Clinical aspects of bowel symptoms in Parkinson's disease.

BACKGROUND: The clinical importance of bowel symptoms in Parkinson's disease (PD) remains to be described in detail. METHODS: A 33-item questionnaire including background parameters, the Cleveland Constipation Score (CCS), and items from the Neurogenic Bowel Dysfunction score was sent to 468 PD patients. Results were compared to a control group (CG) (n = 45). A CCS of at least 15 was used to define severe constipation. RESULTS: Four hundred and sixteen subjects (89%) responded. Median CSS was only 4 (range 0-21) in PD and 2 (range 0-13) in the CG (P < 0.05). Severe constipation was found in 7% with PD and 0% in the CG (P < 0.05). Incomplete emptying at defecation, need for assisted defecation and use of oral laxatives was reported more frequently by PD patients than by the CG (all P < 0.05). The severity of PD was associated with assisted defecation (P < 0.001), unsuccessful attempts at defecation (P < 0.001), incomplete emptying at defecation (P < 0.05), and the CCS (P < 0.01). Time since diagnosis was associated with infrequent defecation (P < 0.0001) and the CCS (P < 0.05). The use of levodopa was associated with less unsuccessful attempts at defecation (P < 0.05). CONCLUSION: Most patients with PD only have minor constipation-related symptoms. However, severe constipation is associated with time since diagnosis and severity of disease.

Socio-economic status and adherence to tuberculosis treatment: a case-control study in a district of Nepal.

SETTING: A western hill district in Nepal, where tuberculosis (TB) treatment under DOTS was offered by the regional tuberculosis centre, two primary health centres, eight health posts, three sub-health posts and one ward of sub-metropolitan Pokhara. OBJECTIVE: To analyse the contribution of socioeconomic status to non-adherence to DOTS. DESIGN: Case-control study. Data were collected by questionnaire-based face-to-face interviews. The study sample consisted of 50 cases and 100 controls. The participation rate was 80% for cases (non-adherents) and 95% for controls. RESULTS: Logistic regression analysis showed that the risk of non-adherence to TB treatment was significantly associated with unemployment (odds ratio [OR] 9.2), low status occupation (OR 4.4), low annual income (OR 5.4), and cost of travel to the TB treatment facility (OR 3.0). Factors significant in the bivariate analyses--living conditions, literacy and difficulty in financing treatment--were not found to be significantly associated with non-adherence when adjusted for other risk factors in the multivariate regression model. CONCLUSION: Low socio-economic status and particularly lack of money are important risk factors for non-adherence to TB treatment in a poor country such as Nepal.

Outcome of pre-hospital antibiotic treatment of meningococcal disease.

OBJECTIVE: To assess the effect of pre-hospital antibiotic treatment given by general practitioners to patients with meningococcal disease. DESIGN: A 16-year population-based historical follow-up study based on referral letters and hospital records in the County of North Jutland, Denmark. SUBJECTS: 320 patients with meningococcal disease, of whom 302 were examined by a general practitioner before admission to hospital. MAIN OUTCOME MEASURES: Death. RESULTS: 44 patients (14.6%) were given antibiotic treatment by the referring general practitioner. Nine of these (20.5%) died, compared with 16 (6.2%) patients who did not receive pre-hospital antibiotic treatment. The presence of skin bleeding, petechiae, and impaired consciousness were strongly associated with case fatality. Even after adjustment for these variables the odds ratio (OR) for death in patients treated with antibiotics was high (OR = 3.2; 95% CI, 0.9-10.6). In the 15 patients with skin bleeding (ecchymoses, suggillations) the case fatality rate was 100% in patients treated with antibiotics, and 50% in patients who did not receive antibiotics before hospitalization. If skin bleeding was replaced in the models by the presence of disseminated intravascular coagulation on admission, the OR for death in patients with pre-hospital antibiotic treatment was 35.9 (95% CI, 2.9-441.8) in the presence of disseminated intravascular coagulation and 1.9 (95% CI, 0.2-19.5) in its absence. CONCLUSIONS: Pre-hospital treatment is mainly given to the most severe cases with expected high case fatality, and this confounding by indication was probably not fully adjusted for with the available data. The results contradict previous findings but provide reason to doubt the benefit of pre-hospital antibiotic treatment in patients with meningococcal disease.

Health selection among members of a Danish Trade Union.

The effect of selection on the mortality of members of the Danish carpenters and cabinet makers trade union is reported. Some 40 000 persons entering or leaving the Union between January 1971 to June 1976 were followed until September 1977, and deaths identified by record linkage with the central person-register. The male leaving cohort had a statistically significant higher age adjusted mortality rate than the male entry cohort with a relative death risk of 1.65. For females the difference was not significant but the relative death risk was estimated to be 1.42. Males leaving to or coming from well paid and socially esteemed jobs had significant lower mortality rates than the remainder. The influence of these results on the choice of study design is discussed.

A follow-up study of non-retired and retired members of the Danish Carpenter/Cabinet Makers' Trade Union.

A 6 years follow-up study of mortality among Danish carpenters and cabinet makers (40 000 persons) shows an SMR of 82 in the group of non-retired and an SMR of 70 in the group of retired union members. No major causes of death except nasal cancer were significantly above the national average. Problems of methodology in using retired workers in the occupational mortality studies are discussed.

A framework for evaluation of secondary data sources for epidemiological research.

BACKGROUND: As part of the development in information technology, increasing amounts of health care data are available for epidemiological research. METHODS: In this review, we discuss the following factors affecting the value of secondary data in research: 1) completeness of registration of individuals, 2) the accuracy and degree of completeness of the registered data, 3) the size of the data source, 4) the registration period, 5) data accessibility, availability and cost, 6) data format, and 7) possibilities of linkage with other data sources (record linkage). RESULTS AND CONCLUSION: The importance of these issues depends on the use of the data and on the problems they have to address. If the evaluation is satisfactory with respect to the above-mentioned factors relevant to the particular study, the data source could be a very cost-effective way of solving the research problem.

Episodic heavy drinking in four Nordic countries: a comparative survey.

AIMS: The purpose of this study was to compare the phenomenon of episodic heavy drinking (binge drinking) and its different indicators in the Nordic countries. DESIGN: A comparative survey of four Nordic countries. SETTING: Telephone interviews in Denmark, 1997; Finland, 1996; Norway, 1996; and Sweden 1996-97. PARTICIPANTS: Random samples of men and women aged 19-71 years. MEASUREMENTS: Episodic heavy drinking was measured by the frequency of subjective intoxication, of drinking six or more drinks at a time (6+), and of negative consequences (mainly hangover symptoms). Additionally, annual consumption and measures of intake per occasion were used. FINDINGS: Annual consumption, overall frequency of drinking and frequency of drinking 6+ were highest in Denmark and lowest in Norway. Frequency of subjectively defined intoxication was highest in Finland. There it was clearly higher than the frequency of drinking 6+, whereas in Denmark the contrary was observed. Finnish and Norwegian men and Danish women reported the largest quantities drunk per occasion. Results on 6+ frequency and the prevalence of negative consequences, with annual consumption held constant, suggest that Danes have the least concentrated drinking pattern. With annual consumption held constant, Norwegians report as high a frequency of intoxication, as do Finns. CONCLUSIONS: The relations between subjective and more objective measures of episodic heavy drinking vary considerably between the Nordic countries. The results suggest that the definition, acceptability and experience of intoxication vary even when a set of relatively homogeneous countries are compared.

Occupational causes of laryngeal cancer.

In a case-control study of all new cases of laryngeal cancer in Denmark from 1980 to 1982, 326 cases and 1134 community selected controls participated. Questionnaires were used to obtain information on education, occupation, and number of occupational exposures as well as smoking and drinking habits. High risk ratios for laryngeal cancer were found for semiskilled and unskilled workers, workers exposed to dust, out of doors workers, drivers, and people working in the cement industries and port services. The study hypothesis was that exposure to chromium or nickel increases the incidence rate of laryngeal cancer. No support for this was found concerning chromium, but exposure to nickel had a statistically significant risk ratio of 1.7.

Participation in a follow up study of health among unemployed and employed people after a company closedown: drop outs and selection bias.

This article presents an analysis of study loss in a three year longitudinal study of 1816 employees at two Danish shipyards, one of which closed just before the start of the study. The aim of the study was to elucidate the health consequences of a company closedown and the subsequent job loss. The study population responded to an identical questionnaire in 1983, 1984 and 1985. The participation rate in 1983 was 73%. The percentage of drop outs in 1984 and 1985 was 15-20% of the total numbers responding in the first year. We examined this study loss in relation to the characteristics of the respondents, using the first round of data collection as a baseline. In a multivariate analysis, age and seniority at the shipyard were the only variables that were significantly associated with non-participation in 1984 and 1985. It is concluded that the drop outs did not appear to introduce a serious risk of selection bias in 1984 and 1985. A comparison between drop outs and late respondents in 1984 and 1985 did not support the supposition that information about late respondents can be extrapolated to drop outs.

Effect of combined alcohol and tobacco exposure on risk of cancer of the hypopharynx.

The effect of moderate to heavy exposure to alcohol and tobacco on the risk of cancer of the hypopharynx is estimated in a case-control study. All incident hypopharyngeal cancer patients in Denmark who were under 75 years of age were compared with incident cases of laryngeal cancer and population sampled controls. The ascertainment of cases and controls took place during March 1980 to March 1982. Thirty-two patients with cancer of the hypopharynx, 321 patients with cancer of the larynx, and 1141 population sampled controls participated in the study. The effect of combined exposure to alcohol and tobacco seemed to be multiplicative rather than additive, a finding which is similar to that in laryngeal cancer patients. However, as there were only small numbers, only major deviations from the additive or multiplicative model for interaction would be detectable.

Age and the operationalization of social support.

In most studies social network is operationalized without any consideration of age. But it is to be expected that both the prevalence and the impact on health of the various sources of social support change through life. If this is true, then the use of a global index may lead to distorted results regarding age changes of the social network. In a cross-sectional study of 1500 occupationally active, Danish men aged 16-74, the hypothesized age dependencies were studied with health operationalized as psychological well-being and social support divided into support from wife, children, family and friends. The prevalence of support from the wife increased with age, whereas her impact on health was only significantly positive in the age range 30-49. Support from family and friends was most prevalent among the youngest, but it had a positive impact on health both among the young and the old. The results regarding impact on health are corroborated by two other studies on mortality. These findings point to methodological errors that may distort results when global network measures are used irrespective of the ages of the participants studied.

Glycosylated hemoglobin as predictor of adverse fetal outcome in type 1 diabetic pregnancies.

The study aimed to determine whether a consistent dose-response association can be demonstrated, after adjustment for maternal age and White classification, between glycosylated hemoglobin (HbA1c) values before conception and in the first trimester of pregnancy of insulin-dependent diabetic mothers and adverse fetal outcome (abortions and major malformations). This is a historical follow-up study based on medical records in a geographically defined catchment area. The study comprised 60 pregnancies with HbA1c determinations before pregnancy and 161 with HbA1c in the first trimester in women with type 1 diabetes admitted between 1980 and 1992. Relative risk calculations indicated a highly significant and consistent correlation between HbA1c values above 6.6% and adverse fetal outcome after adjustment for differences in maternal age and White classification. Our data support a clinically significant and consistent relationship between adverse fetal outcome and HbA1c in the first trimester of pregnancy of type 1 mothers, without any indication of a cut-off level below which further improvement in HbA1c was of minor importance.

Determinants of child mortality in a rural Ugandan community.

OBJECTIVE: To estimate the rate of and risk factors associated with child mortality in rural eastern Uganda. DESIGN: A community based cross-sectional study using the preceding birth technique--a robust method of obtaining information of survival of the previous child. SETTING: A rural district in Eastern Uganda. PARTICIPANTS: In total, 2888 multigravidae were interviewed in April and May 1999. MAIN OUTCOME MEASURE: Number of deaths among children born alive. RESULTS: The under-two child mortality rate was 108 per 1000 livebirths. The annual child mortality was 82 per 1000 child-years of risk. Child mortality was associated with low parental education, being born to adolescent mothers or mothers aged 35 or more. Unconditional logistic regression showed that children born to uneducated parents had a doubled risk of not celebrating their second birthday. It was three times more likely for a child to die in the neonatal period than in the first year of life. Child mortality risk decreased by 4% and 6% for every year of education attained by mothers and fathers, respectively. Parity, residence and marital status were not associated with excess risk of child mortality. Seasonal mortality followed the El Nino rainfall pattern. Finally, there were geographical differences in child mortality although this was not statistically significant. CONCLUSION: Monitoring trends in child mortality at district level can be done using the preceding birth technique in antenatal settings. Maternal education, an important predictor of child survival should be included in routine data collection at clinics.

Hospital admissions before and after shipyard closure.

To determine the effect of job loss on health an investigation was made of admissions to hospitals in 887 men five years before and three years after the closure of a Danish shipyard. The control group comprised 441 men from another shipyard. The information on hospital admissions was obtained from the Danish national register of patients. The relative risk of admission in the control group dropped significantly in terms of the number of men admitted from the study group from 1.29 four to five years before closure to 0.74 in the three years after closure. This was especially true of admissions due to accidents (1.33 to 0.46) and diseases of the digestive system (4.53 to 1.03). For diseases of the circulatory system, particularly cardiovascular diseases, the relative risk increased from 0.8 to 1.60, and from 1.0 to 2.6 respectively. These changes in risk of illness after redundancy are probably a consequence of a change from the effects of a high risk work environment to the effects of psychosocial stresses such as job insecurity and unemployment.

Cigarette smoking and breast cancer.

OBJECTIVE: To investigate cigarette smoking in relation to the risk of breast cancer. DESIGN: Interviews with women referred for mammography. SETTING: Hjørring District Hospital, a public, population based hospital in Denmark. SUBJECTS: 3240 women aged 15-92 years referred for mammography during 1 June 1989 to 1 November 1991. MAIN OUTCOME MEASURES: Smoking, parity, age, reason for referral, breast cancer. RESULTS: In a multiple logistic regression analysis adjusted for six variables a pronounced increased risk of breast cancer was found in women who had smoked for over 20 years, and this was significant in women who had smoked for over 30 years (odds ratio 1.6, 95% confidence interval 1.1 to 2.3). The median age of women with breast cancer was 59 (range 31-81) years for smokers and 67 (38-92) years for nonsmokers. The difference of eight years between the median ages was significant (P < 0.01). CONCLUSION: Smoking may increase the risk of breast cancer after 30 years of smoking.

Psychological distress in pregnancy and preterm delivery.

OBJECTIVE: To investigate if psychological distress during pregnancy is associated with increased risk of preterm delivery. DESIGN: Prospective, population based, follow up study with repeated measures of psychological distress (general health questionnaire), based on the use of questionnaires. SETTING: Antenatal care clinic and delivery ward, Aarhus University Hospital, Denmark. SUBJECTS: 8719 women with singleton pregnancies attending antenatal care for the initial visit between 1 August 1989 and 30 September 1991; 5872 women (67%) completed all questionnaires. MAIN OUTCOME MEASURE: Preterm delivery. Estimation of gestational age at delivery was mainly based on early ultrasound measurements. RESULTS: In 197 cases (3.6%) the woman delivered prematurely (less than 259 days). A dose-response relation between psychological distress in the 30th week of pregnancy and risk of preterm delivery was found, but distress measured in the 16th week was not related to preterm delivery. Control of confounding was secured by the use of multivariate logistic regression models. Relative risk for preterm delivery was 1.22 (95% confidence interval 0.84 to 1.79) for moderate distress and 1.75 (1.20 to 2.54) for high distress in comparison to low distress. CONCLUSIONS: Psychological distress later in pregnancy is associated with an increased risk of preterm delivery. Future interventional studies should focus on ways of lowering psychological distress in late pregnancy.

Birth weight and cognitive function in young adult life: historical cohort study.

OBJECTIVE: To examine the relation between birth weight and cognitive function in young adult life. DESIGN: Retrospective cohort study based on birth registry data and cognitive function measured during evaluation for military service. SUBJECTS: 4300 Danish conscripts born between 1973 and 1975. MAIN OUTCOME MEASURES: Mean score in the Boerge Prien test of cognitive function; score is the number of correct answers to 78 questions and correlates with full scale intelligence quotient (IQ). RESULTS: Mean score in the Boerge Prien test increased from 39.9 at a birth weight of < or = 2500 g to 44.6 at a birth weight of 4200 g even after adjustment for gestational age and length at birth, maternal age and parity, and other variables. Above a birth weight of 4200 g the test score decreased slightly. CONCLUSION: Birth weight is associated with cognitive performance in young adult life. Interference with fetal growth may influence adult cognitive performance.

[Duration of maternity leave and sick leave during pregnancy]. / Orlovsvarighed og fravaersmeldinger i graviditeten.

The aim of the project was to describe the reasons for sick leave during pregnancy. This article presents data on a subgroup of women on sick leave. The purpose of this reanalysis was to examine whether women with short maternity leave had longer sick leave during pregnancy. Pregnant women in a Danish County applying for sick leave in a year were consecutively included in the study. Data were obtained by questionnaires during 1991-1992. Women with rights to a longer maternity leave, obtained through collective bargaining, were mainly employed in occupational groups related to the public sector and were on sick leave significantly longer, than women with short maternity leave, obtained only through legislation. The diagnoses differed among the two groups. Data suggest unequal possibilities for obtaining pregnancy related sick leave, as women with longer predelivery leave and a more secure employment situation had significantly longer sick leave than other women.

[Thymomoa in Denmark]. / Tymomer i Danmark.

This is a descriptive study of thymomas notified to the national Danish Cancer Registry and registered by the departments of pathology during the years 1943-1993. A total of 433 cases of benign and malignant thymomas were included over these 50 years with an increase of the incidence to a stable rate of 2.5/million/year from start to 1973. The male:female ratio is 1:1. While the age-specific incidence rate for persons below 40 years is constantly low throughout the period of investigation, a doubling of the rate is registered for persons between 70 and 79 during the period 1978-1993. The incidence rate in Copenhagen is much higher compared to other regions of Denmark. The above-mentioned increase in incidence is due mainly to an underreporting of benign thymomas during the first period of investigation (1943-1977), but may also be due to improved diagnostic capabilities and to more uniform methods of registration during the last period (1978-1993).

[Fatal accidents in house fires. The most significant causes, such as smoking and alcohol abuse, multiplied by four the incidence during the last 40 years]. / Dødsulykker ved bygningsbrande. Rygning og alkoholmisbrug er vaesentlige årsager til en fordobling over 40 år.

A population-based descriptive investigation of housefire accidents in Denmark was carried out for the two five year periods 1953-58 and 1988-93, based on death certificates, police reports and autopsy reports. The number of deaths due to housefire accidents in Denmark has increased (1953-58: 136 (66 men and 70 women), 1988-93: 363 (212 men and 150 women), mostly due to an increase in tobacco-smoking related fire accidents. In 1988-93 the three common causes of housefire deaths were tobacco-smoking, often in combination with alcohol intoxication or handicap (51%), cooking-accidents (10%) and accidents with candles (9%). The largest risk groups were chronic alcoholics, handicapped and elderly people. In conclusion, warnings should be issued against smoking in bed and use of loose-fitting clothing while cooking on an open fire. Protective aprons and devices for use while smoking, self-extinguishing cigarettes and use of fireproof materials in furniture and clothing may prevent ignition. Smoke-alarms may secure early warning.