World Health Organization MONICA Project Research Articles

Stroke and dysphagia: fluids, diet and medication

Nursing and Residential CareVol. 19, No. 1 EditorialStroke and dysphagia: fluids, diet and medicationLinda NazarkoLinda NazarkoSearch for more papers by this authorLinda NazarkoPublished Online:12 Dec 2016https://doi.org/10.12968/nrec.2017.19.1.12AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Daniels SK, Anderson JA, Willson PC (2012) Valid items for screening dysphagia risk in patients with stroke: a systematic review. Stroke 43(3): 892–7 Crossref, Google ScholarGeorge J, Majeed W, Mackenzie IS et al. (2013) Association between cardiovascular events and sodium-containing effervescent, dispersible, and soluble drugs: nested case-control study. BMJ 347: f6954 Crossref, Google ScholarHolland G, Jayasekeran V, Pendleton N et al. (2011) Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus 24: 476–80 Crossref, Google ScholarImm N (2014) Dysphagia. http://bit.ly/1WRsnOT (accessed 15 November 2016) Google ScholarNazarko L (2016) Dysphagia in primary care: a guide for practice nurses. Practice Nursing 27(2): 65–8 Link, Google ScholarRoyal College of Speech and Language Therapists (2014) RCSLT Manual for Commissioning and Planning Services for Dysphagia. http://bit.ly/1Ct4P7R (accessed 15 November 2016) Google ScholarSacco RL, Kasner SE, Broderick JP et al. (2013) An updated definition of stroke for the 21st century. Stroke 44:2064–89 Crossref, Google ScholarSaver JL (2006) Time is brain—quantified. Stroke 37(1): 263–6 Crossref, Google ScholarScottish Intercollegiate Guidelines Network (2010) Guideline 119: Management of Patients with Stroke: Identification and Management of Dysphagia. http://bit.ly/2eCiqXM (accessed 15 November 2016) Google ScholarSingh S, Hamdy S (2006) Dysphagia in stroke patients. Postgrad Med J 82(968): 383–91 Crossref, Google ScholarSmithard D (2015) Dysphagia: prevalence, management and side effects. http://bit.ly/1SHRII4 (accessed 15 November 2016) Google ScholarTurley R, Cohen S (2009) Impact of voice and swallowing problems in the elderly. Otolaryngol Head Neck Surg 140(1): 33–6 Crossref, Google ScholarWorld Health Organization (1998) The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol 41(2): 105–14 Google Scholar FiguresReferencesRelatedDetails 2 January 2017Volume 19Issue 1ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 12 December 2016 Published in print 2 January 2017 Information© MA Healthcare LimitedPDF download

Relationship between the seismic scale of the 2011 northeast Japan earthquake and the incidence of acute myocardial infarction: A population-based study

Previous studies have reported a relationship between large earthquakes and acute coronary events, but have yielded conflicting results. On March 11, 2011, a massive magnitude 9.0 earthquake hit the northeastern coast of Japan and generated repeated aftershocks. The aim of this study is to clarify the influence of this earthquake on the risk of acute myocardial infarction (AMI) including sudden cardiac death based on the data from a population-based analysis. The study subjects were residents in the northeast of Iwate prefecture, Japan. Cases corresponding to the definition of AMI according to the criteria of the World Health Organization MONICA project were registered from 4 weeks before to 8 weeks after the disaster and in the corresponding periods in 2009 and 2010. The relative risk of AMI was 2.03 (95% CI 1.55-2.66) for the 4-week period after the disaster compared with the corresponding periods in the preceding years. The number of events peaked within the first week after the earthquake decreased to levels seen in the preceding years and then increased again after high-magnitude aftershocks. The incidence of AMI was positively correlated with the seismic scale of the earthquake (r = 0.75, P < .01). This population-based study suggests that the increase in AMI events after a major earthquake varies depending on the seismic scale of the initial shock and each aftershock.

OVERWEIGHT AS ONE OF THE RISK FACTORS FOR HYPERTENSION IN SCHOOLCHILDREN OF TYUMEN

O bjective. To assess the epidemiology of overweight as the main risk factor for hypertension and its 18-year trends in Tyumen pupil population in order to develop basic preventive strategies. Design and methods. Two single epidemiological studies were carried out in a population of pupils ofTyumen schools selected by the method of random numbers. The first study was conducted in 1986–1987 years using a standard questionnaire of World Health Organization (WHO) MONICA project. Altogether 3704 pupils aged 7–15 years (1836 boys and 1866 girls) were examined with 93 % response. The second study was carried out 18 years later (2005–2006 years) when 2640 pupils aged 7–17 years (1308 boys and 1332 girls) were examined with 87,7 % response. The following methods were used in both studies: assessment of blood pressure (BP) and Quetelet index for overweight detection (Quetelet index threshold for 7–9 years old ≥ 20,0 kg/m 2; for 10–14 years old ≥ 22,0 kg/m 2; for 15–17 years old ≥ 25,0 kg/m 2). R esults. The prevalence of overweight in the pupil population was 8,8 %: among boys — 9,2 %, among girls — 8,3 %. A tendency for increased overweight prevalence was found at second screening study as compared to the first one (9,3 vs. 8,5 %, respectively, р > 0,05). It was caused mainly by the increased overweight prevalence (9,3 vs. 7,6 % respectively, р < 0,05). The incidence of high BP in overweight pupils was significantly higher than in pupils with normal body weight (2,7-times higher in boys vs. 2,8-times higher in girls, р < 0,001). Moreover, in overweight pupils puberty progressed more rapidly. Pupils with excessive body weight complain of problems related to autonomic dysfunction 1,5–2 times more often than pupils with normal body weight. C onclusions. Our study showed high prevalence of overweight in the population ofTyumen schoolchildren, a tendency for increasing overweight prevalence in boys nowadays, association between overweight, high BP, puberty and autonomic dysfunction.

Are Vascular Risk Factors Associated With Post-Stroke Depressive Symptoms?

Vascular risk factors (VRFs) have been associated with stroke and cognitive impairment, however, the role of VRFs in predicting post-stroke depression (PSD) has not been assessed. The objective of the current study was to determine whether VRFs are associated with the risk of PSD in an acute stroke population. In this observational study, patients meeting World Health Organization MONICA Project and National Institute of Neurological Disorders and Stroke criteria for stroke were eligible. Patients were assessed for depression, cognition, and stroke severity, and VRF and demographic information were obtained. A total of 102 patients were recruited within 4 months post-stroke. Using a score of ≥16 on the Center for Epidemiological Studies Depression scale to determine depressive symptoms, 38 patients (age 72.1 ± 15.6, 44.7% male) screened positive for depressive symptoms and 64 (age 70.1 ± 13.6, 51.6% male) screened negative. Analysis of VRFs showed that only hypertension (P = .044) independently predicted the presence of depressive symptoms (χ(2) = 4.742, P = .029, Nagelkerke R (2) = .062). Hypertension was associated with post-stroke depressive symptoms, while there was no relationship between PSD and other VRFs. Hypertension may have a greater impact than other VRFs on mood following stroke and may have a role in prevention and treatment of PSD.

Large improvements in major cardiovascular risk factors in the population of northern Sweden: the MONICA study 1986-2009

the incidence of cardiovascular disease has declined rapidly in Sweden since the 1980s. We explored changes in major cardiovascular risk factors in northern Sweden between 1986 and 2009. since 1986, six population surveys have been carried out in northern Sweden using procedures of the World Health Organization MONICA project. The population age range was 25-64 years in 1986 and 1990, and 25-74 years from 1994. Trends were analysed using generalized linear models. a total of 10586 subjects were included in the surveys. Blood pressure decreased by 4.9/3.9 mmHg in women and 1.8/1.5 mmHg in men aged 25-64 years between 1986 and 2009. In men and women aged 65-74 years, the decrease was 12.6/6.1 mmHg between 1994 and 2009. From 1994, the use of blood pressure-lowering drugs increased, particularly among the older subgroup. The prevalence of smoking halved between 1986 and 2009; 11% of women and 9% of men were smokers in 2009. Cholesterol levels decreased by 0.9 mmol L(-1) in the younger age group (25-64 years), and the use of lipid-lowering agents increased from 1994. Among subjects aged 25-64 years, one in five was obese in 2009, which was twice as many as in 1986, and body mass index (BMI) increased by 1.5 kg m(-2) , corresponding to an increase in weight of 4 kg. There was no further increase in BMI from 2004. The prevalence of diabetes did not change between 1986 and 2009. The proportion that received a university education increased markedly in all age groups, especially in women, during the study period. significant improvements were observed in major cardiovascular risk factors in northern Sweden between 1986 and 2009.

Commentary: Maziak's essay, seen from another angle

endotoxin exposure reverse atopy and atopic disease? J Allergy Clinic Immunol 2004;114:1051–54. 53 WHO MONICA Project Principal Investigators. The World Health Organization MONICA project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. J Clinic Epidemiol 1988;41: 105–14. 54 Wenzel S, Holgate ST. The mouse trap: It still yields few answers in asthma. Am J Respir Crit Care Med 2006;174:1173–76; discussion 1176–78. 55 Berry M, Morgan A, Shaw DE et al. Pathological features and inhaled corticosteroid response of eosinophilic and non-eosinophilic asthma. Thorax 2007;62:1043–49. 56 Enarson D. Fostering a spirit of critical thinking: the ISAAC story. Int J Tuberculosis Lung Disease 2005;9:1.

Biomarker Release After Percutaneous Coronary Intervention

Cardiac biomarkers of necrosis provide clinicians with important “messages” from the heart. They are released into the interstitium of the myocardium after loss of the integrity of cardiac myocyte membranes. The pattern of the rise and fall of an individual biomarker (ie, its release kinetics) depends on its intracellular location in the myocyte, molecular weight, and clearance from the interstitium of the myocardium and ultimately the circulation.1 Cardiac biomarkers play an integral role in the clinical diagnosis of myocardial infarction (MI). Referring to the spontaneous occurrence of MI in patients, the World Health Organization required that at least 2 of the following be present to fulfill the criteria for MI: a history of ischemia-type chest discomfort, evolutionary changes on serially obtained ECG tracings, and a rise and fall in serum cardiac markers.2 Article see p 10 See Editorial Circulation . 2008;118:609–611 See Article Circulation . 2008;118:632–638 Several dramatic advances have occurred in the biomarker component of the diagnosis of MI. Analytes with greater specificity for the myocardium were introduced into clinical medicine, with creatine kinase-MB replacing total creatine kinase and subsequently cardiac-specific troponins replacing creatine kinase-MB as the biomarker of choice for diagnosing MI.3 Assay technology improved as clinical chemists moved from enzymatic activity assays for CK to highly specific immunoassays that can detect progressively smaller concentrations of cardiac troponins in the peripheral circulation.4 Although ST-elevation MI (STEMI) is easily identified on the 12-lead ECG, we now recognize that many patients previously diagnosed with unstable angina are more properly diagnosed as having non–ST-elevation MI (NSTEMI) on the basis of the detection of elevated levels of cardiac troponins in their blood.5 Cardiac biomarkers are used as a rough guide to the extent of myocardial necrosis. The higher the peak biomarker level after STEMI, the larger the …

Is the increase in coronary events on Mondays an artifact?

The aim of this article was to investigate the size and possible causes of the reported excess in coronary events on Mondays. We conducted a metaanalysis of data from the World Health Organization (WHO) MONICA Project, which monitored trends and determinants in cardiovascular disease. The MONICA Project was undertaken in 21 countries from 1980 to 1995. We found a small overall excess rate of coronary events on Mondays. In a population experiencing 100 events per week, we estimate there would be approximately 1 more event on Monday than on any other day. Hierarchical logistic regression showed that the Monday excess was greater in centers with less thorough data collection procedures. The excess of coronary events on Mondays is probably an artifact resulting from events with uncertain dates being coded as taking place on Mondays.

Smokers' expectations to quit smoking

We investigate the effectiveness of different smoking policies on smokers' expectations to quit smoking using a choice experiment on a sample of smokers identified within the World Health Organization (WHO) MONICA Project. Our results indicate that restricted availability, increased cigarette prices, cessation subsidies and regulations at restaurants, bars and cafes increase the expected probability of smoking cessation. Regulations at work places do not seem to have any effect. The results also show the significant role of limited self-control; smokers who have the intent to quit smoking are more likely to quit smoking if a stricter regulation is implemented. Further, smokers who have received advice from their children to quit smoking or who perceive the health risks as considerable, are more likely to expect to quit smoking.

Ethnic differences in utilization of invasive cardiac procedures and in long-term survival following acute myocardial infarction.

Ethnic differences in coronary mortality have been documented, and South Asians from the Indian subcontinent are particularly vulnerable. This study sought to determine whether there was a difference in the utilization of invasive cardiac procedures and long-term mortality in survivors of myocardial infarction (MI) among Chinese, Malays, and South Asians in Singapore. All MI events in the country were identified and defined by the Singapore Myocardial Infarction Register, which uses modified procedures of the World Health Organization MONICA Project. Information on utilization of coronary angiography, coronary angioplasty, coronary artery bypass graft, and survival was obtained by data linkage with national billing and death registries. Hazard ratios (HR) were calculated using the Cox proportional hazards model with adjustment for baseline characteristics. From 1991 to 1999, there were 10,294 patients who survived > or = 3 days of MI. Of these, 40.6% underwent coronary angiography and 16.5% a revascularization procedure < or = 28 days. Malays received substantially less angiography (34.0%) and revascularization (11.4%) than Chinese (41.9%, 17.9%) and South Asians (40.0%, 16.3%). The ethnic disparity increased during the 1990s, particularly in the performance of coronary angiography (p = 0.038). While fatality declined during the study period for Chinese and South Asians, the rate remained stable for Malays. After a median follow-up period of 4.1 years, survival was lowest among Malays (adjusted HR, 1.28; 95% confidence interval, 1.15-1.42, compared with Chinese). Ethnic inequalities in invasive cardiac procedures exist in Singapore and were exacerbated in the 1990s. Inequalities in medical care may contribute to the poorer longterm survival among Malays.

Trends in cigarette smoking in 36 populations from the early 1980s to the mid-1990s: findings from the WHO MONICA Project.

This report analyzes cigarette smoking over 10 years in populations in the World Health Organization (WHO) MONICA Project (to monitor trends and determinants of cardiovascular disease). Over 300,000 randomly selected subjects aged 25 to 64 years participated in surveys conducted in geographically defined populations. For men, smoking prevalence decreased by more than 5% in 16 of the 36 study populations, remained static in most others, but increased in Beijing. Where prevalence decreased, this was largely due to higher proportions of never smokers in the younger age groups rather than to smokers quitting. Among women, smoking prevalence increased by more than 5% in 6 populations and decreased by more than 5% in 9 populations. For women, smoking tended to increase in populations with low prevalence and decrease in populations with higher prevalence; for men, the reverse pattern was observed. These data illustrate the evolution of the smoking epidemic in populations and provide the basis for targeted public health interventions to support the WHO priority for tobacco control.

Incidence of myocardial infarction in the Danish MONICA population 1982-1991.

Cardiovascular mortality has been declining in Denmark over the past 20 years. Trends in incidence of myocardial infarction (MI) over the period 1982-1991 are described within the framework of the World Health Organization MONICA Project. The DAN-MONICA heart register included all cases of MI in 25-74-year-old men and women living in 11 municipalities around Glostrup County Hospital evolving over a period of 10 years. They were identified retrospectively based mainly on relevant ICD diagnoses in death certificates and hospital discharge reports. Cases meeting WHO-MONICA criteria for definite or possible MI, recurrent as well as first-ever MI, were registered. Subsequent tracing of cases through national registers on deaths and hospitalizations by means of the patient's civil registration number ensured the completeness of the registration. A total of 6025 cases of MI occurred in the period, 4532 among men and 1493 among women. A total of 2923 men and 1047 women had a first-ever MI in the period. The age-standardized rates show a definite decline over the registration period for men and a less distinct decline for women. The DAN-MONICA heart register meets the requirements for completeness and uniformity throughout the registration period. Causes and magnitude of bias are well described. Even when possible sources of bias are taken into account, the incidence of MI decreased significantly over the 10-year-period 1982-1991 by an average of 5.0% per year for men and 3.5% per year for women.

Changes in estimated coronary risk in the 1980s: data from 38 populations in the WHO MONICA Project

The World Health Organization (WHO) MONICA Project is a 10-year study monitoring trends and determinants of cardiovascular disease in geographically defined populations. Data were collected from over 100 000 randomly selected participants in two risk factor surveys conducted approximately 5 years apart in 38 populations using standardized protocols. The net effects of changes in the risk factor levels were estimated using risk scores derived from longitudinal studies in the Nordic countries. The prevalence of cigarette smoking decreased among men in most populations, but the trends for women varied. The prevalence of hypertension declined in two-thirds of the populations. Changes in the prevalence of raised total cholesterol were small but highly correlated between the genders (r = 0.8). The prevalence of obesity increased in three-quarters of the populations for men and in more than half of the populations for women. In almost half of the populations there were statistically significant declines in the estimated coronary risk for both men and women, although for Beijing the risk score increased significantly for both genders. The net effect of the changes in the risk factor levels in the 1980s in most of the study populations of the WHO MONICA Project is that the rates of coronary disease are predicted to decline in the 1990s.

Mild myocardial infarction—A classification problem in epidemiologic studies

In studies assessing the trends in coronary events, such as the World Health Organization (WHO) MONICA Project (multinational MONItoring of trends and determinants of CArdiovascular disease), the main emphasis has been on coronary deaths and non-fatal definite myocardial infarctions (MI). It is, however, possible that the proportion of milder MIs may be increasing because of improvements in treatment and reductions in levels of risk factors. We used the MI register data of the WHO MONICA Project to investigate several definitions for mild non-fatal MIs that would be applicable in various settings and could be used to assess trends in milder coronary events. Of 38 populations participating in the WHO MONICA MI register study, more than half registered a sufficiently wide spectrum of events that it was possible to identify subsets of milder cases. The event rates and case-fatality rates of MI are clearly dependent on the spectrum of non-fatal MIs, which are included. On clinical grounds we propose that the original MONICA category “non-fatal possible MI” could be divided into two groups: “non-fatal probable MI” and “prolonged chest pain.” Non-fatal probable MIs are cases, which in addition to “typical symptoms” have electrocardiogram (ECG) or enzyme changes suggesting cardiac ischemia, but not severe enough to fulfil the criteria for non-fatal definite MI. In more than half of the MONICA Collaborating Centers, the registration of MI covers these milder events reasonably well. Proportions of non-fatal probable MIs vary less between populations than do proportions of non-fatal possible MIs. Also rates of non-fatal probable MI are somewhat more highly correlated with rates of fatal events and non-fatal definite MI. These findings support the validity of the category of non-fatal probable MI. In each center the increase in event rates and the decrease in case-fatality due to the inclusion of non-fatal probable MI was larger for women than men. For the WHO MONICA Project and other epidemiological studies the proposed category of non-fatal probable MIs can be used for assessing trends in rates of milder MI.

Sex Differences in Myocardial Infarction and Coronary Deaths in the Scottish MONICA Population of Glasgow 1985 to 1991

Scottish MONICA used medical and medico-legal records and World Health Organization MONICA Project criteria to register coronary events in 25- to 64-year-old residents of the high-incidence area of north Glasgow from 1985 to 1991. Age-standardized data from 3991 episodes of nonfatal definite myocardial infarction and coronary deaths in men (mean age, 55.5 years) were compared with 1551 in women (57.0 years). Many results, such as the overall 28-day fatality rates of 49.8% in men and 48.5% in women, showed insignificant differences. However, 74.3% of deaths in men occurred out of hospital versus 67.8% in women (P = .0004). After admission to hospital, fatality rates in women were 14% higher (P = .07) and after admission to coronary care, 22% higher (P = .04). Women were more often widowed. Fewer had a history of previous myocardial infarction, but the prevalence of angina pectoris, of smoking, and of chest pain in the attack was the same as in men; more had shock, syncope, and breathlessness. More consulted a doctor before admission to hospital, which delayed their coming under care. More men had ECG Q-wave progression, and more women had smaller ECG changes. This, and marginally reduced chances of direct admission to coronary care, of thrombolysis, of aspirin, and of beta-blockers, did not explain women's excess hospital fatality. Acute coronary events appear to be recognized and treated fairly equally in men and women 25 to 64 years old in Glasgow, so differences are small but subtle. More men die suddenly out of hospital; the reason why more women die after arrival may be because the equivalent number of men have already died outside.

Relations of Changes in Coronary Disease Rates and Changes in Risk Factor Levels: Methodological Issues and a Practical Example

One of the main hypotheses of the World Health Organization (WHO) MONICA Project is that trends in the major coronary disease risk factors are related to trends in rates of fatal and non-fatal coronary disease events. The units of study are populations rather than individuals. The WHO MONICA Project involves continuous monitoring of all coronary disease events in the populations over a 10-year period and periodic risk factor surveys in random samples of the same populations. Estimation of associations between average annual changes in mortality and risk factor levels is illustrated with the use of data from a subset of MONICA centers. Crude estimates of regression coefficients are compared with estimates obtained by weighting for standard errors in both the outcome and explanatory variables. The results show that the strength of association may be either underestimated or overestimated if these errors are not taken into account.

Impact of apolipoprotein E polymorphism on lipoproteins and risk of myocardial infarction. The ECTIM Study.

Human apolipoprotein (apo) E, a polymorphic protein with three common alleles, epsilon 2, epsilon 3, and epsilon 4, plays an important role in lipoprotein metabolism. This article describes the association of this polymorphism with lipids, apolipoproteins, and lipoproteins with a particular regard to lipoprotein particles, as defined by their apolipoprotein content, as well as the risk of myocardial infarction in a multicenter population-based case-control study (ECTIM study). In the ECTIM study, 574 male patients aged 25 to 64 were examined 3 to 9 months after myocardial infarction in four regions participating in the World Health Organization MONICA project: Belfast (Northern Ireland) and Lille, Strasbourg, and Toulouse (France). Control subjects (n = 722) were randomly selected from the regional populations. The distribution of apoE phenotypes was significantly different across the four control samples (P = .04), with a higher frequency of the epsilon 4 allele in Belfast (14.3%) than in Toulouse (8.2%). The association of apoE polymorphism with biological measurements was studied in the control groups (n = 640) after men with coronary heart disease or those taking hypolipidemic drugs were omitted, with the apoE3/3 phenotype as a reference after adjustment for concomitant factors. Individuals carrying the epsilon 2 allele had lower levels of plasma cholesterol, low-density lipoprotein cholesterol (LDL-C), and apoB and higher levels of triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), apoC-III, apoE, lipoprotein (Lp) C-III:B, and Lp E:B. However, the effect of the epsilon 2 allele on triglyceride, VLDL-C, apoE, and Lp E:B parameters was heterogeneous across the populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality from coronary heart disease and incidence of acute myocardial infarction in Auckland, Newcastle and Perth

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. Descriptive epidemiological study. Community based study. 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. Definite acute myocardial infarction or coronary death classified according to the criteria of the World Health Organization MONICA project. 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. 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.

Does the occupational structure of the Hunter Region explain the high rates of ischaemic heart disease among its men?

To compare rates of ischaemic heart disease (IHD) among men in occupation groups defined by the new Australian Standard Classification of Occupations (ASCO) and to investigate whether their high mortality rates from IHD in the Hunter Region of New South Wales (NSW) could be explained by its occupational structure, we used official death records and data from the World Health Organization MONICA Project conducted in Newcastle. The study population consisted of men aged 25 to 64 years in NSW and in the Hunter Region for whom occupational information was available. For deaths from IHD between 1984 and 1988 in NSW, indirectly standardised mortality and morbidity ratios (SMRs) were: significantly low for professionals, 66 (95% confidence interval (CI) 60-71) and managers and administrators, 79 (95% CI 74-83); intermediate for paraprofessionals (92), clerks (94) and salesmen and personal service workers (97); and significantly high for tradesmen, 113 (95% CI 107-118), labourers and related workers, 118 (95% CI 113-124) and plant and machine operators and drivers, 125 (95% CI 118-133). Broadly similar patterns were found for IHD deaths and for fatal and nonfatal myocardial infarction in the Hunter Region. When occupation- and age-specific mortality rates from IHD were used to calculate SMRs for the Hunter Region, SMRs for all ASCO groups except paraprofessionals were over 100. Mortality rates for occupational groups classified by ASCO were consistent with well-established differences associated with socioeconomic status.(ABSTRACT TRUNCATED AT 250 WORDS)

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.