BACKGROUND: Self-selection may compromise cost-effectiveness of screening programs. We hypothesized that nonparticipants have generally higher morbidity and mortality than participants. METHODS: A Swedish population-based random sample of 1,986 subjects ages 59 to 61 years was invited to sigmoidoscopy screening and followed up for 9 years by means of multiple record linkages to health and population registers. Gender-adjusted cancer incidence rate ratio (IRR) and overall and disease group-specific and mortality rate ratio (MRR) with 95% confidence intervals (95% CI) were estimated for nonparticipants relative to participants. Cancer and mortality rates were also estimated relative to the age-matched, gender-matched, and calendar period-matched Swedish population using standardized incidence ratios and standardized mortality ratios. RESULTS: Thirty-nine percent participated. The incidence of colorectal cancer (IRR, 2.2; 95% CI, 0.8-5.9), other gastrointestinal cancer (IRR, 2.7; 95% CI, 0.6-12.8), lung cancer (IRR, 2.2; 95% CI, 0.8-5.9), and smoking-related cancer overall (IRR, 1.4; 95% CI, 0.7-2.5) tended to be increased among nonparticipants relative to participants. Standardized incidence ratios for most of the studied cancers tended to be >1.0 among nonparticipants and
AIMS: To evaluate the 10-year incidence of later infarction and subsequent mortality, as well as predictors of later infarction, in patients with suspected myocardial infarction and alive on day 15 after admission. METHODS AND RESULTS: 5993 patients admitted with suspected myocardial infarction and alive on day 15 after admission were registered in The First Danish Verapamil Infarction Trial database in 1979-81. 2586 had definite infarction, 402 probable infarction and 3005 no infarction as they fulfilled 3, 2 and 1 criteria for infarction. They were followed for 10 years with respect to later infarction and death, i.e., including death after later infarction. The 10 year infarction rate after index admission was 48.8% in definite, 47.3% in probable and 24.6% in no infarction patients (P 65 years with definite or probable infarction. CONCLUSION: The 10-year infarction rate in patients with suspected myocardial infarction in whom the diagnosis is ruled out is lower than in those with definite or probable infarction, but the mortality after a later infarction is similar in all three groups.
Comment In: Eur Heart J. 1998 Apr;19(4):534-59597397
Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal dialysis (PD) patients using methods easily available in everyday clinical practice.
We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar X ray, and the ankle-brachial index (ABI) using a Doppler device.
The median AACS was 11 (range 0 - 24). In 58% of the patients, all 4 segments of the abdominal aorta showed deposits, while 19% of patients had no visible deposits (AACS 0). Ankle-brachial index was normal in 49%, low ( 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS = 7 (p
All 291 fatal accidents (510 persons on board, 318 drowned) in water traffic in Finland in 1986-1988 were investigated by specific teams. Only some data of this extensive investigation are presented in this study. Staggering and falling in boat because of drunkenness, falling over and sinking of boat were the main causes of getting into water of the people aboard. Only 3.5% of the drowned had used life jackets and 9.7% of them could not swim. The reduced ability to swim because of alcohol and the exhaustion were in about half of the drowned the actual cause and the cold water in one third the background factor for drowning. The results indicate that fatal accidents in water traffic are a major problem of males (95.9%) and give important information for countermeasures.
The goal of this study was to determine the prevalence and evolution of acquired right ventricular outflow tract obstruction (RVOTO) in the recipient twin in twin-twin transfusion syndrome (TTTS).
Twin-twin transfusion syndrome complicates 4% to 26% of diamniotic monochorionic twin gestations and is associated with high fetal morbidity and mortality. Cardiac dysfunction and biventricular hypertrophy may develop in the recipient twin with the potential for RVOTO.
This was a retrospective review of a two-center experience of TTTS to describe the prevalence and evolution of acquired RVOTO in the recipient twin. Right ventricular outflow tract obstruction was diagnosed or excluded by fetal or postnatal echocardiography or clinical assessment.
Of 73 twin pregnancies with TTTS identified between 1994 to 1998, a total of seven (9.6%) were complicated by RVOTO in the recipient twin: two subvalvar/muscular, four valvar and one combined. Of 44 pregnancies with fetal echo, six had in utero RVOTO with antegrade flow diagnosed at gestational ages ranging from 19 to 27 weeks. In utero progression occurred in four cases over a period of four to eight weeks, with the development of RVOT atresia by delivery. Postnatal progression of RVOTO occurred in two cases, one of which required pulmonary balloon valvuloplasty at age two years. Postnatal regression of subvalvar RVOTO occurred in two cases in early infancy. Death related directly or indirectly to the RVOTO occurred in all four patients who developed complete RVOT obliteration.
Right ventricular outflow tract obstruction may occur in the recipient twin of at least 9% of pregnancies complicated by TTTS. Right ventricular outflow tract obstruction progression is common in utero and may worsen neonatal outcome.
BACKGROUND: There are few epidemiological studies on acute renal failure, and as far as we know none have previously been conducted in Norway. The objective of this study was to evaluate the scope, etiology, treatment and results of dialysis-dependent acute renal failure based on data from the Norwegian National Hospital in 1998. MATERIAL: This study is based on data from a questionnaire applied to all patients (n = 44) treated with dialysis for acute renal failure at the Norwegian National Hospital in 1998. The questionnaire was designed by a group of Norwegian nephrologists in cooperation with the Norwegian Society of Nephrology. RESULTS: The incidence of dialysis-dependent acute renal failure was 54.4 per million population. Men constituted 75% of the patient population. The most common underlying disorders were heart disease, peripheral vascular disease, and cancer. 90% of patients had oliguric acute renal failure, most frequently due to postoperative complications, septicaemia or drugs, and in most cases the aetiology was multifactorial. Patients received on average nine intermittent hemodialysis treatments and stayed on average ten days in the intensive care unit. 30% of the patients were either heart, lung, liver or bone marrow transplanted (renal transplant patients were excluded). The 60 day mortality rate was 41%. INTERPRETATION: The incidence of dialysis-dependent acute renal failure was relatively high in the Norwegian National Hospital patient pool, combined with a significant mortality rate. These findings are comparable with those of other studies.
While acute myocardial infarctionÂ Â (AMI) mostly is a disease of the elderly it also affects younger individuals, often with serious consequenses. In 1980-1984 a study was carried out on the incidence, risk factors, infarct location and distribution of atherosclerosis among Icelanders forty years and younger with AMI. Here we present the results of a similar study carried out for the five year period 2005-2009.
Medical and autopsy records of all individuals, forty years and younger, diagnosed with AMI (I21 in ICD-10) at Landspitali, National University Hospital 2005-2009, or suffering sudden cardiac death in Iceland during the same period were reviewed.Â Blood tests, electrocardiograms, echocardiograms, coronary angiograms and autopsy results were reviewed with respect to AMI-criteria. Statistical comparisons of ratios and means were carried out using Chi-square test and T-test, respectively.
38 individuals 40 years and younger, 32 males and 6 females,Â fulfilled the diagnostic criteria ofÂ AMI.Â Calculated incidenceÂ for the population at risk was 10/100.000/year (14/100.000/year in 1980-1984) and theÂ mean age Â±S.D. was 36.7Â±3.9. Three (7.9%) died suddenly before reaching hospital but of the 35 hospitalised patients 30 day mortality was zero, compared to nine (23.7%) pre-hospital deaths and two (6.9%) hospital deaths in 1980-1984.Â Thus, combined pre-hospital and in-hospital (30 day) mortality was 28.9% and 7.9% in the previous and recent time periods, respectively (p=0.02). In 2005-2009, 77.1% hadÂ a smoking history and 31.4% were hypertensive compared to 97% and 6.9% in 1980-85 (p=0.026 and p=0.015, respectively).Â Body mass index (BMI) was higher in the later period, 28.6Â±4,8 kg/m2 compared to 26.1Â±3.6 (meanÂ±S.D.; p=0.04) but s-cholesterol was lower, 5.1Â±1.4 mmol/L compared to 6.3Â±1.16 ( meanÂ±S.D.; p
To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a "lung-protective" strategy, and to define the total costs of care.
A 3-yr (1993 through 1995) retrospective descriptive analysis of all patients with ARDS treated in Kuopio University Hospital.
Intensive care unit in the university hospital.
Fifty-nine patients fulfilled the definition of ARDS: Pao2/Fio2
Comment In: Crit Care Med. 1999 Nov;27(11):2573-410579285
This study investigated suicides by people aged ten to 19 in Newfoundland and Labrador from 1977 to 1988. It is the first study of suicide in the province to use the records of death from all eight hospital pathology departments in the province and from the office of the Chief Forensic Pathologist. Cases were selected for the study using standardized criteria, independent of the manner of death recorded on the death certificate. A suicide rate of 4.37 per 100,000 was found. This rate and the age- and sex-specific suicide rates are lower than the official figures for Canada but higher than those reported in earlier Newfoundland studies. The rate for males was nearly five times the female rate, and the rate for people aged 15 to 19 was nearly six times that of people aged ten to 14. Suicide rates for Labrador were higher than for the island portion of the province for both Native and for non Native adolescents. Extremely high rates of suicide were found only among the Native population living in Northern Labrador, while none were recorded for Native people elsewhere. Firearms accounted for 54% and hanging for 33% of all suicides. Thirty percent of suicides occurred on a Saturday. Only 36 of the 63 deaths included in this study were designated as suicide on death certificates. The higher rate of under-reporting of suicide than in other jurisdictions suggests that official rates may not be useful for comparisons. The reasons for the high rate of under-reporting are discussed.
The adolescent years, being a period of unique developmental changes, are of great interest in understanding suicidal behavior. The occurrence of completed suicide by age in 1-year age groups in adolescence and young adulthood was studied via official Finnish mortality statistics and the population statistics. Suicide rates increased sharply by age during adolescence, starting somewhat earlier among boys than among girls. During the periods of rapidly rising and high suicide rates in the 1970s and 1980s among boys, the increase in suicide rates started at a younger age than during a spell of lower rates in the 1960s.