A population-based study of seasonal variation in children's fractures.

INTRODUCTION Few Scandinavian studies have studied seasonal variations in paediatric fractures, and the studies that have focused on individual fracture sites. Furthermore, their findings do not coincide as they have described peaks in different seasons. Therefore, we described seasonal variation in the incidence rate (IR) of all paediatric fractures in the 1996-2019 period within a Danish population. METHODS We extracted data from the existing emergency room register at Odense University Hospital and included all fractures sustained by children aged 0-14 years and living in Odense Municipality. Seasonal and monthly IR were calculated using population counts stratified by age, gender and fracture site. RESULTS We recorded a significant increase in IR in spring and summer, except for a drop in July. For boys, the IR ranged from 206 in December to 404 per 10,000 person-years in June. For girls, the incidence ranged from 156 in December to 317 in May. Fractures were more frequent in the upper extremities and were up to six-fold more frequent in the epiphysis and metaphysis than in the shafts. All fracture sites showed a peak in spring and summer, suggesting that all fracture sites are subject to seasonal variation, especially the ones near the epiphysis. CONCLUSIONS The fracture peak observed in spring and summer corresponds to an increase in physical activity. The low incidence registered in July corresponds to a low level of sport activities during the summer vacations and families going on vacation in the countryside or travelling abroad. This study gives useful information for coordinating the right resources at hospitals. FUNDING none TRIAL REGISTRATION not relevant.

Development of the annual incidence rate of fracture in children 1980-2018: a population-based study of 32,375 fractures.

Background and purpose - Pediatric fractures are a common cause of morbidity. So far, no larger Danish study has described the development in the incidence rates. Therefore, we describe the development in the incidence rates of pediatric fractures in the time period 1980-2018 and the frequency of the most common type of fractures.Patients and methods - This is a retrospective register study of all children aged 0-15 years with a fracture treated in the Emergency Department at Odense University Hospital, Denmark, between 1980 and 2018. For all cases, information on age, sex, date of treatment, diagnosis, and treatment was obtained from the patient registration system. Based on official public population counts we estimated age and sex-specific annual incidence rates.Results - 32,375 fractures were included. In the study period the incidence rate decreased by 12%. The incidence increased until the early 1990s. Thereafter incidence rates decreased until 2004-09, from then onward increasing towards the end of the study period. The highest age-specific incidence rate in boys of 522 per 10,000 person-years was at 13 years of age. In girls the age of the highest incidence rate decreased from 11 years in 1980 to 10 years in 2018. Fracture of the lower end of the forearm, the clavicle, and the lower end of the humerus had the highest single fracture incidence rates.Interpretation - The incidence rate of pediatric fractures decreased in the study period by 12%. The highest single fracture incidence rates were for fracture of the lower end of the forearm, the clavicle, and the lower end of the humerus. As the first longitudinal Danish study of pediatric fractures this study is a baseline for evaluating future interventions and future studies.

Routine functional assessment for hip fracture patients.

Background and purpose - Pre-fracture functional level has been shown to be a consistent predictor of rehabilitation outcomes in older hip fracture patients. We validated 4 overall pre-fracture functional level assessment instruments in patients aged 65 or more, used the prediction of outcome at 4 months post-fracture, and assessed cutoff values for decision making in treatment and rehabilitation. Patients and methods - 165 consecutive patients with acute primary hip fracture were prospectively included in the study. Pre-fracture Barthel-20, Barthel-100, cumulated ambulation score, and new mobility score were scored immediately after admission. Outcome defined as mortality, residential status, and independent walking ability was assessed at 4 months. Results - 3 of the assessment instruments, namely Barthel-20, Barthel-100, and new mobility score, correlated with outcome at 4 months post-fracture and were valid predictors. Thresholds were estimated. We found no evidence that Barthel-100, with its finer granularity, performs better than Barthel-20 as a predictor. Interpretation - Our findings indicate that pre-fracture scores of Barthel-20 and new mobility score have predictive ability, and further investigation of usage for guidance of clinical and rehabilitation decisions concerning hip fracture patients is warranted.

Patterns of work injuries: cases admitted to emergency room treatment compared to cases reported to the Danish Working Environment Authority during 2003-2010.

OBJECTIVE: To compare work injuries treated in an emergency department (ED) and injuries reported to the Danish Working Environment Authority (DWEA). METHODS: Work injuries of the ED, Odense University Hospital, and injuries from the geographical catchment area reported to the DWEA between 2003 and 2010 were included. The injuries included in both datasets were identified by merging the ED file and the DWEA file using the civil registry number and injury date information as key. RESULTS: Approximately 50 000 work injuries occurred in the catchment area of the ED. The intersection between the two injury registration systems was 16%. A major discordance concerned the type of injuries, as some injuries were seen frequently in the ED but not reported to the DWEA to any significant extent, for example 'eye injuries' and 'superficial lacerations or wounds'. On the other hand, some injuries are rarely seen in the ED, but often reported to the DWEA, for example 'low back pain'. Additionally, younger workers visit the ED more often than older workers, and injuries in the high risk sectors have the lowest reporting proportion. CONCLUSIONS: Neither the ED nor DWEA injury files alone give a complete picture of work injuries. But merged, they represent a significant number of injuries, taking into account differences in data sources, for example concerning uneven distribution of age, sex, type of injury and type of industry. Obviously, not all serious work related ED injuries resulting in lost work time are reported to the DWEA.

Human resource requirements for quality-assured electronic data capture of the tuberculosis case register.

BACKGROUND: The tuberculosis case register is the data source for the reports submitted by basic management units to the national tuberculosis program. Our objective was to measure the data entry time required to complete and double-enter one record, and to estimate the time for the correction of errors in the captured information from tuberculosis case registers in Cambodia and Viet Nam. This should assist in quantifying the additional requirements in human resources for national programs moving towards electronic recording and reporting. METHODS: Data from a representative sample of tuberculosis case registers from Cambodia and Viet Nam were double-entered and discordances resolved by rechecking the original case register. Computer-generated data entry time recorded the time elapsed between opening of a new record and saving it to disk. RESULTS: The dataset comprised 22,732 double-entered records of 11,366 patients (37.1% from Cambodia and 62.9% from Viet Nam). The mean data entry times per record were 97.5 (95% CI: 96.2-98.8) and 66.2 (95% CI: 59.5-73.0) seconds with medians of 90 and 31 s respectively in Cambodia and in Viet Nam. The percentage of records with an error was 6.0% and 39.0% respectively in Cambodia and Viet Nam. Data entry time was inversely associated with error frequency. We estimate that approximately 118-person-hours were required to produce 1,000 validated records. CONCLUSIONS: This study quantifies differences between two countries for data entry time for the tuberculosis case register and frequencies of data entry errors and suggests that higher data entry speed is partially offset by requiring revisiting more records for corrections.

Collecting core data in severely injured patients using a consensus trauma template: an international multicentre study.

INTRODUCTION: No worldwide, standardised definitions exist for documenting, reporting and comparing data from severely injured trauma patients. This study evaluated the feasibility of collecting the data variables of the international consensus-derived Utstein Trauma Template. METHODS: Trauma centres from three different continents were invited to submit Utstein Trauma Template core data during a defined period, for up to 50 consecutive trauma patients. Directly admitted patients with a New Injury Severity Score (NISS) equal to or above 16 were included. Main outcome variables were data completeness, data differences and data collection difficulty. RESULTS: Centres from Europe (n = 20), North America (n = 3) and Australia (n = 1) submitted data on 965 patients, of whom 783 were included. Median age was 41 years (interquartile range (IQR) 24 to 60), and 73.1% were male. Median NISS was 27 (IQR 20 to 38), and blunt trauma predominated (91.1%). Of the 36 Utstein variables, 13 (36%) were collected by all participating centres. Eleven (46%) centres applied definitions of the survival outcome variable that were different from those of the template. Seventeen (71%) centres used the recommended version of the Abbreviated Injury Scale (AIS). Three variables (age, gender and AIS) were documented in all patients. Completeness > 80% was achieved for 28 variables, and 20 variables were > 90% complete. CONCLUSIONS: The Utstein Template was feasible across international trauma centres for the majority of its data variables, with the exception of certain physiological and time variables. Major differences were found in the definition of survival and in AIS coding. The current results give a clear indication of the attainability of information and may serve as a stepping-stone towards creation of a European trauma registry.

Characteristics of tuberculosis patients at intake in Cambodia, two provinces in China, and Viet Nam.

BACKGROUND: The tuberculosis register is a critical data source for the information system of national tuberculosis control programs. From the information in the tuberculosis case register, it is possible to extend the standard analysis of age and sex characteristics among sputum smear-positive cases to all tuberculosis case categories. National tuberculosis programs might utilize such information to identify problems related to referral and access to diagnosis and treatment. OBJECTIVES: Based on the electronic database we created, our objectives were to provide a detailed description of age and sex characteristics of tuberculosis patients at registration and to provide a comparison of age-specific sex characteristics among incident and prevalent sputum smear-positive cases. METHODS: A representative sample of tuberculosis case registers from 1 January 2003 to 31 December 2005 was selected in Cambodia, two provinces in China and Viet Nam. Age and sex characteristics of cases in the three separate prevalence surveys in the three jurisdictions (Cambodia: year 2002; China: year 2000; and Viet Nam: year 2006-2007) were obtained for comparison. RESULTS: A total 37,635 patients had been registered during the period in the selected units in the three countries. Cases were more frequently male in all three countries with 53%, 71%, and 69% in Cambodia, China, and Viet Nam, respectively.The ratios of the female-to-male odds in the notification system to that in the prevalence survey in smear-positive cases in Cambodia, China and Viet Nam were 2.1, 0.9, and 1.8, respectively. Because of the small proportion of extrapulmonary tuberculosis registered in China, we limited the analysis on age and sex distribution for extrapulmonary cases to Cambodia and Viet Nam. The proportion with extrapulmonary tuberculosis among all cases was 18.5% in Cambodia and 15.7% in Viet Nam, decreasing in frequency with increasing age. CONCLUSIONS: Characteristics of patients greatly differed between countries and between patient categories. In Cambodia and Viet Nam, efforts should be made for improved case-finding of sputum smear-positive tuberculosis among males.

Do repeat victims of interpersonal violence have different demographic and socioeconomic characters from non-repeat victims of interpersonal violence and the general population? A population-based case-control study.

AIM: To study if adult repeat victims of violence have different demographic and socioeconomic character from non-repeat victims of violence and the general population. METHODS: Case-control study comparing demographic and socioeconomic characteristics before first-time victimisation among repeat victims of violence to that of non-repeat victims and population-based controls. Repeat and non-repeat victims were included from an urban emergency department and an institute for forensic medicine. Data was analysed using logistic regression in unadjusted, semi-adjusted, and fully-adjusted models. RESULTS: For almost all demographic and socioeconomic factors in our study, the strongest associations were found when repeat victims were compared to population-based controls, whereas associations obtained from comparison with non-repeat victims were less pronounced. Compared to non-repeat victims, factors most strongly associated with repeat victimisation were being a pensioner (OR 3.21), being unemployed (OR 2.11), high level of lifetime unemployment (OR 1.50), high level of household crowding (OR 1.49), and living without a partner (OR 1.30). Compared to population-based controls, factors most strongly associated with victimisation were being a pensioner (OR 6.83), being unemployed (OR 3.01), living without a partner (OR 3.15), high level of lifetime unemployment (OR 2.40), high levels of household crowding (OR 2.35), large age difference to partner (OR 1.82), and citizenship in a country outside Europe (OR 1.61). CONCLUSIONS: The study indicates that repeat victims of violence may be a demographic and socioeconomic subgroup of adult victims of violence characterised by certain pronounced risk factors which are already present at the time of the first episode of violent victimisation.

Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty: a clinical randomized study.

STUDY DESIGN: Clinical randomized study. OBJECTIVE: Percutaneous vertebroplasty is compared to conservative treatment in patients with acute or subacute osteoporotic vertebral fractures with respect to pain, physical and mental outcomes. The risk of vertebral fractures adjacent to treated levels is assessed. SUMMARY OF BACKGROUND DATA: There are some disagreements of the benefits of PVP for the treatment of acute osteoporotic vertebral fractures, but the long-term clinical outcome of PVP compared to conservative treatment has not been evaluated in a randomized study. METHODS: The 3-months follow-up of this study has been published previously, and here we report the completed 12-months analysis. About 50 patients (41 females) were included from January 2001 until January 2008. Patients with vertebral fractures less than 8 weeks old were included and randomized to either PVP or conservative treatment. Pain was assessed with a visual analogue scale. Physical and mental outcomes were assessed by validated questionnaires and tests. Tests, questionnaires, and plain radiographs were performed at the inclusion and after 3 and 12 months. RESULTS: Pain score before and after the operation in the PVP group was 7.9 and 2.0, respectively. There was no difference between the groups concerning pain at the 3- and 12-months follow-up. Supplementary assessment of back pain 1 month after discharge from hospital showed a significant lower VAS score in the PVP group over the conservative group. In the study period, 2 adjacent fractures in the PVP group and no adjacent fractures in the conservative group were registered. CONCLUSION: PVP is a good treatment for some patients with acute/subacute painful osteoporotic vertebral fractures, but the majority of fractures will heal after 8 to 12 weeks of conservative treatment with subsequent decline in pain. The risk of new fractures needs further research.

Seasonal variation among tuberculosis suspects in four countries.

The objective of the study was to analyze monthly trends across a calendar year in tuberculosis suspects and sputum smear-positive cases based on nationally representative samples of tuberculosis laboratory registers from Moldova, Mongolia, Uganda and Zimbabwe. Out of the 47 140 suspects registered in the tuberculosis laboratory registers, 13.4% (6312) were cases. The proportion varied from country to country, Moldova having the lowest (9%) and Uganda the highest (21%). From the monthly proportion of suspects and cases among total suspects and cases, seasonal variations were most marked in Mongolia which, among the four countries, also has the most pronounced seasonal variation in ambient temperature. Female suspects were consistently older than female cases in all four countries. Among males, male suspects were almost consistently older than male cases, most consistently in Moldova. Seasons seem to affect attendance to diagnostic laboratory services, evidenced by the contrasting findings of Mongolia (extreme continental northern climate) compared to Uganda (equatorial climate). A combination of external and possibly endogenous factors seems to determine whether tuberculosis suspects and cases present themselves to health care facilities.

What is the lifetime risk of contact with an A&E Department or an Institute of Forensic Medicine following violent victimisation?

OBJECTIVE: The aim of the study was to estimate the age and gender specific incidence rates of first time contact with an A&E Department and/or an Institute of Forensic Medicine due to violent victimisation in a Danish low-risk urban population and, secondly to estimate the corresponding lifetime risk of violence based upon these incidence rates. METHODS: All first time contacts of victims of violence with the A&E Department at Odense University Hospital and/or the Institute of Forensic Medicine, University of Southern Denmark 1991-2002 were included. Based on estimated age and gender specific annual incidence rates of first time violence and on the survival rates of the background population, the lifetime risk was estimated assuming calendar time stationarity of incidence and survival rates. RESULTS: The overall annual incidence rate of first time violence was 9.2 [95% CI: 9.0-9.4] per 1000 population/year for males and 2.6 [95% CI: 2.5-2.7] per 1000 population/year for females. The estimated lifetime risk was 0.440 [95% CI: 0.438-0.442] for males and 0.180 [95% CI: 0.178-0.181] for females. The highest cumulative risk for both males and females was in the age group 15-24 years, 0.192 [95% CI: 0.188-0.195] for males and 0.048 [95% CI: 0.046-0.051] for females. CONCLUSION: The current study shows, that even in a country with a relatively low risk of violent victimisation a considerable part of the population over a lifetime will need medical assistance after violent victimisation.

The epidemiology of repeat contacts with an Emergency Department or an Institute of Forensic Medicine due to violent victimization in a Danish urban population.

OBJECTIVE: The aim of this study was to describe the epidemiology of repeat contacts with an urban emergency department (ED) and/or an institute of forensic medicine. METHODS: All victims of violence in contact with the ED at Odense University Hospital and/or the Institute of Forensic Medicine, University of Southern Denmark 1991-2002 were included. Victims who had two or more contacts were identified as repeat victims and a recurrence proportion was estimated. Survival analysis was made with time of observation from the first to the second contact due to violence and a repetition percentage was estimated as the proportion with repeated characteristics in the incident leading to the second contact compared to the index contact and a repetition percentage was estimated. RESULTS: Overall 10,216 individuals with 14,307 incidents were included in the study. Overall, the recurrence proportion was 22% and repeat victims who were responsible for 44% of all contacts to the ED and/or the Institute of Forensic Medicine in the study period. The median time from first to the next incident was 1.75 years for males and 1.64 years for females. Overall 34% of the males and 37% of the females experienced the next incident within 1 year. The time span decreased significantly with increasing age for both males and females. The frequency of weapon use was low with a repetition percentage of 17% for males and 7% for females. For potential severe lesions such as bone fractures and internal lesions the repetition percentage was 28% and 19% for males and 23% and 25% for females. CONCLUSIONS: The present study showed that contact with an ED due to violent victimization often is followed by subsequent contacts with the same ED and/or the IFM due re-victimization and that recurrent incidents share characteristics.

Time trends in cancer risk and pesticide exposure, a long-term follow-up of Danish gardeners.

OBJECTIVES: Occupational exposure to petrochemical pesticides was high during the first 10-15 years after their introduction in the late 1940s, and, during these years, many cases of intoxication occurred. In the 1960s, the use and marketing of pesticides was regulated to reduce exposure to these substances, and, since 1970, substantial exposure has been rare in Denmark. The present study aimed at investigating the extent to which these alterations have influenced the cancer risk of gardeners. METHODS: A historical cohort of 3156 male gardeners was followed from May 1975 until 2002 with regard to cancer incidence. RESULTS: The cancer incidence was significantly below the national average [standardized incidence ratio (SIR) 0.86, 95% confidence interval (95% CI) 0.79-0.94], but an analysis by birth cohort indicated marked differences with a downward tendency for younger birth cohorts. Among the gardeners born prior to 1915, significant increases were found for leukemia (12 cases, SIR 2.33, 95% CI 1.32-4.10) and soft tissue sarcoma (3 cases, SIR 5.87, 95% CI 1.89-18.20). CONCLUSIONS: Gardeners constitute a healthy worker group, but an increased risk of soft tissue sarcoma and leukemia is indicated for people born prior to 1915, a finding that may reflect substantial pesticide exposure during the late 1940s and the 1950s. Among the gardeners born in 1915 or later, no excess cancer risk was found. The latter finding suggests a cancer-preventive effect for safety recommendations and improved technical devices with respect to pesticide application, along with legislative control measures to reduce pesticide exposure.

[Barthel Index for evaluation of function: a Danish consensus on its use]. / Barthel indeks til vurdering af funktionsevne: Dansk konsensus om brug.

The Barthel Index is widely used in the evaluation of function. In Denmark at least three versions are used without a consensus of their specific formulation. The term ''Modified Barthel Index'' is used for several versions. A Barthel Index score without version has no meaning since a maximum score in one version indicates very poor function in another. This paper describes the proper usage of the Barthel Index and suggests the terminology ''Barthel-20'' and ''Barthel-100'' for the recommended versions published by Collin et al and Shah et al. The number after ''Barthel-'' indicates the maximum score.

Decreasing incidence of hip fracture in the Funen County, Denmark.

BACKGROUND: Hip fracture incidence rates are high, and increase with increasing age. Previous studies have predicted a continued increase in both crude and age-standardized rates. METHOD: We estimated incidence rates, based on a complete and validated register containing verified and individually sequenced hip fractures from 1996-2003, for a population of 500,000 people in Funen County, Denmark. RESULTS: The verified number of the first hip fractures was 6,676, with 520 subsequent fractures. Between 1996 and 2003, the incidence rate of first hip fracture fell by 2.4% per year for males (p = 0.02) and by 1.8% per year for females (p = 0.004). The highest decrease of 3.4% per year (p = 0.02) was seen in 80-84-year-old women. INTERPRETATION: The incidence rate of the first hip fracture has fallen in both sexes. In most age groups, the actual number of fractures has also decreased. The findings emphasize the need for valid projection studies which should include both demographic projections and modeling of the effects of different levels of prevention.

Prevention of farm injuries in Denmark.

OBJECTIVES: This study examined the effects of a 4-year randomized intervention program that combined a safety audit with safety behavior training in the prevention of farm injuries. METHODS: From a random sample of farms in the county of Ringkoebing, Denmark, 393 farms with 1597 residents and employees participated in a weekly self-registration of work-related accidents and injuries during 1 year. Worktasks and time at risk were recorded. A questionnaire including items on safety behavior was also mailed to each farm. Thereafter, the farms were randomly assigned to an intervention or control group. Two hundred and one farms with 990 persons at risk participated in the intervention study. The main outcome measures were the number and severity of accidents, safety behavior, and farmsite safety audits. RESULTS: Pre- and postmeasurements showed a substantial reduction in injury rates in the intervention group in comparison with a slight reduction in the control group. In a multivariate regression analysis the intervention effect was estimated to be a 30% injury-rate reduction of all injuries, while there was a 42% reduction for medically treated injuries only. Although none of these effects are statistically significant with the present sample size, their magnitude and direction support an intervention effect. The measures of safety behavior revealed significant improvements, and this finding supports the conclusion that the intervention effect was positive, since they concern some of the mediating factors on the pathway from intervention to improved injury rates. CONCLUSIONS: This intervention, which focused on safety behavior and was performed as a randomized controlled trial, was followed by a substantial reduction in the number of farm injuries. The reduction was particularly marked for the more severe injuries demanding medical treatment.

[Economic coverage and average costs related to injuries treated in a hospital]. / Økonomisk daekningsgrad og gennemsnitlige omkostninger ved hospitalsbehandlet tilskadekomst.

INTRODUCTION: The purpose of this study was to estimate the average costs of injuries and the proportion of total (treatment + social) costs covered when including injuries treated at the hospital. MATERIAL AND METHODS: The empirical data consisted of emergency department visits (n = 29,516) from the catchment area of Odense University Hospital in 1992 for all age groups and a representative population sample (n = 1074 injuries) for the age group 15-67 years old. The costs were assessed following the "cost of illness" principles. RESULTS: The average costs per injured person varied significantly by age and were 26,119 DKK for 68+ years old, 2357 DKK for 15-67 years old, and 1528 DKK for 0-14 years old. The total direct costs for hospital treated persons were 117 million DKK, of which "injuries at home among elderly women" totalled 29% and road traffic injuries 25%. The numerical proportion of hospital treated injuries was 36% (95% CI 32-39%), but in economic terms 92% for treatment costs, and 85% when including social costs. DISCUSSION: The proportion of total regional economic costs is considerably higher (85 or 92%) than in numerical terms for hospital based registration of injuries. Future cost studies can be based on hospital data for the age group 15-67 years old for road traffic injuries. If extrapolated conservatively to all of Denmark (population approx five million) the figures indicate that an amount of approx 2.-2.5 billion DKK per year (2002 level) is spent.