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BackgroundNo routinely recommended cardiovascular disease (CVD) risk prediction equations have adjusted for CVD preventive medications initiated during follow-up (treatment drop-in) in their derivation cohorts. This will lead to underestimation of risk when equations are applied in clinical practice if treatment drop-in is common. We aimed to quantify the treatment drop-in in a large contemporary national cohort to determine whether equations are likely to require adjustment.MethodsEight de-identified individual-level national health administrative datasets in Aotearoa New Zealand were linked to establish a cohort of almost all New Zealanders without CVD and aged 30–74 years in 2006. Individuals dispensing blood-pressure-lowering and/or lipid-lowering medications between 1 July 2006 and 31 December 2006 (baseline dispensing), and in each 6-month period during 12 years’ follow-up to 31 December 2018 (follow-up dispensing), were identified. Person-years of treatment drop-in were determined.ResultsA total of 1 399 348 (80%) out of the 1 746 695 individuals in the cohort were not dispensed CVD medications at baseline. Blood-pressure-lowering and/or lipid-lowering treatment drop-in accounted for 14% of follow-up time in the group untreated at baseline and increased significantly with increasing predicted baseline 5-year CVD risk (12%, 31%, 34% and 37% in <5%, 5–9%, 10–14% and ≥15% risk groups, respectively) and with increasing age (8% in 30–44 year-olds to 30% in 60–74 year-olds).ConclusionsCVD preventive treatment drop-in accounted for approximately one-third of follow-up time among participants typically eligible for preventive treatment (≥5% 5-year predicted risk). Equations derived from cohorts with long-term follow-up that do not adjust for treatment drop-in effect will underestimate CVD risk in higher risk individuals and lead to undertreatment. Future CVD risk prediction studies need to address this potential flaw.

We report for the first time the occurrence of an Eutypellaspecies on cotton in New South Wales (NSW), Australia. The putative Eutypellawas isolated from dead cotton plants that exhibited atypical symptoms of either Fusarium or Verticillium wilt. Dead plants had symptoms resembling lightning strike damage with blackened outer bark around the fifth node zone. Internal vascular discoloration was reddish grey and often occurred in V-shaped sections. Sequences of the internal transcribed spacer (ITS) revealed a 93.7–94.1% similarity to Eutypella scoparia, indicating that the NSW cotton isolates represented a putatively novel species within the Eutypellagenus. Pathogenicity of the isolated Eutypellawas assessed on cotton stem cuts and living plants inoculated with culture agar plugs. Typical black necroses on outer bark and reddish vascular discoloration were reinduced in both Eutypella-inoculated stem cuts and living plants. Subsequently, the same Eutypellapathogen was successfully recovered, thus fulfilling Koch’s postulates. The detection of Eutypellaon NSW cotton is believed to be an independent event from a recently reported occurrence of Eutypellaon Queensland cotton. The Queensland detection occurred in the same 2017/18 cropping season at approximately 730 km apart and was associated with distinct Eutypellaisolates.

ObjectiveThe recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. We designed paired ischaemic and major bleeding risk scores to inform this decision.MethodsNew Zealand (NZ) patients with ACS investigated with coronary angiography are recorded in the All NZ ACS Quality Improvement registry and linked to national health datasets. Patients were aged 18–84 years (2012–2020), event free at 28 days postdischarge and without atrial fibrillation. Two 28-day to 1-year postdischarge multivariable risk prediction scores were developed: (1) cardiovascular mortality/rehospitalisation with myocardial infarction or ischaemic stroke (ischaemic score) and (2) bleeding mortality/rehospitalisation with bleeding (bleeding score).FindingsIn 27 755 patients, there were 1200 (4.3%) ischaemic and 548 (2.0%) major bleeding events. Both scores were well calibrated with moderate discrimination performance (Harrell’s c-statistic 0.75 (95% CI, 0.74 to 0.77) and 0.69 (95% CI, 0.67 to 0 .71), respectively). Applying these scores to the 2020 European Society of Cardiology ACS antithrombotic treatment algorithm, the 31% of the cohort at elevated (>2%) bleeding and ischaemic risk would be considered for an abbreviated DAPT duration. For those at low bleeding risk, but elevated ischaemic risk (37% of the cohort), prolonged DAPT may be appropriate, and for those with low bleeding and ischaemic risk (29% of the cohort) short duration DAPT may be justified.ConclusionWe present a pair of ischaemic and bleeding risk scores specifically to assist clinicians and their patients in deciding on DAPT duration beyond the first month post-ACS.

ObjectivesCharacterisation of trends in acute coronary syndrome (ACS) outcomes are critical to informing clinical practice and quality improvement, but there are few recent population studies for ACS. We reviewed the recent trends in the outcomes of ACS in New Zealand (NZ).MethodsAll patients with ACS admitted to NZ public hospitals in 2006–2016 were identified from hospital discharge records, and their first ACS hospitalisations per year extracted for analysis. Thirty-day and 1-year death, myocardial infarction, stroke, heart failure and bleeding rates were calculated for each calendar year. Trends in outcome rates were assessed using generalised linear mixed models.ResultsTotal annual ACS hospitalisations decreased from 685 to 424 per 100 000. Using first patient hospitalisations per year (n=1 55 060), we found significant annual declines in all major outcomes except for non-cardiovascular deaths. All-cause mortality fell from 10.5% to 9.1% at 30 days (adjusted OR 0.985 per year change, p<0.001) and from 21.8% to 18.7% at 1 year (OR=0.994, p=0.016). This was related to significant decreases in cardiovascular death at both time points (OR=0.982 and 0.987, respectively, p<0.001), outweighing a slight increase in non-cardiovascular death at 1 year (OR=1.009, p=0.014). One-year rates of myocardial infarction, heart failure, stroke and bleeding rates all decreased significantly over time.ConclusionACS outcomes including all-cause mortality, cardiovascular death, myocardial infarction, stroke, heart failure and bleeding at 30 days and 1 year improved over the last decade in NZ, reflecting successful implementation and advances in prevention, medical and invasive management in ACS over time.

ObjectivesRecent studies in acute coronary syndrome (ACS) have reported mixed results for trends in ACS subtypes. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) 31 study evaluated trends in ACS event rates, invasive management and mortality of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in New Zealand.MethodsAll ACS hospitalisations between 2006 and 2016 were identified from routinely collected national data and categorised into STEMI, NSTEMI, UA and MI unspecified (MIU). Annual hospitalisation, coronary procedure, 28-day and 1-year mortality rates were calculated and trends tested using Poisson regression adjusting for age and sex.ResultsOver the 11-year study period, there were 188 264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MIU. Event rates of all ACS subtypes fell: STEMI by 3.4%/year, NSTEMI by 5.9%/year and UA by 8.5%/year, while the proportion of patients with ACS receiving angiography and revascularisation increased by 5.6% per year. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but coronary artery bypass grafting increased only for NSTEMI and UA. Mortality at 28 days and 1 year was higher for STEMI than NSTEMI and lowest for UA. There was a relative 1.6%/year decline in 1 year mortality for NSTEMI (p<0.001), but no significant change for STEMI and UA.ConclusionsWe observed declines in the event rates of all ACS subtypes and increases in revascularisation rates. The finding that mortality declined in patients with NSTEMI, but not in patients with STEMI and UA, despite increases in invasive procedures, requires further investigation.

Objectives: To investigate (i) dietary patterns associated with consumption of vegetable oils rich in monounsaturated fatty acids (MUFA), and (ii) the risk of prostate cancer associated with consumption of these oils. Methods: A population-based case–control study was conducted in Auckland, New Zealand, involving 317 prostate cancer cases and 480 controls. A food-frequency questionnaire was used to collect data concerning consumption of MUFA-rich vegetable oils (including olive oil, canola or peanut oil) and other dietary variables. Biomarkers for fatty acids were measured in erythrocytes. Results: The group of participants who reported regular consumption of greater than 5.5 ml of MUFA-rich vegetable oils per day had a diet relatively high in monounsaturated fat, vegetables, lycopene, vitamin E, selenium, and n-3 fish oils. Increasing levels of MUFA-rich vegetable oil intake were associated with a progressive reduction in prostate cancer risk (multivariate relative risk = 0.5; 95% confidence interval 0.3–0.9; > 5.5 ml per day vs. non-consumption, ptrend = 0.005), and similar trends were observed across all strata of socioeconomic status. Prostate cancer risk was not associated with intake of total MUFA or the major animal food sources of MUFA. Conclusion: This finding may be explained by the protective effect of an associated dietary pattern high in antioxidants and fish oils, an independent protective effect of MUFA-rich vegetable oils unrelated to the MUFA component, or a combination of these factors.

This study was undertaken in spring, 2019 to assess the applicability of the double‐observer survey method for estimating blue sheep Pseudois nayaurabundance in Nar‐Phu valley of Manang District located in Annapurna Conservation Area of northern Nepal. Since counting large mammals in rugged mountain habitat poses a special challenge, we tested the efficacy of the double observer method for generating robust population estimates for this important protected area. The overall detection probability for observers (O1 and O2) was 0.94 and 0.91 for a total of 106 groups comprised of 2059 individual blue sheep. We estimated the area's blue sheep population at 2070 (SE ± 168.77; 95% CI 2059–2405) for the 246.2 km2of sampled habitat. We determined blue sheep to be widely distributed within the study area with a mean density of 8.4 individuals per km2based on a total study area of 246.2 km2. We discuss demographic population structure and identify limitations when applying the double observer approach, along with recommending viewshed mapping for ensuring more robust density estimates of mountain‐dwelling ungulates like blue sheep or ibex that inhabit extremely heterogeneous terrain which strongly influences sighting distances and overall animal detection rates.

ABSTRACT As part of the World Health Organization MONICA Study, the prevalence of cardiovascular risk factors was estimated for Auckland (1982), Perth (1983) and Newcastle (1983). Measurements of blood pressure, blood lipid levels, the prevalence of cigarette smoking, obesity and other factors were obtained by similar methods in each centre from random samples of men and women aged between 35 and 64 years whose names were drawn from the electoral rolls. These risk‐factor levels were then compared with official statistics on mortality of all causes and of ischaemic heart disease for the three populations around the same time. There were substantial differences in mortality among the three centres. Death rates of all causes and of ischaemic heart disease were lowest in Perth and highest in Newcastle (except for all‐causes mortality for women, which was highest in Auckland). Compared with Perth, differences in the mortality rates of ischaemic heart disease were 27% higher for men and 35% higher for women in Auckland, and 44% and 95% higher, respectively, in Newcastle. Levels of risk factors showed the same pattern for Perth (lower) and Newcastle (higher) but were somewhat inconsistent for Auckland. The relative magnitudes of the differences in risk factors were less than for the differences in mortality. Thus, other risk factors, socioeconomic differences and differences in medical care may also contribute to the differences in ischaemic heart disease mortality rates and further explanations should be sought for the large differences among these cities. (Med J Aust 1988; 148: 61‐65)

Recent international trends in asthma mortality among people aged five to 34 years were examined as a follow-up to an epidemic of asthma deaths in the late 1970s which appeared to be confined to New Zealand. Mortality rates were compared in 14 countries with suitable statistics; Australia, Canada, England and Wales, Finland, France, Japan, Israel, the Netherlands, New Zealand, Singapore, Sweden, Switzerland, the United States, and West Germany, for the period 1970 to 1984/5. In New Zealand, asthma mortality in this age group more than trebled from 1.3 per 100,000 in 1974 to 4.2 per 100,000 in 1979 and since then has declined substantially to 1.85 per 100,000 in 1985. Asthma death rates vary more than six-fold among the other countries examined, and although the New Zealand experience has not been seen to the same degree elsewhere, a gradual increase in reported asthma mortality has occurred since the mid to late 1970s in the majority of countries studied. The increase and subsequent decline in asthma mortality in New Zealand could not be explained by changes in diagnostic fashions or in the International Classification of Disease coding rules. Similarly, the US data do not suggest there is diagnostic transfer among diseases of airway obstruction. However, part of the differences in asthma mortality among the countries examined and the recent increases in asthma death rates, could be due to changing diagnostic fashions rather than true differences in mortality. International studies on the validity of asthma death statistics and on asthma prevalence are required to clarify these issues.

The risk of coronary death associated with Type A behaviour (Framingham definition) and social contact was examined using a retrospective case-control design. Logistic regression analysis of 134 male cases and 339 controls showed that increased risk was associated with Type B behaviour, and independently with limited social contact. Discussion focuses on issues surrounding the use of retrospective, proxy data; and on the speculation that Type A behaviour may increase risk of non-fatal coronary events, but protect against coronary death.

Objective: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. Design:Descriptive epidemiological study. Setting:Community based study. Subjects: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. Main outcome measures:Definite acute myocardial infarction or coronary death classified according to the criteria of the World Health Organization MONICA project. Results: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. Conclusion: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.

The objective of this study was to determine the rate of the decline in risk of a major coronary event after quitting cigarette smoking. It was a population‐based case‐control study of men and women aged 35 to 69 years in Newcastle, Australia, and men and women aged 35 to 64 years in Auckland, New Zealand, between 1986 and 1994. Cases were 5,572 people identified in population registers of coronary events and controls were 6,268 participants in independent community‐based risk factor prevalence surveys from the same study populations. There was a rapid reduction in risk after quitting cigarette smoking. The risk of suffering a major coronary event for men who were current cigarette smokers was 3.5 (95% CI 3.0–4.0) times higher than the risk for never smokers but this fell to 1.5 (95% CI 1.1–1.9) for men who had quit for 1–3 years. Women who were current cigarette smokers were 4.8 (95% CI 4.0–5.9) times more likely to suffer a major coronary event than never smokers and this fell to 1.6 (95% CI 1.0–2.5) for women who had quit for 1–3 years. Those who had quit cigarette smoking for 4–6 years or more had a similar risk to never smokers. These results reinforce the importance of smoking cessation. The public health message is that the benefit of giving up smoking occurs rapidly.

This study compares the antihypertensive and lipid modifying effects of treatment of mild to moderate hypertension with celiprolol or atenolol. It also models the 5-year cardiovascular risk reduction and the cost effectiveness of monotherapy from a partial societal perspective. The effects of celiprolol and atenolol on systolic blood pressure (SBP), total serum cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) were obtained from a pooled analysis of published studies. Although celiprolol and atenolol had similar effects on SBP, celiprolol reduced the ratio of TC to HDL-C by 10.2% [95% confidence intervals (95% CI) −16.4%, −4.0%] but atenolol increased the ratio by 7.7% (95% CI of 3.4%, 12.0%). The 5-year absolute risks of an initial coronary or cerebrovascular event or cardiovascular death were computed for cohorts of patients treated with either agent or remaining untreated, using an accelerated failure time (AFT) model, based on Framingham Heart Study data. Inputs to the model were age, gender, smoking status, SBP, TC and HDL-C. The change in absolute risk was estimated using the changes in SBP and TC: HDL-C obtained from the pooled analysis. Average life-months gained by therapy were computed as differences between the Kaplan-Meier survival curves estimated from the model plus differences in 5-year cardiovascular death rates multiplied by average life expectancy obtained from life tables. Direct medical costs included drug treatment, and the costs of acute care for initial coronary and cerebrovascular events deferred by therapy over the 5-year treatment period. The model shows that in the lowest-risk base case (60-year-old men who are nondiabetic and nonsmokers with SBP of 160mm Hg and a 5-year absolute cardiovascular risk of 12%), celiprolol (271 mg/day) is 2-fold more effective than atenolol (77.4 mg/day) in reducing coronary event risk, and equally effective in reducing cerebrovascular event risk. The number of individuals that would have to be treated for 5 years to avoid 1 coronary event is about 30 for celiprolol versus 70 for atenolol. Therapy with celiprolol yields more life-months and at current prices, the cost per life-year gained by therapy is significantly lower. Both drugs are cost effective by international standards in the treatment of patients with 5-year absolute cardiovascular risk greater than 10%, and are more cost effective in those patients at higher levels of absolute cardiovascular risk. The direct medical costs of treatment for 5 years with celiprolol are the same or slightly less than treatment with atenolol at the dosages used in the clinical trials, despite a 19% higher tablet price. Both drugs are more cost effective in patients at higher levels of absolute cardiovascular risk. These findings are sensitive to the drug dosages, tablet prices and the discount rate. Based on epidemiological and clinical data, replacing atenolol with celiprolol in patients with mild to moderate hypertension, but without overt cardiovascular disease, is predicted to have similar effects on stroke risk, but to be substantially more effective in reducing the risk of coronary events at no additional direct medical cost over a 5-year treatment period.

The risk of myocardial infarction (MI) associated with Type A behaviour, anger management and social contact was examined using a retrospective case-control design. Binary multiple regression analyses were used to compare 206 male and 67 female MI cases with 454 male and 316 female controls. To examine the potential moderating role of sex and Type A behaviour, moderated and subgroup regressions were run. Type A behaviour was significantly more prevalent in cases than controls. MI risk was further increased in males who combined Type A behaviour and aggressive expression of anger. In females MI risk was associated with the combination of Type A behaviour and not expressing anger. In addition female cases were significantly less likely than controls to discuss their anger, and reported fewer available social contacts. Discussion of results includes consideration of the problems generated by the retrospective case-control design.

An apparent protective effect of light-to-moderate alcohol consumption on the risk of coronary heart disease has been documented in numerous ecological, case-control and cohort studies. The findings are consistent and there are several biological effects of alcohol which could explain the findings. It has been argued, however, that the observed association is an artefact due to either the misclassification of ex-drinkers as never-drinkers or to confounding factors. A series of recent studies have addressed these concerns and examined the possible biological mechanisms involved. These studies add support to the hypothesis that the inverse association between light-to-moderate alcohol consumption and coronary disease risk is causal. Increasing consumption offsets the benefits for coronary heart disease with adverse health effects epidemiological evidence indicates that safe limits are up to two to three drinks a day for men and one to two drinks a day for women.

Experimental studies have suggested that the biosynthesis of arachidonic acid-derived eicosanoids such as prostaglandin E2 via the cyclo-oxygenase pathway may play a significant role in supporting cell proliferation in human prostate cancer cell lines. However, the aetiological significance of this for clinical prostate cancer has remained unclear. In particular, the potential for prostate cancer chemoprevention using non-steroidal anti-inflammatory drugs (cyclo-oxygenase inhibitors; NSAIDs) has received little attention. The purpose of our study was to investigate associations between prostate cancer risk and use of NSAIDs. A population-based case-control study was carried out over 13 months from 1996 in metropolitan Auckland, New Zealand. A total of 317 newly diagnosed prostate cancer cases (including 192 “advanced” cases) representative of all cancer cases in the study population were identified from urology clinic referrals and histology reports. A total of 480 age-matched controls were recruited following random selection from the study population using electoral rolls as the sampling frame. After adjusting for potential confounding by socio-economic status and dietary fat consumption, there was a trend toward reduced risks of advanced prostate cancer associated with regular use of total NSAIDs (RR = 0.73; 95% CI 0.50–1.07) and total aspirin (RR = 0.71; 95% CI 0.47–1.08). However, these associations failed to reach statistical significance at the usually accepted levels. Weaker inverse associations were found for total prostate cancers, which included a number of small, low-grade tumours of less clinical significance. These findings lend support to proposed underlying aetiological hypotheses which imply a role for cyclo-oxygenase activity in prostate cancer progression. Int. J. Cancer 77:511–515, 1998. © 1998 Wiley-Liss, Inc.

Blood donors have made important contributions to research, most notably in cross-sectional seroprevalence studies. The proposed New Zealand Blood Donors Health Study is a prospective cohort study of 30,000 New Zealand donors designed to investigate the determinants of common injuries, cardiovascular disease and cancer. While robust from an analytic perspective, the execution of prospective cohort studies in many settings is impeded by methodological, economicand organisational barriers. We examined the operational considerations of implementing a large-scale cohort study at a transfusion centre and evaluated measures taken to optimise data collection procedures. A pilot study of 1,000 participants revealed donor motivation to participate in this research was high (91% response rate). Comprehensive exposure data on lifestyle, behavioural and psychosocial factors were obtained from 95% of participants. Substantial heterogeneity in levels of potential risk factors was noted among respondents. Detailed dietary habit information and a study blood sample were obtained from 67% and 100% of participants, respectively. Study recruitmentand baseline data collection was feasible during routine donor visits with minimal interruption to donor centre staff and procedures. We conclude the study design and characteristics of the regional donor program enhance the efficiency and significance of the proposed research.

The objective of this study was to determine the rate of the decline in risk of a major coronary event after quitting cigarette smoking. It was a population-based case-control study of men and women aged 35 to 69 years in Newcastle, Australia, and men and women aged 35 to 64 years in Auckland, New Zealand, between 1986 and 1994. Cases were 5,572 people identified in population registers of coronary events and controls were 6,268 participants in independent community-based risk factor prevalence surveys from the same study populations. There was a rapid reduction in risk after quitting cigarette smoking. The risk of suffering a major coronary event for men who were current cigarette smokers was 3.5 (95% CI 3.0-4.0) times higher than the risk for never smokers but this fell to 1.5 (95% CI 1.1-1.9) for men who had quit for 1-3 years. Women who were current cigarette smokers were 4.8 (95% CI 4.0-5.9) times more likely to suffer a major coronary event than never smokers and this fell to 1.6 (95% CI 1.0-2.5) for women who had quit for 1-3 years. Those who had quit cigarette smoking for 4-6 years or more had a similar risk to never smokers. These results reinforce the importance of smoking cessation. The public health message is that the benefit of giving up smoking occurs rapidly.

Blood donors have made important contributions to research, most notably in cross‐sectional seroprevalence studies. The proposed New Zealand Blood Donors Health Study is a prospective cohort study of 30,000 New Zealand donors designed to investigate the determinants of common injuries, cardiovascular disease and cancer. While robust from an analytic perspective, the execution of prospective cohort studies in many settings is impeded by methodological, economicand organisational barriers. We examined the operational considerations of implementing a large‐scale cohort study at a transfusion centre and evaluated measures taken to optimise data collection procedures. A pilot study of 1,000 participants revealed donor motivation to participate in this research was high (91% response rate). Comprehensive exposure data on lifestyle, behavioural and psychosocial factors were obtained from 95% of participants. Substantial heterogeneity in levels of potential risk factors was noted among respondents. Detailed dietary habit information and a study blood sample were obtained from 67% and 100% of participants, respectively. Study recruitmentand baseline data collection was feasible during routine donor visits with minimal interruption to donor centre staff and procedures. We conclude the study design and characteristics of the regional donor program enhance the efficiency and significance of the proposed research.

We studied the activity of 27 young white—tailed deer (Odocoileus virginianus) fawns on the Welder Wildlife Refuge in South Texas. we attached motion—sensitive radiotransmitters to 15 male and 12 female fawns, 3—12 day old,and monitored their activity for as long as 9 weeks. These fawns primarily were diurnal, although most were active for short periods once or twice a night. The amount and timing of activity of each fawn varied considerably; however, total activity increased with age as a fawn became stronger and more agile. Males were more active than females during daytime and in total at all ages, but females were more active at night. During their first two weeks of life, fawns were active an average of 8% of the time. By 1 month of age, males were active about 16% of the time, and females were active 12% of the time. The average number of daytime activity periods increased from two in fawns during their first week to five—six periods at 1 month of age. Most activity periods were less than 35 minutes long, but they increased in duration with fawn age. Two—hour activity periods were rare until fawns were more than a month old. The increase in fawn activity with age was related to the fawn's increasing ability to follow its dam, and its gradual integration into the adult deer social unit. Fawns were more active during midday hours in their first week of life, but they were most active in morning and evening thereafter.

To investigate the association between risk of motor vehicle driver injury and body mass index (BMI).

We assessed the validity of a three-month physical activity questionnaire. The validation instrument was a seven-day self-report diary of physical activity and food intake, given to 113 randomly selected persons. We obtained Spearman correlations of 0.60, 0.48, and 0.91 and kappa scores of 0.36, 0.23, and 0.62 from the physical activity recall and diary for moderate, vigorous, and total activity. We conclude that the three-month recall questionnaire reasonably reflects activity in this community-based sample

Recommendations, possibly resulting in the long‐term treatment of one million Australians, require a serious cost‐benefit analysis

The endangered snow leopard (Panthera uncia) is widely but sparsely distributed throughout the mountainous regions of central Asia. Detailed information on the status and abundance of the snow leopard is limited because of the logistical challenges faced when working in the rugged terrain it occupies, along with its secretive nature. Camera-trapping and noninvasive genetic techniques have been used successfully to survey this felid. We compared noninvasive genetic and camera-trapping snow leopard surveys in the Gobi Desert of Mongolia. We collected 180 putative snow leopard scats from 3 sites during an 8-day period along 37.74 km of transects. We then conducted a 65-day photographic survey at 1 of these sites, approximately 2 months after scat collection. In the site where both techniques were used noninvasive genetics detected 5 individuals in only 2 days of fieldwork compared to 7 individuals observed in the 65-day camera-trapping session. Estimates of population size from noninvasive genetics ranged between 16 and 19 snow leopards in the 314.3-km2 area surveyed, yielding densities of 4.9–5.9 individuals/100 km2. In comparison, the population estimate from the 65-day photographic survey was 4 individuals (adults only) within the 264-km2 area, for a density estimate of 1.5 snow leopards/100 km2. Higher density estimates from the noninvasive genetic survey were due partly to an inability to determine age and exclude subadults, reduced spatial distribution of sampling points as a consequence of collecting scats along linear transects, and deposition of scats by multiple snow leopards on common sites. Resulting differences could inflate abundance estimated from noninvasive genetic surveys and prevent direct comparison of densities derived from the 2 approaches unless appropriate adjustments are made to the study design.

Background The purpose of this study is to describe associations between a number of standard cardiovascular risk factors and all-cause mortality. Methods Mortality data were collected for a randomly selected cohort of 1029 New Zealand men aged 35–64 years, followed up over a 9-year period. A proportional hazards regression model was used to estimate the relative risks (RR) for all-cause mortality associated with a number of cardiovascular risk factors. Results In all, 96 deaths occurred over the 9-year period, of which 50% were due to cardiovascular causes. All-cause mortality was positively associated with cigarette smoking (age-adjusted RR = 2.01, 95% CI : 1.15–3.53, current versus never), systolic blood pressure (age-adjusted RR = 2.18, 95% CI : 1.23–4.44, upper versus lower tertile), and body mass index (age-adjusted RR = 1.59, 95% CI : 0.94–2.66, upper versus lower tertile) and inversely associated with high density lipoprotein (HDL)-cholesterol (age-adjusted RR = 0.45, 95% CI : 0.25–0.80, upper versus lower tertile). All-cause mortality was only weakly associated with serum total cholesterol (age-adjusted RR = 1.19, 95% CI : 0.70–1.99, upper versus lower tertile), and there was no evidence of a U-shaped relationship for this risk factor. There was an inverse association between all-cause mortality and socioeconomic status (age-adjusted RR = 1.70, 95% CI : 1.03–2.80, lower versus upper). Light alcohol consumption was associated with reduced all-cause mortality (age-adjusted RR = 0.63, 95% CI : 0.37–1.05, light versus teetotal), but this benefit did not persist for alcohol consumption above about three standard drinks per day. Conclusions The findings of this study indicate that the standard cardiovascular risk factors are likely to have a beneficial impact on all-cause mortality as well as cardiovascular disease in middle-aged and older men.

Jackson R (Department of Community Health, School of Medicine, University of Auckland, Private Bag, Auckland, New Zealand), Stewart A and Beaglehole R. Trends in coronary heart disease mortality and morbidity in Auckland, New Zealand, 1974–1986. International Journal of Epidemiology 1990, 19: 279–283. Routine mortality statistics show that coronary heart disease (CHD) death rates have declined consistently in Auckland men since 1968; in women, death rates declined between 1968 and 1986 but since 1981 there may have been a reduction in the rate of decline. Data from CHD registers conducted in Auckland, New Zealand in 1974, 1981, and since 1983 as part of the WHO MONICA Project, have been used to investigate the validity and reasons for the decline in the age group 35–64 years. In Auckland age-standardized sudden coronary death rates in men declined by approximately 2% per year between 1974 and 1986; there was no apparent decline in women. There was also an indication of a decline in age-standardized definite myocardial infarction rates but again only in men; 28 day case fatality in patients with a definite myocardial infarction has not changed significantly in the period 1981–1986. These results validate the mortality trends based on death certificates and in particular the differing recent trends in men and women. The decline in CHD mortality in men without a concomitant change in case fatality and the lack of recent decline in women, suggest that changes in the natural history of the disease rather than treatment are responsible for the mortality trends. Since disease events are rare in absolute numbers, long-term monitoring of coronary heart disease in large population groups will be necessary to usefully study disease trends, particularly in women.

Coronary heart disease (CHD) mortality declined by approximately 23.5% in New Zealand men aged 35–64 years between 1968 and 1980. The contributions of secular trends in dietary fat and tobacco consumption to this decline were examined using data from national consumption statistics and population based studies of risk factor levels. Per capita saturated fat and dietary cholesterol consumption fell by approximately 12% and 10% respectively during this period while polyunsaturated fat consumption increased by 73%. Per capita tobacco consumption fell by approximately 15%. Using equations developed by Keys and Hegsted it was calculated that the mean serum cholesterol level declined by between 6.6 and 10.3mg/dl (2.9%−4.4%) during this period. The potential impact of these risk factor changes on CHD mortality was estimated using a Framingham multivariate logistic risk function. Between 38% and 51% of the observed decline in CHD mortality in men aged 35–64 years in New Zealand between 1968 and 1980 could be accounted for by the calculated changes in serum cholesterol and tobacco consumption. If serum cholesterol and cigarette smoking were reduced further to meet current recommendations, it is estimated that CHD mortality would decline by a further 26%−30% from the 1980 level.

Scragg R (Department of Community Health, University of Auckland, Private Bag, Auckland, New Zealand), Jackson R, Holdaway I M, Lim T and Beaglehole R. Myocardial infarction is inversely associated with plasma 25-hydroxyvitamin D3 levels: A community-based study. International Journal of Epidemiology 1990; 19: 559–563. The relation between the plasma level of 25-hydroxyvitamin D3, the main metabolite of sun-induced vitamin D, and myocardial infarction (MI) was investigated in a community-based case-control study. Some 179 MI patients presenting to hospital within 12 hours of the onset of symptoms were individually matched with controls by age, sex and date of blood collection. MI patients had significantly lower mean 25-hydroxyvitamin D3 levels than controls (32.0 versus 35.5 nmol/L; p = 0.017), with the case-control differences being greatest in winter and spring. The relative risk of MI for subjects with 25-hydroxyvitomin D3 levels equal to or above the median was 0.43 (95% confidence limits = 0.27, 0.69) compared to subjects below the median. The decrease in MI risk associated with raised vitamin D3 levels was observed in all seasons. These results provide support for the hypothesis that increased exposure to sunlight is protective against coronary heart disease.

The relationship between whole blood selenium levels and risk of acute myocardial infarction was investigated in a community-based control study in Auckland, New Zealand. A pilot study in 14 patients admitted to hospital within 4 hours of onset of symptoms demonstrated that selenium levels were stable in the first 16 hours after admission for an acute myocardial infarction. Some 252 cases (199 men, 53 women) presenting to hospital within 20 hours of onset of acute myocardial infarction were compared with 838 controls (500 men, 338 women), group-matched for age and sex. Myocardial infarction patients had significantly lower mean selenium levels: 82.8 and 87.9 ug/l in male cases and controls (p = 0.003) and 82.1 and 88.5 ug/1 in female cases and controls (p = 0.02) respectively. The relative risks of myocardial infarction in participants with selenium levels below the median level (85 ug/1) in comparison with participants above the median were 1.6 (95% CL 1.1–2.2) and 1.7 (95% CL 0.9–3.5) in men and women respectively. The effects of a low selenium level on risk of myocardial infarction were confined to cigarette smokers. These results suggest the hypothesis that a decreased blood selenium in the presence of cigarette smoking is a risk factor for coronary heart disease.