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PubMed2001

Community surveys of late-life depression: who are the non-responders?

BACKGROUND: community surveys of depression among older people may be particularly prone to non-response. Information on non-responders is difficult to obtain and often limited to demographics. Therefore, the full extent of response bias is not always known. OBJECTIVE: to determine factors associated with non-response at each stage of a two-stage survey of late-life depression. SETTING: one large general practice (registered population >30000) serving the market town of Melton Mowbray, Leicestershire, UK. SUBJECTS: community residents (n=2633) aged 65-74 years registered with the practice. METHODS: a two-stage community survey of patients aged 65-74 years. The first stage was an interviewer-administered general health survey including a measure of depressive symptoms. We asked those who screened positive for possible depression to undergo a semi-structured psychiatric interview. We compared use of services and medication by non-responders and responders to both stages using primary-care records. We compared Townsend deprivation scores using data obtained from the 1991 census. RESULTS: responders to stage 1 were more likely to use both primary [odds ratio (OR) 1.65, 95% confidence interval (CI) 1.38-1.96] and secondary (OR 1.59, 95% CI 1.25-2.02) services and tended to live in more affluent areas (P=0.002). At stage 2, the only difference observed was a lower level of use of tranquillisers or hypnotics among responders (OR 0.27, 95% CI 0.11-0.67). CONCLUSIONS: older people with low levels of contact with health services may be under-represented in community surveys of depression. Investigators should look outside traditional health settings to promote the uptake of response in these studies.

Aged↗
PubMed1999

Post-stroke depression and functional recovery in a population-based stroke register. The Finnstroke study.

Post-stroke depression and functional outcome were examined in a population-based stroke register active in four different districts (total population, 134 804) in Finland. Five hundred and ninety four first time strokes were registered. Beck's depression inventory (BDI), with ten as the cutoff point for depression, was applied to 321 of 423 survivors after three months and to 311 of 390 survivors after 12 months. Functional outcome was measured with the Barthel Index (BI) and the Rankin Scale (RS). One hundred and fifty one of 321 (47.0%) and 147 of 311 (47.3%) patients were depressed after three and 12 months, respectively. Depression at three months was associated with poor functional outcome at the one-year follow-up (P = 0.001 for the BI and the RS). On the other hand, poor functional outcome at three months was associated with depression after one year (P = 0.004 and 0.002 for the BI and the RS, respectively). Patients who were depressed at three months were more often in institutional care between three and 12 months later than non-depressed patients (P = 0.005). Post-stroke depression is associated with poor functional recovery of patients. If depression were diagnosed and treated early, it might help patients to recover more completely and/or faster, which could save community healthcare resources by avoiding or shortening the time of institutional care or reducing the need for home care.

Aged↗
PubMed2003

An association of maternal age and birth weight with end-stage renal disease in Saskatchewan. Sub-analysis of registered Indians and those with diabetes.

AIMS: To determine links between birth related factors and end-stage renal disease (ESRD). METHODS: This 1:3 age, sex, and source population (registered Indians [SkRI] and other Saskatchewan people [OSkP]) matched case-control study, compared maternal age and parity, gestational age, low birth weight (LBW), and high birth weight (HBW), between subjects with and without ESRD. RESULTS: Of 1,162 subjects, 277 cases (48 SkRI and 229 OSkP) and 601 controls (112 SkRI and 489 OSkP) had birth weight information. A trend for increased LBW rates occurred among SkRI and OSkP cases compared to controls (10.4 vs. 5.3% and 6.6 vs. 4.3%), and was significant for OSkP female cases (OR 3.66; 95% confidence interval [CI] 1.05, 12.73). Higher HBW rates occurred in SkRI cases (14.6% compared to 11.6% controls; N/S), and 3/5 female SkRI diabetic ESRD (DESRD) cases were over 3,750 g compared to 1/14 controls (p < 0.05). Only maternal age >/=30 years was an independent predictor for ESRD, particularly for OSkP non-DESRD cases (OR 2.45; 95% CI 1.03, 5.8). Cases with older mothers had lower mean birth weights than controls (3,236 vs. 3,434 g; p = 0.005). CONCLUSIONS: Older maternal age may predispose offspring to ESRD through mechanisms that differ for DESRD versus non-DESRD, and that may relate to ethnicity.

Adolescent↗
PubMed1996

Creation of a District Diabetes Register using the DIALOG system.

A District Diabetes Register has been created using the Family Health Services Computer Unit system, DIALOG, linked to the Family Health Services Authority (FHSA) population register. Initial informal discussions between the Diabetes Centre, Public Health, and the FHSA led to a formal proposal being accepted by the Local Diabetes Services Advisory Group to pilot the DIALOG software. Following installation of DIALOG on a separate computer, electronically linked to the main FHSA system, the register was compiled. This was approached in three ways. The existing Diabetes Centre Register was downloaded into DIALOG and patients matched with the FHSA register. A 'diabetes roadshow' was mounted, with Postgraduate Education Allowance approval, to individually visit every general practice in the district to explain the aims and objectives of creating a diabetes register and to enlist the support of these practices. Where practices already held their own diabetes register this was similarly transferred, if not, assistance was provided to identify their patients with diabetes. All patients were notified in writing that their names were being placed upon a diabetes register and that clinical data would be held against their entry. This notification included an opportunity to opt out. Additionally, a self registrations scheme was introduced whereby all retail pharmacists dispensing any diabetes related product and all optometrists seeing a person with diabetes, gave the patient a leaflet, describing the register and its purposes and inviting them to register themselves. A 'Data Ownership Committee' was established to control the use and interpretation of all clinical data held upon the register. The process of diabetes annual review is now being prompted across both primary and secondary care and clinical data is being returned to the register.

Diabetes Mellitus↗
PubMed1980

Survival and mortality pattern among Swedish smelter workers.

The study analyses work history and mortality data for 3919 male workers first employed during 1928-66 at Rönnskärsverken, a copper smelter in north-east Sweden. 99% of the workers were traced from employment records and central population registers. By means of standarized mortality ratios and life-table analysis comparisons were made with both the general and local populations. For all causes excess mortality is 18% relative to the general population. This can be ascribed to tumours and circulatory diseases, for which excess figures are 39 and 32% respectively. For tumours, the excess mortality is mainly due to lung cancer for which the risk is trebled relative to the general population and 5-fold relative to local populations. For circulatory diseases, the excess figure is mainly accounted for by cerebrovascular disease with an elevated risk of 60-70%. The probable remaining life-time from 50 years is 2 years shorter than for Swedish men in the 60's. Internal comparisons were made to analyse the importance of latency, exposure, calendar time and place of work. A dose-response analysis clearly indicates that the roasters and arsenic departments are risk places for the development of cancer, especially lung cancer. A 50-year old worker who has been exposed to the roasters for more than 5 years, has a probable remaining life-time which is almost 3 years shorter than the average Rönnskär employee and almost 5 years shorter than the average Swedish male. Case-control studies aimed at exploring exposure associated with stomach cancer and cerebrovascular mortality are under way.

Adolescent↗
PubMed2005

Demogenetic study of three populations within a region with strong founder effects.

OBJECTIVES: The population of the Saguenay-Lac-St-Jean (SLSJ) region (Quebec, Canada) is known to have a relatively high prevalence of certain hereditary disorders, which can be explained by the consequences of founder effects. This study aims at providing new insights on the origins and subregional stratification of these founder effects. METHODS: The genealogies of 300 individuals were reconstructed and analyzed using the BALSAC population register. RESULTS: Inbreeding and kinship levels are higher in Lower Saguenay than in Upper Saguenay and Lac-St-Jean. The population of Lower Saguenay also distinguishes itself because of a fewer number of distinct ancestors. CONCLUSION: Beyond the genetic features that characterize the whole region, SLSJ also displays intraregional variability. Thus it is important to take into account the settlement patterns and the demographic history of this population for a better appraisal of its contemporary genetic structure.

Demography↗
PubMed1996

The Danish Twin Register.

BACKGROUND: Population based twin registers represent a valuable tool for genetic epidemiological research, since twin studies aim at separating the effect of genes and environment for complex traits. The Danish Twin Register's history, size, ascertainment and completeness of data, as well as data accessibility and availability are described. RESULTS: The Danish Twin Register comprises 14,051 twin pairs born 1870-1930, representing all twins surviving to age six years, and 20,888 twin pairs born 1953-1982, representing 75% of those born 1953-1967 and 95% of those born 1968-1982. The birth cohorts 1931-1952 og 1983-1993 are being ascertained at the moment. The register is available for research given certain conditions are fulfilled. CONCLUSION: This register will in a few years be the most comprehensive twin register in the world. It is a very valuable Danish research resource.

Child↗
PubMed1998

Coronary events and exposure to environmental tobacco smoke: a case-control study from Australia and New Zealand.

OBJECTIVES: To estimate the relative risk of coronary heart disease (CHD) associated with exposure to environmental tobacco smoke (ETS). DESIGN: Population-based case-control study. SUBJECTS: Cases were 953 people identified in a population register of coronary events, and controls were 3189 participants in independent community-based risk factor prevalence surveys from the same study populations. SETTING: Newcastle, Australia and Auckland, New Zealand. MAIN OUTCOME MEASURES: Acute myocardial infarction or coronary death. RESULTS: After adjusting for the effects of age, education, history of heart disease, and body mass index, women had a statistically significant increased risk of a coronary event associated with exposure to ETS (relative risk (RR) = 1.99; 95% confidence interval (CI) = 1.40-2.81). There was little statistical evidence of increased risk found in men (RR = 1.02, 95% CI = 0.81-1.28). CONCLUSION: Our study found evidence for the adverse effects of exposure to ETS on risk of coronary heart disease among women, especially at home. For men the issue is unclear according to the data from our study. Additional studies with detailed information on possible confounders and adequate statistical power are needed. Most importantly, they should use methods for measuring exposure to ETS that are sufficiently accurate to permit the investigation of dose-response relationships.

Adult↗
PubMed1998

Family planning in China: out of control?

OBJECTIVES: This study examined sex ratios in 6 counties in China. METHODS: Data from a household survey (n = 5756) were retrospectively analyzed. RESULTS: A normal sex ratio was found for children less than 18 years of age. Significant differences in sex ratios and family size were observed between the household survey data and population registers. CONCLUSIONS: The findings indicate a high number of unregistered female births and are consistent with calls for a rethinking of Chinese population policies in the direction of a more collaborative policy based on female education and participation.

Adolescent↗
PubMed1992

Spatial population mobility in Poland, 1952-1985.

This is a summary of the author's 1989 study on internal migration in Poland from 1952 to 1985. "The main aims of the study are: to describe spatial patterns of different types of migration vis-a-vis national socioeconomic change on the basis of the available unified statistical material...; to identify changes in the intensity and range (distance) of those movements; [and] to propose a hierarchical regionalization of permanent migration based on inter-voivodship flows, using the Slater method, as well as to identify the stage by the process of modernization of spatial mobility which has been reached in Poland." Data are primarily from official sources, including censuses and the current population register.

Demography↗
PubMed1998

Rapid reduction in coronary risk for those who quit cigarette smoking.

The objective of this study was to determine the rate of the decline in risk of a major coronary event after quitting cigarette smoking. It was a population-based case-control study of men and women aged 35 to 69 years in Newcastle, Australia, and men and women aged 35 to 64 years in Auckland, New Zealand, between 1986 and 1994. Cases were 5,572 people identified in population registers of coronary events and controls were 6,268 participants in independent community-based risk factor prevalence surveys from the same study populations. There was a rapid reduction in risk after quitting cigarette smoking. The risk of suffering a major coronary event for men who were current cigarette smokers was 3.5 (95% CI 3.0-4.0) times higher than the risk for never smokers but this fell to 1.5 (95% CI 1.1-1.9) for men who had quit for 1-3 years. Women who were current cigarette smokers were 4.8 (95% CI 4.0-5.9) times more likely to suffer a major coronary event than never smokers and this fell to 1.6 (95% CI 1.0-2.5) for women who had quit for 1-3 years. Those who had quit cigarette smoking for 4-6 years or more had a similar risk to never smokers. These results reinforce the importance of smoking cessation. The public health message is that the benefit of giving up smoking occurs rapidly.

Adult↗
PubMed2001

[Social economical status, behaviors and environment as the risk factors of tuberculosis in Chengdu China].

OBJECTIVE: To study the risk factors of pulmonary tuberculosis in Chengdu, Southwest China. METHODS: A population-based case-control study was used which included 174 cases selected from 12 communities in Chengdu and 174 controls selected from registered population with normal chest radiograph. Cases were active TB patients which were matched for age, sex with controls, then interviewed by trained interviewers using a standardized questionnaire. RESULTS: Social economic status measured by education, occupation and income did not show obvions influence to TB; It found that the active smoking, passive smoking, type of cigarettes and alcohol consumption had no significanct effects on TB during logistic regression analysis. The study showed that a person who was smoking and also alcohol intake had a higher risk to get TB (OR = 6.12, 95% CI = 1.15 - 32.49). Significant association was showed in the Dose-Response Analysis (OR = 1.37, 95% CI = 1.30 - 2.30). Crowded living space (OR = 1.14, 95% CI = 1.05 - 1.25), degree of darkness (OR = 2.18, 95% CI = 1.11 - 4.27) and moisture (OR = 4.06, 95% CI = 2.25 - 7.33), poor sanitary (OR = 3.03, 95% CI = 1.22 - 4.44), airpollution of working environment, which were filled with dusts (OR = 2.35, 95% CI = 1.18 - 4.70) and chemical fumes (OR = 5.15, 95% CI = 1.44 - 18.40) were strongly associated with pulmonary tuberculosis. BMI also had strong relationship with TB (OR = 4.72, 95% CI = 2.68 - 8.33). CONCLUSION: Poor environment and exposure to dust and chemical fume under working condition, low BMI, smoking combining alcohol consumption were the risk factors of adult pulmonary tuberculosis in Chengdu, China.

Adolescent↗
PubMed1999

Adipose tissue distribution in postmenopausal women with adenomatous hyperplasia of the endometrium.

OBJECTIVE: To investigate body fat distribution in postmenopausal women with adenomatous and atypical hyperplasia of the endometrium. METHODS: A prospective population-based case control study was performed in a health care county in Sweden. General obesity, as reflected by body mass index (BMI), and adipose tissue distribution, expressed as waist to hip circumference ratio (WHR), were evaluated in a cohort of 367 postmenopausal women who underwent dilatation and curettage because of uterine bleeding. The study group consisted of 29 women with adenomatous or atypical hyperplasia of the endometrium. The controls consisted of 49 age-matched postmenopausal women randomly selected from the computerized population register of the same region. RESULTS: The frequency of endometrial adenomatous and atypical hyperplasia in postmenopausal women with bleeding was 7.2%. In the total population of postmenopausal women the incidence of these endometrial lesions was 44 per 100,000 per year. Body weight (P = 0.039), BMI (P = 0.007), and WHR (P = 0.022) were higher in postmenopausal women with endometrial adenomatous and atypical hyperplasia than in controls. In multivariate analysis only BMI remained statistically associated with adenomatous hyperplasia (P = 0.012). CONCLUSIONS: General obesity, but neither upper nor lower body fat distribution, was characteristic of postmenopausal women with adenomatous and atypical hyperplasia of the endometrium. Overall obesity is a risk factor for these endometrial precancerous lesions, as it is also claimed to be for endometrial cancer.

Adipose Tissue↗
PubMed2006

Polymorphisms in the DNA repair genes XRCC1, APEX1, XRCC3 and NBS1, and the risk for lung cancer in never- and ever-smokers.

This case-control study examines the association between lung cancer and genetic polymorphisms in two base excision repair (BER) genes, XRCC1 and APEX1 and two genes involved in homologous recombination repair (HR), XRCC3 and NBS1. Never-smoking lung cancer patients were recruited, and also the next diagnosed ever-smoking case of the same gender and age group. Controls were recruited from the regional population register, frequency matched to cases by hospital catchment area, gender, age group and smoking category. As a result more than 70% of the study population were women. A total of 331 individuals were analysed. Presence of the XRCC1 399Gln allele was associated with a significantly decreased risk for lung cancer among non-smoking women (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.2-0.9). No significant effect was seen with the APEX1 polymorphism. Women smokers carrying the XRCC3 241Met allele showed a significantly decreased risk for lung cancer (OR 0.3, CI 0.2-0.7). The NBS1 185Gln allele was significantly associated with an increased risk for lung cancer among non-smoking women (OR 2.2, CI 1.0-4.8) and low-dose smoking women (OR 4.8, CI 1.5-15.7). The protective effect of the variant XRCC3 241Met allele was strengthened when combined with the low-risk Glu185 allele of the NBS1 gene. Smokers (OR 0.38, CI 0.16-0.90) and women (OR 0.42, CI 0.21-0.85) with at least three low-risk alleles in these two HR genes showed a significantly decreased risk for lung cancer. Thus, in spite of a relatively small study population, this study, including a comparatively large number of never-smokers and women, presents several novel aspects on genetic susceptibility to lung cancer. Our results show that the genetic variation in XRCC1, XRCC3 and NBS1 influence lung cancer susceptibility among women, and that combinations of risk alleles in the two HR genes can enhance the effects.

Adult↗
PubMed2002

The risk of asthma among Finnish patients with farmer's lung.

OBJECTIVES: To assess the incidence and risk of asthma in patients with farmer's lung in comparison with farm workers without farmer's lung. METHODS: The details of farmers and animal-husbandry workers notified in 1988-1999 for farmer's lung ( n=1,272) or other occupational disease ( n=5,045) to the Finnish Register of Occupational Diseases were followed until 31 December 2000 through two national registries of individuals eligible for reimbursement of the cost of asthma medication and the Population Register Center. Incidence rates of asthma were calculated, and a log-linear model adjusted for age, gender and occupation was used to estimate relative risks of asthma among those with farmer's lung compared to those with other occupational disease. RESULTS: Of the patients with farmer's lung, 109 (8.6%) were diagnosed with asthma during the follow-up compared with 202 (4.0%) incident cases of asthma among those in the reference population. The crude relative risk of asthma was 2.1 (95% CI 1.6-2.6) among those with farmer's lung compared with the reference population. The age- and occupation-adjusted relative risk of asthma among patients with farmer's lung was 2.5 (1.8-3.5) in men and 1.4 (1.0-1.9) in women. The rate of asthma was especially high during the first 2 years after notification of farmer's lung. CONCLUSIONS: Patients with farmer's lung have an increased risk of developing asthma in comparison to farm workers in general. Most of the cases of asthma occur relatively shortly after the diagnosis of farmer's lung, which should be taken into account in medical follow-up of patients with farmer's lung.

Adolescent↗
PubMed2007

Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry-based study.

OBJECTIVES: To describe the true incidence, prenatal detection rate and fetal outcome of congenital diaphragmatic hernia (CDH) in a systematically registered population over an 18-year period and to determine any change in trends over time. METHODS: This was a retrospective study of all cases of CDH registered in the Central-Eastern France Birth Defects Registry from 1986 to 2003. All fetuses and infants up to 1 year of age diagnosed with CDH were registered, including miscarriages later than 22 weeks of gestation, stillbirths and terminations of pregnancy (TOP). Routine prenatal screening consisted of three ultrasound examinations and there was no upper limit of gestational age for TOP. RESULTS: Five hundred and one cases of CDH were identified from a total of 1 835 022 live births (2.7 cases per 10 000 live births). The overall prenatal detection rate was 54%. There was a significant increase over time in the detection rate mainly for associated CDH and left-sided CDH (P < 0.0001), and in the proportion of neonates delivered in tertiary centers (P < 0.0001). The overall survival rate at discharge was 47% and this increased significantly over time for isolated CDH (P = 0.04), whereas it was lower and remained stable for associated CDH (P = 0.64). The TOP rate for isolated CDH did not vary significantly in contrast to that for associated CDH cases in which the TOP rate increased over time, progressively replacing the neonatal death rate (P = 0.01). CONCLUSIONS: Over an 18-year period, this large population-based study demonstrated increasing prenatal detection rates for associated CDH and left-sided CDH and confirmed an increasing survival rate mainly for isolated CDH.

Female↗
PubMed1987

[New long-term patients--demographic and diagnostic peculiarities].

This paper presents results of a study which was done as part of an investigation on predictor variables for new long-stay patients. Using easily accessible data, e.g. age, sex, diagnosis, etc., 145 new long-stay patients of the Psychiatric Department of Berne University (PUK Bern) admitted from 1979 to 1982 were compared with all in-patients and 396 old long-stay patients of the same clinic, as well as with British and German case-register populations. A total of 3.1% of all admissions in this four-year-period received in-patient treatment for more than one year; this proportion is similar to those reported from British and German case-registers. Older patients tend to have more long stays in hospitalizations; only 25% in the PUK new long-stay population were aged 65 and over. The sex ratio men: women was 1:1, whereas there are twice as many women as men among new long-stay patients in Great Britain. Looking at marital status we found, as could be expected, only very few married people (15%), compared with 62% unmarried and 23% widowed or divorced. The diagnostic composition showed that organic brain syndromes, schizophrenia, personality disorders, and mental retardation were over-represented in the new long-stay population. The diagnostic comparison between new and old long-stay patients showed substantial differences which proved to be congruent with the results of other investigators.

Adult↗
PubMed1990

Laryngeal cancer in Denmark: a nationwide longitudinal study based on register linkage data.

To identify high and low risk groups for laryngeal cancer in Denmark, all individuals aged 30-74 in the 1970 census were followed up over 10 years. Census data were linked with the Central Population Register to identify persons who died or emigrated during the follow up, and with the Danish Cancer Register to identify cases of laryngeal cancer. Individuals were categorised according to sex, age, and sociodemographic characteristics as declared on the census forms. A multivariate analysis was carried out by means of multiplicative Poisson models. The study showed that the risk of laryngeal cancer was strongly related to sociodemographic factors. The risk for skilled workers living in Copenhagen (relative risk (RR) 4.76, 95% confidence interval (CI) 3.61-6.28) was estimated to be almost five times higher than the risk for men self employed in agriculture and living in rural areas. The variation in the risk of laryngeal cancer is not fully explained by known variations in tobacco and alcohol consumption, and this study highlights additional risk factors particularly related to occupation and marital state.

Adult↗