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Biomedical subjects

M Osler

Publications and source records attributed to M Osler.

At least 55 records · Page 3Linked to original sources
PubMed1999

Consequences of removing iron fortification of flour on iron status among Danish adults: some longitudinal observations between 1987 and 1994.

BACKGROUND: Health authorities recommend that populations consume a diet providing sufficient iron, and in order to prevent iron deficiency, a number of countries have fortified certain foods with iron. In Denmark, flour was fortified with iron from 1954 until 1987, at which time the mandatory fortification was stopped. This study examines the effect of iron fortification on iron status by comparing the intake of iron with serum ferritin over time and in relation to the removal of flour fortification. METHODS: In a cohort of 238 Danish men and women, at baseline ages 35-65 years, dietary intake and serum ferritin were measured, first in 1987/1988 and again in 1993/1994. RESULTS: In 1987/1988 the fortification may have supplied up to 25% of total iron intake, and without this enrichment some 35% of the men and 73% of the women may have had iron intakes lower than 10 mg/day. Assuming that no flour was enriched, iron intake was constant during the 6-year study period. Despite this, after flour fortification was stopped in 1987, serum ferritin increased among both men and postmenopausal women. CONCLUSIONS: Considering that mandatory iron fortification of flour affects the entire population, including subjects who are at risk for chronic diseases because of too-high iron stores, the decision to stop the mandatory fortification in Denmark seems to have been well-founded.

Adult↗
PubMed1999

Gender and determinants of smoking cessation: a longitudinal study.

BACKGROUND: The less favorable trend in smoking prevalence in women compared to men may be due to lower cessation rates. We analyzed determinants of spontaneous smoking cessation with particular reference to gender differences. METHODS: Data on smoking were collected by questionnaire in three samples of the adult population, examined for the first time at intervals between 1976 and 1984. In total 11,802 (59%) subjects were smokers, and 9085 of them attended a reexamination after 5 years. Ten to 16 years later 6053 were examined once again. Logistic regression was performed to study the relation of determinants to having quit after 5 and 10-16 years. RESULTS: The prevalence of quitting was 12 and 22% at first and second follow-up, respectively. At both reexaminations, quitting smoking was positively associated with male sex and cigar smoking and negatively associated with the amount of tobacco smoked, inhalation, and alcohol consumption. Furthermore, in women, smoking cessation was positively associated with level of education and body mass index (BMI). Smoking cessation was not affected by cohabitation status, leisure activity, or bronchitis symptoms. CONCLUSIONS: Smoking cessation initiatives should be targeted at heavy cigarette smokers, and at women, in particular the lean and poorly educated.

Adult↗
PubMed1999

The effect of recurrent events on register-based estimates of level and trends in incidence of acute myocardial infarction.

Although changes in incidence of first acute myocardial infarctions (AMI) are of primary interest in the evaluation of preventive efforts, only few studies have used this measure. In the present study, the risk of recurrence over time in subjects with first AMI is analyzed, and the effect of inclusion of recurrent cases on the estimation of level and trend in the incidence of AMI is evaluated. The National Patient Register of Hospital Discharges and the Causes-of-Death Register were linked, and all cases of admission for AMI and fatal manifestation of the disease since 1977 and until 1992 in the Danish population were identified. New events occurred during the following 12 years in 46% of men and 42% of women with their first AMI in 1980. Ninety percent of the recurrent events occurred during the first 5 years. Using absence of events during only 1 preceding year as the inclusion criteria, the incidence rate would be overestimated by about 20%-30%. However, if the preceding event-free period was of the same duration throughout the study period, the trends in AMI rates were not altered by expanding the event-free period up to 14 years before the index event. Although rates of AMI based on the total number of affected persons without AMI in the previous year overestimate the true incidence by 20%-30%, trends in these rates reflect trends in rates of first events with reasonable accuracy.

Bias↗
PubMed1999

Health education pamphlets about smoking--their benefit to smokers and non-smokers.

The aim of this present study was to compare the use by smokers and non-smokers of pamphlets about smoking as delivered from different settings. The study was a nation-wide cross-sectional survey of 1924 randomly selected, Danish men and women, aged 14-77 y, who had answered a mailed questionnaire in 1994. Of these 71% also participated in a telephone interview enquiring about the use of health education material, smoking status and socio-demographic variables, 39% of readers of household-delivered anti-smoking pamphlets reported having gained information from them and 22% reported having made changes in their own smoking behaviour such as avoiding smoking in the presence of non-smokers. In general practice settings, these percentages were higher among smokers. Smokers who were thinking of stopping smoking in the near future were in addition more likely to take and to read smoking related health education materials from other places. Non-smokers received (3 49%) and read pamphlets about smoking as frequently as did smokers who did not intend to quit. In conclusion, written health education material was well received by readers, but, when distributed in a more open setting it needs to be targeted towards smokers who are considering stopping smoking. In general practice, smokers not thinking of stopping were open to health education, and pamphlets used in this setting should also target this group. Non-smokers contribute indirectly to smokers quitting by providing support to smokers and pamphlets for non-smokers need to be more targeted towards this social role.

Adolescent↗
PubMed1999

A sensitivity analysis of secular trends in risk factors and mortality based on cohort studies.

Because of a "healthy responder effect," secular trends in mortality based on cohort studies may be biased if based on responders only. Because responders are selected on the basis of their health at study entry, subjects just entering a study are not comparable with subjects who have been in the study for several years. The result may be an artificial increase in mortality, which impedes analyzing the effect of secular trends in risk factors on mortality. The objective of this paper is to suggest a solution by using data on nonresponders and applying a sensitivity analysis. We illustrate this solution with data on trends in smoking prevalence and all-cause mortality based on a large Danish cohort study with 19 years of complete follow-up on responders and nonresponders. Secular trends in mortality based on the whole sample vs responders only illustrated that results based on responders were biased. In a sensitivity analysis, the observed person-years of nonresponders were distributed among six categories of persons with respect to smoking behavior (never-smokers; ex-smokers; noninhaling current smokers; and current smokers of 1-14, 15-24, and > or =25 gm tobacco per day) according to preset assumptions regarding smoking habits. The observed deaths among nonresponders were then distributed on the six smoking categories according to relative risks derived from a Poisson regression analysis among responders. This procedure allowed us to study the effect of adjustment for smoking on the unbiased secular trend in mortality. By applying different assumptions regarding smoking habits among nonresponders, we explored the effect of the assumptions on the adjusted secular trend in mortality. We conclude that secular trends in mortality based on responders in a cohort study are likely to be biased. If complete follow-up on nonresponders is available, this method could prove useful in other cohort studies.

Aged↗
PubMed1999

The 'Mini Nutritional Assessment' (MNA) and the 'Determine Your Nutritional Health' Checklist (NSI Checklist) as predictors of morbidity and mortality in an elderly Danish population.

The purpose of the present study was to evaluate the capacity of the 'Determine Your Nutritional Health' Checklist (NSI Checklist) and the 'Mini Nutritional Assessment' (MNA) methods to predict nutrition-related health problems. Data were from the Danish part of the 'Survey in Europe of Nutrition in the Elderly, a Concerted Action' (SENECA) baseline survey from 1988, and the follow-up study from 1993. Based on the baseline survey thirty-nine (19.3%) of the subjects were classified at high nutritional risk, 103 (51%) were considered at moderate nutritional risk and sixty (29.7%) were within the 'good' range according to the criteria in the NSI Checklist. With the MNA, 171 subjects were classified according to their nutritional risk into a well-nourished group, comprising 78.4%, and a group who were at risk of undernutrition, comprising 21.6% at baseline. A total of 115 subjects participated in the follow-up study. The mortality rate and the prevalence of various morbidity indicators were compared between the different risk groups. The analysis showed that subjects with a high MNA score (> or = 24) had significantly lower mortality (rate ratio estimate: 0.35; 95% Cl 0.18, 0.66) compared with subjects with a low MNA score (< or = 23.5). In contrast, the NSI Checklist score was not a significant predictor of mortality (rate ratio estimate: 1.45; 95% Cl 0.78, 2.71). The sixteen Danes judged to be at high nutritional risk by the NSI Checklist in 1988, had more acute diseases (P < 0.001) than the rest of the participants, between 1988 and 1993. No significant differences were found in the participation rates, hospitalization rates, physician visits, need of help or weight loss between the groups. The thirteen Danes judged to be at risk of undernutrition in 1988 by the MNA, had a lower participation rate (P < 0.01) and higher occurrence of acute disease (P < 0.05), need of help (P < 0.05), and weight loss (P < 0.001) than the well-nourished group, between 1988 and 1993. No significant differences were found in hospitalization rates and physician visits between the two groups. In conclusion, the results indicate that modified versions of the NSI Checklist and the MNA are capable of identifying a group of 70-75-year-old subjects with increased risk of certain nutrition-related health problems. Further, an MNA score < or = 23.5 predicts mortality in a Danish population.

Aged↗
PubMed1998

Dietary and non-dietary factors associated with iron status in a cohort of Danish adults followed for six years.

OBJECTIVE: To examine the association between food intake and serum ferritin over time. DESIGN: Two hundred and thirty-eight individuals, at baseline aged 35, 45, 55 and 65 y, had their food intake assessed by a short food frequency questionnaire and a diet history interview, and serum ferritin measured, first in 1987/88, and again in 1993/94. SETTING: The County of Copenhagen, Denmark. RESULTS: Apart from intake frequencies of alcoholic beverages dietary items were poor predictors of serum ferritin. Besides food intake serum ferritin was associated with blood donation in men, and with menopausal status in women. CONCLUSIONS: For this middle-aged population, information on alcohol intake and blood loss may be used to rank individuals in relation to iron status, whereas information on intake frequency of dietary items may not.

Adult↗
PubMed1998

Mortality in women and men in relation to smoking.

BACKGROUND: Mortality from smoking-related diseases in women is increasing worldwide. Studies comparing hazards associated with smoking in women and men based on a sufficient number of heavy smokers of both genders are lacking. METHODS: We used pooled data from three prospective population studies conducted in Copenhagen to compare total and cause-specific mortality in relation to smoking habits. A total of 30917 subjects, 44% women, with initial examinations between 1964 and 1992 were followed until 1994 for date and cause of death. RESULTS: During follow up, 2900 women and 5744 men died. Smoking characteristics differed considerably with gender, particularly in the older subjects. Overall mortality rates in smokers were approximately twice those in people who never smoked. Positive associations with smoking in both men and women were confirmed for all-cause mortality as well as mortality from respiratory disease, vascular disease, lung cancer, and other tobacco-related cancers. Despite large gender differences in age at smoking debut, total and cause-specific relative mortality in smokers was similar in men and women. After excluding non-inhalers, relative risks associated with smoking for respiratory and vascular disease were higher for women than men whereas there were no gender differences in smoking related risk of cancers. CONCLUSIONS: The relative risks suggest that women may be more sensitive than men to some of the deleterious effects of smoking. However, because of lower baseline mortality rates in women, rate differences may be similar and results should be interpreted with caution.

Adolescent↗
PubMed1998

Food patterns, flour fortification, and intakes of calcium and vitamin D: a longitudinal study of Danish adults.

STUDY OBJECTIVE: Deficiencies in calcium and vitamin D intakes are involved in the aetiology of osteoporosis, and health authorities recommend that the population consume a diet providing sufficient calcium and vitamin D. However, in 1987 the Danish Government withdrew a mandatory fortification of flour with calcium. This study examines intakes of calcium and vitamin D over time, in relation to food patterns, recommendations, and legislation. DESIGN: Food and nutrient intakes were measured by a short food frequency questionnaire (FFQ) and a thorough diet history interview, in 1987/88, and again six years later. SETTING: Copenhagen County, Denmark. PARTICIPANTS: 329 men and women, aged 35-65 years at first examination in 1987/88. RESULTS: At both examinations the non-enriched median intakes of calcium in men as well as women were above the recommended 600 mg/day. However, apparently the fortification of flour supplied up to 30% of the total calcium intake, and without the mandatory fortification, the percentage of adults with intakes below this recommendation increased from 6% to 22%. This group of subjects consumed cheese, milk, and oatmeal less often than those who had calcium intakes over 600 mg/day. During the study period the median intakes of vitamin D, which were well below the recommended 5 micrograms/day, did not change significantly. Associations between foods and vitamin D intakes were, in general, weak and insignificant, except for a positive association with fish intake. CONCLUSIONS: Data on calcium intakes suggest that the decision to stop the mandatory fortification of flour with calcium may have been premature. The short FFQ may be used for a rough classification of people in relation to their calcium intake, while this method seems insufficient for ranking vitamin D intakes.

Adult↗
PubMed1998

Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults.

OBJECTIVE: To examine the factors that determine whether or not smokers become long-term quitters, and to study whether determinants of successful cessation differ with levels of motivation to stop. DESIGN: In a cohort of men and women, aged 30-60 years at first examination in 1982/1984, smoking behaviour was evaluated from questionnaires at baseline and at follow up 10 years later. SETTING: County of Copenhagen, Denmark. PARTICIPANTS: 2554 subjects from the original sample of 4581 were successfully followed. This study deals with the 1365 subjects who were smokers at the first examination. MAIN OUTCOME MEASURE: Smoking status (abstinent for one year or more) at follow up. RESULTS: At follow up 15% of the baseline smokers had been abstinent for one year or more. In multivariate analysis, successful smoking cessation was associated with older age, high social status, low prior tobacco consumption, baseline motivation to stop smoking, and having a non-smoking spouse/cohabitant. The same result was obtained when the analyses were repeated separately for smokers with and without motivation to stop. CONCLUSIONS: Smokers motivated to stop are more likely to quit and remain abstinent than smokers with no such motivation. Age, social status, spouse/cohabitant's smoking behaviour, and the daily consumption of tobacco predict success in smoking cessation, irrespective of smokers' former motivation to stop.

Adult↗
PubMed1998

Social differences in health in an affluent Danish county.

The aim of the present study was to examine whether selected health indicators were related to the level of social conditions in the municipalities in an affluent Danish county with a tax system aiming at narrowing income differences and with the same free health facilities for all. The 18 municipalities were separated into three groups by a sum score calculated on the basis of 10 social status variables. For each of the three groups average mortality, hospital discharge rates, cancer incidence and health services use were calculated with data from National Registers. There was a distinct gradient in all-cause, infant and cause-specific mortality, cancer incidence and use of health services related to level of social conditions. Apart from the incidence of breast cancer and melanoma, and use of general practice, all the analysed health indicators were most frequent in the group of the least affluent municipalities. It is concluded that even in an affluent county, the variation in the socioeconomic characteristics of neighbouring municipalities could be related to differences in health.

Adolescent↗
PubMed1998

Trends in smoking prevalence in Danish adults, 1964-1994. The influence of gender, age, and education.

BACKGROUND: Studies of time trends in smoking prevalence provide a better understanding of the determinants of smoking. The present study analyses changes over time in the prevalence of smoking and heavy smoking in relation to sex, age, and education. METHODS: Data on smoking behaviour were collected by questionnaire in random samples of the general population in the area of Copenhagen. The database used included 71,842 measurements of smoking behaviour for 32,156 subjects aged 30 years or more, who had been examined at intervals between 1964 and 1994. In bi- and multivariate analyses the effects of sex, age, education, time period, and study group on the prevalence of smoking and of heavy smoking were assessed. RESULTS: Smoking was least prevalent in women, in the oldest age group (more than 70 years), and among those with 8 years or more of school education. During the study period (from 1964/74 to 1990/94), the prevalence of smoking decreased from 72% to 54% in men and from 52% to 46% in women. In both men and women this decrease was smallest in the least educated (less than 8 years of school education). Heavy smoking was also least prevalent in women, in the oldest age group, and among the well educated. During the study period, the unadjusted prevalence of heavy smoking decreased from 52% to 38% in men, while it increased from 17% to 21% in women. The multivariate analysis showed that the time trend for heavy smoking only depended on sex, while educational attainment and age had no impact on the trend. CONCLUSION: During the last 30 years the prevalence of smoking has decreased in Denmark. The decrease has been smallest in women, and among the least educated, and the increasing trend in the prevalence of heavy smoking in women is a cause for concern.

Adult↗
PubMed1998

Gender and smoking-related risk of lung cancer. The Copenhagen Center for Prospective Population Studies.

Our aim was to compare risk of lung cancer associated with smoking by gender and histologic type. A total of 30,874 subjects, 44% women, from three prospective population-based studies with initial examinations between 1964 and 1992 were followed until 1994 through the National Cancer Registry. There were 867 cases of lung cancer, 203 among women and 664 among men. Rates among female and male never-smokers were similar, although confidence intervals around rates were wide. Rate ratios (RRs) increased with number of pack-years for both men and women to a maximum of approximately 20 in inhaling smokers with more than 60 pack-years of tobacco exposure. RRs did not differ much between men and women: adjusted for pack-years, age, and study population, the ratio between female and male smokers' RRs of developing lung cancer was 0.8 (95% confidence interval = 0.3-2.1). All histologic types were associated with smoking, with the largest RR seen for squamous cell carcinoma and anaplastic carcinoma. This prospective population-based study does not confirm previous reports from case-control studies of a higher relative risk in women than in men for lung cancer associated with smoking.

Adult↗
PubMed1997

[Development in mortality, incidence and lethality of ischemic heart disease in Denmark 1982-1992].

In Denmark, as in many other Western countries, a decline in mortality from ischaemic heart disease (IHD) has been observed. The present study assesses whether the decline in IHD mortality is due to a decrease in incidence and/or case-fatality, and whether parallel changes occurred in the various manifestations of IHD requiring hospitalization. The National Patient Register of hospital discharges and the Causes-of-Death Register were linked and all cases of first admission for IHD including acute myocardial infarction (AMI) and fatal first manifestation of IHD since 1977 in the entire Danish population were identified. Cases of AMI and IHD were considered as incident cases if no admission for these diagnoses had occurred during the preceding five years for the same person. Sex-specific, age-standardized annual mortality, incidence and case-fatality rates of AMI (ICD8 code 410), narrowly defined IHD (NIHD, ICD8 codes 410-4) and broadly defined IHD (BIHD, ICD8 codes 410-4, 427 & 795-6) were calculated for the period 1982 through 1992. During the entire period the age-standardized mortality of AMI, NIHD and BIHD decreased in both men and women. The incidence of AMI and NIHD decreased, while the incidence of BIHD remained constant. Case-fatality of AMI decreased in both men and women, while case-fatality of NIHD and BIHD decreased in men and in women aged 0-64 years only. The declining mortality from IHD in Denmark may be partly due to declining incidence as well as declining case-fatality, but changes in disease manifestation or a diagnostic drift may also contribute, since more broadly defined diagnostic groups showed less or no decline in incidence.

Adult↗
PubMed1997

[Changing life expectancy in the 1980's. Why was Denmark different from Sweden?].

The aim of the present study was to identify the contribution from specific causes of death to the changes in life expectancy at birth in Denmark relative to Sweden in different age groups during the 1980s and to compare the difference in life expectancy between the two countries in 1990. Mortality data from WHO mortality tapes grouped in smaller series of clinically meaningful categories were used to calculate the contribution of each of these categories at each ten year age group to the difference in life expectancy at birth in each country between 1979 and 1990 and between the two countries. During the period from 1979 to 1990 life expectancy increased in both Denmark and Sweden. However, Sweden experienced the greatest increase in life expectancy (more than two years) while it increased less than one year in Denmark. In both countries a decrease in cardiovascular disease mortality contributed most to the increase in life expectancy among males as well as females. Both among males and females the less favourable development in Denmark was mainly caused by differences in mortality trends related to cardio-vascular diseases, respiratory and non-respiratory cancer. Over a short period of time two Nordic countries experienced remarkable, but different changes in mortality. These findings suggest that mortality rates are sensitive to even minor differences in social and cultural factors across countries and over short time periods.

Adolescent↗