John M. Stanhope

Blood pressure and social interaction in Tokelauan migrants in New Zealand

Abstract As part of the Tokelau Island Migrant Study the relationship between social interaction and blood pressure level has been examined in a sample of 635 adult Tokelauans resident in New Zealand. A composite social interaction index was designed to assess differential interaction between each Tokelauan and both his fellow migrants and the New Zealand society. Partial correlation analysis, controlling for body mass and length of residence in New Zealand, showed a significant positive association between blood pressure z-scores and the degree of social interaction with New Zealand society (for systolic blood pressure: males r = 0.150, P = 0.005, N = 356; females r = 0.123, P = 0.042, N = 275). Between 1.9 and 2.3% of the variance in blood pressure in this sample can be explained by social interaction.

The Tokelau island migrant study: Serum lipid concentrations in two environments

Abstract Polynesian immigrants in New Zealand were compared with subjects living in Tokelau, the island group from which the migrants originated. The mean length of time in New Zealand was 7.1 yr. Migrant males had higher mean concentrations of serum low-density lipoprotein cholesterol and triglycerides, and lower mean concentrations of serum high-density lipoprotein cholesterol than nonmigrant males. Among females, the differences were in the same direction, but significant only for triglycerides. Females had higher levels of total cholesterol and low-density lipoprotein cholesterol than males in Tokelau and in most age groups in New Zealand. Pregnancy elevated the high-density lipoprotein cholesterol levels and this effect was greater in Tokelau than New Zealand. In Tokelau 53% of energy is from fat and 80% from coconut, rich in short chain lauric and myristic fatty acids, while cholesterol and sugar intake is low. In New Zealand, saturated fat intake declines, while cholesterol, carbohydrates and sugar intakes increase. Alcohol is used modestly in both environments. The role of exercise, diet and alcohol consumption in the emergence of these contrasts between serum lipid concentration in migrants and nonmigrants is considered.

HIGH-DENSITY-LIPOPROTEIN CHOLESTEROL AND OTHER SERUM LIPIDS IN A NEW ZEALAND BIRACIAL ADOLESCENT SAMPLE: The Wairoa College Survey

Among New Zealand adolescents, Maoris have lower serum high-density-lipoprotein cholesterol levels and higher serum triglyceride levels than non-Maoris. Boys have lower high-density-lipoprotein cholesterol and triglyceride levels than girls. Low-density-lipoprotein cholesterol levels do not show sex/race differences. These findings are reflected in an excess of hyperlipidaemia type IV in Maori girls. There may be a relation between these lipid distributions and the excess Maori mortality, especially among females, from ischaemic heart-disease.

THE LANGTON CLINIC CLIENTELE: SOCIAL & DEMOGRAPHIC CHARACTERISTICS OF ALCOHOL AND DRUG DEPENDENT PATIENTS

One years experience of patients admitted to the Langton Clinic for the first time in 1980–81 is reviewed. Alcohol was the principal or only drug abused by 388 patients, and was abused conjointly with other drugs by 58 patients; 188 patients abused other drugs, but not alcohol.Various sub-cultural groups were suspected from the distribution of drug used, sex, age, religion and country of birth. Patients were characterized by social, marital and employment difficulties rather than physical and psychiatric morbidity.

Heroin dependence: Inpatient detoxification with clonidine

The traditional regime for detoxification of heroin dependence at this Clinic has been based on sedation with chlormethiazole or chlordiazepoxide, supplemented with chlorpromazine. A new regime based on clonidine has been compared with this and found superior in that fewer patients on clonidine were discharged for misbehaviour and fewer patients on clonidine required supplementary medication. Clonidine was as effective as the sedative regime in relieving most withdrawal symptoms, with the additional advantage that clients who were less sedated were more responsive to supportive counselling.

Epidemics health and disease in a small isolated environment

Abstract Some health consequences of the interaction of man and his environment on the three small Pacific atolls that constitute Tokelau are examined. The demographic history of Tokelau is described. The pattern of health, with emphasis on certain infectious diseases, illustrates the way in which small isolated islands react to such exposures. The strength of the community approach, which has achieved greater compliance than can usually be expected in larger communities, will be illustrated by referring to certain treatment programmes instituted over recent years. Atolls, such as Tokelau, are very different in their characteristics from other types of islands. Therefore, much of what will be presented will only be applicable to such a small isolated traditional society. There are, however, some general observations and lessons which will have much wider application.

The use of carbamazepine in chlormethiazole-modified withdrawal from alcohol

SummaryThe effect on seizure frequency and other withdrawal symptoms of the addition of carbamazepine or placebo was compared in 304 patients being managed during alcohol withdrawal. Patients were studied for a minimum of four days, unless terminated earlier by self-discharge.The incidence of seizures was 2% in both test and placebo groups. The addition of carbamazepine was not found useful in the management of alcohol withdrawal, but the low frequency of fits may have masked an effect. Such a low frequency had not been anticipated when the study was planned.

Maori and European teenagers: A comparison of self and examiner health appraisal: The Rotorua Lakes study 4

Abstract A health survey of a secondary school population in New Zealand enabled comparison between health as determined by an examining doctor and as assessed by the subject. Subjective appraisal identified respiratory symptoms, joint dysfunction and neuropsychiatric disorders as contributing to poorer health. Examiner-determined ill-health was commoner in the lowest socioeconomic strata but showed no relation to sex or ethnicity. Among students without examiner-determined ill-health, lower socioeconomic status was associated with lower self-appraisal of health. Among students having any examiner-determined abnormality, an ethnic difference emerged, but this was attributable mainly to the higher prevalence of respiratory symptoms in Maori subjects.

Assessment Method and Medication Requirement in Chlormethiazole Detoxification from Alcohol

Two policies governing treatment of the alcohol withdrawal syndrome by administration of chlormethiazole were compared. One regime (“the old”) used subjective assessment of symptoms by nurses, the other (“the new”) used a more objective rating scale. Under the new regime chlormethiazole and carbamazepine use was less, but use of antinauseants and other sedatives was more, compared with the old regime. There was no difference in occurrence of side-effects or proportion of patients completing detoxification. The new regime offered a small cost advantage (78 cents per patient), but indirect advantages were believed to exist in patient orientation and reassurance, earlier awareness of underlying psychiatric disorder and improved staff communication.

The Langton Clinic clientele: Characteristics of outpatients

SUMMARYOne years experience of patients seeking treatment for the first time at the Langton Clinic, but not admitted, in 1980–81, is reviewed. The majority (64%) did not require admission, while 30% needed admission but declined the offer. Of all patients attending however, those who declined were only 11% of those who needed admission.Alcohol-related problems accounted for 75% of the outpatients, including some nondependent abusers, abstinent alcoholics and social drinkers with transitory disturbances. Of the 18% who were abusing some other drug with or without alcohol abuse, 10% were opiate dependent.Outpatient alcohol dependents tended to be younger and to have suffered less social damage than inpatients.