Smoking and alcohol intake in surgical patients: identification and information in Danish surgical departments.
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Alcohol Drinking↗
Biomedical subjects
H Tønnesen
Publications and source records attributed to H Tønnesen.
Perioperative morbidity and mortality in chronic alcoholic patients.
This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The chairs were Claudia Spies and Hanne Tønnesen. The presentations were (1) Relevance of alcohol misuse in surgical patients, by Hanne Tønnesen; (2) Diagnosis of alcohol abuse and alcohol dependence, by Sven Andreasson; (3) Diagnosis of acute alcohol misuse, by Anders Helander; (4) Preoperative intervention for excessive alcohol consumption, by Kate Conigrave; and (5) Prevention and treatment of perioperative complications in chronic alcoholics, by Claudia Spies.
Alcoholism↗
[Emergency room patients and alcohol consumption].
To investigate the consumption of alcohol among emergency room patients, we included 395 patients above 18 years old entering the emergency room during a period of ten days. The patients completed a questionnaire about alcohol consumption, smoking habits and medication. In our investigation 56% of the men and 25% of the women had a daily consumption above the limits recommended by the Ministry of Health (three drinks daily for men and two for women), while 41% men and 14% women consumed at least five drinks daily or 35 per week. Trauma seen in male patients with high alcohol consumption was characterised by excessive damage to the head, trauma of the lower limb and blows from an object, person or an animal. The alcoholic women were characterised by excessive chemical injuries, incisions and stab wounds, and trauma of the upper limb. In conclusion a surprisingly large amount of emergency room patients can be defined as alcohol abusers and drinking is found to be associated with excessive damage.
Adult↗
[Active and passive smoking among personnel at the Bispebjerg Hospital 1992-1999].
The purpose of this study was to describe changes in smoking behaviour and exposure to passive smoking among hospital employees at a large Danish University Hospital (Bispebjerg Hospital) from 1992 until 1999 as part of a program toward a smoke-free hospital. The study was based upon three cross-sectional self-administered questionnaires surveys carried out among all employees at the hospital--approximately 4000 persons--in October 1992, April 1997 and April 1999, participation rates being 84, 80 and 76 percent. During the seven year period the smoking rate has decreased from 46% to 32% among male and 40% to 33% among female employees. A decrease in smoking rate was found among all subgroups of employees. Among male employees the rate of heavy smokers has decreased from 25 to 16%, among female employees this decrease is lacking, the rate of heavy smokers being 15% during the whole period. The numbers of employees exposed to passive smoking all day or most of the day has changed from 39% to 25% from 1992 until 1999. Among the smokers 30%--8% of all employees--responded that they would not be able to manage without smoking tobacco during working hours. This answer is most commonly found among heavy smokers, smokers with short or no education and smokers who smoke at any time of day. It is concluded that even though there has been a reduction in the smoking rate, the exposure to passive smoking among employees at the hospital still is unacceptably high. Based upon these results it has been decided that Bispebjerg Hospital is smoke-free for all employees from the 1st of January 2000. There is a need for initiatives for the smokers, who can't manage work without smoking.
Attitude to Health↗
[Cooperation in the Sound region when it comes to developmental perspectives of prevention].
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Denmark↗
[Smoking cessation and pregnancy].
OBJECTIVES: To assess the effectiveness of smoking cessation programs implemented during pregnancy and to assess the impact of these programs on the health of the fetus and infant, on the mother and on the family. SEARCH STRATEGY: Randomized and quasi-randomized controlled trials identified by the search strategy of the Cochrane Pregnancy and Childbirth Group, supplemented by the search strategy of the Cochrane Tobacco Group. SELECTION CRITERIA: Trials in which programs to increase smoking cessation were implemented during pregnancy. DATA COLLECTION AND ANALYSIS: Data were abstracted according to predetermined criteria by two observers (S Oliver + J Lumley or E Waters + J Lumley). A total of 40 trials, conducted between 1975 and 1997, comprising over 9,000 women were identified and included in the review. An additional study provided data on over 3,000 women in a cluster-randomized trial. Interventions commonly included in these programs were: the provision of information on the risks of smoking to the fetus and infant and the benefits of quitting; recommendations to quit; feedback about the fetus; teaching cognitive-behavioural strategies for quitting smoking. There was substantial variation in the intensity of the intervention and the extent of reminders and reinforcement through pregnancy. Participants were healthy pregnant women and the usual setting was a hospital or community antenatal clinic. The principal outcome measure was continued smoking in late pregnancy. Eight trials provided some information on fetal outcomes: mean birthweight, low birthweight, preterm birth and perinatal mortality. MAIN RESULTS: Pooled data from 30 trials revealed a significant reduction in the odds of continued smoking in late pregnancy in the intervention groups (odds ratio (OR) = 0.51, 95% confidence interval 0.45 to 0.58). This equates to an absolute difference in the proportion continuing to smoke of 6.6%. The findings were similar when analyses were restricted to the 17 trials with biochemical validated smoking cessation (OR = 0.49, 95% CI 0.42 to 0.58 and an absolute difference in continued smoking of 7.2%); to the 11 trials where the intervention intensity was high (OR = 0.50, 95% CI 0.42 to 0.59 and an absolute difference in continued smoking of 8.6%); and to the 12 trials with a high quality score for the intervention--rated on the theoretical basis, the intensity of the intervention, detailed description of the intervention, process evaluation, validated smoking cessation--(OR = 0.47, 95% CI 0.40 to 0.56 and an absolute difference in continued smoking of 8.9%). The six trials with validated smoking cessation, a high intensity intervention and a high quality score had a pooled OR = 0.47, 95% CI 0.38 to 0.57 and an absolute difference in continued smoking of 9.2%. The subset of trials with information on fetal outcome revealed a reduction in low birthweight (pooled OR = 0.80, 95% CI 0.67 to 0.97), a non-significant reduction in preterm birth (pooled OR = 0.82, 95% CI 0.66 to 1.01), and an increase in mean birthweight of 41 g (95% CI 16.6 to 65.5), but no differences in very low birthweight, stillbirths, neonatal deaths or total perinatal mortality. Three trials of smoking relapse prevention among women who had stopped smoking by the first antenatal visit had a pooled OR = 0.73, 95% CI 0.45 to 1.18, for smoking in late pregnancy, with an absolute difference of 5.5%. The single large cluster-randomized trial showed no evidence of a decrease in continued smoking: the adjusted OR for quitting smoking by late pregnancy was 1.0, 95% CI 0.69 to 1.6. There were no differences in adjusted mean birthweight in this trial by intervention or control clinic. Process evaluation identified some problems with the implementation of this trial. CONCLUSIONS: Smoking cessation programs implemented in pregnancy increase smoking cessation, lead to a small increase in mean birthweight and a small reduction in low birthweight and preterm birth. (ABSTRACT TRUN
Controlled Clinical Trials as Topic↗
[Group therapy and smoking cessation].
OBJECTIVES: Smoking cessation programmes in which groups of smokers have the opportunity to learn behavioural techniques and benefit from mutual support for quitting are widely available. The aim of this review is to determine the effectiveness of smoking cessation programmes delivered in a group format, for helping smokers achieve long-term smoking cessation. SEARCH STRATEGY: The Tobacco Addiction Group specialised register was used to identify trials in which one or more treatment arms used behaviour therapy, group therapy or cognitive therapy. SELECTION CRITERIA: Randomised trials which compared group therapy with self-help, individual counselling, another intervention or usual care or waiting list control were selected. Trials which compared two group programmes with manipulation of the group interaction and social support components were also included. There had to be a minimum of two group meetings, and follow-up of smoking status at least six months after the start of the programme. Trials in which group therapy was provided to both active therapy and placebo arms of trials of pharmacotherapies were not included unless they had a factorial design. DATA COLLECTION AND ANALYSIS: The outcome ceasure extracted was the number of successful quitters at the maximum follow-up using the strictest definition of abstinence, with biochemical validation where possible. Participants lost to follow-up were classified as still smoking. Meta-analysis was performed using a fixed effects model. MAIN RESULTS: Ten studies compared a group programme with a self-help programme presenting the same or similar information and behavioural techniques. There was an increase in cessation with the use of a group programme (OR 2.10 (95% C.I. 1.64-2.70). The direction of effect and significance was robust whether or not trials randomizing workplaces rather than individuals, and trials carried out during campaigns with televised cessation programmes were included. There was no evidence from two trials that group therapy was more effective than a similar intensity of individual counselling, and the trend favoured individual treatment. Comparison of group therapy with advice from a physician or nurse advice found no evidence for an effect, with heterogeneity in the results. Group programmes were more effective than no intervention or minimal contract interventions (OR 1.91 (95% C.I. 1.20-3.04). There was no evidence that manipulating the social interactions between participants in a group programme had an effect on outcome. CONCLUSIONS: There is reasonable evidence that groups are better than self-help, and other less intensive interventions. There is not enough evidence on their effectiveness compared to intensive individual counselling. From the point of view of the consumer who is motivated to make a quit attempt it is probably worth joining a group if one is available--it will increase the likelihood of quitting. From the public health perspective, groups are unlikely to make a substantial impact because of the low uptake.
Behavior Therapy↗
[Alcohol, surgery and prevention].
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Alcoholism↗
[Smoking intervention among hospital staff at the H:S Bispebjerg Hospital. Toward a non-smoking hospital--short-term results].
As part of aiming towards a non-smoking hospital environment, staff at a Copenhagen university hospital were offered participation in a differentiated smoking cessation programme. This consisted of lectures, group therapy, follow-up visits and individually tailored nicotine replacement therapy free-of-charge for six weeks. Three hundred and seventy-four employees started the programme, with 353 continuing for the full six weeks. They were moderately nicotine dependent with a Fagerström score of 5 (0-10). Almost all smoked daily and smoked at work, with 87% having a CO measurement above 5 at the first visit. At six weeks follow-up 209 (59%) were still not smoking and a further seven (2%) had reduced their tobacco consumption substantially. The remainder had started smoking again. Only 10% had a CO measurement > 5 at the end of the study. In conclusion, a combination of theoretical education, individual follow-up visits and nicotine replacement therapy is useful and worthwhile in the effort to support hospital staff in smoking cessation.
Adolescent↗
Association between alcoholism and diverticulitis.
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Alcoholism↗
Observer variation in the assessment of the histopathologic diagnosis of acute appendicitis.
BACKGROUND: The objectives of this study were to determine observer variation in the assessment of the histopathologic diagnosis of acute appendicitis. METHODS: Two consultant pathologists independently evaluated 415 appendectomy specimens (set I). After a consensus conference at which the observers unified the criteria of the diagnosis of acute appendicitis, another 396 appendectomy specimens (set II) were evaluated. To calculate the intra-observer variation, one observer evaluated set II once more. Finally, using the consensus diagnosis as the final diagnosis, the diagnostic accuracy of the surgeon, the primary pathology report, and the two observer evaluations was calculated. RESULTS: In set I no difference was found in the level of agreement on the diagnosis of acute appendicitis versus other diagnoses, and a kappa value of 0.85 was obtained. In set II a kappa value of 0.88 was obtained, which was not significantly different from the kappa value in set I. However, the consensus conference did increase the level of agreement on the diagnosis of acute appendicitis. The intra-observer variation was calculated, and a kappa value of 0.88 was obtained. The cases in which the observers disagreed on a positive diagnosis were cases of mild appendicitis. The question remains how many specimens would have shown these changes if all tissue had been developed for microscopy. The observers' diagnoses were the most reliable, and there was a significant decrease in the diagnostic accuracy compared with both the primary pathology report and the surgeon's opinion, the last one being the least accurate. CONCLUSIONS: These observations stress how important it is for the pathologist to discuss the diagnostic criteria of the diagnosis of acute appendicitis and for the surgeon to go back to the patient's record and look up the histopathologic diagnosis.
Acute Disease↗
Stress response to endoscopy.
BACKGROUND: Upper gastrointestinal endoscopy is often accompanied by tachycardia, which may lead to myocardial ischaemia. The pathogenesis for tachycardia is unknown, but the classic endocrine stress response may be of importance. METHODS: Seventeen patients (median age, 60 years) undergoing diagnostic gastroscopy without sedation or supplemental oxygen therapy were monitored by means of electrocardiogram, blood pressure, and pulse oximetry from 20 min before to 2 h after the procedure. Blood concentrations of glucose, cortisol, epinephrine, and norepinephrine were measured before, during, and after the endoscopy. Anxiety level was rated before the examination. RESULTS: Endoscopy was followed by a significant increase in norepinephrine and cortisol levels concomitant with a significant peak in heart rate (76 to 90 min(-1)) and mean arterial blood pressure (97 to 111 mmHg). Epinephrine was significantly reduced after the endoscopic procedure. We found no changes in glucose level or in arterial oxygen saturation. None of the patients developed signs of myocardial ischaemia during the procedure. There was no correlation between preendoscopy anxiety and the different stress variables (P > 0.3). CONCLUSIONS: The endoscopic procedure induces a classic endocrine metabolic stress response, probably causing the observed tachycardia.
Adult↗
Is carbohydrate deficient transferrin a useful marker of harmful alcohol intake among surgical patients?
OBJECTIVE: To find out whether the biological marker, carbohydrate deficient transferrin (CDT), was helpful in the detection of alcoholic patients in a surgical unit. DESIGN: Prospective open study. SETTING: Teaching hospital, Denmark. SUBJECTS: 286 men and 248 women admitted to the department of surgical gastroenterology between March and July 1996. MAIN OUTCOME MEASURES: Specific interview about drinking and correlation with CDT concentration. RESULTS: 31 men (13%) and 10 women (3%) were alcoholic and at special risk of operation. The correlation between intake and CDT:transferrin ratio was 0.63 for men and 0.53 for women. The correlation between consumption and CDT was better, being 0.77 and 0.58, respectively. Younger women had the lowest correlation (0.33). Sensitivity of CDT for men and women was 100% and 80%, respectively; the specificity was 97% and 96%; the positive predictive value 82% and 44%; and the negative predictive value 97% and 99%. CONCLUSION: CDT is a valid marker of harmful alcohol intake among surgical patients, except among younger women.
Alcoholism↗
[Munchausen syndrome].
The case of 43 year old man who had numerous contacts with the health care system is reported. Since 1984 he had been treated 95 times for testicular problems at 45 different hospitals including 36 operations for torsion. Computer record systems had only once stopped the patient from going through another unnecessary operation. An alarm in the computer record system with reference to a contact place could make it easier to spot a patient with diagnosed Münchhausen's syndrome and give him treatment.
Adult↗
Population based cohort study of the association between alcohol intake and cancer of the upper digestive tract.
OBJECTIVE: To examine the relation between different types of alcoholic drinks and upper digestive tract cancers (oropharyngeal and oesophageal). DESIGN: Population based study with baseline assessment of intake of beer, wine, and spirits, smoking habits, educational level, and 2-19 years' follow up on risk of upper digestive tract cancer. SETTING: Denmark. SUBJECTS: 15 117 men and 13 063 women aged 20 to 98 years. MAIN OUTCOME MEASURE: Number and time of identification of incident upper digestive tract cancer during follow up. RESULTS: During a mean follow up of 13.5 years, 156 subjects developed upper digestive tract cancer. Compared with non-drinkers (drinkers of <1 drink/week), subjects who drank 7-21 beers or spirits a week but no wine were at a risk of 3.0 (95% confidence interval 1.5 to 6.1), whereas those who had the same total alcohol intake but with wine as >=30% of their intake had a risk of 0.5 (0.2 to 1.4). Drinkers of >21 beers and spirits but no wine had a relative risk of 5.2 (2.7 to 10.2) compared with non-drinkers, whereas those who drank the same amount, but included wine in their alcohol intake, had a relative risk of 1.7 (0.6 to 4. 4). CONCLUSION: A moderate intake of wine probably does not increase the risk of upper digestive tract cancer, whereas a moderate intake of beer or spirits increases the risk considerably.
Adult↗
[Thromboembolic complications after ambulatory herniotomy].
Thromboembolism is a serious complication of surgery and prophylaxis is therefore recommended. This study examines a new aspect of the problem, the incidence of thromboembolism after day-case surgery. From 1982 to 1992, 2281 patients underwent day-case repair for inguinal hernia management. Hospital admission for thromboembolism within the first 30 days after surgery was identified by computer linkage to the National In-Patient register, which contains details of all hospital admissions in Denmark. One patient developed non-fatal pulmonary embolism. No other patients were admitted to hospital with venous thromboembolism within 30 days of herniorrhaphy. It is concluded that there is no need for routine prophylaxis for thromboembolism in day-case hernia surgery.
Adolescent↗
Intestinal obstruction after appendectomy.
BACKGROUND: The frequency of intestinal obstruction varies in the literature (0.2-10.7%) and requires evaluation in a proper design. METHODS: From 1978 to 1985, 1951 patients underwent appendectomy; 58 patients were excluded because of appendectomy per occasionem, 156 because of previous laparotomy, and 190 because of simultaneous major surgery. Three foreigners were lost to follow-up. The cohort was linked to the Danish National Inpatient Register for identification of cases, defined by intestinal obstruction requiring surgical intervention. RESULTS: The follow-up period was long (median, 3563 days; range, 2-5113). Twenty-one patients developed intestinal obstruction. The cumulated incidence was 0.33% after 30 days, 0.79% after 1 year, and 1.51% after 14 years. Female sex as compared with male sex (RR = 3.91; 95% confidence limits (CL), 1.25-12.0) and removal of a removal of a normal appendix as compared with an inflamed appendix (RR = 4.0; 95% CL, 1.28-12.5) carried a significantly higher risk of intestinal obstruction. CONCLUSION: Intestinal obstruction after open appendectomy is rare.
Adolescent↗