At an average follow-up of 2.1 years, we reviewed the records of 241 patients who had had a fracture of the hip. The average age of the patients was 75.4 years. The rate of mortality one year after the fracture was 21.6 per cent for the total group, 8.0 per cent for the low-risk group, and 49.4 per cent for the high-risk group. The standard mortality ratio was six times higher for the high-risk group than for the general population (individuals who did not have a fracture), matched for age. It was highest for patients who were less than seventy years old and lowest for those who were older than eighty. However, in the second year after the fracture, the standard mortality ratio approached unity--that is, the rate of mortality approached that of the general population. The results suggest that there is an inverse relationship between mortality and advanced age and that the impact of a fracture of the hip on mortality is seen primarily in the first year after injury.
This paper reports the levels of radiocesium registered in about 9000 samples collected in different parts of Sweden following the Chernobyl accident during the period May-November 1986. The maximum Cs levels were detected in reindeer, freshwater fish and mushrooms. Parameters possibly affecting the nuclide concentration in different biota are briefly discussed.
Acid precipitation affects the solubility of several metals in aquatic systems and in soil. Cadmium levels in tap water samples from geological areas having low resistance to acidic pollution were significantly higher than those in samples from a neighbouring reference area where there was a different geological structure. The median cadmium levels and pH values were 0.14 microgram l-1 and 5.6 respectively, for the acidic areas compared with 0.07 microgram l-1 and 6.4 respectively for the reference area. Further, there was a significant inverse relationship between both cadmium and lead contents and the pH values of the samples. The mobility of the metals was thus dependent on the acidity. The blood lead levels in 195 subjects from the acidic areas were lower than those in 91 subjects from the reference area (medians 60 vs. 70 micrograms l-1); no significant differences were found in blood cadmium or blood mercury levels. Subjects in the acidic areas had lower plasma selenium levels than those from the reference area (medians 85 vs. 90 micrograms l-1); the difference was mainly attributed to subjects with private wells. The data may indicate a negative effect of the acidic pollution on selenium intake via water and/or foods. There was also a positive relationship between intake of fish on the one hand and blood mercury and plasma selenium on the other, which is in accordance with the role of fish as a source of these metals.
Questionnaire responses of 38 Czechoslovak refugees indicated that 84.2% experienced, at least once, a nightmare about being back in their ex-homeland and trying to escape again. The escape nightmares were most frequent within the first 2 years after escape. A significant decrease in frequency was noted 4 years after escape and during the subsequent years.
Originally published in 1984, the Copenhagen Pocket Chart for early differentiation between causes of jaundice has been tested with success in centres outside Denmark. Using a logistic discrimination model, it estimates probabilities of obstruction and non-obstruction in each case (and provides a further subdivision if desired). Here we evaluate its performance in the hands of young clinicians on a consecutive series of 173 jaundiced patients from two Danish hospitals. The chart performed as well as in the original series: confident diagnoses (probability greater than or equal to 0.80) were assigned to 124 patients; of these 115 proved correct (93%). In 46 patients diagnostic probabilities were less than 0.80, and 3 patients had an unknown cause of jaundice. There were 108 cases in which physician and chart were in agreement, both with a confident diagnosis, and only one of these cases was wrong. In one hospital, contributing 107 cases, each patient was independently examined by a medical student in addition to the physician's examination. Student performance was equally good, practically speaking, in particular when taking the scores on the chart into consideration. As to observer disagreement, the student and the physician typically differed on 0-2 of the chart's 21 items. In no case, however, did this lead to a confident obstructive diagnosis being changed into a confident diagnosis of non-obstruction, or vice versa.
The National Cancer Institute of Canada (NCIC) Clinical Trials Group has carried out a phase II study of acivicin given as a 72-hour continuous infusion in previously untreated patients with measurable metastatic colorectal carcinoma. Toxicity in 24 patients was mild to moderate and consisted primarily of GI symptoms such as nausea, vomiting, diarrhea or CNS changes including drowsiness, lethargy, dizziness. No responses were seen in 23 evaluable patients. We did not find acivicin given as described to be effective in colorectal carcinoma.
Consecutive female admissions to the Winnipeg Remand Centre were studied and data concerning personal history, family background, psychological factors and mental health were recorded. An effort was made to determine a typical profile of female offenders and relate this to the alleged offences. Our data failed to identify what has been described by others as the "new female criminal".