Recent changes in lung cancer incidence for south Asians: a population based register study.
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Adult↗
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Survival in trisomy 13 and trisomy 18 cases ascertained from population based registers.
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Chromosomes, Human, Pair 13↗
Growth hormone testing for the diagnosis of growth hormone deficiency in childhood: a population register-based study.
Evaluation of GH secretion using pharmacological GH stimulation tests (GHST) remains a current practice, although the reliability of GHST has been questioned, and many pitfalls have been pointed out. We have analyzed all of the 6373 GH stimulation tests that led to the initiation of GH therapy in 3233 children treated in France from 1973-1989. Tests and GH measurements were performed by individual centers and collected by the Association France-Hypophyse. GH deficiency (GHD) was due to craniospinal irradiation (11%), was due to organic causes or associated with multiple deficiencies (22%), or was considered idiopathic (65%); 2% of the patients were considered non-GHD. Eleven different pharmacological tests were used, and 62 of the 66 theoretical pairs of tests were used at least once. The most frequent combination of tests (ornithine in one instance and insulin in another) was used in 12.7% of patients. The reliability of the GH peak measured by comparing the results of 2 tests in the same patient was poor, as measured by intraclass correlation coefficients below 0.8. Multivariate analysis identified several parameters positively or negatively associated with peak plasma GH: calendar year of initiation of treatment, etiology of GHD, height SD score, bone age SD score, puberty, weight SD score, genetic target height SD score, and the nature of the pharmacological agent used. We believe that several of these factors (weight SD score, genetic target height SD score, and nature of the agent) identify biases in the diagnosis of GHD. We conclude that GHST should be performed with a very limited number of agents, interpreted after the establishment of reference values in age-matched normal children, and associated with other clinical and biochemical parameters for establishing the diagnosis of GHD.
Adolescent↗
Hypertriglyceridemia in different degrees of glucose intolerance in a Finnish population-based study.
OBJECTIVE: To determine the prevalence of hypertriglyceridemia and the mean serum triglyceride concentrations in different degrees of glucose tolerance--non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT). In addition, we analyzed the correlates of serum triglyceride concentration to explain why it is more prevalent in diabetic subjects. RESEARCH DESIGN AND METHODS: This study was a cross-sectional survey of 4000 people aged 45-64 yr randomly drawn from the population register of the Finnish population of the provinces of North Karelia and Kuopio in eastern Finland and Turku/Loimaa area in southwestern Finland and stratified by four 10-yr age- and sex groups. The final material comprised 96 subjects with NIDDM, 102 subjects with IGT, and 323 subjects with normal glucose tolerance classified on the basis of two 2-h oral glucose tolerance tests. The prevalence of hypertriglyceridemia by the glucose tolerance status and the variation in serum triglycerides associated with selected life-style and biochemical factors were executed as the main outcome measures. RESULTS: The prevalence of hypertriglyceridemia (greater than or equal to 2.3 mM) was 47.6% (95% confidence interval [CI] 32.5-62.7%) in NIDDM men, 21.9% (95% CI 7.6-36.2%) in IGT men, and 15.4% (95% CI 9.3-21.5%) in NGT. In women, hypertriglyceridemia was found in 51.9% (95% CI 38.6-65.2%) among those with NIDDM, 25.7% (95% CI 15.5-35.9%) among those with IGT, and 10.7% (95% CI 6.3-15.1%) in women with NGT. After adjusting for body mass index (BMI) and age, the difference in the prevalence of hypertriglyceridemia between the glucose tolerance groups remained significant in both men (P = 0.008) and women (P = 0.0001). High serum total cholesterol, high BMI, high waist-hip ratio, and low high-density lipoprotein (HDL) cholesterol were significantly associated with high serum triglycerides in all glucose tolerance groups. No synergistic effect between these parameters and glucose tolerance status was found. In multiple linear regression analyses, fasting plasma insulin, diabetes status, and serum uric acid were significant predictors of serum triglyceride concentration after taking into account age, BMI, and HDL and total cholesterol. The association between BMI and serum triglycerides in the regression analysis was significant only when plasma insulin was not included in the model. CONCLUSIONS: Hypertriglyceridemia is common in subjects with NIDDM and IGT and is often associated with low HDL cholesterol, high total cholesterol, hyperinsulinemia, and elevated serum uric acid concentration.
Adult↗
Estimates of genetic trend for yield traits of the registered Jersey population.
Data for American Jersey cattle from 1960 to 1990 were used to study genetic progress achieved by four paths of selection (sires of bulls, dams of bulls, sires of cows, and dams of cows). Possible methods of obtaining optimal genetic gain for the breed were suggested by the analysis. The generation interval by year of birth for parents of AI bulls was greater from 1975 to 1984 than for most recent 5 yr (1983 to 1987) because previously the use of old proven bulls was greater. Sires of bulls tended to have a longer average generation interval (9.3 yr) than the more nearly optimal interval reported in the literature for AI populations (7.0 yr). Selection differentials for the last 5 yr were larger than the average over all years for milk yield, fat yield, protein yield, and fat percentage. More intense selection for sires of bulls gave a larger increase in PTA over time than did other paths of selection. When all paths of selection were combined, estimated annual genetic change for the Jersey breed was greater from 1983 to 1987 than from 1960 to 1987 for milk yield, fat yield, protein yield, and fat percentage. Potential genetic response from the sires and dams that were available to produce sons was greater than the response from parents actually used. Therefore, better sires and dams were available for genetic enhancement of their progeny than those actually used to produce young sires and replacement females.
Animals↗
Health information system for a professionally limited population: health register of crews of Finnish merchant fleet.
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Finland↗
[Leading causes of blindness and visual impairment in the region of Eastern Herzegovina].
INTRODUCTION: Visual impairment and blindness are serious social and health problems in the world. 1992 classification of visual disorders by World Health Organization has recently been implemented. The goal of this study was to determine common causes of visual impairment and blindness in the region of Eastern Herzegovina. MATERIAL AND METHODS: In this population based study we have analyzed medical records stored in the regional Association of Visually Impaired and Blind Persons of the Republic of Srpska (Trebinje, Bileća, Foca, Eastern Sarajevo). The analysis included sex and age distribution of registered population, classification and leading causes of visual disability and blindness. RESULTS There are 298 registered persons with visual disability and blindness in the region of Eastern Herzegovina and Eastern Sarajevo. The prevalence of visual impairment and blindness in the aforementioned region is 0.1%. Among the studied population, there are more males than females with visual disability or blindness (56% versus 44%). Most (78%) of registered persons are blind, and only 22% are visualy impaired. 43% of registered population are in the IV category and only 8.38% are registered in the II category. Only 2% of registered population are children. Common causes of visual disability and blindness in the region of Eastern Herzegovina are: glaucoma (22%), cataract (17%), myopia alta (13%), diabetic retinopathy (12%) and ocular trauma (11). Common causes of children's visual impairment include. optic nerve anomalies, congenital cataract and premature retinopathy. DISCUSSION AND CONCLUSION: Compared with literature data, common causes of blindness and visual impairment in the region of Eastern Herzegovina do not differ significantly from those in other regions. Registration is based on the WHO model, but it is possible only by performing active epidemiological studies.
Adolescent↗
Feasibility of using different approaches for recruiting younger twins to establish a population based twin register in Sri Lanka.
Identifying twins for a population-based register can be achieved through birth records or community surveys. We studied the feasibility and effectiveness of different methods of identifying and recruiting twins to establish a population based register. To trace twins a population survey was carried out using an interviewer administered questionnaire. We also inspected the birth registration certificates at a divisional secretariat reported from a specified hospital between the years of 1985-1997 and compared it to the birth register of this same hospital. To recruit twins a random sample of 75 twin pairs (150 twins) identified at the Divisional Secretariat were contacted through the post and 25 twin pairs (50 twins) were personally visited. The prevalence of twins was 6.5 twins per 1000 people in the area surveyed. The twinning rate at the hospital was 18.92 twins per 1000 births. A discrepancy of 38 multiples births between the hospital labour room records and those registered at the DS was noted. The response from the postal invitation for recruitment was 59% and the response from the personal invitation was 68%. (Difference 9.4% 95% CI; 7.06-11.73). Community survey and systematic inspection of birth records either at the hospital or the birth registration office was an effective method to trace twins. Once traced, personal contact was more effective than the postal invitation for recruitment of younger twins. A cost-effective approach would be to use a postal coverage followed by personal contact for non-responders. The alternative method, community coverage, would have financial implications.
Birth Certificates↗
Surveys using general practice registers: who are the non-responders?
BACKGROUND: General practice population registers are important sampling frames for surveys of disease prevalence, lifestyles and health needs. In any survey there is a problem of non-response in the target population which can reduce precision and may bias any estimates derived from the study. Bias related to those who choose not to respond has been studied, but the problems posed by those who no longer live at the address on the register have received less attention. The specific objectives of this study were to estimate the number of non-responders in a registered general practice population who had not received a questionnaire ('ghosts') as distinct from those who chose not to respond to it ('refusers') and to determine whether ghosts and refusers were different from non-responders in ways which might affect the purpose of the survey. METHODS: A total of 500 people aged 18-75 years were selected from a general practice register in Stockport for a postal survey of shoulder pain in the adult population. Forty-one were identified as "ghosts' during the survey. After three mailings of a baseline screening questionnaire for shoulder pain and a further mailing of a final reminder, there were 120 further non-responders. They were classified as ghosts or refusers on the basis of a comparison of their current address on the practice register with that on the electoral roll. A matched sample of 120 survey responders was identified and was used to check the accuracy of the electoral roll in classifying non-responders. Ghosts and refusers were compared with the sample of responders using consultation information obtained from medical records at the practice, if the latter were available. RESULTS: In total, 108 of the 500 people in the sample (22 per cent) were classified as "ghosts'-41 on the basis of information obtained during the survey and 67 on the basis of a comparison with electoral roll details. In addition, 48 were classified as refusers on the basis of the electoral roll comparison. This compared with 8 (7 per cent) of the matched sample of responders who would have been classified as "ghosts' using the electoral roll. People who had addresses outside the electoral district were excluded from classification. Medical records were available for 105 (90 per cent) of the responders, 31 (46 per cent) of the ghosts and 40 (83 per cent) of the refusers. Of those who had consulted at least once for any reason in the previous two years, a similar proportion of responders and refusers (48 per cent and 46 per cent) had attended because of musculoskeletal problems, but responders were more likely to have consulted specifically about shoulder pain (10 per cent compared with 3 per cent, but based on small numbers). Ghosts by contrast had a lower proportion of consultations for both all musculoskeletal (33 per cent) and shoulder-specific problems (none), but were more likely to have consulted with a psychological problem than responders. CONCLUSIONS: We have estimated the number of non-responders to a survey of shoulder pain who were likely not to have received the baseline questionnaire (ghosts) to have been 22 per cent of a sample drawn from a practice-based Family Health Services Authority register. The error of using the electoral roll to make such a classification was found to be small, with only 8 (7 per cent) of the samples of responders being misclassified as ghosts. Those ghosts who still had records at the practice appeared to differ from refusers with respect to musculoskeletal and psychological morbidity. It may be inappropriate to exclude ghosts from the denominator in population surveys.
Adolescent↗
The epidemiology of chronic pain in a Swedish rural area.
In order to establish basic epidemiological data on chronic pain (duration > 3 months) in a rural population, a survey of pain symptoms was conducted by means of a postal questionnaire. The questionnaire was sent to a random sample (from the population register) of 15% of the population aged 25-74 (n = 1806) in two Swedish primary health care districts. The response rate was 90%. In a follow-up study individuals selected among the responders (neck-shoulder pain, widespread pain and controls without pain; n = 213) were examined and interviewed. They were requestioned about pain symptoms 24 months after the initial survey. Without sex differences 55% of the population had perceived persistent pain for 3 months and 49% for 6 months. Women experienced more multiple localizations of pain and had pain in neck, shoulder, arm and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (women 32.9%, men 27.5%). Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. Examination of selected pain groups indicated a high proportion of unspecific musculoskeletal symptoms. Diagnosis with definite definitions, explaining the pains, were found in 40% of the individuals. Individuals with widespread pain had a higher pain intensity, more somatic symptoms, were more depressive and had the lowest scores for quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization.
OBJECTIVE: To establish basic epidemiological data on chronic pain (duration > 3 months) in a defined population. Relationships between age, gender, and social class were tested. DESIGN: A survey of pain symptoms, including location, intensity, duration, and functional capacity, was conducted by means of a mail questionnaire. SETTING: General populations in two Swedish primary health care districts. Medical care was provided in a state health system. SUBJECTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1,806). The response rate was 90%. OUTCOME MEASURES: Descriptive epidemiologic data in relation to objectives of the study. RESULTS: Without sex differences, 55% (95% confidence interval, 53-58%) of the population had perceived persistent pain for 3 months and 49% for 6 months. Among individuals with chronic pain, 90% localized their pain to the musculoskeletal system to a variable extent. Women experienced more multiple localizations of pain and had pain in the neck, shoulder, arm, and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (30.2%), followed by the lower back (23.2%). Even in the youngest age groups more than one of four reported chronic pain. Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. CONCLUSION: Chronic pain symptoms are common but unevenly distributed in a general population. The results may influence planning and consultation in primary health care as well as warranting selective prevention activities.
Adult↗
Intensity of physical activity and respiratory function in subjects with and without bronchial asthma.
The aim of this study was to assess the intensity of physical activity of asthmatic adults in Finland and the associations between the intensity of physical activity and respiratory function in asthmatic and nonasthmatic persons. The study population (n=8000) was drawn from the population register to represent the Finnish population aged 30 years or over. Adequate information was available from 7193 subjects (89.9% of the sample). Physical activity at work, at leisure and during commuting was recorded with a standard questionnaire. The responses to the questionnaire were expressed as MET values. Asthma was defined on the basis of self-reports of chronic diseases previously diagnosed by a physician. The spirometric values (VC, FVC, FEV1, FEV%, and PEF) were negatively correlated with age. The results showed clear and significant associations between spirometric values and intensities of physical activity at work and during leisure time in asthmatic men. Although healthier subjects may select more physically demanding activities, it is an equally possible hypothesis that physical activity may improve respiratory function in subjects with and without bronchial asthma.
Adult↗
Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study.
STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms.
Activities of Daily Living↗
Carpal tunnel syndrome (CTS) and exposure to vibration, repetitive wrist movements, and heavy manual work: a case-referent study.
Possible connections between carpal tunnel syndrome (CTS) and exposure to vibrating handheld tools, repetitive wrist movements, and heavy manual work were examined in a case-referent study. The cases were 38 men operated on for CTS between 1974 and 1980. For each case, two referents were drawn from among other surgical cases (hospital referents) and two further referents from the population register and telephone directory, respectively (population referents). Thirty four of 38 cases (89%) and 143 of 152 referents (94%) were interviewed by telephone. An increased prevalence of obesity, rheumatoid disease, diabetes, or thyroid disease was observed among the cases but most did not suffer from any of these disorders. CTS was significantly correlated with exposure to vibration from handheld tools and to repetitive wrist movements but showed a weaker correlation with work producing a heavy load on the wrist. A cause-effect relation between CTS and exposures to handheld vibrating tools and to work causing repetitive movements of the wrist seems probable. Some differences between hospital and population referents indicate that a case-referent study of this type could be biased by inappropriate selection of referents.
Adult↗
Hysterectomy on benign indication in Denmark 1988-1998. A register based trend analysis.
BACKGROUND: The aims of the study were to describe the trends in Danish hysterectomy rates from 1988 to 1998 for operations done on benign indication. METHODS: Data from all women (n=67,096) undergoing hysterectomy from 1988 to 1998 were obtained from the Danish National Patient Register. Data on the female population distribution were obtained from the Danish National Population Register. RESULTS: During the last 11 years the incidence rate of hysterectomy performed for benign diseases has been stable. However, the rate of women treated surgically for benign diseases of the uterus has increased by 14%. During the study period the number of total abdominal hysterectomies has decreased by 38%, the number of subtotal abdominal hysterectomies has increased by 458%, the number of vaginal hysterectomies has increased by 107% and two new methods of surgical treatment for benign diseases of the uterus have been introduced. Abdominal hysterectomy still accounts for 80% of the total number of hysterectomies performed in Denmark in 1998. The age distribution for all hysterectomies has changed, from a maximum of 36-45 years in 1988 to 46-55 years in 1998. The age maximum for abdominal hysterectomy corresponds to that of all hysterectomies. For vaginal hysterectomy the age maximum is 56 years or older, while it is 36-45 years for laparoscopic hysterectomy. CONCLUSIONS: The incidence rate of hysterectomy was stable during the study period and the age distribution for all hysterectomies has changed. The study showed a change in the choice of surgical methods, although no evidence supports this practice.
Adolescent↗
Telephone directory listings of presumptive Chinese surnames: an appropriate sampling frame for a dispersed population with characteristic surnames.
Choosing an appropriate sampling frame for an epidemiologic study depends on the characteristics of the population under investigation and the sources available for identification of potential subjects. Not all countries maintain (or permit sampling from) population registers. In studies of dispersed populations, electoral rolls may lead to sampling bias, and random-digit dialing is inefficient. A dispersed population characterized by distinctive surnames might be appropriately identified and sampled through telephone directory listings, however. The method proved feasible and efficient for a prevalence study of health-related characteristics of Chinese residents in Melbourne, Australia, yielding a sample demographically comparable to the corresponding census population.
Adult↗
Socioeconomic inequities in invasive cardiac procedures after first myocardial infarction in Finland in 1995.
OBJECTIVE: We examined socioeconomic disparities in coronary procedure rates after first events among hospitalized myocardial infarction (MI) patients. STUDY DESIGN AND SETTING: Information on MI patients in 1995 in Finland was obtained from the Finnish Cardiovascular Disease Register Project. Data on comorbidity, invasive treatments, hospitalizations, mortality, and socioeconomic status were obtained by linking data from the Finnish Hospital Discharge Register, cause of death register, population census, and the health insurance register using personal identity numbers. RESULTS: In 1995, 5172 patients aged 40 to 74 years were hospitalized for first MI. This corresponds to age-standardized event rates of 354/100,000 for men and 152/100,000 for women. Within 2 years, 33% of men and 21% of women underwent an invasive coronary procedure. Men in the lowest income third underwent 25% (95% confidence interval [CI] 12-36) fewer procedures than men in the highest third. Among women, the corresponding difference was 43% (95% CI 24-57). These disparities persisted throughout the 2-year follow-up, and they were not reduced by adjustment for comorbidity or hospital district. CONCLUSION: Socioeconomic disparities were observed in receipt of invasive cardiac procedures. More attention should be paid to equitable distribution of scarce health care resources.
Adult↗
Family structure and risk factors for schizophrenia: case-sibling study.
BACKGROUND: Several family structure-related factors, such as birth order, family size, parental age, and age differences to siblings, have been suggested as risk factors for schizophrenia. We examined how family-structure-related variables modified the risk of schizophrenia in Finnish families with at least one child with schizophrenia born from 1950 to 1976. METHODS: We used case-sibling design, a variant of the matched case-control design in the analysis. Patients hospitalized for schizophrenia between 1969 and 1996 were identified from the Finnish Hospital Discharge Register, and their families from the Population Register Center. Only families with at least two children (7914 sibships and 21059 individuals) were included in the analysis. Conditional logistic regression with sex, birth cohort, maternal schizophrenia status, and several family-related variables as explanatory variables was used in the case-sibling design. The effect of variables with the same value in each sibship was analyzed using ordinary logistic regression. RESULTS: Having a sibling who was less than five years older (OR 1.46, 95% CI 1.29-1.66), or being the firstborn (first born vs. second born 1.62, 1.87-1.4) predicted an elevated risk, but having siblings who were more than ten years older predicted a lower risk (0.66, 0.56-0.79). CONCLUSIONS: Several family-structure-related variables were identified as risk factors for schizophrenia. The underlying causative mechanisms are likely to be variable.
Adult↗