Quality of life and level of post-traumatic stress disorder among trauma patients: A comparative study between a regional and a university hospital.

BACKGROUND: The aim of this study was to assess outcome in long-term quality of life (QoL) and post-traumatic stress disorder (PTSD) among adult survivors of trauma. Secondary aim was to compare levels of the outcome with injury severity and specialization level of two trauma centres. METHODS: A retrospective study included patients received by the trauma response teams at two hospitals in 2013 aged 18 or more at follow-up. We assessed QoL and PTSD with one mailed questionnaire to each patient at either 12 or 24 months of follow-up. Health status was measured by EuroQol EQ-5D and the Glasgow Outcome Scale. PTSD symptoms were classified according to the Post-Traumatic Stress Disorder Checklist (PCL) and Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). RESULTS: A questionnaire was mailed to 774 patients at end of 2014 or early 2015, 455 were included for analysis; median age 44 (IQR 25-57; 68% male); median NISS 9 (IQR 2-17); At follow-up 24% (95% CI 20-28) reported a EQ index score value equivalent to the lowest 2.3% in the Danish population norm. Probable PTSD was present in 19% (95% CI 13-27) of patients with severe injuries (NISS> 15), and 23% (95% CI 19-28) of those with NISS < 15. CONCLUSION: Severe trauma has substantial impact on QoL and PTSD assessed at 12-24 months after the trauma. The QoL was well below the Danish population norm. The presence of PTSD was independent of injury severity. Trauma Centres should consider to include this as part of the treatment principles.

The relationship between macroeconomic and industry-specific business cycle indicators and work-related injuries among Danish construction workers.

OBJECTIVES: The current study examines and compares the relationship between both macroeconomic and industry-specific business cycle indicators, and work-related injuries among construction workers in Denmark using emergency department (ED) injury data and also officially reported injuries to the Danish Working Environment Authority (WEA). METHODS: The correlations between ED and WEA injury data from the catchment area of Odense University Hospital during the period 1984-2010 were tested separately for variability and trend with two general macroeconomic indicators (gross domestic product and the Danish unemployment rate) and two construction industry-specific indicators (gross value added and the number of employees). RESULTS: The results show that injury rates increase during economic booms and decrease during recessions. However, the regression coefficients were generally weak for both the ED (range 0.14-0.20) and WEA injuries (range 0.13-0.36). Furthermore, although there is some variability in the strength of the relationship of the different business cycle indicators, the relationships are generally not stronger for the WEA injuries than for the ED injuries, except for general unemployment. Similarly, no substantial differences in strength of relation between industry-specific and macroeconomic indicators were identified. CONCLUSIONS: The study shows that there was no difference in the relationship between business cycle indicators, and WEA and ED injury data. This indicates that changes in reporting behaviour do not seem to play a major role in the relation between the business cycle and workplace injuries in a Danish context.

Sex-related risks of trauma in medieval to early modern Denmark, and its relationship to change in interpersonal violence over time.

Skeletons from three Danish cemeteries, Sortebrødre, Tirup, and St. Mikkel, that collectively held 822 adults (>15 years) and spanned the medieval to early modern periods (ca. AD 1100-1610) show that men, in general, experienced more bone fractures than women. Men were three times more likely to have healed cranial vault and ulnar shaft fractures than women, with many of these bones presumably broken in interpersonal violence. More women, however, broke distal radii, presumably often the result of falls. Both sexes suffered more cranial fractures than modern Danes, with the proportional difference for men and women being about the same. The difference in cranial trauma frequencies between historic-period and modern Danes has implications for a decline over the past several centuries in interpersonal violence that scholars in other disciplines have inferred from historical sources.

Changes in body weight and tuberculosis treatment outcome in Viet Nam.

SETTING: National Tuberculosis Programme, Viet Nam, 2008. OBJECTIVE: To assess the relationship between changes in body weight and tuberculosis (TB) treatment outcome. METHODS: All treatment cards of patients from a sample of 30 randomly selected treatment units in the country were analysed. RESULTS: Of 2609 patients, 2506 (96.1%) had a successful treatment outcome. The median body weight of all patients at diagnosis was 46.0 kg (25th and 75th percentiles 41-51). New sputum smear-positive TB patients with a successful treatment outcome gained an average of 2.6 kg during treatment. Patients with weight loss during the first 2 months of treatment were more likely to have an unsuccessful outcome than patients without (OR 4.9, 95%CI 3.0-7.9). Patients weighing <40 kg at treatment start who gained more than 5% of their body weight after 2 months of treatment had a significantly smaller risk of an unsuccessful treatment outcome than patients who did not (OR 0.2, 95%CI 0.05-0.96). CONCLUSIONS: Patients failing to gain weight or losing weight, particularly during the first 2 months of treatment, require particular attention, as they appear to be at an increased risk of unsuccessful treatment outcome.

Efficient, quality-assured data capture in operational research through innovative use of open-access technology.

Ensuring quality of data during electronic data capture has been one of the most neglected components of operational research. Multicentre studies are also challenged with issues about logistics of travel, training, supervision, monitoring and troubleshooting support. Allocating resources to these issues can pose a significant bottleneck for operational research in resource-limited settings. In this article, we describe an innovative and efficient way of coordinating data capture in multicentre operational research using a combination of three open access technologies-EpiData for data capture, Dropbox for sharing files and TeamViewer for providing remote support.

La garantie de la qualité des données au cours de la capture des données électroniques a constitué une des composantes les plus négligées de la recherche opérationnelle. De plus, les défis des études multicentriques comportent des problèmes concernant les logistiques du voyage, la formation, la supervision, le suivi et le soutien au dépannage. Une allocation de ressources à ces problèmes peut constituer un goulot significatif pour les recherches opérationnelles dans les contextes à ressources limitées. Dans cet article, nous décrivons une façon innovatrice et efficiente pour la capture des données de coordination dans la recherche opérationnelle multicentrique au moyen d'une combinaison de trois technologies libres d'accès­EpiData pour la capture des données, Dropbox pour le partage des dossiers et TeamViewer pour procurer un soutien à distance.

Garantizar la calidad de los datos durante la captura electrónica ha sido uno de los componentes más desatendidos de la investigación operativa. Los estudios multicéntricos afrontan además dificultades relacionadas con la logística del desplazamiento, la capacitación, la supervisión el seguimiento y de la asistencia técnica para la resolución de los problemas. La atribución de recursos a estas esferas puede representar un cuello de botella de la investigación operativa en los entornos con escasos recursos. En el presente artículo se describe un método innovador y eficaz de coordinar la captura de datos en investigación operativa mediante la aplicación de tres tecnologías de acceso abierto, a saber: EpiData en la captura de datos, Dropbox en la puesta en común de los archivos y TeamViewer en la prestación de asistencia técnica a distancia.

Adequacy of anti-tuberculosis drug prescriptions in Viet Nam.

SETTING: National Tuberculosis Program, Viet Nam, 2008. OBJECTIVES: To determine drug prescription adherence to national guidelines, to examine factors associated with an erroneous dosage of rifampin (RMP) and to evaluate the impact of an insufficient RMP dosage on treatment outcome. METHODS: A representative sample of 30 treatment units was randomly selected. All patient treatment cards enrolled in these units were obtained, and data were double-entered and validated before calculating the adequacy of the individual drug prescriptions. RESULTS: Of 3412 tuberculosis treatment cards, 3225 (94.5%) had information on treatment regimen and the patient's weight. Treatment was successful in 89.4%. Prescriptions of tablets/vials conforming to recommendations were found for respectively 91.2%, 89.9%, 92.3% and 94.6% of the patients for RMP/isoniazid, pyrazinamide, ethambutol and streptomycin. Patients in the 25-39 kg weight bracket received insufficient dosages. This was almost entirely attributable to patients at the end of the weight bracket. Nevertheless, no significant association was found between treatment failure and death, body weight and insufficient RMP dosage. CONCLUSIONS: Adherence to national recommendations was high. RMP was given in insufficient dosage for patients at the end of a weight range bracket, but the under-dosage was small and did not measurably affect treatment outcome.

Time to unsuccessful tuberculosis treatment outcome, Cambodia, China, and Viet Nam.

OBJECTIVE: To determine the frequency and characteristics of patients with unsuccessful tuberculosis (TB) treatment. METHODS: Random selection of TB case registers among all treatment units in Cambodia, two provinces in China, and Viet Nam. The data of two calendar years were analyzed to assess unsuccessful outcomes and their time of occurrence. RESULTS: Among the 33 309 TB patients, treatment was unsuccessful in respectively 10.1%, 3.0% and 9.1% of patients in Cambodia, China and Viet Nam. The risk of death was highest in Cambodia, higher among males than females, increased with age, and was more common among retreatment cases than new cases, and among patients with a high than a low sputum smear microscopy grade. Half of all deaths occurred in the first 2 months in Cambodia and within 11 weeks in China and Viet Nam. Median time to default was 3 months in Cambodia and Viet Nam, and about 2 months in China. CONCLUSIONS: Treatment was highly successful in the three study countries, with a low proportion of death and default. As the majority of defaulting occurs at the beginning of treatment, all countries should critically review their current policy of treatment support in this period.

Quality assurance of data: ensuring that numbers reflect operational definitions and contain real measurements.

Any analysis is only as convincing as the quality of the underlying data. In this article, the role of data quality is exemplified by its impact on the interpretation of surveillance data, by operations research projects conducted in the training courses of the International Union Against Tuberculosis and Lung Disease, and the lessons learnt through them. It provides information why double-entry and validation of data are part of 'good clinical practice'. It is suggested how the efficiency of data entry can be maximized to reduce data entry time and data entry errors, so that psychological and physical barriers to double-entry are reduced.

Completeness and consistency in recording information in the tuberculosis case register, Cambodia, China and Viet Nam.

SETTING: Tuberculosis (TB) case registers in Cambodia, two provinces in China and in Viet Nam. OBJECTIVE: To determine completeness and consistency of information for quarterly reports on case finding and treatment outcome. METHODS: A representative sample of TB case registers was selected in Cambodia, in two provinces in China and in Viet Nam. Quarterly reports were reproduced from double-entered, validated data to determine completeness and consistency. RESULTS: The dataset comprised 37,635 patient records in 2 calendar years. Only 0.2%, 3.6% and 1.1% of cases, respectively, in Cambodia, the two China provinces, and Viet Nam did not allow classification for the quarterly report on case finding. If the treatment outcome was reported as cured, it was correct in 99.9%, 85.7%, and 98.5% of the respective three jurisdictions: errors were mostly due to misclassification of completion as cure. Under-reporting of failures was more frequent than over-reporting in Cambodia and Viet Nam, while in the two provinces in China 84% of reported failures did not actually meet the bacteriological criterion. CONCLUSIONS: This evaluation demonstrates that recording essential information is exemplary in all three countries. It will be essential to carefully supervise the ability of staff to correctly define TB treatment outcome results in all three countries.

Quantitative differences in sputum smear microscopy results for acid-fast bacilli by age and sex in four countries.

OBJECTIVE: To examine the influence of age and sex on the grading of tuberculosis (TB) sputum smear microscopy results. SETTING: Laboratories in Moldova, Mongolia, Uganda and Zimbabwe. METHODS: Data from nationally representative samples of laboratory registers were double-entered and validated, and discordances were resolved by rechecking against the registers. RESULTS: The dataset comprised 128,808 examinees from 23 laboratories in Moldova, all 31 in Mongolia, 30 in Uganda and 23 in Zimbabwe, each covering at least one calendar year. Among all examinees, 89,362 had a diagnostic examination, 13,577 (15.2%) of whom were cases. A non-quantified positive result was recorded among 1272 (9.4%) of these. Scanty results were most frequent in Zimbabwe (8.5%) and most infrequent in Uganda (1.1%). In contrast, the highest grade, of 3+ positive, was most frequent (43.9%) in Mongolia. The lowest proportion of low-grade positivity was recorded for males aged 15-24 years and the highest among females aged >or=65 years. CONCLUSION: Differences in the frequency of low-grade positivity between the four countries were striking. Females tended to have lower bacillary counts, and low-grade positivity was more frequent at the extremes of age. These results reinforce the need for appropriate instructions on how to produce high-quality sputum to improve yield.

Making pragmatic sense of data in the tuberculosis laboratory register.

SETTING: Tuberculosis (TB) microscopy network in Moldova, Mongolia, Uganda and Zimbabwe. OBJECTIVE: To evaluate how scrutinising the information recorded in the TB Laboratory Register can assist in improving the performance of the microscopy laboratory network and TB case management. METHODS: Review of records for completeness in registration of age, sex, reason for examination, analysis of variability patterns in serial smears and provision of exemplary statistical process charts of scanty positive results over time in the four countries. RESULTS: A total of 128808 records were analysed. A large proportion of examinees in Uganda (6.9%) and Zimbabwe (3.9%) had no information on sex. The reason for examination was unknown for 7.4%. Among suspects with three smear results with at least one positive result, 56.1% had no variation in the pattern. Statistical process control charts revealed considerable fluctuation in the frequency of scanty positive smears over a calendar year. CONCLUSION: An analysis of information recorded in the TB Laboratory Register not only identifies strengths and weaknesses in the laboratory, it also reveals weaknesses on a much wider scale, in the entire case management system. TB laboratory data can thus demonstrate when, where and what action is indicated, and how performance might be monitored over time.

Sputum smear-positive tuberculosis: empiric evidence challenges the need for confirmatory smears.

OBJECTIVE: To determine the frequency of single scanty or positive sputum smear results and its impact on the surveillance definition of sputum smear-positive tuberculosis (TB). SETTING: Moldova, Mongolia, Uganda and Zimbabwe. METHODS: A representative sample of laboratories was selected in each country. Data were double-entered and discordances resolved by rechecking the register. RESULTS: The dataset comprised 128808 examinees with valid information from 23 laboratories in Moldova, all 31 in Mongolia, 30 in Uganda and 23 in Zimbabwe, each covering at least one calendar year. The reason for the examination was diagnostic for 89362, of which 15.2% (n = 13577) were defined as laboratory cases with at least one bacillus on at least one examination. Cases were confirmed by another examination in 72.6% (n = 9861). Of the 9014 cases who had a full set of three examinations, confirmation was obtained in 92.4% (n = 8325). CONCLUSION: One quarter of laboratory cases had no confirmatory result, almost entirely attributable to not examining another specimen. The current definition of sputum smear-positive TB requires two positive smears or one positive smear result plus more complex confirmatory evidence. Accepting a single positive examination as sufficient for the definition would greatly increase the sensitivity of the surveillance definition without sacrificing its specificity.

Short time-frame from first to second hip fracture in the Funen County Hip Fracture Study.

INTRODUCTION: Hip fracture patients represent a frail group of elderly with increased morbidity and mortality. The aim of this study was to evaluate the occurrence and distribution of a second hip fracture in the time interval between the first and the second hip fracture. METHODS: All incident hip fractures in residents of Funen County, Denmark, from 1994 through 2004 were recorded. Verified fractures were sequenced within each patient using the unique Danish identification numbers. RESULTS: In total, 9990 incident hip fractures occurred: 9122 first hip fractures and 868 (8.7%) second fractures. Within the first year after the first hip fracture, the incidence rate of the second fracture in men decreased from 73 per 1000 person-years (py) during the first 3 months to 8 per 1000 py at 12 months; in women, it decreased from 116 per 1000 py during the first 3 months to 15 per 1000 py at 12 months. Of all the second fractures, 50% occurred within 12 months in men and within 19 months in women. CONCLUSIONS: Few hip fracture patients experience a second hip fracture and when they do, it is within a short time-frame from the first. The risk of sustaining a second hip fracture is high during the first 12 months following the first hip fracture, decreasing to a level equal to or below the incidence of the first hip fracture after this 12-month period. Preventive strategies at the time of the first hip fracture should therefore aim at immediate effects, as interventions with effects after 12 months (men) and 19 months (women) bypass at least 50% of the fractures.

Prevalence of atopic dermatitis, asthma, allergic rhinitis, and hand and contact dermatitis in adolescents. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis.

BACKGROUND: Atopic diseases are common in children and adolescents. However, epidemiological knowledge is sparse for hand eczema and allergic contact dermatitis in this age group. Furthermore, no population-based studies have evaluated the prevalence of atopic diseases and hand and contact dermatitis in the same group of adolescents. OBJECTIVES: To assess prevalence measures of atopic dermatitis (AD), asthma, allergic rhinitis and hand and contact dermatitis in adolescents in Odense municipality, Denmark. METHODS: The study was carried out as a cross-sectional study among 1501 eighth grade school children (age 12-16 years) and included questionnaire, interview, clinical examination and patch testing. RESULTS: The lifetime prevalence of AD was 21.3% (girls 25.7% vs. boys 17.0%, P < 0.001) using predefined questionnaire criteria. The 1-year period prevalence of AD was 6.7% and the point prevalence 3.6% (Hanifin and Rajka criteria). In the interview the lifetime prevalence of inhalant allergy was estimated as 17.7% (6.9% allergic asthma, 15.7% allergic rhinitis). The lifetime prevalence of hand eczema based on the questionnaire was 9.2%, the 1-year period prevalence was 7.3% and the point prevalence 3.2%, with a significant predominance in girls. A significant association was found both between AD and inhalant allergy, and between AD and hand eczema using lifetime prevalence measures. The point prevalence of contact allergy was 15.2% (girls 19.4% vs. boys 10.3%, P < 0.001), and present or past allergic contact dermatitis was found in 7.2% (girls 11.3% vs. boys 2.5%). Contact allergy was most common to nickel (8.6%) and fragrance mix (1.8%). CONCLUSIONS: High prevalence figures were found for atopic diseases, hand eczema and allergic contact dermatitis, and the diseases were closely associated. A considerable number of adolescents still suffers from AD, and a considerable sex difference was noted for hand eczema and allergic contact dermatitis. Nickel allergy and perfume allergy were the major contact allergies. In the future this cohort of eighth grade school children will be followed up with regard to the course and development of atopic diseases, hand eczema and contact dermatitis.

Incidence of unintentional injuries in farming based on one year of weekly registration in Danish farms.

BACKGROUND: In Denmark, farming ranks as the industry with the highest incidence rate of fatal injuries. For nonfatal injuries, insufficient registration practices prevent valid comparisons between occupations. This study examines the occurrence of farm accidents and injuries, as well as work-specific factors, via weekly registration in a representative sample of 393 farms in one county during 1 year. METHODS: From a random sample of 794 farms, (10% of farms in the county of Ringkoebing, Denmark) 393 farms with 1,597 residents and employees participated in a 1-year self-registration of work-related unintentional incidents. The procedure included a detailed registration of hours spent on all main working tasks. Weekly recording of incident occurrence or nonoccurrence resulted in the completion of 19,782 registration forms. Three months after incident occurrence, a telephone interview was conducted about the related work situation and resulting injuries. RESULTS: During the 12-month period, 479 occupational accidents were reported, of which 389 resulted in an injury. The absolute number of injuries increased with number of work hours, but there was no relative increase of incidence by work hours. Persons below the age of 50 had slightly less than a doubled risk compared with those over 50 years of age. No other marked, reliable age effect was found. There was, however, a seasonal variation, with summer and autumn having a double relative incidence compared with winter and spring. Among farm owners, 35% experienced at least one injury per year, while this was the case for 17% of farm laborers. When adjusting for work hours, the increased frequency of injuries among farm owners was reduced to a factor of 1.5. Animal-related work was the most common injury mechanism. Repair and maintenance work was found to be the most dangerous task relative to the number of task-specific work hours. Subgroups of tasks with a markedly increased injury rate were moving animals within the farm, veterinary procedures, and repair of field machinery and stable equipment. CONCLUSIONS: Farm injuries occur among 32% of full-time farmers and farm laborers each year. A quarter of these require professional treatment. This area calls for preventive action.

Manganese exposure in foundry furnacemen and scrap recycling workers.

OBJECTIVES: Cast iron products are alloyed with small quantities of manganese, and foundry furnacemen are potentially exposed to manganese during tapping and handling of smelts. Manganese is a neurotoxic substance that accumulates in the central nervous system, where it may cause a neurological disorder that bears many similarities to Parkinson's disease. The aim of the study was to investigate the sources and levels of manganese exposure in foundry furnacemen by a combined measuring of blood-manganese (B-Mn) and manganese in ambient air (air-Mn). METHODS: During a period of 16 months, Air-Mn and B-Mn (denoted 'exposure values') were measured involving 24 furnacemen employed in three small size foundries and 21 scrap recycling workers from one plant. In the study period, 18 furnacemen had B-Mn measured 3-4 weeks after decreasing or stopping exposure (denoted 'post-exposure values'). The reference group for the B-Mn measurements consisted of 90 Danish male subjects. RESULTS: Furnacemen who work in insufficiently ventilated smelting departments inhale, absorb, and retain significant amounts of manganese in their blood (approx. 2.5-5 microg/l above reference values) despite a generally low measured airborne level of manganese fumes (0.002-0.064 mg/m(3)). The 'exposure values' compared with 'post-exposure values' revealed a significant decrease in the B-Mn (on average 3.7 microg/l) level of the most exposed furnacemen. Two persons in our study were suspected of suffering clinically subacute manganese intoxication as both had B-Mn levels beyond the normal limit (25 and 29 microg/l, respectively). The potential problem disappeared completely after cessation of exposure, and the B-Mn levels decreased to 9.4 and 14.1 microg/l, respectively. CONCLUSIONS: Risk assessment based on combined measurements of B-Mn and air-Mn seems to be valid in the interpretation of workers' hazard. Our study indicates that B-Mn may be a valuable parameter for estimating recent exposure (within 1-2 weeks). However, more knowledge is needed about the B-Mn level and its relation to neurological symptoms.

[Occupational hand injuries. A population-based description of the incidence and referral to casualty departments]. / Arbejdsbetingede håndskader. En populationsbaseret beskrivelse af forekomst og henvendelse til skadestue.

The overall incidence of self-reported occupational hand injuries in a Danish population was estimated to 4.7%, with the highest incidence among the youngest, men and employees in the production and building industries. The life-time risk were 93% for men and 73% for women. Age and gender were found to be independent risk factors for the occupational hand injuries. The proportion treated in the casualty department was 0.28, for injuries with disability and time off work the proportions were 0.46 and 0.69 respectively. No age, gender or occupation specific selection for attending the hospital was found. Prevention-trials against hand injuries should therefore have a high priority, and it is recommended that hospital data files are used increasingly in future prevention programs.

Time off work after occupational hand injuries.

This study analysed the impact of several factors on the start and duration of time off work among 802 patients with occupational hand injuries, in order to identify prognostic indicators. The study showed that external factors such as work and social condition seemed to have less influence on time off work than expected, whereas advice from doctors, flashbacks and impairment symptoms were important determinants.

Helicobacter pylori and risk of ulcer bleeding among users of nonsteroidal anti-inflammatory drugs: a case-control study.

BACKGROUND & AIMS: Peptic ulcer complications related to use of nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common serious adverse drug reactions. Whether Helicobacter pylori infection potentiates this gastrointestinal toxicity of NSAIDs is still unresolved. In this study, we investigated the role of H. pylori as a cause of bleeding peptic ulcer among NSAID users. METHODS: A case-control study of current users (n = 132) of NSAIDs (including acetylsalicylic acid), admitted because of bleeding peptic ulcer, was performed. Controls were 136 NSAID users without gastrointestinal complications. H. pylori was diagnosed by either increased levels of serum immunoglobulin G or by 13C-urea breath test. RESULTS: Fifty-eight (44%) case subjects had a bleeding gastric ulcer, 54 (41%) had a bleeding duodenal ulcer, 12 (9%) had both gastric and duodenal ulcers, and 8 (6%) had hemorrhagic gastritis. H. pylori was present in 75 (57%) cases compared with 59 (43%) controls. The adjusted odds ratio of bleeding peptic ulcer among NSAID users associated with H. pylori infection was 1.81 (95% confidence interval, 1.02-3.21). H. pylori accounted for approximately 24% of bleeding peptic ulcers among elderly NSAID users. CONCLUSIONS: NSAID users infected with H. pylori have an almost twofold increased risk of bleeding peptic ulcer compared with NSAID users without H. pylori.