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PubMed2004

Behavioural problems and psychiatric symptoms in 5-13 year-old Swedish children-a comparison of parent ratings on the FTF (Five to Fifteen) with the ratings on CBCL (Child Behavior Checklist).

As part of the validation procedure of a new parent questionnaire ("Five to Fifteen" or the FTF) a random sample of 1500 children aged 5-13 years from the Swedish Population Register (SPAR) was approached. The FTF and the Child Behavior Checklist (CBCL) were sent to the parents of the children together with questions about background conditions. After two reminders the response rate was 55.6%. The final sample had a mean age of 9.12 years (SD=1.89) and a sex distribution with 55% boys and 45% girls. Analysis of attrition did not support overrepresentation of foreigners/immigrants in the attrition population. FTF like CBCL showed sensitivity to sociodemographic variables. On the FTF fewer problems were indicated for girls in all domain scales, whereas this was true for the summary scale Externalizing and Mixed problems of the CBCL. The effects of age and area of residence were slight, but parental education was negatively related to all domain scales of the FTF and to all the CBCL scales. The intercorrelations of the FTF and CBCL scales with common content showed substantial overlap supporting the validity of the FTF scales. The correlation between scales within the FTF however also indicates a substantial comorbidity. This is also supported by the substantial correlation between problem score of the FTF domains perception, language, motor skills and the CBCL scale scores Attention, Social problems as well as the summary scale Mixed problems. These findings indicate that problems with inattention and social relations are shared across the various problem domains. Factor analysis of the FTF subdomain scores resulted in two factors, one representing learning problems and the other behavioural/emotional problems. Despite the low response rate the representativity of the sample was supported by the fact that the total problem score of CBCL was very similar to that of another Swedish sample with a relatively high response rate. The finding of a frequency of AD/HD symptoms in the FTF rating corresponding to the figures of prevalence of AD/HD in several international epidemiological studies could also be seen as support for the relevance of the findings. Thus, the results give support to the usefulness of the FTF questionnaire as an instrument that can help in delineating specific problem areas within the field of child neuropsychiatry. Through the comparison with the CBCL the validity of the FTF for the parts that the two instruments share could be ascertained and the value of tapping a broader problem area could be elucidated.

Adolescent↗
PubMed2000

Influence of ascertainment strategy on finding sex differences in genetic estimates from twin studies of alcoholism.

Twin studies have yielded contradictory findings about sex differences in genetic influences on the etiology of alcoholism. Studies based on population registers or epidemiological samples have yielded similar estimates of heritability (50-60% of the total variance) for males and females. In contrast, studies of twins identified through treatment settings have found sizeable genetic contributions to alcoholism in males but usually negligible heritabilities for females. We investigated this discrepancy by applying a "simulated" treatment ascertainment strategy to data on alcohol-related disorders collected by structured interviews with a population-based sample of adult twins aged 18-56 years from the Mid-Atlantic Twin Registry. Structural models were used to estimate heritabilities for two definitions of treatment, and these estimates were compared with those obtained from the population-based sample. In males, heritability estimates were similar across sampling methods, but the treatment ascertainment methods yielded higher estimates of common environmental influences. For females, heritability estimates based on a broad definition of treatment were similar to those obtained by using the random ascertainment design. However, estimates based on sampling women who had been in alcohol-treatment programs were (nonsignificantly) lower than those obtained with the other methods. These results provide partial support for the hypothesis that differences in sampling method may account for differences in heritability estimates for alcoholism among studies of female twins. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:754-761, 2000.

Adolescent↗
PubMed1982

[Netherlands Fertility Survey, 1977: description of non-response].

This article is concerned with the effect of non-response on the quality of results from the Netherlands Fertility Survey of 1977. "The description of the non-response extends to reasons for non-response, the number of visits paid by the interviewers, some characteristics of the municipality of residence of the women and some demographic characteristics. These final data, as at October 1st, 1977, were obtained by writing to the municipal population registers. The non-response turned out to be 25.5%. It occurred particularly in the western part of the country and in more urbanized areas." (summary in ENG)

Behavior↗
PubMed2006

Cancer screening in the USA.

Once screening for cancer has been shown to be effective, reducing cancer morbidity and mortality in the population depends on the successful delivery of mass screening. Today, screening for cancer may be achieved through the organized delivery of services, or unsystematically, by individual referral for screening at intervals which are not necessarily optimal or regularly spaced. Organized screening is distinguished from unsystematic screening primarily on the basis of how the offer of screening occurs--whether by invitation, issued from centralized population registers or coincidently, depending on individuals seeking screening on their own, or having providers initiate screening during visits for care for other reasons. This manuscript describes cancer screening in the USA, which for most Americans is unsystematic. While this model can achieve many of the goals of screening, these goals are achieved at a greater cost, less efficiently, and without the assurance of full participation of the entire, eligible population. In order to achieve the fullest potential of cancer screening in the most cost-effective manner, screening should be organized, with attention to monitoring the fullest performance of the programme from recruitment to follow-up.

Adolescent↗
PubMed1999

Genetic predisposition, environment and cancer incidence: a nationwide twin study in Finland, 1976-1995.

Twin studies integrate genetic and environmental (including physical environment and life-style) information by comparing monozygotic and dizygotic twins for the occurrence of disease. Our objectives were to compare cancer incidence in twins with national rates and to estimate both the probability that co-twins of affected twins may develop cancer and the importance of genetic predisposition and environment in cancer development. The nationwide record linkage of the Finnish Twin Cohort Study, the Finnish Cancer Registry and the Central Population Register allowed the follow-up of 12,941 same-sexed twin pairs for incident primary cancers from 1976 to 1995. Zygosity was determined by use of a validated questionnaire in 1975. Methods included calculation of standardized incidence ratios and concordances and fitting of structural equation models. A total of 1,613 malignant neoplasms occurred in the cohort. The overall cancer incidence among twins resembled that among the general population. Monozygotic co-twins of affected twins were at 50% higher risk than were dizygotic co-twins. Based on genetic modeling, inherited genetic factors accounted for 18% (95% confidence interval 4-32%) of the liability in inter-individual variation in the risk of overall cancer, while non-genetic factors shared by twins accounted for 7% (0-16%) and unique environmental factors for 75% (65-85%). Our results appear to exclude a contribution greater than one-third for genetic predisposition in the development of cancer in the general population, thus pointing to the earlier confirmed substantial role of environment.

Adult↗
PubMed2001

Rheumatic manifestations in danish women with silicone breast implants.

The aim of this study was to investigate whether women with silicone breast implants (SBI) present with a unique rheumatic symptomatology. We assessed the profile of rheumatic disease in six groups of women identified through Danish hospital and population registers, three groups of women with a prior hospital diagnosis of muscular rheumatism (a non-specific diagnostic code) who had previously undergone SBI surgery (n = 28), breast reduction surgery (n = 29) or no breast surgery (n = 27); and three groups of women without a diagnosis of muscular rheumatism who had undergone SBI surgery (n = 21), breast reduction surgery (n = 27) or no breast sugery (n = 56). All women in the study population (n = 188) underwent a thorough clinical examination, blood tests and a personal interview. In all study groups soft-tissue rheumatism and degenerative diseases were the most frequent diagnoses. Women with a prior diagnosis of muscular rheumatism but no prior breast surgery had a significantly higher prevalence of soft-tissue rheumatism than those with breast implant or reduction surgery. No significant differences in the frequencies of rheumatic diseases were observed among the three groups of women without previous muscular rheumatism. No specific pattern of inflammatory rheumatic disorders or soft-tissue complaints was identified among the women with SBI, and blood tests for autoimmunity revealed no unique pattern. Overall, women with earlier rheumatism had significantly increased frequencies of rheumatic conditions than did those without. We found no evidence of a rheumatic symptomatology unique to women with silicone breast implants. Our study emphasises the need for consideration of prior rheumatic disease when evaluating rheumatic manifestations in women with SBI.

Adult↗
PubMed2005

Prevalence of Menière's disease in general population of Southern Finland.

OBJECTIVE: To study the prevalence of Menière's disease (MD) in the general population of Southern Finland. STUDY DESIGN AND SETTING: Prospective study based on population register data. A questionnaire was sent to 5000 randomly selected persons aged 12 years or more living in the Helsinki University Hospital area. We enquired about whether recipients had experienced vertigo associated with a moving sensation, hearing loss, or tinnitus. For exclusion purposes, we also asked about general illnesses, ear infections, former head and ear traumas, noise exposure, medication, and use of tobacco and alcohol. To assess the validity of the population-based study, we randomly selected a sample of 100 people among those reporting vertigo. They were clinically examined at our vestibular unit. The clinical examination was supplemented by audiologic and otoneurologic tests. RESULTS: The response rate was 63%. In the final study sample of 3116 people, 216 reported the triad of vertigo, hearing loss, and tinnitus. By using the most recent criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery, we were able to identify 16 definite MD patients from the total sample, yielding a prevalence of 513 of 100,000 persons. Among the 16 MD subjects, 9 patients had already been diagnosed with MD and 1 patient was diagnosed during the clinical examination. A peak prevalence of 1709 of 100,000 was seen in the age group 61 to 70 years. CONCLUSIONS: Our population-based estimate of MD prevalence is much higher than in previous reports. EBM RATING: B-3.

Adolescent↗
PubMed1993

Infant mortality in myotonic dystrophy in Saguenay-Lac-St-Jean: a historical perspective.

Infant mortality among children born to 373 individuals with myotonic dystrophy (MD) who lived in Saguenay-Lac-St-Jean during the period 1838 to the present time was analyzed using a case-control approach based on a population register. A statistically significant increase was found in the rate of deaths during the first week of life among children born to MD mothers (57.5%) compared to control mothers (34.8%) and MD fathers (39.1%) (p < 0.01). The stillbirth rate was not increased. The rate of mortality after the first week fell significantly in both MD and control groups during the period of observation. There was evidence of a slight selective disadvantage among this MD population.

Adolescent↗
PubMed1996

Population views on access to community nursing services in Finland.

The aim of this study was to evaluate potential access to personal community nursing services and the desirability of these services from the point of view of different population groups. Potential access to personal community nursing services was defined as having one or more particular nurses to contact when needing help and advice in health matters. The desirability of these services was defined as the respondents' estimation of how useful they considered it to be for them to have access to personal community nursing services. A computer-assisted telephone interview for the population living in the catchment areas of 10 health centres in Finland was conducted. A random sample of the total population aged 16-79 years was drawn from the population register. Logistic regression revealed that gender, type of community and employment status had best explanatory power in having potential access to personal nursing services and in considering these services desirable. However, many of those who considered personal nursing services very desirable, indicated that they did not have potential access to such services. Most of these persons were elderly and had a chronic disease or disability. Developing access to personal community nursing services particularly for these population. groups appears to be needed.

Adolescent↗
PubMedDate not supplied

[Inequalities in mortality in the Italian longitudinal studies].

The article presents some of the most relevant results on inequalities in mortality, obtained by the two Italian longitudinal studies carried out in Turin, and Tuscany (in Leghorn and Florence). The two studies share the same methodology. Each database contains census data, information from population register and from death certificates. The authors approach this issue not in an analytical way (as they did in the works cited in the reference list), but answering some questions, relevant both from a scientific and a political point of view. How big are the health inequalities in Italy? Are the health inequalities in Italy increasing or decreasing? Are the health inequalities due to absolute or to relative deprivation? Does the mortality profile of the Italian population express the presence of old or new health inequalities? Can the health inequalities be reduced? The study's results prove that the health inequalities in Italy are deep and strictly related to individuals' position in the social fabric. Facing the other questions the authors focus only in the Turin data. From the 1970's to the 1990's the health inequalities in Turin have increased, despite of general improvement of population's health condition and the progressive reduction of the size of deprived groups. Turin data support both the hypotheses on the source of health inequalities, using long term unemployment as absolute deprivation's indicator, and status' inconsistency as (a row) indicator of relative deprivation. The growth of drug-related causes of death (AIDS and overdose) shows that in the Turin and--quite reasonably--Italian population old and new health inequalities live together. The essay closes offering evidence on the possibility to reduce health inequalities. For this purpose the authors analyses the Turin trend of avoidable deaths and infant and adolescent mortality.

Adult↗
PubMed1997

The Israeli Maternal Perinatal Database: methods and preliminary evaluation.

The Israel Maternal Perinatal Database (IMPD) includes the 1980-92 birth cohorts and was created using deterministic linkage, based on a unique identity number. This number is assigned at birth for Israeli-born infants and upon acquiring permanent or temporary residential status for immigrants and is used widely. The IMPD includes approximately 1.3 million births and about 400,000 mothers with more than one birth, 40,000 mothers with more than three births and 20,000 grand multipara mothers with four births or more. The pretest-based estimates of incorrectly matched births are 2%. The expected percentage of underlinkage is 5-10% for births occurring before 1985. Since 1985, incorrect maternal underlinkages result only when a birth occurs out of Israel to an Israeli resident. One of the advantages of the IMPD is the ability to estimate linkage reliability, validity and censoring effects by comparison with an external data sources, the National Population Register, which groups each mother with all her living children under the age of 18 years. One of the potential analysis pitfalls is the effect of censoring at entry as a result of influx of immigrants from the former Soviet Union and Ethiopia.

Databases, Factual↗
PubMed1998

Estrogen-replacement therapy and Alzheimer's disease in the Italian Longitudinal Study on Aging.

OBJECTIVE: To study the association of estrogen-replacement therapy and other estrogen-related variables with Alzheimer's disease in postmenopausal women. BACKGROUND: Postmenopausal estrogen use has been reported to lower the risk of Alzheimer's disease. DESIGN: A population-based, multicenter survey was carried out in eight Italian municipalities. The sample of 2,816 women, aged 65 to 84 years, was randomly selected from the population register of each municipality and stratified in 5-year age groups. All women were screened using the Mini-Mental State Examination and interviewed concerning risk factors. Those who screened positive underwent a clinical assessment. Dementia syndrome was diagnosed according to DSM-III-R criteria, and Alzheimer's disease was diagnosed according to NINCDS-ADRDA criteria for possible and probable Alzheimer's disease. RESULTS: The estimated prevalence of postmenopausal estrogen use adjusted to the 1991 Italian female population was 12.3%. The frequency of estrogen use was higher among nonpatients compared with Alzheimer's disease patients (odds ratio, 0.24; 95% confidence interval, 0.07 to 0.77). The inverse association between estrogen therapy and Alzheimer's disease remained significant after adjustment for age, education, age at menarche, age at menopause, smoking and alcohol habits, body weight at the age of 50 years, and number of children (odds ratio, 0.28; 95% confidence interval, 0.08 to 0.98). CONCLUSIONS: Our data from a population-based study support the hypothesis that estrogen-replacement therapy is associated with a reduced prevalence of Alzheimer's disease in postmenopausal women. Prospective clinical trials are required to enable women and their physicians to weigh risks and benefits of estrogen-replacement therapy for the prevention of dementia.

Age Distribution↗
PubMed1992

Reproductive function prior to disease onset in women with scleroderma.

We tested in a retrospective study the hypothesis that women with scleroderma have an increased risk, before disease presentation, of problems in pregnancy. Reproductive history, as reported from a validated postal questionnaire, was obtained from 204 women with scleroderma [mean year of birth (yob) 1942] and compared to that reported by 233 women with primary Raynaud's phenomenon (mean yob 1948) and 189 healthy women from a population register (mean yob 1950). Only pregnancies occurring before symptom onset in the scleroderma group were considered for analysis. All analyses were adjusted for job, social class, age at first pregnancy, smoking habit, and where relevant, parity. The results are expressed as odds ratios (OR) [with 95% confidence limits (CL)] giving the risk of developing scleroderma, with previous exposure to each of the specific reproductive variables analyzed, relative to the 2 comparison groups. The women with scleroderma were more likely than the population women to have had a delay in conception (> or = 12 months): OR 2.6 (1.1, 5.7) or be infertile: OR 2.3 (0.7, 7.2). These differences were not apparent when the scleroderma group was compared to the women with Raynaud's: OR's 0.7 and 1.1, respectively. Similarly there was a greater self report of maternal ill health in pregnancy in the group with scleroderma compared to the population women: OR 2.1 (1.2, 3.5) but not compared to the women with Raynaud's: OR 1.0 (0.7, 1.6).(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed2002

Oral contraceptive use before first birth and risk of breast cancer: a case control study.

BACKGROUND: The aim of this study was first, to investigate whether women starting oral contraceptive (OC) use at a young age and before first birth have an increased risk for breast cancer and second, to report difficulties encountered in studying long-term health impacts of medical technologies. METHODS: Breast cancers occurring up until 1997 among 37153 Helsinki students born between 1946 and 1960 were identified by record linkage from the Finnish Cancer Registry; for each cancer case, five age-matched random controls were picked from the same student population. Those who had used the Helsinki Student Health Service (HSHS) at least three times (150 cases and 316 controls) form the final study subjects. Data on OC use and background characteristics were collected from patient records, and data on live births were derived from the population register. Odds ratios (OR) were adjusted for number of births, smoking and sports activity. RESULTS: Compared to the few non-users, OC users had a higher risk of breast cancer: the adjusted OR was 2.1 (95% confidence interval 1.1-4.2). Among OC users, no statistically significant differences in risk of breast cancer were found in regard to starting age or first birth, but small numbers made confidence intervals wide. Even though we had chosen students to be our study group, the population turned out to be unsuitable to answer our research question: most women had started their OC use old (at the age of 20 or later) and there were very few unexposed (almost all had used OC and before their first birth). CONCLUSIONS: Because adoption of the modern pattern of OC use was not common among students, it is unlikely that the impact of early and extended OC use can be studied before 2010, when women born in the 1960s are 40 to 50 years old.

Journal Article↗
PubMed2006

Characteristics of Primary Care Trusts in financial deficit and surplus - a comparative study in the English NHS.

BACKGROUND: Recently the financial status of primary care trusts has come under considerable scrutiny by the government, and financial deficits have been blamed on poor local management of resources. This paper examines the factors that differ between those Primary Care Trusts (PCT) in financial deficit and those in surplus, using readily available data at PCT level. PCTs are the National Health Service organisations in England responsible for improving the health of their population, developing primary and community health services, and commissioning secondary care services. METHODS: A descriptive comparative study using data from 58 PCTs; 29 in greatest financial surplus and 29 in greatest deficit in the English National Health Service. RESULTS: Nearly half the study deficit PCTs (14 out of 29) are in the East of England and of the 29 surplus PCTs, five each are in Birmingham and Black Country Strategic Health Authority (SHA), and Greater Manchester SHA. The median population density of the deficit PCTs is almost seven times lower than that of surplus PCTs (p = 0.004). Surplus PCTs predominantly serve deprived communities. Nearly half the surplus PCTs are 'spearhead' PCTs compared to only one of the deficit PCTs. Percentage population increase by local authority of the PCT showed that on average deficit PCTs had 2.7 times higher change during 1982-2002 (13.37% for deficit and 4.94% for surplus PCTs). Work pressure felt by staff is significantly higher in deficit PCTs, and they also reported working higher amount of extra hours due to work pressures. The proportion of dispensing general practitioners is significantly higher in deficit PCTs 40.5% vs. 12.9% (p = 0.002). Deficit PCTs on average received pound123 less per head of registered population compared to surplus PCTs. CONCLUSION: The two groups of PCTs serve two distinct populations with marked differences between the two. Deficit PCTs tend to be in relatively affluent and rural areas. Poor management alone is unlikely to be the cause of deficits, and potential reasons for deficits including rurality and increased demand for health services in more affluent communities need further in-depth studies.

Budgets↗
PubMed1990

[Aliens in the Netherlands on January 1, 1990].

Data on the foreign-born population living in the Netherlands are presented and analyzed. "On January 1st 1990 there were 641 thousand aliens living in the Netherlands, i.e. 4.3% of the total population. These figures only relate to people included in Dutch municipal population registers who do not possess... Dutch nationality.... The largest category of aliens on January 1st 1990 was that of the Turks (185 thousand), followed by the 11 EC-nationalities (160 thousand) and... Moroccans (144 thousand)." (SUMMARY IN ENG)

Demography↗
PubMed2003

Chronic upper extremity pain and co-occurring symptoms in a general population.

OBJECTIVE: To estimate the prevalence of self reported chronic upper extremity pain associated with physical impairment in a general population, and its co-occurrence with chronic upper extremity numbness or tingling and chronic pain at other locations. METHODS: A general health questionnaire was mailed to 3,000 persons (age 25-74 years) who were randomly selected from a general population register. RESULTS: The response rate was 83%. The prevalence of chronic upper extremity pain associated with physical impairment was 20.8% (95% confidence interval [95% CI] 19.2-22.5), and that of co-occurring numbness or tingling was 6.7% (95% CI 5.7-7.7). Among the responders with chronic upper extremity pain associated with physical impairment, 84% reported more than 1 painful area. CONCLUSION: Chronic upper extremity pain associated with physical impairment and co-occurring chronic upper extremity numbness or tingling were common in the general population. The presence of more than 1 location for pain in the upper extremity as well as in other parts of the body was frequent.

Adult↗
PubMed2000

Prevalence and risk factors for prelabor rupture of the membranes (PROM) at or near-term in an urban Swedish population.

AIMS: To determine the prevalence, recurrence rate and to identify risk factors for prelabor rupture of the membranes (PROM) after 34 completed weeks in an urban Swedish population. METHODS: In a retrospective cohort study a sample of 2880 women aged 25-41 years, resident in the city of Göteborg, was randomly selected from the population register. According to information from the national Medical Birth Register (MBR), 1507 of these 2880 women had given birth 2736 times. 2270 of these deliveries had occurred in hospitals in the city of Göteborg and case records for 2242 of these deliveries were found. The case records were systematically analyzed for the occurrence of PROM and potential risk factors for PROM. 2208 of these deliveries occurred after 34 weeks of gestation. The further analyses were based on these 2208 deliveries. RESULTS: The prevalence of PROM after 34 week of gestation in this urban Swedish population was 12.9% and about 20% of the women in the population had experienced PROM at least once. In the multiple stepwise regression analysis, risk factors for PROM were primiparity, premature contractions, PROM in a previous pregnancy and bleeding in the first trimester. CONCLUSIONS: PROM is a common complication at or near term. The risk factors for PROM found in this representative study are difficult to influence and thus provide no guidance about how pregnancies should be managed to reduce the occurrence of PROM in the future.

Adult↗