.8%) agreed to participate. A stratified sub-sample of subjects from the abstainers, infrequent, weekly, and daily drinkers was subsequently investigated in more detail. Men took alcohol more frequently than women and in greater quantities although frequency and amount decreased with age. The usual place for drinking was the home. The highest use of psychotropic drugs occurred in the abstainers, but this was significant for men only. When compared with drinking patterns in middle age, 60.1% of men and 30.3% of women said that they took less alcohol, while 7.4% of men and 11.1% of women said that they took more. The main reasons for decrease in alcohol intake were change in health and fewer social opportunities. The main reasons for increase in alcohol intake were more money and more time. Drinking was most commonly associated with social activities and few took alcohol to help cope with personal situations.

Salivary THC following cannabis smoking correlates with subjective intoxication and heart rate.

A cannabis smoking trial was conducted using paid volunteers. Subjective intoxication, measured using a visual analogue scale, was compared with heart rate and with salivary delta-9-tetrahydrocannabinol (THC) levels at various times after smoking a cigarette containing 11 mg THC. Subjective intoxication and heart rate elevation were significantly correlated with the log of salivary THC. Salivary THC levels are a sensitive index of recent cannabis smoking, and appear more closely linked with the effects of intoxication than do either blood or urine cannabinoid levels.

Frequency of moles in a defined population.

The occurrence of moles was studied in a community survey of 872 adults, using criteria that allowed comparison with two earlier surveys. Men and women had similar numbers of moles-on average, 15 moles of diameter 2 mm or greater, and 39 moles of all sizes. The frequency of moles declined with age and varied according to body site. Comparison of the findings with those of previous surveys-in New York in about 1950 and in Sydney in about 1970-suggested that the frequency of moles has increased as malignant melanoma has become more common. Little is known about the epidemiology of moles, which may hold the key to the explanation of the rising incidence of melanoma in many countries.

Distribution of vectors, transmission indices and microfilaria rates of subperiodic Wuchereria bancrofti in relation to village ecotypes in Samoa.

Aedes polynesiensis and Ae. samoanus biting densities and Wuchereria bancrofti infection and infective rates were studied in 47 villages throughout the islands of Samoa Upolu, Manono and Savaii during 1978-79, and microfilaria (mf) rates were surveyed in 28 of the villages. The mf rate was correlated with both infection and infective rates of Ae. polynesiensis in Upolu, but not of Ae. samoanus. In Upolu, Ae. polynesiensis was apparently the major vector. It was relatively more abundant in more cultivated and populated areas, along the northern coast of Upolu, except Apia town area. In Savaii, Ae. samoanus predominated over Ae. polynesiensis except in "plantation" villages. Relatively high biting densities and rates of infection and infectivity indicated that Ae. samoanus was not less important than Ae. polynesiensis as a vector in Savaii. Ae. samoanus preferred natural vegetation, in contrast to Ae. polynesiensis which was found near human habitations in cultivated land. There was no difference between the biting densities of Ae. polynesiensis in "coastal" and "inland" villages, indicating that crab holes (numerous only in some coastal villages) may not influence the density of Ae. polynesiensis. Higher mf rates were associated with villages where Ae. polynesiensis, rather than Ae. samoanus, was dominant, indicating that Ae. polynesiensis was generally a more efficient vector. In the former villages, the difference in mf rates between males and females was smaller than in the latter, probably reflecting a difference in biting habits of the vectors. Ae. polynesiensis infections were recorded in plantations over 2 km from any village, suggesting that both habitats were foci of transmission.

Premenstrual syndrome: a double-blind controlled trial of desipramine and methylscopolamine.

The aim of this study was to compare the effect of the selective noradrenergic reuptake inhibitor desipramine and methylscopolamine bromide, a parasympatholytic agent, on late luteal phase dysphoric disorder (LLPDD), or premenstrual syndrome (PMS), as defined in DSM-III-R. Fourteen patients with PMS were assessed both retrospectively and prospectively during premenstrual cycles. All met the DSM-III-R criteria for LLPDD. They received 3 months treatment each with both desipramine and methylscopolamine in random order using a double-blind cross-over design. PMS symptomatology was significantly reduced after treatment with desipramine and methylscopolamine bromide compared with baseline, but there was no significant difference between them in efficacy. There is evidence from this study that both anticholinergic and noradrenergic pathways may be involved in the genesis of PMS.

Diet and dental caries in preschool children.

A study was carried out in two New Zealand cities with a fluoridated water supply, to look at the dietary habits of preschool children and to investigate whether any dietary factors or other variables are associated with dental decay in the deciduous teeth of these children. From a final study of 355 (a 59% response rate), demographic data, a dental examination, a series of three 24 h recalls over a period of 1 year, and a food frequency questionnaire to cover the same 1 year interval were collected. The sample included 93 children with dental decay and 262 caries-free children, matched for age, sex and sociodemographic variables. The energy and nutrient intakes of the preschool children were sufficient to support normal growth. The main sources of dietary energy in the diets of this study group came from bakery and dairy products. Boys had slightly higher mean intakes of most nutrients than girls. No significant differences were found in the food patterns or intakes of macronutrients between the children of this study group with caries and those without. There was an inverse relationship between social background and dental health, with increasing social advantage being associated with decreasing dental health problems. Syrup medicines and, in particular, antibiotic syrups independently increased the risk that a child would have a number of carious lesions, especially if taken frequently.

The relationship between blood pressure and personality in a large unselected adult sample.

As part of a general health survey of a small New Zealand town, the Crow-Crisp Experiential Index, the State-Trait Anxiety Inventory, a shortened version of the Hostility and Direction of Hostility Questionnaire, and the Zung Self-rating Depression Scale were administered to 1173 subjects over the age of 15. Blood pressure was moderately correlated with age and Quetelet's Index, a measure of obesity. Low but significant correlations were found between Somatic Anxiety, Hysteria, and the Urge to Act-out Hostility scale. However, when effects of age were controlled for, in a series of multiple regression analyses, the correlations with psychometric test scores were no longer significant. This study confirms several previous reports that neuroticism, anxiety, depression, and hostility are of little significant in predicting levels of blood pressure in the general population.

Some norms and reliability data for the State--Trait Anxiety Inventory and the Zung Self-Rating Depression scale.

Means and standard deviations are reported for the State-Trait Anxiety Inventory and the Zung Self-Rating Depression scale, collected during the course of a general health survey. Data for different age samples and for both sexes are presented for use in the evaluation of the significance of anxiety and depression levels in patients presenting with these symptoms. High estimates of reliability based on internal consistency statistics were found for all scales. Females scored more highly on both the measures and scores were inversely correlated with age, indicating the importance of specific and appropriate norms in assessing affective states.

Dental configuration among different breeds of sheep.

Three breeds of sheep, Southdown, Suffolk and Romney, and two mixed breeds, Border Leicester over Romney and Coopworth over Romney, managed identically on a research station, where they were free from culling and allowed to live their natural life, had their dental configuration examined. The sheep were divided into age groups with 10 sheep in each. The least variation was found in the relation of the upper dental pad to the lower jaw. The most statistically significant differences were found in the first age group: one year six months. The Suffolk breed was noticeably different from the others. Deepened gingival sulci, as well as the inconsistency of bleeding after probing associated with labial gingivitis highlighted the problems of using these latter criteria as indicators of health or disease among sheep on the basis of a single examination.

A comparison of patients' perception of dental care offered by male or female dentists in New Zealand.

Recent increases in women dentists in New Zealand follow similar trends in other Western countries. The career patterns of female dentists, and male dentists' attitudes towards women dentists in New Zealand have been previously studied. The aim of this study was to compare the attitudes and preferences of patients towards dental care offered by either male or female dentists, to determine what influences these preferences, and to discover whether or not these opinions differed between regular or irregular attenders.

Some perceived postgraduate education needs of house surgeons. Registrars and specialists.

In December 1974 questionnaires concerning postgraduate education were sent to all New Zealand medical practitioners. This paper refers to the replies from house-surgeons/registrars and from specialists. Fifty-seven percent of the house surgeons/registrars replied to their questionnaire. Nearly 70 percent of those who chose general practice expected to train vocationally for this discipline wholly in New Zealand, compared with nearly 60 percent of pathology/radiology and undecided candidates, and 20 to 35 percent of medical surgical and O and G candidates. On the average the house officers will expect full-time continuing medical education (CME) for about three weeks every one to three years and local CME for about three hours each week. Seventy percent of GP candidates and 30 percent of specialist candidates expected and full-time CME to be in New Zealand. Fifty-six percent of the specialists gave information. Only 14 percent had trained solely in New Zealand and 80 to 90 percent of physician and surgeon groups had trained beyond Australasia. Full-time CME amounted to about five days each year and local CME to about two hours each week. New Zealand CME was not rated highly, but visiting overseas specialists were regarded as essential by most respondents, as was travel overseas for vocational training and CME. Learning methods most preferred were reading, lectures followed by small group discussions and plenary sessions, and small groups using member expertise. Television, tapes and films were poorly regarded.

Mode of delivery and developmental characteristics in a thousand Dunedin three year olds: a report from the Dunedin Multidisciplinary Child Development Study.

A study of 1037 representative Dunedin children delivered by a variety of modes was described. The results showed that there were no significant differences in maternal general mental ability, training in child development, or background of child experiences among the five delivery groups studied. Also, there were no significant differences between children who were spontaneous deliveries or any of the other groups in age at which the developmental milestones were achieved, nor in any of the developmental characteristics assessed.

Experience with a slow-release formulation of oxprenolol.

Fifteen hypertensive patients with well controlled blood pressure on antihypertensive regiments consisting of a diuretic (in all but one) and a thrice-daily regimen of oxprenolol, were switched to an equal total daily dose of slow-release oxprenolol given once daily. Other drugs were continued unchanged. Observations on blood pressure and heart rate during half-day tests (lying, standing and post-exercise) indicated a little loss of control of the blood pressure towards the end of the 24-hour period when the next daily dose was due. Ectopic beats associated with exertion were observed more frequently at the end of the 24-hour period. Maximum advantage would seem to be gained by giving slow-release oxprenolol as a twice daily regimen with two-thirds of the daily dose in the morning and one-third at night.

Occurrence of AIDS in New Zealand: the first seven years. MRC AIDS Epidemiology Group.

The 179 people in New Zealand with AIDS diagnosed up to the end of 1989 and notified by 30 June 1990 are reviewed. Retrospective data collection provided the first available information on date of diagnosis, ethnic affiliation, district of usual residence, and survival. Of the 179 people with AIDS, 173 were male. AIDS occurred most commonly between the ages of 30 and 50, but there were two children under 10. The standardised cumulative incidence rates (per 100,000) in the European, Maori, and Pacific Island populations were 5.3, 4.5, and 5.5, respectively. The majority affected (154) were men who had had sexual contact with men. Three of five intravenous drug users also reported such contact. Smaller numbers were presumed to have been infected through heterosexual contact (7), treatment of haemophilia (3), blood transfusions (2), or perinatally (1). In seven cases the mode of transmission was unknown. The proportion of people who had been living overseas when first diagnosed was initially high but declined, so that 134 were known to have been diagnosed in New Zealand. Of these, 107 lived in Auckland or Wellington. Survival analysis using the Kaplan-Meier method showed that the median time from diagnosis to death was 58 weeks.

Biases in estimates from the RNZCGP computer research group.

AIM: This study aimed to determine whether conclusions drawn in studies using data from the computer research group of the Royal New Zealand College of General Practitioners (RNZCGP) could be extrapolated to other New Zealand general practices. METHOD: Retrospectively collected data on doctor, practice, and consultation variables form the study database. The control group comprised a random sample of 106 New Zealand general practitioners. The study group were 67 general practitioners participating in the RNZCGP computer research group. Comparisons between groups were based on doctor and practice variables, patient demography and morbidity, and number and type of service items observed. RESULTS: Study group doctors were more likely to have received post graduate training in general practice (p < 0.01) and saw more patients entitled to government subsidised health care (p < 0.01). The geographical distribution of the study group was skewed with more located in the south of New Zealand. Wide variability on most other study parameters was seen among doctors in both groups although overall patient morbidity was similar for both groups in the 8612 consultations analysed. Computer research group general practitioners reported lower rates of patient referral and laboratory investigations, and higher immunisation rates than the control group (p < 0.01). CONCLUSION: Although the profile of study group general practitioners was different from that of the control group, data collected by both groups provided a similar reflection of the morbidity and services of New Zealand general practice. Adjustments will be needed for extrapolating the results of research from the RNZCGP computer research group where the focus of the investigation is referrals from primary care, investigations, or immunisations.

A two year follow-up of a hypertension screening programme Napier 1973-1975.

Two years after a hypertension screening survey conducted at Napier in 1973 the blood pressure levels of 350 adults were re-examined. The sample comprised 152 persons previously referred for investigation because of high blood pressure detected during the 1973 survey, a matched control group of 146 normotensives and a small supplementary control group. Of the 152 persons in the referred group 31 (20.4%) were under medical supervision at the time of the 1973 survey, 89 (58.5%) attended a doctor within the next 12 months and 32 (21.1%) took no further action. Two years later the 31 cases previously under medical supervision had remained on therapy but only 43 of the 89 new cases were receiving treatment at the time of re-examination. More than 50% of the cases in the referred group showed a decrease in the mean systolic pressure of 10mmHg or greater over the two-year period compared with 20.5% of the normotensive control group. Only 32% of referred cases were regarded as effectively controlled at the time of re-examination ie had mean systolic pressures less than 160mmHg and mean diastolic pressures less than 95mmHg. The low level of effective control resulting from the earlier survey casts further doubt on the value of mass screening procedures for hypertension.

Poisoning, burns, and other accidents experienced by a thousand Dunedin three year olds: a report from the Dunedin multidisciplinary child development study.

Poisoning, burns, and other accidents experienced by 1037 Dunedin children during their first three years of life are described. 7.8% of the children ingested poison, 4.9% were burned, and 21.4% experienced other accidents for which medical advice was sought. The children who had been poisoned were of significantly lower intelligence than the remainder although those who had had other accidents did not differ significantly in this respect. The mothers of children poisoned or who had had accidents were not significantly different from the remainder in terms of general mental ability or training in child development.

Contraceptive practice in New Zealand.

A survey of contraceptive practice in New Zealand was carried out using a population-based sample of women, aged 25 to 54, selected as control subjects in a national case-control study. The results showed that sterilisation has become the most common means of family limitation. Overall, 45% of women aged 25 to 54 were in a union where one or the other partner had been sterilised. Vasectomy was the most common method of contraceptive sterilisation. The frequency of hysterectomy contributed to the high rates of sterilisation; 12% of women had had a hysterectomy. Over 80% of New Zealand women had used an oral contraceptive at some time, but only 11% were using the pill at the time of the survey. Comparison with earlier studies of contraceptive use in New Zealand show there has been a marked increase in the prevalence of contraceptive sterilisation, and a marked decrease in the use of oral contraceptives.

Nutrient intake of Dunedin women during pregnancy.

AIM: To assess the adequacy of dietary intake of women during the three trimesters of pregnancy. METHOD: Dietary intakes of 63 primiparous and 32 multiparous healthy pregnant Dunedin women were obtained by 3 day weighed records at about 12 weeks, 24 weeks, and 36 weeks of gestation. Energy and nutrient intakes were derived using the University of Otago food composition database. RESULTS: Mean energy and nutrient intakes differed remarkably little between primiparous and multiparous women; data were combined for analysis. Energy intakes at first and second trimesters were similar to that for non pregnant women in the National Heart Foundation 1977 survey but greater than in the LINZ 1989 survey. Energy and carbohydrate intakes had increased at third trimester; across the trimesters carbohydrate accounted for 44-46% energy intake, fat for 39% and protein for 15%. Protein intakes at the 10th centile were almost the same as the recommended low risk intake of 51 g/d set by WHO/FAO: No vitamin or mineral showed a trend in intake through the trimesters. Vitamin and mineral intakes were in general greater for the pregnant women than for nonpregnant women in both 1977 and 1989 studies. By comparison with recommended intakes for NZ, Australia, USA and UK, intakes for folate, vitamin B-6, iron and possibly zinc and thiamin were potentially inadequate. Over 10% were heavy smokers and 20% were light smokers; nutrient intakes were less for the smokers than for the nonsmokers, as were birth weights; energy intakes for smokers had not increased at the third trimester. CONCLUSION: An improvement in quality of diet is needed during pregnancy and in prenatal period; smoking should continue to be strongly discouraged.