INTRODUCTION: The aim of the study was to assess the results of a well-defined rehabilitation programme after hip arthroplasty. METHODS: The effects of a revised, optimised, perioperative care programme with continuous epidural analgesia, oral nutrition, and physiotherapy were assessed in 60 patients before intervention and 60 patients after intervention. RESULTS: The hospital stay was reduced from nine to six days (p
The purpose of this study was to describe changes in smoking behaviour and exposure to passive smoking among hospital employees at a large Danish University Hospital (Bispebjerg Hospital) from 1992 until 1999 as part of a program toward a smoke-free hospital. The study was based upon three cross-sectional self-administered questionnaires surveys carried out among all employees at the hospital--approximately 4000 persons--in October 1992, April 1997 and April 1999, participation rates being 84, 80 and 76 percent. During the seven year period the smoking rate has decreased from 46% to 32% among male and 40% to 33% among female employees. A decrease in smoking rate was found among all subgroups of employees. Among male employees the rate of heavy smokers has decreased from 25 to 16%, among female employees this decrease is lacking, the rate of heavy smokers being 15% during the whole period. The numbers of employees exposed to passive smoking all day or most of the day has changed from 39% to 25% from 1992 until 1999. Among the smokers 30%--8% of all employees--responded that they would not be able to manage without smoking tobacco during working hours. This answer is most commonly found among heavy smokers, smokers with short or no education and smokers who smoke at any time of day. It is concluded that even though there has been a reduction in the smoking rate, the exposure to passive smoking among employees at the hospital still is unacceptably high. Based upon these results it has been decided that Bispebjerg Hospital is smoke-free for all employees from the 1st of January 2000. There is a need for initiatives for the smokers, who can't manage work without smoking.
INTRODUCTION: The paper describes the epidemiology of acute myocardial infarction in Denmark. The study provides statistics on mortality, incidence and case-fatality for 1996 and the time trend since 1978. The results are compared to the results from the international MONICA study. METHOD: The analyses are based on national population-based registers on causes of death and hospital admissions. RESULTS: The mortality from ischaemic heart disease has declined considerably. The study confirms that the decline in mortality can be ascribed to a decrease in incidence as well as a decrease in case fatality. In the period 1985-1996 the incidence decreased by 3.5% per year for men and 2.5% for women. Mortality rates within 28 days after admission to hospital with MI was almost constant until 1988 following which there was a significant drop. Despite the improved prognosis for MI patients, one quarter die before admission to hospital, and one quarter die within one year after an MI. DISCUSSION: The incidence rates of MI based on the national population-based registers are consistent with the results from the Danish MONICA study. The reduction in incidence rates is a little smaller than the results in the Danish part of the MONICA study, whereas the marked reduction in case-fatality found in this study is not in agreement with the results from MONICA. This discrepancy is not yet understood. The declining trend in case fatality started in 1988 and may be related to the introduction of thrombolysis and acetylsalcylic acid treatment.
We investigated the antibody levels against early antigens of Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpesvirus 6 (HHV6) in systemic lupus erythematosus (SLE) patients and healthy controls, and further correlated these antibodies to haematology/biochemistry, serology, and disease activity measures.
Immunoglobulin (Ig)M, IgG, and IgA levels against the DNA polymerase processivity factors of EBV, CMV, and HHV6, termed early antigen diffuse (EA/D), pp52, and p41, respectively, were determined in plasma samples from 77 SLE patients and 29 healthy controls by using enzyme-linked immunosorbent assays (ELISAs).
IgM, IgG, and IgA levels against EBV EA/D, and IgG and IgA levels against CMV pp52, were significantly higher in SLE patients compared with healthy controls. Furthermore, EBV EA/D- and CMV pp52-directed IgG levels were inversely and positively associated, respectively, with lymphocyte counts in SLE patients. None of the findings seemed to be associated with use of immunosuppressive medication.
Our results suggest strong, but opposite, associations of lytic EBV and CMV infections with SLE. The amplified humoral responses to EBV EA/D and CMV pp52 in our SLE patient cohort probably reflect aberrant control of EBV and CMV reactivation. However, reactivation of EBV appeared to correlate with lymphopenic manifestations in SLE patients whereas CMV reactivation seemed to correlate with increments in lymphocyte levels.
In Norway, ultrasound measurement of the fetal biparietal diameter is used to determine the date of confinement according to Eik-Nes & Grøttum's method. We aimed to evaluate the precision of this method. 8,029 women with singleton pregnancy and spontaneous vaginal delivery were arranged in groups according to gestational age at the time of the ultrasound examination. The precision of the biparietal diameter measurement for predicting the date of birth was determined for each group. An alternative method by Altman & Chitty was also tested on the population. Eik-Nes & Grøttum's method predicts well the date of confinement if the biparietal diameter is measured at 17-20 weeks. Measurements at an earlier stage predict the date of birth with less confidence, particularly during completed gestational weeks 13-16, when the mean error reaches four days. Altman & Chitty's chart seemed to perform more evenly for the various gestational ages, but was systematically shifted by 3-4 days when used on our population. Eik-Nes & Grøttum's chart for assessing gestational age should preferably not be used before 17 weeks of gestation. Introducing new charts based on a different population is not a good option. New charts based on a Norwegian population are needed.
Notes
Comment In: Tidsskr Nor Laegeforen. 2000 Mar 30;120(9):107910833970
To investigate if advanced maternal age at first birth increases the risk of psychological distress during pregnancy at 17 and 30 weeks of gestation and at 6 and 18 months after birth.
National cohort study.
Norway.
A total of 19 291 nulliparous women recruited between 1999 and 2008 from hospitals and maternity units.
Questionnaire data were obtained from the longitudinal Norwegian Mother and Child Cohort Study, and register data from the national Medical Birth Register. Advanced maternal age was defined as = 32 years and a reference group of women aged 25-31 years was used for comparisons. The distribution of psychological distress from 20 to = 40 years was investigated, and the prevalence of psychological distress at the four time-points was estimated. Logistic regression analyses based on generalised estimation equations were used to investigate associations between advanced maternal age and psychological distress.
Psychological distress measured by SCL-5.
Women of advanced age had slightly higher scores of psychological distress over the period than the reference group, also after controlling for obstetric and infant variables. The youngest women had the highest scores. A history of depression increased the risk of distress in all women. With no history of depression, women of advanced age were not at higher risk. Changes over time were similar between groups and lowest at 6 months.
Women of 32 years and beyond had slightly increased risk of psychological distress during pregnancy and the first 18 months of motherhood compared with women aged 25-31 years.
The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied.
We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes.
Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P
To investigate rates of caesarean delivery in Sweden and Norway from 1973 to 2008 in relation to advanced and very advanced maternal age.
Register study.
Sweden and Norway.
All nulliparous women aged over 30 years with a singleton pregnancy, with the fetus in a cephalic presentation, and delivering at term between 1973 and 2008 were evaluated. The study population comprised 329 824 women in Sweden and 127 810 women in Norway.
Data from the national Medical Birth Registers were used to describe caesarean section rates in three age groups: 30-34 years (reference group); 35-39 years (advanced age group); and = 40 years (very advanced age group). Logistic regression analyses estimated the risk in each age group over four decades, in each of the two national samples.
Caesarean delivery decreased from 1973-1979 to 2000-2008 in the two oldest age groups in Sweden (35-39 years, OR = 0.53, 95% CI = 0.50-0.58; = 40 years, OR = 0.36, 95% CI = 0.30-0.43) and Norway (35-39 years, OR = 0.61, 95% CI = 0.54-0.68; = 40 years, OR = 0.45, 95% CI = 0.34-0.58), but increased in women aged 30-34 years. The caesarean delivery rate in the two oldest groups peaked in the second half of the 1970s. Regardless of time point, the caesarean delivery rate was always highest in women aged = 40 years, followed by women aged 35-39 years and lowest in women aged 30-34 years.
Caesarean delivery in nulliparous women of advanced and very advanced age peaked by end of the 1970s in Sweden and Norway. The subsequent reduction was contemporaneous with the introduction of electronic fetal monitoring and a more consistent use of the partogram, suggesting that more effective surveillance of labour increased the chance of a vaginal birth in these high-risk women.
