Prevalence of nocturia and fecal and urinary incontinence and the association to childhood obesity: a study of 6803 Danish school children.

INTRODUCTION: Fecal and urinary incontinence are common disorders in children. Obesity and its associated comorbidities have become increasingly common, and a relation between obesity, nocturia, incontinence, and nocturnal enuresis has been suggested. OBJECTIVE: This large scale population study aims to determine the prevalence of fecal incontinence (FI), daytime urinary incontinence (DUI), nocturnal enuresis (NE), and nocturia in children at school entry and in adolescence and to clarify whether obesity is associated to any of the aforementioned symptoms. STUDY DESIGN: First-grade children and their parents and adolescents in the seventh to ninth grades were interviewed in relation to school nurse visits. The interview included questions on whether incontinence or nocturia were experienced at least once per month. The participants' age was recorded, and weight and height were measured. Body mass index (BMI) was calculated and age standardized by the use of BMI-standard deviation score (SDS), with reference to World Health Organization normative BMI data. Obesity was defined as BMI-SDS >2. Associations between obesity and incontinence and nocturia were quantified by odds ratio (OR). RESULTS: Completed interview questionnaires and measurements were obtained from 4002 children (95.1%) in the child population and 2801 adolescents (84.4%) in the adolescent population. The mean age of children was 6.45 ± 0.39 years, and 4.4% were obese. Overall 11.2% reported FI, 21.8% DUI, 16.8% NE, and 31.4% experienced nocturia. Obesity was associated with FI in first-grade boys (OR 1.86 compared with normal weight). Mean age of adolescents was 13.9 ± 0.85 years, and 7.6% of adolescent boys and 5.5% of the girls were obese. Fecal incontinence was reported by 2.1% of the adolescents, 4.5% had DUI, 1.0% stated to have NE, and 32.3% reported nocturia. Obesity was significantly associated with nocturia in adolescents (OR 1.74-2.01). DISCUSSION: The prevalence of nocturia seems constant throughout childhood and adolescent life; this has not previously been documented. Incontinence is very common at school entry, with DUI reported more frequently than enuresis by both children and adolescents. Obesity is associated with nocturia in adolescents and FI in first-grade boys, but no significant association between obesity and NE or DUI is found. Strength of this study is the very high participation rates, but the study does not reveal information on previous treatment, subtype, or severity of symptoms. CONCLUSIONS: Incontinence is very common in children. One-third of both children and adolescents experience nocturia. Obesity is associated with FI in first-grade boys and nocturia in adolescents.

Occupation, employment status and chronic inflammatory bowel disease in Denmark.

BACKGROUND: Certain occupational groups have formerly been identified as having higher risks of suffering from chronic inflammatory bowel diseases. These were evaluated in an independent data set. METHODS: A cohort, comprising all 2 273 872 male and female Danes aged 20-59 years on 1 January 1986 were followed up for hospitalizations due to chronic inflammatory bowel disease until 31 December 1990. RESULTS: From 1981 to 1990 6296 first time admissions occurred. The incidence increased from 1981-1985 to 1986-1990. Of 363 male and 213 female occupational groups eight and five groups respectively had statistically significant raised standardized hospitalization ratios. Among 15 groups previously found to have significant odds ratios only female office staff and health occupations were found to have statistically significant raised standardized hospitalization ratios. Ratios for occupational groups with non-daytime work were not statistically significant. Compared to occupations without sedentary work occupations with predominantly sedentary work had a standardized hospitalization ratio of 125 (95% confidence interval [95% CI] : 116.9-133.1). Self-employed had low hospitalization rates, while 'other salaried staff' and 'not economically active' had high rates. CONCLUSIONS: We found no consistent pattern of occupations at increased risk except that sedentary work may increase the risk of attracting chronic inflammatory bowel disease.

Antideuteron production in 158A GeV/c Pb + Pb collisions

The invariant cross section as a function of transverse momentum for antideuterons produced in 158A GeV/c per nucleon Pb+Pb central collisions has been measured by the NA44 experiment at CERN. This measurement, together with a measurement of antiprotons, allows for the determination of the antideuteron coalescence parameter. The extracted coalescence radius is found to agree with the deuteron coalescence radius and radii determined from two particle correlations.

Shift work, risk factors and cardiovascular disease.

The literature on shift work, morbidity and mortality from cardiovascular disease, and changes in traditional risk factors is reviewed. Seventeen studies have dealt with shift work and cardiovascular disease risk. On balance, shift workers were found to have a 40% increase in risk. Causal mechanisms of this risk via known cardiovascular risk factors, in relation to circadian rhythms, disturbed sociotemporal patterns, social support, stress, behavior (smoking, diet, alcohol, exercise), and biochemical changes (cholesterol, triglycerides, etc) are discussed. The risk is probably multifactorial, but the literature has focused on the behavior of shift workers and has neglected other possible causal connections. In most studies methodological problems are present; these problems are related to selection bias, exposure classification, outcome classification, and the appropriateness of comparison groups. Suggestions for the direction of future research on this topic are proposed.

Intervention in shift scheduling and changes in biomarkers of heart disease in hospital wards.

OBJECTIVES: The effect of introducing regularity, few consecutive night shifts, more weekends off, and only 2 different types of shifts (day-evening or day-night) into shift scheduling on biomarkers of heart disease was studied. METHODS: Ergonomic shift criteria were introduced in a quasi-experimental controlled intervention in 4 hospital wards. Six wards participated as controls. Altogether 101 nurses and nurses' aides were followed for 6 months with measurements of cholesterol and triglycerides. The intervention led to more regular schedules and more staff having 2 shifts in 2 of the intervention wards 1 year after the intervention. The schedules among the controls became less regular and less predictable. The number of consecutive night shifts remained unchanged. RESULTS: After 6 months the high-density lipoprotein (HDL) cholesterol level had increased in the intervention group, and the total cholesterol and low-density lipoprotein (LDL) cholesterol levels and the total:HDL cholesterol ratio had decreased. Regardless of the intervention, changes in regularity were associated with the triglyceride and HDL cholesterol levels and also with the total:HDL cholesterol ratio. More ergonomic changes were associated with lower LDL cholesterol levels, a lower total:HDL cholesterol ratio, and higher HDL cholesterol levels. CONCLUSIONS: Increased ergonomic scheduling was possible. Lipids and lipoproteins changed as predicted, both when the changes were assessed in respect to the changes in schedules that resulted from the intervention and the changes that occurred regardless of the intervention. The study suggests that scheduling based on ergonomic criteria is a possible means for reducing the risk of heart disease among shift workers.

Management of health and safety in the organization of worktime at the local level.

OBJECTIVES: This study examined the consideration of health and safety issues in the local process of organizing worktime within the framework of regulations. METHODS: The study encompassed all 7 hospitals in one region of Denmark. Twenty-three semi-structured interviews were carried out with 2 representatives from the different parties involved (management, cooperation committees, health and safety committees from each hospital, and 2 local unions). Furthermore, a questionnaire was sent to all 114 wards with day and night duty. The response rate was 84%. Data were collected on alterations in worktime schedules, responsibilities, reasons for the present design of schedules, and use of inspection reports. RESULTS: The organization of worktime takes place in single wards without external interference and without guidelines other than the minimum standards set in regulations. At the ward level, management and employees were united in a mutual desire for flexibility, despite the fact that regulations were not always followed. No interaction was found in the management of health and safety factors between the parties concerned at different levels. CONCLUSIONS: The demands for flexibility in combination with the absence of guidelines and the missing dynamics between the parties involved imply that the handling of health and safety issues in the organization of worktime may be accidental and unsystematic. In order to consider the health and safety of night and shift workers within the framework of regulations, a clarification of responsibilities, operational levels, and cooperation is required between the parties concerned.

Shift work and sick leave.

OBJECTIVE: Shift workers working nights are known to have higher morbidity from certain illnesses than day workers. This study examined episodes of certified sick leaves of day workers and shift workers in a large industrial plant to examine whether slowly rotating shift work leads to increased risk of sick leave. METHODS: In a case-base design more than 11000 episodes of sick leave, lasting more than 3 days, were obtained from the sick-leave files of a chemical plant in Norway. The diagnoses were grouped into 5 categories according to information on their work schedules. The workers included in the study were divided into 3 groups. They worked slowly rotating 3 shifts, 2 shifts without night work, and daytime schedules. RESULTS: For all the diagnoses the shift workers and day workers were evenly distributed among the cases and the referents, the odds ratios ranging from 0.8 to 1.2. The risk of sick leave did not change with the number of years in shift work. There was a higher risk of sick leave with musculoskeletal diagnoses among the 2-shift workers. CONCLUSIONS: In this study shift workers did not have a higher risk of sick leave for diseases that, in previous studies, have been shown to be related to shift and night work. Although bias may be present in the study, the results are in line with those of previous studies, and they suggest that even certified sick leaves are not a valid proxy for morbidity.

Work environment of Danish shift and day workers.

OBJECTIVES: Both shift work and other work environment factors have been shown to be related to heart disease. This study examined whether shift work is associated with other work environment factors related to heart disease in a random sample of the population. If so, shift work could be acting as a proxy for work environment differences. METHODS: Data on 5940 employees in the Danish Work Environment Cohort Study from 1990 were reanalyzed. The information included work schedules [permanent day work, irregular workhours (including morning work), 2-shift or fixed evening and 3-shift or fixed night], length of workweek, physical factors (noise, heat, dust, passive smoking, walking, standing and monotonous repetitive tasks), and psychosocial factors (including demands and control dimensions, social support, conflicts and job insecurity). RESULTS: At least 1 group of shift workers had a higher prevalence of nearly every unfavorable work environment factor investigated. Exceptions were dust exposure and quantitative demands. Especially conflicts at work and low decision latitude were higher among all the groups of shift workers, and all-day walking or standing work and part-time jobs were more often found among female shift workers. The 3 different shiftwork groups were exposed to different parts of the work environment, and also men and women in shift work differed in relation to the work environment. Age and social class influenced the relationship, but not in any particular pattern. CONCLUSIONS: In a heterogenous population shift work was found to be associated with other work environment factors suspected to cause heart disease.

Shiftwork and cardiovascular disease: review of disease mechanisms.

This paper reviews the main findings concerning mechanisms explaining the increased risk of coronary heart disease (CHD) in shiftworkers. We discuss a conceptual model, in which three main shiftwork pathways to CHD are postulated--social problems, behavioral change, and disturbed circadian rhythm. Social problems that are associated with shiftwork might lead to stress. Significant shiftwork-related behavioral problems are smoking and unhealthy food habits. Disturbed circadian rhythm might result in sleep deprivation. Unphysiologic timing of physical activity and food intake in relation to circadian rhythms is another possible explanation for the negative impact on the cardiovascular system.

[Occupational and chronic inflammatory bowel disease in Denmark]. / Erhverv og kronisk inflammatorisk tarmsygdom i Danmark.

It has been suggested that some occupational groups have a high risk of contracting chronic inflammatory bowel diseases. A cohort, comprising 2,273,872 male and female Danes aged 20-59 on 1 January 1981, and a cohort similarly defined as of 1 January 1986 were followed up for hospitalizations due to chronic inflammatory bowel disease until 31. December 1990. From 1981 to 1990, 6296 first time admissions occurred. Among 15 groups previously found to be at high or low risk only female office staff and health personnel had statistically significantly increased standardized hospitalization ratios. Occupations with non-daytime work did not have an increased risk. Occupations with predominantly sedentary work had a standardized hospitalization ratio of 125 (95% confidence interval 116.9-133.1) compared to occupations without sedentary work. Self-employed had low hospitalization rates, while 'other salaried staff' and "not economically active" had high rates.

[Occupational environment and strain induced gout. A review of epidemiological studies of the connection between occupational environment and coxarthrosis]. / Arbejdsmiljø og slidgigt i hoften. En oversigt over epidemiologiske undersøgelser of sammenhaengen mellem arbejdsmiljø og coxarthrosis.

Osteoarthrosis of the hip is a frequent complaint with multifactorial causal relations. The causes have hitherto not been associated with the work environment. Through a systematic literature search 15 epidemiological studies dealing with the relation between occupation or factors in the work environment and coxarthrosis were found. A critical evaluation finds that farmers and construction workers have an increased risk of contracting coxarthrosis. Work that is strenuous for the hip such as lifting and ladder climbing might also be risk factors. Prevention of heavy work involving the hip is proposed as a consequence of this knowledge. The Danish Workers Compensation Act should also take these findings into consideration.

[Shift work, social class and ischemic heart disease in middle-aged and elderly men. A 22-year follow-up in the "Copenhagen Male Study"]. / Skiftearbejde, socialklasse og iskaemisk hjertesygdom hos midaldrende og aeldre maend. 22-års opfølgning i "Copenhagen Male Study".

Shift work has been reported as a risk factor for ischaemic heart disease. Most studies have only partly controlled for social class differences, a recognized risk factor for ischaemic heart disease (IHD), and the relative risk of 1.4 could be a result of confounding. The Copenhagen Male Study was established in 1971 as a prospective cohort study of 5,249 men, and included questions on working time, social class and other potential confounders. The cohort was followed through registers for 22 years. Risk of IHD and all cause mortality did not differ between shift and day workers, the adjusted relative risk for IHD being 0.9 (0.7-1.1). Restriction to social class III led to lower risk estimates, with an adjusted relative risk of 0.7 (0.5-1.0). The study gave no support to the hypothesis that shift work is an independent risk factor for IHD. The role of shift work as an independent risk factor for IHD is still controversial.

Single-transverse-spin asymmetries of identified charged hadrons in polarized pp collisions at sqrt[s]=62.4 GeV.

The first measurements of xF-dependent single-spin asymmetries of identified charged hadrons, pi+/-, K+/-, and protons, from transversely polarized proton-proton collisions at 62.4 GeV at RHIC are presented. Large asymmetries are seen in the pion and kaon channels. The asymmetries in inclusive pi+ production, AN(pi+), increase with xF from 0 to approximately 0.25 and AN(pi-) decrease from 0 to approximately -0.4. Observed asymmetries for K- unexpectedly show positive values similar to those for K+, increasing with xF, whereas proton asymmetries are consistent with zero over the measured kinematic range. Comparisons of the data with predictions of QCD-based models are presented.

Internal locus of control and choice in health service shift workers.

This study examined the relationship between shift work-specific locus of control (SH-LOC), active choice of work schedule and health outcomes, personal initiatives and coping behaviours in 1611 Danish Health Service shift workers. The 20-item SH-LOC scale was administered as part of a battery of measures. Multivariate analysis of covariance (controlling for age, workplace experience and weekly work hours) tested for differential responses to shift working and coping strategies. Interactive effects of internality and type of work rota were examined. Higher internality was linked to better tolerance to shift work. This did not appear to be a result of greater personal action in higher internals. The importance of control as a potential moderating factor to shift work exposure and the possible use of this measure in the process of shift worker monitoring is highlighted.

Production of mesons and baryons at high rapidity and high p(T) in proton-proton collisions at square root[s] = 200 GeV.

We present particle spectra for charged hadrons pi(+/-), K(+/-), p, and p[over] from pp collisions at square root[s] = 200 GeV measured for the first time at forward rapidities (2.95 and 3.3). The kinematics of these measurements are skewed in a way that probes the small momentum fraction in one of the protons and large fractions in the other. Large proton to pion ratios are observed at values of transverse momentum that extend up to 4 GeV/c, where protons have momenta up to 35 GeV. Next-to-leading order perturbative QCD calculations describe the production of pions and kaons well at these rapidities, but fail to account for the large proton yields and small p[over]/p ratios.

Centrality dependence of charged-particle pseudorapidity distributions from d + Au collisions at sqrt[sNN] = 200 GeV.

Charged-particle pseudorapidity densities are presented for the d + Au reaction at sqrt[s(NN)] = 200 GeV with -4.2 < or = eta < or = 4.2. The results, from the BRAHMS experiment at BNL Relativistic Heavy-Ion Collider, are shown for minimum-bias events and 0%-30%, 30%-60%, and 60%-80% centrality classes. Models incorporating both soft physics and hard, perturbative QCD-based scattering physics agree well with the experimental results. The data do not support predictions based on strong-coupling, semiclassical QCD. In the deuteron-fragmentation region the central 200 GeV data show behavior similar to full-overlap d+Au results at sqrt[s(NN)] = 19.4 GeV.

Charged meson rapidity distributions in central Au+Au collisions at square root(sNN) = 200 GeV.

We have measured rapidity densities dN/dy of pi+/- and K+/- over a broad rapidity range (-0.1 < y < 3.5) for central Au + Au collisions at square root(sNN) = 200 GeV. These data have significant implications for the chemistry and dynamics of the dense system that is initially created in the collisions. The full phase-space yields are 1660 +/- 15 +/- 133 (pi+), 1683 +/- 16 +/- 135 (pi-), 286 +/- 5 +/- 23 (K+), and 242 +/- 4 +/- 19 (K-). The systematics of the strange to nonstrange meson ratios are found to track the variation of the baryochemical potential with rapidity and energy. Landau-Carruthers hydrodynamics is found to describe the bulk transport of the pions in the longitudinal direction.