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PubMed1996

Sex differential for suicide among Austrian age cohorts.

The suicide mortality data in Austria were studied over a period of four decades of continuous reporting. The data were studied for age, period and cohort effects. For the period 1951 to 1990 suicides among eight birth cohorts, born between 1932 and 1975, show a marked sex differential in time trends. Up to 1985, the rates increase in a constant manner for males in all age groups, in contrast to females. Results obtained using the Poisson regression models demonstrate a 35% (incidence rate ratio (IRR), 1.35%; 95% CI, 1.27-1.45) increased risk for male cohorts born later compared with those born earlier. The risk for later-born females was not increased (IRR, 1.03; 95% CI, 0.91-1.17). Explanations such as improved living conditions for Austrian women remain tentative, however, as age, period and cohort effects cannot be separated as independent variables in the suicide mortality data available in Austria.

Adolescent↗
PubMed1998

Immigration, moving house and psychiatric admissions.

This study was designed to elucidate psychiatric admission rates for native Swedes and foreign-born individuals during the period 1991-1994, when Sweden had a great influx of refugees. During the same period, and even earlier, psychiatric in-patient care had been reduced. Tests of differences between Swedes and foreign-born individuals in first psychiatric admission rates were performed using Poisson regressions, and the risk of a readmission was assessed using a proportional hazard model. Foreign-born individuals and native Swedes, both males and females, showed a similar admission pattern with regard to the number of admissions. Foreign-born males under 55 years of age and foreign-born females under 35 years of age had significantly higher admission rates than native Swedes. In total, native Swedes, both males and females, were hospitalized for a significantly longer period than the foreign-born subjects. About 43% of the patients were readmitted. The risk of a readmission was significantly increased among those with a high rate of internal migration. The high admission rates for young foreign-born individuals might be explained by a high incidence of mental illness owing to the trauma of being violently forced to migrate, acculturation difficulties, or unsatisfactory social circumstances such as high unemployment. The shorter hospitalization time could be due to undertreatment or less serious mental illness.

Adult↗
PubMed1997

HIV-associated oral lesions: prevalence in Zambia.

OBJECTIVES: To describe the prevalence of HIV-associated oral lesions in known HIV+ subjects in Zambia and assess the predictive value of these lesions to identify individuals with CD4 cell counts less than 200 x 10(6) L-1. SETTING: St Francis Hospital, situated in the rural Katete District, Eastern Province, Zambia. SUBJECTS: 107 newly diagnosed heterosexual HIV positive individuals included 42% males and 58% females (mean age 34.5, range 16-62). METHODS: Following a medical history and detailed oral examination, blood and whole saliva were collected in each subject. RESULTS: A total of 47.7% from this sample had an AIDS diagnosis. The mean CD4 count was 252.2 cells mm-3 (s.d. +/- 160.5, range 44-810); 40.2% of the study group demonstrated oral lesions associated with HIV seropositivity. Candidiasis was most commonly seen (25% prevalence). In this population erythematous candidiasis was the only oral lesion significantly associated with CD4 counts of less than 200 x 10(6) L-1 (P < 0.05, Two-tailed Fisher's Exact Test). CONCLUSION: In resource poor countries a thorough oral examination may suggest HIV infection and predict disease progression. Health care professional education regarding the orofacial manifestations of HIV infection needs urgent reinforcement in these areas.

AIDS-Related Opportunistic Infections↗
PubMed2005

Risk factors of primary thyroid dysfunction in early infants born to mothers with autoimmune thyroid disease.

AIM: To assess whether the state of maternal thyroid function and the pattern of thyroid alterations during gestation would affect the infants' thyroid function and to evaluate the risk factors affecting early infants' thyroid function by means of multiple logistic regression. METHODS: In a cross-sectional study, 78 neonates born to mothers with Graves disease or Hashimoto thyroiditis were examined and followed clinically and biochemically. Neonates born to healthy mothers during the same period were set as controls. Tests of thyroid function, antithyroid peroxidase antibody (TPOAb), antithyroglobulin antibody (TGAb), anti-TSH receptor antibody (TRAb) and antithyroid-stimulating antibody (TSAb) were performed both in early infants and their mothers. All possible maternal and/or infantile risk factors for thyroid dysfunction during early infancy were analysed by means of multiple-factor logistical regression. RESULTS: The overall prevalence of underlying subtle thyroid abnormalities in these 78 infants was 52.6%, which was significantly higher than that witnessed among infants from healthy mothers (5.4 per thousand, p<0.01). By using multiple logistic regression analysis, the state of maternal thyroid function in gestation, the type of autoimmune thyroid disease during pregnancy and the level of TRAb in the newborn were significantly correlated with the early infants' thyroid dysfunction. CONCLUSION: Maternal autoimmune thyroid disease during pregnancy will affect infant thyroid function. Therefore, appropriate management of maternal autoimmune thyroid disease throughout pregnancy is essential in the prevention of undesirable neonatal outcomes.

China↗
PubMed2005

Congenital heart defects: the patients who die.

AIMS: To register mortality and causes of death in patients with congenital heart defects (CHDs). METHODS: Prospective population-based observational study. RESULTS: 553 infants with CHD (1.1% of live born) were observed for 1-22 y (median 10 7/12 y). Sixty-four died (11.6%), of whom 32 (50%) died during the first 4 wk, and 51 (79.7%) during the first year of life. Of the total neonatal deaths in the population (3 per 1000), CHDs occurred in 21.5%. Mortality for children with CHDs was not significantly different between the cohorts born in 1982-1991 and 1992-2002, for either neonatal deaths or deaths later on (p>0.05). Out of 170 patients in whom therapeutic procedures (surgery, catheter interventions) were undertaken, 34 (20%) died. Nine cases (1.6%) died with unrecognized CHDs; seven of these on the first day of life with severe extracardiac malformations. In 50 (78.1%) cases, death was judged to be caused directly or indirectly from the CHD, and in 14 (21.9%) from extracardiac malformations or other conditions. CONCLUSION: CHDs occur in a substantial number of neonatal deaths. Most deaths are caused by cardiac insufficiency. The mortality rate remained unchanged.

Adolescent↗
PubMed2005

Impact of Ramadan on demographics and frequencies of disease-related visits in the emergency department.

Summary The objective of this study was to determine whether Ramadan is changing frequencies and demographics of visits due to certain diseases. Data obtained from the charts of the adult patients admitted into the emergency department (ED) due to 10 predetermined entities between 2000 and 2004 were analysed. Demographic variables analysed separately for certain entities visiting the ED in Ramadan were not found to be different from visits in other times of year. Visit frequencies for hypertension and uncomplicated headache in Ramadan were significantly higher than in non-Ramadan months (chi(2) test, p = 0.015 for hypertension, p < 0.001 for uncomplicated headache). Mean age of the patients admitted to the ED due to diabetes-related conditions in Ramadan was significantly lower than in pre- and post-Ramadan months (59.91 +/- 14.60 and 62.11 +/- 14.61, respectively) (Mann-Whitney U-test, p = 0.032). The patients with diabetes presenting in Ramadan were found significantly younger than their peers in the rest of the year. For other diseases, Ramadan does not appear to be a risk factor.

Adult↗
PubMed2001

Prevalence and correlates of sunscreen use among US high school students.

Sun exposure during childhood and adolescence increases the risk of skin cancer later in life. To determine the prevalence and correlates of sunscreen use among US high school students, researchers assessed data on sunscreen use, demographic characteristics, and health behaviors obtained from the 1999 Youth Risk Behavior Survey (YRBS). This survey used a three-stage cluster sample design to produce a nationally representative sample of students in grades 9-12 (N = 15,349). Overall, 13.3% (95% confidence interval, +/- 1.3) of students used sunscreen always or most of the time (i.e., frequent use). Frequent sunscreen use was lower among males (8.6%, +/- 1.2) than females (18.1%, +/- 1.9) and among Blacks (4.8%, +/- 1.7) and Hispanics (10.8%, +/- 2.8) than Whites (16.5%, +/- 1.9). Frequent sunscreen use decreased with age. Infrequent use of sunscreen was associated with other risky health behaviors, such as driving after drinking or riding in a car with a drinking driver, smoking cigarettes, being sexually active, and being physically inactive. Results indicate a need for health education interventions addressing sunscreen use that target high school students.

Administration, Cutaneous↗
PubMed2001

Practice belief scales among private general dental practitioners.

BACKGROUND: Practice beliefs have been related to service rate variation. The aims of this study were to replicate practice belief scales in Australia and investigate associations with dentist and practice characteristics and services. METHODS: A random sample of Australian dentists completed mailed questionnaires (response rate 60.3 per cent). RESULTS: Private general practitioners (n = 345) provided service data from a typical day. Eight practice belief items were recorded on a five-point Likert scale, yielding four factor-based scales. Approximately 85 per cent of responses were on the agreement side of the midpoint for the scales of Information giving and Patient influence, 45 per cent for Preventive orientation and approximately 10 per cent for Controlling active disease rather than developing better preventive advice. Capital city dentists had higher agreement with the Preventive orientation scale, while males and older dentists showed less disagreement with the Controlling active disease item (Mann-Whitney, Kruskal-Wallis P < 0.05). Those agreeing with the scales (that is scores < or = the median) showed (Poisson regression P < 0.05): a higher rate of crown and bridge, a rate ratio (RR) of 1.31, but lower rates of extraction (RR = 0.76) and prosthodontic services (RR = 0.64) for the Information giving scale; a higher rate of restorative (RR = 1.22) and total services per visit (RR = 1.06) for the Preventive orientation scale; a higher rate of preventive services (RR = 1.14), but a lower rate of crown and bridge services (0.78) for the Patient influence scale; and higher rates of crown and bridge (RR = 1.40) and prosthodontic (RR = 1.59) but lower rates of periodontic (RR = 0.60) and extraction services (RR = 0.62) for the Controlling active disease item. CONCLUSIONS: These findings confirm the factor structure of practice beliefs and demonstrate small to moderate associations with variation in service rates.

Adult↗
PubMed2004

Periodontal treatment needs of patients with renal disease receiving haemodialysis.

AIM/OBJECTIVE: The aim of this study was to perform periodontal assessment, using the CPITN index, on patients undergoing renal dialysis. METHODS: The periodontal conditions of 342 subjects undergoing renal dialysis from eight renal dialysis centres were examined using CPITN. Subjects were distributed into four age groups, 16-19, 20-34, 35-44 and > or =45 years. The study was conducted during a 6-month period. All clinical examinations were performed by one examiner. RESULTS: There was a significant positive relationship between the CPITN scores and age (r=0.164, p=0.002) and dialysis duration (r = 0.240, p=0.000). There was no statistically significant difference between male and female patients (p>0.05). None of the age groups had healthy sextants. The 35-44 year-age group had a higher number of sextants with deep pockets (0.19) than the other age groups and edentulous sextants were the highest among the oldest age group (1.89). CONCLUSION: A very small portion of the renal dialysis population is affected by severe forms of periodontitis requiring complex periodontal treatment. However, all such patients should be given oral hygiene education as a priority.

Adolescent↗
PubMed2002

Risk of pancreatic adenocarcinoma in chronic pancreatitis.

BACKGROUND: The risk of pancreatic cancer in patients with chronic pancreatitis (CP) is difficult to assess. Previous studies, mostly case control studies or studies relying on data case registers, reported relative risks varying from 2.3 to 18.5. METHODS: We studied a prospective, single centre, medical-surgical cohort of 373 consecutive patients (322 (86%) men, median age 40 years) with proven CP (alcoholic origin 85%) and a follow up of at least two years (median follow up 9.2 years; range 2.0-34.8) in order to exclude pancreatitis revealing pancreatic cancer. We calculated the age and sex standardised incidence ratio (SIR) as the ratio of the number of observed cases of pancreatic cancer in this cohort to the number of expected cases, as provided by the French National Cancer Register. RESULTS: Four cases of pancreatic adenocarcinoma (1.1% of patients) were observed in 3437 patient years (expected number of cases 0.15; SIR 26.7, 95% confidence interval (CI) 7.3-68.3; p=0.00002). In a second analysis in which patients lost to follow up were considered to be followed up until the end point without having developed pancreatic adenocarcinoma (4762 patient years), SIR was 19.0 (CI 5.2-48.8; p=0.00007). CONCLUSION: Patients with CP have a markedly increased risk of pancreatic cancer compared with the general population.

Adenocarcinoma↗
PubMed1998

Relation between attempted suicide and suicide rates among young people in Europe.

STUDY OBJECTIVE: To determine if there are associations between rates of suicide and attempted suicide in 15-24 year olds in different countries in Europe. DESIGN: Attempted suicide rates were based on data collected in centres in Europe between 1989 and 1992 as part of the WHO/EURO Multicentre Study of Parasuicide. Comparison was made with both national suicide rates and local suicide rates for the areas in which the attempted suicide monitoring centres are based. SETTING: 15 centres in 13 European countries. PATIENTS: Young people aged 15-24 years who had taken overdoses or deliberately injured themselves and been identified in health care facilities. MAIN RESULTS: There were positive correlations (Spearman rank order) between rates of attempted suicide and suicide rates in both sexes. The correlations only reached statistical significance for male subjects: regional suicide rates, r = 0.65, p < 0.02; national suicide rates, r = 0.55, p < 0.02. CONCLUSIONS: Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates.

Adolescent↗
PubMed2003

Comparative study of bone mineral density, calcium, and vitamin D status in the Gujarati and white populations of Leicester.

OBJECTIVES: To evaluate differences in bone mineral density (BMD), calcium, and vitamin D status between the Gujarati (South Asian) and white populations resident in Leicester and to determine whether this was linked to lifestyle factors. DESIGN: An observational cross sectional study of randomly selected Gujarati and white volunteers aged from 20-40 years. SETTING: City of Leicester. PARTICIPANTS: Subjects were randomly selected by age (20-40 years) and ethnicity. A total of 262 individuals volunteered to participate, of which 201 (51 white females, 71 Gujarati females, 37 white males, 42 Gujarati males) were eligible for the study. MAIN OUTCOME MEASURES: Results of questionnaire, BMD at the hip and lumbar spine, and measurement of serum calcium, albumin, alkaline phosphatase, and 25-hydroxyvitamin D. RESULTS: Male and female white subjects were significantly taller and heavier than their Gujarati counterparts. There was a statistically significant difference in BMD both at the spine (p<0.001) and hip (p<0.001) between the white and Gujarati females with the Gujaratis having a lower BMD. There was a trend for Gujarati males to have a lower BMD at the hip and spine than their white counterparts but these figures did not reach statistical significance. The intensity of cigarette smoking and the amount of alcohol consumption were both higher in the white male and female subjects. Sunlight exposure (>4 hours per day) was significantly higher in white subjects compared with Gujaratis. There were no significant differences in the mean level of serum calcium or alkaline phosphatase between the Gujaratis and whites. A significantly higher proportion (p<0.001) of the Gujarati men and women had a vitamin D level that was not measurable (that is, below the lower limit of the laboratory range of normal). Of those who had a measurable level (that is, in the normal range) mean levels of vitamin D were lower (p<0.05) in the Gujarati men and women. CONCLUSION: The present study is the first of its kind to note a low BMD in Gujarati subjects of South Asian origin compared with their white counterparts, living in Leicester. This study also confirms the presence of low serum vitamin D levels in Gujaratis. There is a need for more research in South Asians with regard to the collection of normal BMD values. This could provide a more meaningful reference range for identifying South Asians at risk of osteoporotic fractures and may have public health implications of relevance to this ethnic group.

Adult↗
PubMed2004

Hemoglobin levels in Qinghai-Tibet: different effects of gender for Tibetans vs. Han.

The Tibetan population, long a resident on the Qinghai-Tibetan Plateau, has lower hemoglobin concentrations than Han Chinese migrants, but it is incompletely known how gender affects the hemoglobin concentrations in the two populations at various altitudes. Measurements of hemoglobin concentration were obtained in 5,887 healthy male and female Tibetan and Han residents aged 5-60 yr, at altitudes of 2,664, 3,813, 4,525, and 5,200 m. Multiple regression equations showed the beta-coefficients for altitude and for age were higher (P < 0.05) in Han men than in Tibetan men and in Han women than in Tibetan women. Analysis indicated a significant three-way interaction between altitude, gender, and ethnicity (chi2 = 3.72, P = 0.05). With increasing altitude, men progressively had more hemoglobin than women in the Han, but not the Tibetan, population. Above 2,664 m, this gender-related difference in hemoglobin concentration increased from childhood to young adulthood more in Han than in Tibetans. We suggest that the Han-Tibetan ethnic difference in the effect of altitude on hemoglobin concentration depends to a large extent on gender.

Adolescent↗
PubMed2005

Extracellular water: greater expansion with age in African Americans.

Aging is associated with the onset of chronic diseases that lead to pathological expansion of the extracellular water (ECW) compartment. Healthy aging, in the absence of disease, is also reportedly accompanied by a relative expansion of the ECW compartment, although the studies on which this observation is based are few in number, applied different ECW measurement methods, included small ethnically homogeneous subject samples, and failed to adjust ECW for non-age-related influencing factors. The aim of the current study was to examine, in a large (n = 1,538) ethnically diverse [African American (AA), Asian, Caucasian, Hispanic] subject group the cross-sectional relationships between ECW and age after controlling first for other potential factors that may influence fluid distribution. ECW and intracellular water (ICW) were derived from measured total body water (isotope dilution) and potassium (40K whole body counting). The cross-sectional relationships between ECW, ICW, and ECW/ICW (E/I), and age were developed using multiple regression modelling methods. Body weight, weight squared, height, age, sex, race, and interactions were all significant ECW predictors. The slope of the observed race x age interaction was significantly greater in AA (beta = 0.0005, P = 0.005) than in the three other race groups. Race, sex, and age differences in fluid distribution persisted after adjusting for body composition in a subgroup (n = 994) with dual-energy X-ray absorptiometry lean soft tissue and fat measurements. A relative ECW expansion (i.e., E/I) was present with greater age in most sex-race groups, although the effect was not significantly larger in AA males (P > 0.05) compared with the other race groups, except Asians (P < 0.05). For females, a larger E/I-age effect was found in AA compared with the other race groups, but only the comparison against Hispanics was significant (P < 0.05). The ECW compartment and E/I are thus variably larger, according to race, in healthy older subjects independent of sex, lean soft tissue, and fat mass.

Black or African American↗
PubMed2003

Clostridium difficile-associated diarrhea: predictors of severity in patients presenting to the emergency department.

OBJECTIVE: Experiences with Clostridium difficile-associated diarrhea (CDAD) were reviewed to determine predictors of severity in patients presenting from the community. METHODS: All patients admitted to two hospitals over 4.5 years with a primary diagnosis of CDAD were reviewed. Patients requiring a hospital stay of greater than 14 days, colectomy, intensive care unit admission or who died were classified as 'severe CDAD' and compared with the remainder of the patients (termed 'mild CDAD'). RESULTS: One hundred fifty-three patients (mean age 63.4+/-20.5 years, range 21 to 93, 64.7% female) were reviewed. Forty-four per cent of the patients had community-acquired CDAD, and the remainder had hospital-acquired disease. There were 44/153 (28.8%) patients with severe CDAD, of which 10/153 (6.5%) died. The severe group had more patients over 70 years old (75% versus 43% in the mild group, OR 3.09, CI 1.81-8.63, P<0.001) and had more comorbid disease (median two major organ systems affected [range zero to five] versus one [range zero to four] in the mild group, OR 1.52, CI 1.27-2.65, P<0.05). Patients with recurrent CDAD were more likely to have severe CDAD (12/44 versus 10/109 in the mild group, OR 4.10, CI 1.47-9.40, P<0.01). CONCLUSION: Age over 70 years, comorbid illness and CDAD recurrence are significant risk factors for severe disease and a poor outcome in patients admitted to hospital for CDAD.

Adult↗
PubMedDate not supplied

Initial symptoms of Parkinson's disease with elderly onset.

BACKGROUND/OBJECTIVE: As the incidence of Parkinson's disease (PD) is related to aging, we consider it important to determine how the initial symptoms change with age in order to diagnose early elderly cases of PD accurately. METHODS: 84 patients (age at onset 70.7+/-9.0 years; mean +/-1 SD) were studied to see whether the initial symptoms change according to age. RESULTS: The prevalence of resting tremor was significantly lower in patients of advanced age (p = 0.041). In contrast, the incidence of postural and gait disorders increased significantly with aging (p = 0.032). The prevalences of rigidity and kinetic disorders, which are important clinical features of PD, were not influenced by aging. CONCLUSION: These findings suggest that the cause of PD is not related to the aging process itself, since the prevalences of all symptoms were not influenced by aging. Knowledge of the prevalence of the initial symptoms of PD may contribute to the accurate diagnosis in early and elderly cases.

Adult↗
PubMed1998

The epidemiology of hospital-referred head injury in northern Norway.

This retrospective population-based survey describes the epidemiology of head injury in a defined population in Northern Norway. It includes all 247 patients with head injury referred to the University Hospital of Tromsø, Norway, during 1993. Head injury was defined as physical damage to the brain or skull caused by external force. The annual incidence rate of hospital-referred head injury was 229/100,000 population with a male preponderance of 1.7:1.0. The cause was a fall in 62%, road traffic accident in 21% and assault in 7% of the cases. The observed incidence rate is low despite the use of wide inclusion criteria, probably due to a decrease in road traffic accidents. A further decrease in the number of head injuries in our region may be achieved by preventing falls.

Accidental Falls↗