During 1977, 5279 male and 4616 female visits (9895 in all) for acute abdominal conditions were made to the emergency room at the Department of Surgery in Malmö, Sweden. Twice as many patients were seen on Mondays and Tuesdays as on Saturdays. More than 50% of the visits were classified as non-specific abdominal pain or gastritis. The highest incidence of these two conditions was found in the 20-29-year age group and 2-3 times as many patients in this age group were seen on Mondays as on Saturdays and Sundays. It is concluded that studies on the age- and sex-specific incidence rates of different abdominal disorders should be of great value for proper planning of diagnostic and therapeutic resources and further of importance for the planning of the education and training of the general surgeon. Differences in the age- and sex-specific incidence rates as well as differences in the incidence rates from one time period to another illustrate the value of retrospective studies as a basis for future prospective studies regarding cause and potential for prevention of acute abdominal diseases.
Malmö General Hospital is the single referral unit for 240000 people living in Malmö, Sweden. In order to assess the influence of age on annual risk and clinical course in acute appendicitis we reviewed hospital records of 673 randomly selected patients operated on 1972-1978. Annual incidence in 20-year-olds 4/1000 was four times higher than in the 59-70-year-olds. Perforation was more common in old than in young patients. Fifty-four percent of all cases above 60 were perforated. Patients older than 60 with perforation had the longest duration of symptoms. Age above 60 and perforation were both associated with an increased body temperature at arrival an increased risk of wound infection and other complications and a longer period of hospitalization.
Adaptive behavior in stressful situations and stroke incidence in hypertensive men: results from prospective cohort study "men born in 1914" in Malmö, Sweden.
Division of Epidemiology, Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden. Lena.Andre-Petersson@psychology.lu.ses
Although hypertension is a major risk factor for stroke, many hypertensive persons remain healthy. The aim of the present study was to analyze whether adaptation in a stressful situation was associated with the incidence of stroke in hypertensive men.
Two hundred thirty-eight hypertensive men were followed from baseline in 1982/1983 until first stroke, death, or December 31, 1996. Adaptation to stress was studied with the serial Color-Word Test. In the Regression dimension, 4 patterns of adaptation could be distinguished according to mastering of the test. Successful mastering of the test was shown in stabilized patterns, increasing difficulty in cumulative patterns, fluctuating difficulty in dissociative patterns, and fluctuating difficulty that increased during testing in cumulative-dissociative patterns. The patterns were compared regarding stroke incidence.
Forty-three men experienced a stroke during follow-up. Stroke rates per 1000 person-years were 12.6 for men with stabilized patterns, 14.3 for men with cumulative patterns, 16.2 for men with dissociative patterns, and 31.2 for men with cumulative-dissociative patterns. Multivariate analysis, adjusted for relevant cerebrovascular risk factors, showed that the cumulative-dissociative pattern of the Regression dimension was associated with an increased risk of stroke during follow-up (relative risk 3.00, 95% CI 1.32 to 6.81).
The specific behavior pattern, characterized by the greatest difficulties in managing the test, was associated with incidence of stroke in hypertensive men. One interpretation is that hypertensive men who chronically fail to find successful strategies in stressful situations are vulnerable to the damaging effects of stress and thereby at an increased risk of a future stroke.
Smoking-related airflow obstruction can develop with or without emphysema. Moderate alcohol consumption has been suggested to diminish the risk of centrilobular emphysema caused by smoking. Our aim was to study the influence of total energy and nutrient (protein, fat, carbohydrate and alcohol) intake on smoking-related emphysema. Lung function and nutrient intake including alcohol consumption were recorded at age of 68 years in 478 men as part of the population study 'Men Born in 1914' in Malmö, Sweden. In nonsmokers (n = 88) and ex-smokers (n = 223), there were no significant relationships between energy and nutrient intake and lung function. In smokers (n = 167), men in the highest and lowest quintile of total lung capacity (TLC) differed in alcohol intake (p = 0.004) but not in intake of total energy or other nutrients. In smokers with a forced expiratory volume in 1 s/vital capacity ratio of below 70% (n = 81), alcohol intake was positively correlated with TLC (r = 0.31; p = 0.006) after adjustment for smoking and body mass index. We conclude that in men with smoking-related airway obstruction, emphysema defined as large TLC was associated with high alcohol consumption but not with the intake of total energy or other nutrients.
To explore the effect of social characteristics of residential areas on carotid atherosclerosis prevalence.
The associations among area social characteristics and B-mode ultrasound determined carotid plaque-score (a semi-quantitative scale measuring the degree of atherosclerosis in the carotid bifurcation area) were cross-sectionally investigated in a general population sample of 4033 men and women. Area socioeconomic circumstances were described through a social deprivation index calculated from migration rate, percentage residents with foreign citizenship among those with foreign background, dependency on social welfare support, and employment rate. Living in socially deprived areas was associated with an increased carotid plaque-score in both men (P for trend = 0.004) and women (P for trend = 0.007). These associations were only slightly reduced after adjustment for individual level indicators with a decrease of the absolute mean difference in carotid plaque-score between worse-off and better-off areas of 9% for men and 13% for women, whereas adjustment for risk factors turned the trend non-significant in women, however, not in men.
Those living in socially deprived areas in general had more extensive carotid atherosclerosis. However, in these areas there were a substantial number of individuals with low degrees of carotid atherosclerosis and vice versa. Thus, with regard to conceptual ideas of causal inference, the social characteristics of an area seem to be associated with the prevalence of carotid atherosclerosis. However, with regard to benefits of prevention, focusing on geographical areas would probably give a restricted benefit, where only some high-risk individuals would be reached.
To test the feasibility of using a system for classification of surgical errors and of in-hospital deaths and long hospital stay as markers for errors in surgery we reviewed the hospital records of 273 patients with 285 admissions. During the one year study period there were in all 3767 patients admitted for surgical care. From these we selected the 131 who died in the department during the year, the 100 who had the longest stay (greater than 33 days) and the 91 patients were referred to the departments of internal medicine, infectious diseases or orthopedic surgery. Errors were classified as error of omission or commission, in diagnosis or in therapy. Possible or definitive errors were found in the care of 23% of the patients who died and in 10% of the ones with a long hospital stay. Only 3% of patients referred to other departments experienced errors. It is concluded, that "in-hospital death and "long hospital stay" can be used as markers to identify errors in surgery.
Asthma but not smoking-related airflow limitation is associated with a high fat diet in men: results from the population study "Men born in 1914", Malmö, Sweden.
The purpose of this study was to investigate whether there is an association between asthma and the intake of food with pro-oxidant or antioxidant activity (fat, alcohol, iron, zinc, and vitamins A and C), and to analyse whether any such association is specific to asthma or is found in airflow limitation in general. This study deals with 478 men, who were randomly selected from all the men born in Malmö in 1914. They were investigated using spirometry and their medical, occupational and dietary history was recorded in 1982-1983, at the age of 68 yrs, as part of the cohort study "Men born in 1914". Asthma was defined as a past or present physician's or nurse's diagnosis of asthma and airflow limitation was defined as a forced expiratory volume in one second/vital capacity ratio (FEV1/VC) of less than 70%. The relative risk of having asthma or airflow limitation as related to dietary intake at the age of 68 yrs was analysed after adjustments for smoking history and body mass index. Asthma was reported in 21 men and was not related to smoking history. Asthma was more common in men with a high fat intake (relative risk of asthma 1.74 for a 10% increase in fat intake, 95% confidence interval for the relative risk 1.13-2.68). The consumption of alcohol was higher for current smokers than ex-smokers and nonsmokers, and the intake of carbohydrates, vitamin C and iron was lower. Airflow limitation without asthma was present in 156 men and was related to smoking but not to dietary intake. Men with asthma had a significantly higher intake of fat than men without asthma. This difference appeared to be specific to asthma and was not found in airflow limitation in general.
Asymptomatic leg and carotid atherosclerosis in smokers is related to degree of ventilatory capacity: longitudinal and cross-sectional results from 'Men born in 1914', Sweden.
Although smoking is associated with cardiovascular disease (CVD), many individuals remain healthy after many years of smoking. The population based cohort 'Men born in 1914' was used to investigate whether the occurrence of non-invasively detected atherosclerosis among smokers is associated with lung function [(i.e. height-adjusted forced expiratory volume during 1 s (FEV1.0) and vital capacity (VC)]. Two hundred and seven smokers without history of CVD were examined with spirometry and calf plethysmography at 55 years, and with spirometry, ankle-arm blood pressure recordings and ultrasound examinations of the carotid arteries at 68 years. Eighty-three men had atherosclerosis defined as carotid stenosis >30% or ankle-arm index
OBJECTIVE: To study whether physical activity is associated with reduced occurrence of asymptomatic leg atherosclerosis. DESIGN: Longitudinal and cross-sectional analyses of the population-based cohort "men born in 1914". METHODS: Comparison of the systolic ankle/arm pressure index (AAI) at age 68 in groups who were sedentary, performed some activity, and performed regular physical training at 55 and 68 years of age. RESULTS: At 55 years of age, 100 (27%) were sedentary, 209 (58%) reported some physical activity and 54 (15%) reported regular physical training. At 68 years, 194 men (53%) reported the same degree of physical activity, 127 (35%) reported a higher physical activity, and 42 (12%) reported lower physical activity. Physical activity at 55 years (p =0.03) and increased physical activity between 55 and 68 years (p =0.03) were both associated with higher AAI at 68 after adjusting for potential confounders. At 68 years, AAI was 0.89+/-0.21, 1.01+/-0.13 and 1.05+/-0.11, respectively, in men who were sedentary, reported some physical activity, and regular physical training (p =0.0002). This association remained significant after adjustments for potential confounders. CONCLUSIONS: regular physical activity is associated with reduced occurrence of asymptomatic leg atherosclerosis, even in men taking up exercise after age of 55.
Biased risk factor assessment in prospective studies of peripheral arterial disease due to change in exposure and selective mortality of high-risk individuals.
BACKGROUND: Our aim was to assess whether risk factor assessment in prospective studies of peripheral disease (PAD) might be biased by change in exposure and selective mortality of individuals at high risk. METHODS: The cohort 'Men born in 1914' has been followed since the baseline examination 1969. PAD, (i.e. ankle-brachial pressure index
