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PubMed2005

Tideswell health survey: a population survey of the health needs and service utilization of a farming community.

OBJECTIVES: In the UK, there have been no epidemiological studies focusing on the general health status of rural communities, despite the prevalence of rural deprivation and the widely acknowledged link between poverty and ill health. The primary objective of this study was to test the null hypothesis that no differences existed between the health status of the farming and non-farming populations registered with one general practice, in order to inform a local health needs assessment. The secondary objective was to test the suitability of the research method as a model for a wider study. STUDY DESIGN: A postal questionnaire survey was undertaken with the total farming population (n = 248) registered with Tideswell general practice, and matched with an equivalent random sample of non-farmers (n = 248) from the remainder of the practice list. The main outcome measures were income, general health status, quality of life (EQ5D), musculoskeletal problems, mental health status and service utilization. RESULTS: Significant differences were found between the two groups. Farmers were identified as having health needs that were greater than those found in the local non-farming sample. In addition, the observed EQ5D value for farmers was found to be significantly lower than that found in social classes IV and V (0.78 vs 0.82) and the UK mean. CONCLUSIONS: This modest controlled study is the first of its kind in the UK. Health inequalities and inequities were identified that may be generalizable to other UK hill farmers. However, a larger, wider epidemiological study across different types of farming groups is now required to gain a fuller understanding of the health status of this indigenous rural population. The methodology employed in this study was successful and could serve as a model for such a study.

Agriculture↗
PubMed1991

Cancer incidence among parents of patients with colorectal cancer.

To investigate the genetic factor in the development of colorectal cancer, a cohort study was undertaken of parents of patients with this disease. All 1,524 patients, who were diagnosed with colorectal cancer in Denmark in 1982-84 and were below the age of 60 years, were selected from the National Cancer Register. The parents of these patients were identified from the public population registers. The index persons had a total of 1,478 eligible mothers, of whom 96% were successfully traced, and a total of 1,414 eligible fathers, of whom 96% were traced. These parents were sought in the Cancer Register for cancer cases diagnosed in the period January 1, 1943 to December 31, 1986. The incidence rates for the Danish population were used to estimate the expected numbers of colorectal cancer cases among the parents. Both the mothers and the fathers exhibited an increased risk of colorectal cancer. The standardized incidence ratios were 1.62 (95% CI 1.31-2.01) and 1.87 (95% CI 1.54-2.27), respectively. In a previous study we found that spouses of patients with colorectal cancer in Denmark did not have an increased risk of this disease. The increased risk found in the present study among the parents of patients therefore indicates that a possible genetic factor is present in the aetiology of colorectal cancer, and that it is of importance in the general population.

Aged↗
PubMed2004

The prevalence of injecting drug use in a Russian city: implications for harm reduction and coverage.

AIM: This study sought to estimate the prevalence of injecting drug users (IDU) in Togliatti city and to examine the implications of these estimates for HIV prevalence and harm reduction. DESIGN: Routine data sources of IDUs were identified. Covariate capture-recapture techniques were used on the individuals identified on the three data sources and used to estimate the number of IDU 'not observed' by the data sources, and thereby estimate the prevalence of IDU. SETTING: Togliatti City, Samara Oblast, Russian Federation. PARTICIPANTS: IDUs recorded on three data sources (narcology records, HIV positive test results and police arrest data) during 2001. MEASUREMENTS: Poisson regression models were fitted to the observed data, with interactions between data sources fitted to replicate 'dependencies' between those data sources. To select the best model the goodness of fit was approximated by chi2 distribution and the best-fitting model was selected on the basis of standard information criteria and log likelihood ratio tests. FINDINGS: The total estimated population of IDUs is 20 226 [95% confidence interval (CI): 16 971-24 749] giving a population prevalence of 5.4% (95% CI: 4.5-6.6%) of the registered population and 2.7% (95% CI: 2.4-3.5%) of the population (including migrants) aged 15-44 years. For every one IDU in contact with a service there were three out of contact. CONCLUSIONS: There is a high prevalence of IDU which, in the context of a fast-emerging IDU-associated HIV epidemic, will have serious public health implications.

Adolescent↗
PubMed2002

Grand multiparity and incidence of endometrial cancer: a population-based study in Finland.

The hormonal background of endometrial cancer is insufficiently characterised. We investigated the significance of parity, age at first birth, intensity between births, length of time from the first to the last birth and length of delivery-free premenopausal period in a cohort of grand multiparous (GM) women, i.e., women with at least 5 births. Data of the Population Register of Finland (86,978 GM-women) and the population-based Finnish Cancer Registry were combined. Standardised incidence ratios (SIRs) were calculated by dividing the number of observed cancer cases by the expected number based on the national incidence rates. Multivariate relative risks (RRs) were estimated by Poisson regression analysis. The SIR for endometrial cancer among GM-women was low [419 cases; SIR=0.57, 95% confidence interval (CI) 0.52-0.63]. The RR of endometrial cancer was 0.58 (95% CI 0.34-0.97) among women giving their first birth at an age of more than 30 years compared to women with first birth before the age of 20. In ages 50+ (94% of endometrial cancer cases), the RR for women with at least 8 births was 0.63 (95% CI 0.44-0.92) compared to those with 5 births, and those with a birth period of 20+ years had RR=0.57 (95% CI 0.34-0.96) compared to those with a period of <10 years, while prolonged average intensity between births showed only a small protective effect. The RR of endometrial cancer also correlated with the length of premenopausal delivery-free period (RR = 0.61, 95% CI 0.44-0.86) for women with a short (<10 years) period compared to women with a long (>15 years) period. Our findings, that a large number of births, old age at first birth, a long birth period and a short premenopausal delivery-free period reduced the risk of postmenopausal endometrial cancer of GM-women, emphasise the protective role of progesterone and the stimulatory role of estradiol in the hormonal background of this disease.

Adenocarcinoma↗
PubMed1999

Osteoarthrosis of the knee in men and women in association with overweight, smoking, and hormone therapy.

OBJECTIVES: The aim was to examine the relation between osteoarthrosis of the knee leading to prosthetic surgery among men and women and overweight, smoking, and hormone therapy. METHODS: A case-referent study was performed with a study base of all men and women, born 1921-1938, living in 14 counties in Sweden during 1991-95. The cases (n = 625) were identified through the Swedish Knee Arthroplasty Register. The referents (n = 548) were randomly selected through the central population register from the same counties. Detailed information on general health status, height, weight, smoking habits, medication, use of hormones, specific physical loads from occupation and housework, and sports activities was collected by a telephone interview and a postal questionnaire. The cases were classified in terms of high, medium or low/non-exposure to the factors studied, according to the distribution of variables among the referents. RESULTS: Women with high body mass index (BMI) at the age of 40 had a relative risk of 9.2 (95% CI 5.3, 16.0) of developing severe knee osteoarthrosis later in life, and for men at the same age the relative risk was 3.9 (95% CI 2.3, 6.4). Smokers were less likely to develop severe knee osteoarthrosis compared with nonsmokers. Oestrogen therapy for women over 50 showed an increased relative risk of 1.8 (95% CI 1.2, 2.6), while use of oral contraceptives did not influence the risk. CONCLUSION: Overweight is a risk factor for knee osteoarthrosis leading to prosthetic surgery in men and women, with the strongest relation for women. Oestrogen therapy after 50 increased the relative risk, while smoking decreased it.

Adult↗
PubMed1992

Intrauterine growth and spastic cerebral palsy II. The association with morphology at birth.

This study tests the hypothesis that children with spastic cerebral palsy had different birth morphologies, defined in terms of their weight, length, head circumference, ponderal index and length to head circumference ratio, from that of the normal liveborn population. An earlier study showed a highly significant association of spastic cerebral palsy with low birthweight for gestational age in infants over 34 weeks gestation at delivery. This analysis defines morphological measurements as "abnormal" if not within the 10th-90th percentile ranges of appropriate total liveborn populations. The proportions with combinations of such measurements in 104 cases of spastic cerebral palsy from a population register of cerebral palsy are compared with those in a total liveborn population. Categories of 'abnormal' measurements associated with increased risk contained 44.4% of cases in excess of the proportion observed in the total population. More than half these excess cases were short for their gestation (suggesting size deficits originating before the 3rd trimester) and tended to have more severe forms of cerebral palsy. A further excess of 7.4% of cases had a head circumference above their 90th percentile: these generally developed mild cerebral palsy.

Birth Weight↗
PubMed2002

Birthplace and social characteristics as risk factors for acute myocardial infarction in the province of Halland, Sweden.

The aim of the study was to explore the impact of birthplace and socio-economic characteristics on the risk of acute myocardial infarction (AMI) in a rural Swedish province. A case control study was performed and cases were all patients 30-72-y-old treated for the first time for an AMI during 1980-1992 and identified in a computerised hospital register. Three controls for each case were randomly selected from the national population register and were matched for gender, age and municipality. Birthplace ie within or outside the province, and a variety of socio-economic background factors were determined for cases and controls. The study comprised a total of 18 948 individuals including cases and controls. Altogether 4737 cases of AMI were identified whereof 3514 were men. Being born in the province was associated with the lowest risk for AMI in both sexes (RR=0.62, CI 0.57-0.67 for men and RR=0.61, CI 0.53-0.69 for women). A substantially reduced risk for men was found in farmers. In both sexes, high socio-economic status had a favourable effect on the risk to suffer an AMI. Being born in the province carried the lowest risk for AMI in both sexes and was independent of other tested socio-economic factors (income, education, occupation, and civil status). Province characteristics might be associated with this protective factor. Alternatively, migration as such might include unfavourable exposures that increase the risk for AMI among those who had moved to the province.

Adult↗
PubMed1998

Do changes in cardiovascular risk factors explain the increasing socioeconomic difference in mortality from ischaemic heart disease in Finland?

STUDY OBJECTIVE: To estimate the extent to which changes in blood pressure, smoking, and serum cholesterol concentration explain the observed increase in socioeconomic differences in mortality from ischaemic heart disease (IHD) in Finland during the past 20 years. DESIGN: Predicted changes in mortality from IHD were calculated using logistic regression models with the risk factor levels assessed by cross sectional population surveys conducted in 1972, 1977, 1982, and 1987. The subjects included white collar and blue collar workers and farmers. The predicted changes were compared with the observed mortality changes in the same socioeconomic groups in the total population of the same geographical area. SETTING: North Karelia and Kuopio provinces, eastern Finland. PARTICIPANTS: 16,741 men and 16,389 women aged 30-59 randomly drawn from the population registers of the study areas. Mortality data were obtained from the total population in the same areas. MAIN RESULTS: In men, the changes in diastolic blood pressure, total serum cholesterol, and smoking predicted a 28% decline in the mortality from IHD among white collar workers, a 30% decline among blue collar workers, and a 33% decline in farmers. Observed declines in the same socioeconomic groups were 61%, 40%, and 37%, respectively. In women, the predicted decline was 41% among white collar workers, 35% among blue collar workers, and 39% among farmers. The respective observed declines were 57%, 43%, and 20%. CONCLUSIONS: Less than half of the decline in IHD mortality among white collar men was explained by the risk factor changes, while they explained 75% of the decline among blue collar men and 89% of the decline among male farmers. Changes in risk factors did not explain the increasing difference in IHD mortality between the socioeconomic groups, especially among men.

Adult↗
PubMed1975

Risks of mortality of suicide attempters compared with psychiatric and general populations.

This study compares mortality risk among suicide attempters, psychiatric patients, and members of the general population using demographic data from the Monroe County (New York) Psychiatric Case Register for 1960 to 1970. During this 11-year period there were 172 deaths reported for the suicide attempt group, 6, 108 for the Psychiatric Register population, and 58,542 for the general population. The relative risk of death from all causes of the suicide attempt group was nearly twice that of the general population and slightly higher than that of the psychiatric group. High risks of mortality were differentially associated with several demographic and treatment variables. Implications for predictive criteria and interventive strategies are discussed.

Accidents↗
PubMed1996

Rapid village survey to determine the size of the leprosy problem in Khon Kaen Province, Thailand.

The rapid village survey (RVS) method has been developed as a simpler, less-expensive alternative to random sample surveys for determining the prevalence of leprosy and was compared with a total population survey (TVS). In the RVS, the cluster population receives clear information about the disease, and those with symptoms are invited to be examined by the survey team. A list of household contacts and suspects was made and those on the list were actively traced. The registered population was 20,815; 10 new patients were found among the 2034 people self-reporting in the RVS, 0 among the household contacts and suspects, and an additional 2 new patients in the TVS. There were 12 registered patients among the sample population. The prevalence rate found by the RVS was 1.06 per 1000(95% CI = 0.49-1.63) and in the TVS 1.16 per 1000 (95% CI = 0.5-1.77). The man-days and costs of an RVS are considerably less than those for a TVS. It was concluded that the RVS is a valid replacement for the TVS as conducted in Khon Kaen Province, Thailand. The RVS can be applied under low-endemic conditions and could be carried out by the general health staff.

Humans↗
PubMed2005

Pregnancy outcome after maternal organ transplantation in Sweden.

OBJECTIVE: To study pregnancy outcome before and after organ transplantation. DESIGN: Registry study. SETTING: Swedish Health Registers. POPULATION: All births in Sweden 1973-2002. METHODS: Women who had organ transplantation were identified from the Hospital Discharge Register and their deliveries before and after the transplantation were identified from the Medical Birth Register. Abortions requiring hospitalisation were identified from the Hospital Discharge Register. Outcomes were compared with those in the total population. Adjustments were made for maternal age, parity and smoking habits. MAIN OUTCOME MEASURES: Miscarriage, preterm delivery, low birthweight, small for gestational age, congenital malformations, infant death, pre-eclampsia and placental abruption. RESULTS: A total of 980 infants born before and 152 born after transplantation were identified. A high frequency of pre-eclampsia (22%), preterm birth (46%), low birthweight (41%), small for gestational age (16%) and infant death (5% before the age of one) were found for deliveries after transplantation but similar frequencies were found also among deliveries a few years before transplantation. No significant increase in congenital malformation rate was seen. Among 15 infants born after liver transplantation, 2 were malformed. CONCLUSIONS: Pregnancies after organ transplantation have an increased risk of complications but this is similar to pregnancies occurring before the transplantation.

Adult↗
PubMed1999

Dental caries, social deprivation and enhanced capitation payments for children.

OBJECTIVE: Investigate the appropriateness of the under fives' enhanced capitation scheme. DESIGN: Calculation of mean caries indices for socially deprived wards (Jarman score 2.5 or greater) and less socially deprived wards (Jarman score below 2.5) in Sheffield using dental epidemiology data and social deprivation data. Calculation of electoral ward dental registration rate using health authority population register data and dental practice board data. SETTING: Within a health authority using population data already held by the health authority. RESULTS: Children living in deprived wards are 1.5 times as likely to have experienced decay (47% versus 31%). Of those children with decay, children in deprived wards have more teeth which have experienced decay (mean dmft (dmft > 0) 5.4) and more untreated decay (mean dt (dmft > 0) 3.4) compared with their peers in less deprived wards (mean dmft (dmft > 0) 4.6 and mean dt (dmft > 0) 3.1). Dental Practice Board data is based upon dental practice postcode, hence some Sheffield electoral wards have dental registration levels as high as 1400 per 1000 residents. CONCLUSIONS: The principle of targeting dental need by use of Jarman Score is appropriate, however the targeting is undermined by the use of dental practice postcode as the basis of payments. Payment should be based upon the home postcode of the child patient.

Capitation Fee↗
PubMed1995

Age-specific standardized mortality rates in people with learning disability.

The aim of the present study was to calculate the age-and sex-specific standardized mortality ratios (SMRs) in two populations of people with learning disability (LD). These populations included people living in institutions and community settings. It was found that SMRs tended to be raised for both males and females in each population, but SMRs do not always significantly differ from unity. For the combined Register populations, SMRs are generally significantly greater than unity. We conclude that these data provide evidence that death rates for people with LD are often higher than in the general population.

Activities of Daily Living↗
PubMed2005

Hospitalisations from birth to 5 years in a population cohort of Western Australian children with intellectual disability.

AIMS: To describe the hospitalisation history in the first five years of life for all children born in Western Australia (WA) between 1983 and 1992 and diagnosed with intellectual disability (ID). METHODS: Unit record linkage of the WA Midwives Collection, WA Intellectual Disability Database, and the WA Hospital Morbidity Dataset provided the population database of WA born children with and without ID. Affected children were divided into those co-affected with autism spectrum disorders (ASD), and those whose ID had or had no known biomedical cause. Those without a biomedical cause were further subdivided into mild-moderate and severe categories. RESULTS: On average, ID affected children were more likely than non-affected children to be admitted to hospital (RR: 1.64; 95% CI 1.6 to 1.7), on more occasions (5.3 versus 2.2 admissions), for longer (29.6 versus 8.3 days), and for a larger range of clinical diagnoses. The only exception was the group of children co-diagnosed with ASD whose hospitalisation profile resembled more that of non-affected children. CONCLUSIONS: This total population study is unique because of the availability of the system of linkable population registers and administrative health databases in WA. The results indicated that this vulnerable population of children with ID has substantial medical needs. This paper points to the need for authorities to develop supportive programmes for this population especially in the current climate of de-medicalisation of ID. More research is not only needed on the welfare of the affected children but also on the impact of the substantial medical and other needs of affected children on the rest of their immediate and extended families.

Autistic Disorder↗
PubMed1999

Identification of incident stroke in Norway: hospital discharge data compared with a population-based stroke register.

BACKGROUND AND PURPOSE: The validity of hospital discharge diagnoses is essential in improving stroke surveillance and estimating healthcare costs of stroke. The aim of this study was to assess sensitivity, positive predictive value, and accuracy of discharge diagnoses compared with a stroke register. METHODS: A record linkage was made between a population-based stroke register and the discharge records of the hospital serving the population of the stroke register (n=70 000). The stroke register (including patients aged 15 and older and with no upper age limit), applied here as a "gold standard," was used to estimate sensitivity, positive predictive value, and accuracy of the discharge diagnoses classification. The length of stay in hospital by stroke patients was measured. RESULTS: Identifying cerebrovascular diseases by hospital discharge diagnoses (International Classification of Diseases, 9th Revision [ICD-9], codes 430 to 438.9, first admission) lead to a substantial overestimation of stroke in the target population. Restricting the retrieval to acute stroke diagnoses (ICD-9 codes 430, 431, 434, and 436) gave an incidence estimate closer to the "true" incidence rate in the stroke register. Selecting ICD-9 codes 430 to 438 of cerebrovascular diseases gave the highest sensitivity (86%). The highest positive predictive value (68%) was achieved by selecting acute stroke diagnoses (ICD-9 codes 430, 431, 434, and 436), at the expense of a lower sensitivity (81%). Accuracy of ICD codes 430 to 438.9 (n=678) revealed the highest proportion of incident strokes identified by the acute stroke diagnoses (ICD-9 codes 430, 431, 434, and 436). Seventy-four percent of hospital discharge diagnoses classified as first-ever stroke kept the original diagnosis. Only 4.6% of the discharge diagnoses were classified as nonstroke diagnoses after validation. The estimation of length of stay in the hospital was improved by selection of acute stroke diagnoses from hospital discharge data (ICD-9 codes 430, 431, 434, and 436), which gave the same estimate of length of stay, a median of 8 days (2.5 percentile=0 and 97.5 percentile=56), compared with a median of 8 days (2.5 percentile=0 and 97.5 percentile=51) based on the stroke register. CONCLUSIONS: Hospital discharge data may overestimate stroke incidence and underestimate the length of stay in the hospital, unless selection routines of hospital discharge diagnoses are restricted to acute stroke diagnoses (ICD-9 codes 430, 431, 434, and 436). If supplemented by a validation procedure, including estimates of sensitivity, positive predictive value, and accuracy, hospital discharge data may provide valid information on hospital-based stroke incidence and lead to better allocation of health resources. Distinguishing subtypes of stroke from hospital discharge diagnoses should not be performed unless coding practices are improved.

Cerebrovascular Disorders↗
PubMed2003

Prescription drugs during pregnancy and lactation--a Finnish register-based study.

OBJECTIVE: To examine the use of prescription drugs in Finnish women before and during pregnancy and lactation. METHODS: A register-based study linking four nation-wide registers in Finland: the Maternal Grants Register, the Drug Prescription Register, and the Special Refund Register (all maintained by the Social Insurance Institution in Finland; KELA), and the Finnish Population Register. The study included all women applying for maternity support (maternal grants) during the year 1999, and non-pregnant control women matched by age and hospital district. Data collection included the number and type of prescription drugs purchased by the two cohorts during preconception (3 months before pregnancy), each trimester, and lactation. RESULTS: Of the 43,470 pregnant women, 46.2% purchased at least one drug and 12.7% three or more different drugs during pregnancy. Corresponding proportions for the control cohort were 55.2% (OR 0.7, 95% CI 0.6-0.7) and 23.0% (OR 0.5, 95% CI 0.5-0.5). The drugs most frequently purchased during pregnancy were systemic antibiotics (24.1% of pregnant women vs 27.3% controls; OR 0.8, 95% CI 0.8-0.9) and gynaecological anti-infective agents (8.3% vs 1.5%; OR 5.5, 95% CI 5.5-6.5). For pregnant women, purchases of most drug groups had already declined during the first trimester, but no reduction was apparent in drugs for chronic illnesses (epilepsy, asthma, diabetes). CONCLUSIONS: Although drugs were purchased abundantly during pregnancy, a significant decline occurred for most drug groups. The medication pattern for chronic illnesses remained unchanged. The purchase of several different drugs was relatively common and raises concerns.

Adolescent↗
PubMed2000

Dental caries, contact with dental services and deprivation in young children: their relationship at a small area level.

OBJECTIVE: To measure the relationship between tooth decay, contact with dental services and deprivation at electoral ward level. SETTING: The study was carried out in 1998 in Ellesmere Port in the North West of England. SUBJECTS AND MATERIALS: All children younger than six years resident in Ellesmere Port registered with GDS services and those using CDS services were matched against the HA population register to identify unregistered children. Rates for children aged 3-5 years 'in contact' with primary dental care services, whether CDS or GDS, were calculated at ward level. One calibrated examiner examined all 5-year-old children in Ellesmere Port and dmft scores were calculated at ward level. Ward deprivation was measured using the Jarman score. Bivariate linear regressions at ward level were performed in turn between: dmft and Jarman score; rates for 3-5-year-olds in contact with dental services and Jarman score; and dmft and rates for 3-5-year-olds in contact with dental services. RESULTS: A significant linear relationship was observed between dmft and Jarman score (P=0.02, R2 = 0.43). Significant inverse relationships were found between rates for 3-5-year-olds in contact with dental services and Jarman score (P=0.001, R2 = 0.67), and also between dmft and rates for 3-5-year-olds in contact with dental services (P=0.002, R2 = 0.65). CONCLUSIONS: A strong inverse relationship was found between dental caries and contact with primary dental care services at electoral ward level. This relationship needs to be explored over a wider geographical area to establish if it is consistent and independent of deprivation.

Child Health Services↗
PubMed2000

Cancer among children of parents with autoimmune diseases.

Many different aetiologies for childhood cancer have been suggested, but few are well established. One is that parental autoimmune disease is linked with susceptibility for haematopoietic malignancies in their offspring during childhood. The present study is the first to investigate this hypothesis using a follow-up design. A cohort of 53,811 children of more than 36,000 patients diagnosed with a systemic, organ-specific or suspected autoimmune disease were followed up for cancer incidence in the Danish Cancer Registry during 1968-1993. The parents were identified through the National Registry of Patients, while their children were traced in the Central Population Register. Cancer incidence among the offspring was compared with that in the corresponding childhood population of Denmark. In total, 115 cancers were observed among children aged 0-19 years, yielding a non-significant standardized incidence ratio of 1.07. Lymphomas contributed 21 cases to the overall number of tumours, 60% more than expected (95% confidence interval (CI) 1.0-2.4); leukaemia contributed 37 cases representing an excess of 30% (95% CI 0.9-1.8). Our results give some support to the hypothesis that parental autoimmune disease is associated with childhood lymphoma and leukaemia.

Adolescent↗