In medical practices that do not have rosters, only the number of patients who come to the practice can be enumerated: the number who might have visited if they had had a reason to do so remains unknown. The Quadratic Odds Estimator is a technique for estimating the total number of patients cared for by a primary care medical practice, including the non-visitors. A revised version of the model is shown to have an error of less than 1% in predicting the number of patients at risk of visiting a primary care medical practice. Aggregate and sex-specific estimates of total practice size are shown to be comparable to within 2%. The model estimates the prevalence of hypertension among the patients of two family practice resdencies as 18 and 11%. The rationale for employing unconventional regression weights and dual regressions is explained.
OBJECTIVES--To describe parent-reported morbidity in relation to the psycho-social conditions of the families and to characterize families whose children are frequently ill. DESIGN--The parent-reported morbidity in a two-month prospective period, and the psychosocial conditions of the families were registered by means of a questionnaire. The conditioned probability of parents' reporting an episode of illness was estimated by means of logistic regression analysis, taking the psycho-social conditions into consideration. SETTING--18,949 families with at least one child under the age of 8 years, resident in the County of Ringkjøbing in western Denmark at 1 March 1988. SUBJECTS--An age-stratified random sample of 1982 families was entered in the study. 1588 (82%) families returned the questionnaire. RESULTS--The parents reported considerable morbidity in their children. The cumulative incidence proportion (CIP) for the period was 48%. The multivariate analysis of the parent-reported morbidity led to the following main results: 1) the morbidity was greatest for children aged 6 to 18 months, after which it decreased with age, 2) there was interaction between the care conditions and the child's age--CIP for children up to two years was largest for the children who were cared for in daycare, while the CIP for the older children was largest for the children who were cared for at home, 3) if the parents reported that the child's siblings suffered from chronic or frequently recurring morbidity, the child's morbidity rate was significantly increased, 4) mothers with higher education reported more morbidity in their children than mothers without this education, and 5) parents with a high perception of the general health threat ("worried" parents) reported more morbidity than did parents with a low perception. CONCLUSIONS--The results made it possible to characterize families whose children were frequently reported ill.
OBJECTIVE: We analysed the variation in the outcome of infrainguinal bypass surgery between departments in a register for clinical audit to see if variation in case-mix influenced the results. MATERIALS AND METHODS: The study was a retrospective analysis of 764 infrainguinal bypass operations performed from 1988 to 1990 at six Swedish surgical departments. Results were assessed at 30 days and at 1 year postoperatively. RESULTS: There was a significant variation (p
This paper examines how the unemployment rate is related to adolescent alcohol use and experience of binge drinking during a time period characterized by big societal changes. The paper uses repeated cross-sectional adolescent survey data from a Swedish region, collected in 1988, 1991, 1995, 1998, 2002 and 2005, and merges this with data on local unemployment rates for the same time periods. Individual level frequency of alcohol use as well as experience of binge drinking is connected to local level unemployment rate to estimate the relationship using multilevel modeling. The model includes municipality effects controlling for time-invariant differences between municipalities as well as year fixed effects controlling for municipality-invariant changes over time in alcohol use. The results show that the unemployment rate is negatively associated with adolescents' alcohol use and the experience of binge drinking. When the unemployment rate increases, more adolescents do not drink at all. Regular drinking (twice per month or more) is, on the other hand, unrelated to the unemployment rate. Examining gender-differences in the relationship, it is shown that the results are driven by behavior in girls, whereas drinking among boys does not show any significant relationship with changes in the unemployment rate.
Shorter stature is an established risk factor for coronary artery disease (CAD), but less is known about its association with extent of the disease.
We assessed the relationship between self-reported height and angiographic findings in 7706 men and 3572 women identified from a nationwide coronary angiography registry in Iceland.
After adjustment for traditional cardiovascular risk factors, a standard deviation decrease in height associated with a greater likelihood of significant CAD (defined as =50% luminal diameter stenosis) both in men (adjusted odds ratio [ORadj]: 1.24, 95% confidence interval [CI]: 1.18, 1.31; p = 3.2 × 10-16) and women (ORadj = 1.10, 95% CI: 1.02, 1.18; p = 0.012). In partial proportional odds logistic regression models, a standard deviation decrease in height was associated with higher odds of having greater extent of CAD in men (ORadj = 1.19, 95% CI: 1.15, 1.25; p = 1.5 × 10-16) and women (ORadj = 1.09, 95% CI: 1.02, 1.16; p = 0.014). When limited to patients with significant CAD, the association was statistically significant in men (ORadj = 1.08, 95% CI: 1.03, 1.14; p = 0.0022) but not in women (p = 0.56).
Our findings show that shorter stature is associated with greater extent of coronary atherosclerosis in a large unselected population of individuals undergoing coronary angiography. This relationship appears to be sex-dependent, with stronger effects in men than in women.
The first survey carried out in Finland specifically to study men's violence against women showed that partner violence is quite common in Finland and it is directed especially toward young women. The statistical findings don't support the idea that violence has become more widespread in Finland. Life situation factors that are usually viewed as making women vulnerable to spousal violence, such as having children, cohabiting, low educational level, and financial dependency on the male partner, failed to explain partnership violence against women in Finland as such, too. The author's objective is to find out whether meanings of violence have changed and whether this could be one reason why young women report in a survey such cases of violence that other women would not. This could explain why violence in partnerships is so common among young women in Finland.
This study aimed to describe the natural course of DSM-III-R alcohol disorders as a function of age at first alcohol use and to investigate the influence of early use as a risk factor for progression to the development of alcohol disorders, exclusive of the effect of confounding influences.
Data were obtained from a community sample (N=5,856) of lifetime drinkers participating in the 1990-1991 Mental Health Supplement of the Ontario Health Survey.
Survival analyses revealed a rapid progression to alcohol-related harm among those who reported having their first drink at ages 11-14. After 10 years, 13.5% of the subjects who began to drink at ages 11 and 12 met the criteria for a diagnosis of alcohol abuse, and 15.9% had a diagnosis of dependence. Rates for subjects who began to drink at ages 13 and 14 were 13.7% and 9.0%, respectively. In contrast, rates for those who started drinking at ages 19 and older were 2.0% and 1.0%. Unexpectedly, a delay in progression to harm was observed for the youngest drinkers (ages 10 and under). Hazard regression analyses revealed a nonlinear effect of age at first alcohol use, marked by an elevated risk of developing disorders among subjects first using alcohol at ages 11-14.
First use of alcohol at ages 11-14 greatly heightens the risk of progression to the development of alcohol disorders and therefore is a reasonable target for intervention strategies that seek to delay first use as a means of averting problems later in life.
Comment In: Am J Psychiatry. 2001 Sep;158(9):153011532753
The study investigated whether occupational accident risks were equally distributed across age categories over time in the context of production reorganization and work rationalization in a Swedish iron ore mine between 1980 and 1993. Three phases of reorganization, defined by productivity levels, and four age categories were related to age-related accident risk ratios using the Poisson-regression method. Accident risk ratios (ARRs) were found systematically to be higher during the two first phases and also for younger workers, in the cases of both nonspecific and specific accident risks. The steady reduction in accident rates observed did not favor all age groups of workers to the same extent. For two accident patterns out of five, workers in their thirties and forties recorded higher ARRs than those in their fifties.
AIM: This study examined the earliest stages in drug involvement, in terms of the relationship between alcohol and tobacco use, among adolescents from six European countries (Denmark, Finland, the Netherlands, Portugal, Spain and the United Kingdom). International, gender and age differences were studied. DESIGN, SETTING AND PARTICIPANTS: A large international sample of European adolescents (n = 10170, mean age = 13.3 years) was followed longitudinally. Data were gathered in the autumn terms of 1998 and 1999 by means of self-administered questionnaires. MEASURES: Adolescents' self-reports on smoking and alcohol behaviour were used. Both behaviours were classified into two categories, that of adolescents who had never used the substance and that of those who had used the substance at least once in their lives. Logistic regression was used to determine which substance was the best predictor of the subsequent use of the other substance. FINDINGS: Alcohol use and tobacco use were found to be associated with each other reciprocally. Results revealed that in Europe as a whole, tobacco use predicted subsequent alcohol use better than the converse. However, for Dutch girls, alcohol use predicted subsequent smoking behaviour better than the converse. CONCLUSION: The findings suggest that the development of alcohol and tobacco use patterns are closely related, but the order of progression is not universal and may reflect cultural factors.
Recent evidence has implicated the genes for 5-lipoxygenase activating protein (ALOX5AP) and phosphodiesterase 4D (PDE4D) as susceptibility genes for stroke in the Icelandic population. The aim of the present study was to explore the role of these genes in a central European population of stroke patients.
A total of 639 consecutive stroke patients and 736 unrelated population-based controls that had been matched for age and sex were examined using a case-control design. Twenty-two single-nucleotide polymorphisms (SNPs) covering ALOX5AP were genotyped. For PDE4D, microsatellite AC008818-1 and 12 SNPs, which tag all common haplotypes in previously identified linkage disequilibrium (LD) blocks, were analyzed.
A nominally significant association with stroke was observed with several SNPs from ALOX5AP, including SNP SG13S114, which had been part of the Icelandic at-risk haplotype. Associations were stronger in males than in females, with SG13S114 (odds ratio, 1.24; 95% CI, 1.04 to 1.55; P=0.017) and SG13S100 (odds ratio, 1.26; 95% CI 1.03 to 1.54; P=0.024) showing the strongest associations. No significant associations were detected with single markers and haplotypes in PDE4D. The frequencies of single-marker alleles and haplotypes differed largely from those in the Icelandic population.
The present study suggests that sequence variants in the ALOX5AP gene are significantly associated with stroke, particularly in males. Variants in the PDE4D gene are not a major risk factor for stroke in individuals from central Europe. Population differences in allele and haplotype frequencies as well as LD structure may contribute to the observed differences between populations.