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".
A nationwide record linkage of the Finnish Twin Cohort Study (FTCS) with the Hospital Discharge Registry and the Registry of Rights for Free medication is presented. This study consists of 108 pairs (114 individuals) of twins with chronic open-angle glaucoma. Of the twin pairs 29 were monozygotic (MZ), while 79 pairs were dizygotic (DZ). Three monozygotic and 3 dizygotic pairs were concordant for chronic open-angle glaucoma (OAG), while 26 monozygotic and 76 dizygotic pairs were discordant. Seventy-three twins had chronic simple glaucoma, while 34 twins had capsular glaucoma, and in 7 patients chronic simple glaucoma was noted in one eye and capsular glaucoma in the second eye. The heritability of chronic open angle glaucoma was 13%. The higher O/E-ratio of concordant twin pairs among MZ twins indicates that genetic factors play a role in this disease. The difference is anyhow surprisingly low compared to former estimates of heritability of open angle glaucoma. The steep rise in prevalence in older age groups was confirmed. The age-adjusted prevalence of chronic open-angle glaucoma in this study was 0.63%.
A population-based case-referent study provided information on the associations between several types of cancer and 12 petroleum-derived liquids. All site-exposure combinations were investigated. The most interesting results concerned the following combinations: leaded gasoline-stomach cancer, aviation gasoline-kidney cancer (and the possible implications of this association for a similar effect of unleaded automotive gasoline), mineral spirits-squamous-cell cancer of the lung, diesel fuel-nonadenocarcinoma lung cancer, lubricating oils-squamous-cell lung cancer, cutting fluids-bladder cancer, other mineral oils-bladder cancer, mineral spirits-prostate cancer, diesel fuel-prostate cancer, and lubricating oils-prostate cancer.
A multi-cancer site, multi-factor, case-referent study was undertaken to generate hypotheses about possible occupational carcinogens. About 20 types of cancer were included. Incident cases among men aged 35-70 years and diagnosed in any of the major Montreal hospitals were eligible. Probing interviews were carried out for 3 726 eligible cases. The interview was designed to obtain detailed lifetime job histories and information on potential confounders. Each job history was reviewed by a team of chemists who translated it into a history of occupational exposures. These occupational exposures were then analyzed as potential risk factors in relation to the sites of cancer included. For each site of cancer analyzed, referents were selected from among the other sites in the study. The analysis was carried out in stages. First a Mantel-Haenszel analysis was undertaken of all cancer-substance associations, stratifying on a limited number of covariates, and, then, for those associations which were noteworthy in the initial analysis, a logistic regression analysis was made taking into account all potential confounders. This report describes the fieldwork and analytical methods.
The annual number of hospital discharges for peptic ulcer decreased in Finland from 1969 to 1974, mainly because of a smaller number of men with uncomplicated peptic ulcer disease. After the mid-1970s the number of hospital admissions remained stable, whereas the number of elderly patients increased. From 1979 to 1984 the number of hospitalizations for perforated ulcers remained stable, whereas those for ulcer haemorrhages increased, the increase being most marked in the older age groups. The age-specific mortality from peptic ulcer remained stable from 1969 to 1984 and rose thereafter among old patients. The risk of death from peptic ulcer was about 10-fold higher in patients over 75 years old than in younger age groups, and about half of the deaths caused by peptic ulcer occurred in patients over 75 years old. The men to women ratio among hospitalized patients decreased from 3.5 in the late 1960s to 2.1 in the 1980s, and the gastric ulcer to duodenal ulcer ratio was about 1.1 throughout the observation period.
In a survey of 67,774 patient days in 27 Swedish acute care hospitals, an indwelling urinary tract catheter (IUTC) was in place during 12% of patient days. There were marked differences between services (from 2% in rheumatology to 49% in urology), but also between hospitals for the same type of service (general surgery, internal medicine, gynecology, orthopaedic surgery) concerning proportion IUTC days, average duration of catheterization and the indications for IUTC use. The great local variation in IUTC usage for a particular service was usually not correlated with type of hospital (district, county, or regional/teaching), ie, with the mix of patients studied. We propose that the results mainly reflect a variable local impact of infection control and that a much more restrictive use of IUTCs is possible in many wards. This condition would imply a considerable potential for reducing the incidences of urinary tract infection and bacteremia and thus, mortality among hospitalized patients in Sweden.
In the badminton season 1983/1984, a prospective injury registration was done in 375 randomly chosen elite and recreational badminton players, of whom 81% could be followed. We found 257 injuries: an incidence of 2.9 injuries/player/1000 badminton hours. Men were more frequently injured than women. The prevalence was 0.3 injury per player. It was highest in men, and there was no difference between elite and recreational badminton players; 92% of the injured were playing with their injury. The pathophysiology was overuse in 74% (169/229), strains in 12% (28/229), sprains in 11% (26/229), and fractures in 1.5% (3/229). Possibilities for reducing the number of injuries and their severity are increased injury information to players and trainers and the introduction of stretching all involved muscle groups.
In this article, Michel O'Neill, Ph. D., discusses the necessity of taking political factors into consideration when embarking on preventive programmes, regardless of the level in the community in which the intervention is to take place. When using the term, "political factors", the author is referring to the powers of influence which certain individuals or groups inevitably have over members of a community, regardless of its size. The influence is thus not necessarily linked to partisan politics but potentially has extensive implications for health promotion activities. After an introduction to the history of the development of a community health oriented system in Quebec, O'Neill presents four examples (at the local, regional, provincial, and federal levels) to introduce his analysis of political influence in community health and its implications in health promotion programmes. The marketing genius and tremendous budget of a multinational, American-based fast food corporation represents the political influence contrary of health promotion interests in two of the examples: competing with nutrition education efforts at a local level and "philanthropically" supporting curative efforts at a regional level. At a provincial level, the perpetual problem of tobacco corporations influencing elected officials in their social policies is presented while the aberration between rhetoric vis à vis policy and the reality of non-action is cited as political influence at a federal level. The examples cited are only four among "dozens and dozens" and serve as a reminder that health promotion professionals must take political influences into account if they wish to implement effective policies and programmes.(ABSTRACT TRUNCATED AT 250 WORDS)
There has been a suggestion that esophageal atresia with tracheoesophageal fistula (EA/TEF) may be related to the occurrence of infectious disease in the population during the time of early gestation. There is therefore a need for further data on trends in incidence related to infectious diseases. Data on the occurrence of EA/TEF with and without additional congenital malformations may also be relevant. The British Columbia Health Surveillance Registry is population-based with excellent case ascertainment of birth defects, and data are available on the incidence of infectious diseases for B.C., allowing comparison of trends to be made. One hundred forty-nine cases of EA/TEF occurred among 534,834 consecutive livebirths during the period 1966-1980 for an incidence rate of 1/3,590. No significant (p less than 0.05) annual, seasonal or monthly incidence trends were observed. In addition, the occurrence of EA/TEF could not be correlated with the prior incidence of infectious hepatitis, rubella, salmonella, or rubeola. Fifty-five percent of individuals with EA/TEF had congenital malformations in other systems, most frequently cardiovascular, gastrointestinal, and genitourinary. Most individuals with additional congenital malformations had multiple system involvement.