A comparison of trends of coronary heart disease mortality in Australia, USA and England and Wales with reference to three major risk factors-hypertension, cigarette smoking and diet

A comparison has been made of the recent changes in coronary heart disease mortality in Australia, the USA, and in the United Kingdom (England and Wales). Sharp declines in mortality dating from 1966 in Australia and from 1968 in the USA in both sexes contrast with a persistent increase in men in England and Wales until 1972 (after which a sight fall occurred) and a consistent slight fall in women since 1950. An investigation has been made of changes in 3 major risk factors-hypertension, cigarette smoking and diet in the 3 countries in an attempt to determine to what extent such changes might correlate with the different patterns of mortality. There has been a progressive and similar fall in mortality due to hypertension in both sexes in all 3 countries since 1950. There was a rise in cigarette smoking in all 3 countries from 1947 followed by a fall in the USA from 1963 and a more recent fall in men in Australia. There has been a levelling off of smoking in the United Kingdom in middle-aged and older men but not in women where smoking rates have increased from 1950 since when there has been a progressive slight fall in overall coronary heart disease mortality (although there is evidence of a recent rise in younger women.) Changes in dietary constituents (meat, eggs, milk and cheese, butter or margarine) have been examined by reference to aggregate consumption data. In Australia and the USA increases in vegetable fat consumption have occurred since 1950 with a reduction in animal fat in Australia but not in the USA. In the United Kingdom increases in vegetable fat have not been observed while there has been some increase in animal fat. It is concluded that the different patterns of coronary heart disease mortality in the 3 countries do correlate to some extent with changes in diet and cigarette smoking.

Migration and mental illness: what role do traditional childhood socialization practices play?

Interpretations of studies which show a correlation between migration and mental illness generally focus on sociocultural variables while giving scant attention to determinants of cognitive-personality orientations. This article examines childhood socialization practices as a key variable for comparing points of psychological stress between the traditional rural culture and the post-industrial urban culture. The hypothesis that harsh and restrictive childhood socialization practices foster the development of a cognitive-personality orientation which increases the likelihood of maladaptive responses to culture change is illustrated by anthropological and psychological data obtained from Sicilians living in Sicily, the U.S.A. and Australia. Suggestions are given for minimizing the mental health risks involved during the critical transition period following migration.

[Lung cancer mortality and cigarette smoking in Europe, North America, Japan, and Australia: regional differences and chronological development]

Trends and regional differences in lung cancer mortality and cigarette smoking are examined for 26 developed countries. "In 1975, lung cancer mortality figures for females aged 55 to 64 years...showed 12 to 60 deaths per 100,000 inhabitants, for males 60 to 270 deaths. In nearly all countries the mortality rates of males have been increasing since 1958.... For females the rise in lung cancer mortality is particularly steep...." An increase in cigarette smoking between 1935 and 1973 is also noted, and it is found that "the ranking of the countries by cigarette consumption essentially corresponds to that by lung cancer mortality." (summary in ENG)

Use of contraception among married women in New South Wales, Australia

This paper examines the current use of contraception among a sample of 6646 married women of reproductive age interviewed during 1972–73 in metropolitan and country areas of the state of New South Wales, Australia. The analysis shows that contraception is widely practised in all segments of the population, though to a lesser extent among the Catholic women and those born is southern Europe. In conjunction with now easily available induced abortion, this has resulted in a precipitous drop in the annual number of marital births.

Evaluation of a new antihelminthic for trichuriasis, hookworm, and stronglyloidiasis

Mebendazole was tested in a double-blind trial for its efficacy in the treatment and control of enteric helminths. One hundred and twenty-two children from a community near the Gulf of Carpentaria, and from a community in Cape York Peninsula in northern Queensland were divided into two equal groups to receive a course of either mebendazole or placebo after the identification of one or more intestinal helminths in a single pretreatment specimen of faeces. Between the tenth and twentieth days after a four-day course of treatment, three specimens of faeces were collected from each child. Mebendazole cured trichuriasis in 75% of cases, and over-all egg reduction rate was 96%. The drug also cured hookworm in 13 out of 15 cases and Strongyloides sterocoralis infestation in 14 out of 21 cases. Mebendazole was ineffective against Hymenolepis nana. No cases of Ascaris lumbricoides infestation were present. No side effects or adverse reactions to the drug were noted and patient acceptance was excellent. Mebendazole appears to be a safe drug for use in the treatment of human parasitic intestinal nematode infestations, and should be especially useful in the treatment and control of trichuriasis.

Current status of sterilization

About 50 per cent of child bearing women in Australia are being sterilized. The selection of patients for the procedure requires careful counseling in order to avoid the risk of regret. Factors increasing the risk of regret are enumerated. Laparoscopy is the most popular method for sterilization, but mini laparotomy is a reasonable alternative for patients not having access to skilled laparoscopists. Clips and rings provide a greater chance of successful reversal of sterilization, and are recommended for use in younger women. The sequelae of sterilization are slight, with failure of technique, infection and temporary regret being the commonest. Serious psychological or physical sequelae are rare. If reversal is required the microsurgical technique is recommended.

Prolactin secretion during prolonged lactational amenorrhoea

Basal serum prolactin levels were elevated up to 66 weeks postpartum in lactating amenorrhoeic women. The serum prolactin level in fully breast-feeding women was significantly higher than in women who were partially breast-feeding. The mean basal serum prolactin level in menstruating, lactating women was significantly higher than the mean level in women who had weaned and had normal menstrual cycles. The rise in prolactin due to suckling was seen up to 66 weeks postpartum. The marked variability and lack of reproducibility of individual suckling responses may obscure the importance of prolactin secretion in the postpartum period. Nevertheless, this study confirms that prolactin secretion is increased in women with prolonged lactational amenorrhoea.

The urban density function and its application: cross-sectional approach

Using population census data for the years 1947-1971, the author analyzes the relationship between changes in urban density and population growth in three major coastal urban centers in Queensland, Australia. "Changes in density patterns over time are examined in terms of the empirical exponential density gradient models which emphasise the significance of the distance from the CBD (Central Business District), and a projection of residential population in the centres is made for the year 1990."

Changes in peripheral hormone levels after therapeutic abortion

Plasma levels of progesterone, 17 alpha-OH progesterone, hPL and beta-subunit hCG were measured in a group of women for 24 h after therapeutic abortion. Progesterone, hCG and hPL levels fell more rapidly than 17 alpha-OH progesterone levels. This might suggest that the main site of synthesis of 17 alpha-OH progesterone is probably in the corpus luteum of pregnancy or that the prolonged half-life of hCG maintains the corpus luteum to secrete longer. Human placental lactogen fell dramatically within 4 h but the hCG level was maintained. This difference probably reflects only the differences in half-lives of these hormones.

Distribution - on or off prescription (of oral contraceptives)?

Restrictions on sale of oral contraceptives (OCs) in Australia are based on their classification as Schedule 4 poisons; as such they are "restricted substances" and obtainable only on a prescription. In general only a medical practitioner can prescribe OCs and only a chemist or a licensed person can dispense them. Doctors at Family Planning Clinics and Hospital Outpatient Departments may also supply OCs. There are arguments for and against a relaxation of restrictions controlling the distribution of OCs, many of these views were stated in submissions to the Royal Commission on Human Relationships. At present in Australia, a nurse must work under the supervision of a medical practitioner when providing family planning services. A doctor may delegate certain functions to nursing staff but remains ultimately responsible. The Royal Commission "suggests that steps should be taken to enable nurse practitioners to take a wider role in prescribing oral contraceptives." They also think "that the pill should be available only through a person trained to give information and advice on its proper use. (They) would not necessarily restrict the categories of such persons; they might include nurses, or other specially trained personnel, at family planning clinics, specially trained social workers, pharmacists, and possibly others. It would be important to establish proper standards for training these personnel and for their competence to be recognized by the Commonwealth and States under appropriate legislation. This would require cooperation. The Family Planning Associations or other recognized training bodies could be authorized to issue certificates of competence to persons who have received the appropriate training; this would in turn authorize those persons to prescribe OCs. When more is known about the OC it is hoped that it will be possible to make it available without restriction.

Characteristics of women using the pill

Pill users tend to differ from other women. They are generally younger and have more children (they have their families before going on the pill). There are more smokers among them and they smoke more heavily. They are less likely to have had a previous serious illness because when determining a patient's suitability to take the pill, a doctor would take into account previous medical history. They also have a higher coital frequency than women using other methods of contraception. The level of education is a significant factor in contraceptive choice. A Melbourne survey found that "within the first three years of (the pill's) introduction, 23 percent of the wives with tertiary education had adopted this new method compared with 3, 12, and 18 percent respectively of those with elementary, lower secondary and upper secondary education as their highest achieved levels .... Over the decade, the educational differential in pill use has declined, especially amongst the Australian born. However, it should be noted that by 1970-71 a new innovational differential had appeared; the most highly educated women had already begun to move away from the pill while levels of usage were reaching a plateau or still rising in other educational groups." It is impossible to generalize about this, even though much research has been done in this area. A Melbourne survey, found that 95% of women had either heard of or used the pill. Another survey, found that 26% of women were using the pill and yet another found that most women disliked the pill. (See also Part 2, Section 5, Attitudes to the pill.))

Adolescents and the pill

For the sexually active adolescent girl without medical contraindications who is sufficiently motivated to adapt to daily pill-taking, orals are the most effective contraceptive method. Some medical specialists have advised that oral contraceptives should not be a routine method of contraception for young girls who have not established a regular menstrual pattern for 1 or 2 years, due to the risk of amenorrhea after discontinuing the pill. The legal position must also be considered; for instance, the age of consent in Australia varies between 13-17 years. The Family Planning and the Law Symposium held in Melbourne in 1976 confirmed the ambiguity of the law on fertility control and minors. The current advice to family planning doctors is: 1) No doctor in Australia has yet been prosecuted for prescribing the pill to a minor. 2) It is preferable to prescribe to girls over 16 years but doctors have no confirmation of client's ages. 3) Parents ringing up about their child's attendance at Family Planning Association Centres are not entitled to information. Doctors observe normal discretion about their clients. 4) Girls who come to ask for the pill are usually already involved in a sexual relationship. "Studies of cervical cancer and its precursors in users of oral contraceptives have produced varied results. Most found no links between the use of orals and the risk of developing malignant or premalignant neoplasms, but several have reported a positive relationship and several a negative relationship." There may not be any link between the early use of oral contraceptives and subsequent neoplasia, however, there may be an association between early coitus and subsequent cervical neoplasia. In individual cases, the known risks of unwanted pregnancy must be weighed against the potential risks of taking the pill.

Patients denied abortion at a private early pregnancy termination service in Auckland

Follow-up of patients who were denied abortion at a private early pregnancy termination service shows at least half of the sample eventually had an abortion elsewhere.

Artificial insemination with donor semen

Fifty-three consecutive couples requesting artificial insemination with donor semen are presented. Insemination was carried out with fresh semen. Forty-three proven pregnancies were achieved with a mean of 3-4 treatment cycles per pregnancy. Psychological and legal aspects relating to this method of treatment are discussed.

Vasectomy

Fifty consecutive patients who underwent vasectomy were followed up over a period of two years, and were subjected to a questionnaire, and the results were analysed. The technique for vasectomy is described and a few modifications are suggested, so that there is a reasonable chance of reversing the operation if need be. Special emphasis has been placed on the poorly understood medicolegal implications of vasectomy.