As the development in mean age of the population and life expectancy has been less favourable in Denmark than in the rest of Western Europe, the Ministry of Health decided to investigate statistics for the period, 1972-1990, for the main areas where Danish life expectancy was poorer. A sharp increase in the incidence of accidental poisoning with medical drugs and alcohol during the period was found to be a factor contributing to the poorer Danish statistics during the period. In the subcategory, death after a fall, there was an increase in incidence among the elderly, but the loss of life-years remained constant. The subcategory, fatal road accidents, manifested a marked reduction in incidence, despite the increase in traffic density during the period, and there was a reduction in the loss of life-years. Thus, in the category, accidental deaths, the increase in the incidence of accidental poisonings would appear to be the only factor contributing to the poorer development in mean age and life expectancy in Denmark.
INTRODUCTION: In some rare inherited disorders, such as Li-Fraumeni syndrome, relatives of children with cancer are at increased risk of cancer. We aimed to assess relations between childhood cancer and sibling risk, and evaluate the influence of recessive conditions in cancer causation. MATERIAL AND METHODS: We did a population-based cohort study in the Nordic countries of 42,277 siblings of 25,605 children with cancer. Children with cancer were identified from records in the five Nordic cancer registries, and their siblings from nationwide population registries. Cancers in siblings were documented through record linkage with cancer registries and compared with national incidence rates. We also assessed cancer incidence in parents to identify familial cancer syndromes. RESULTS: 284.2 cancers were expected in siblings, whereas 353 were diagnosed (standardised incidence ratio 1.24 95% CI, 1.12-1.38). Risk ratios for siblings were highest in the first decade of life (2.59; 1.89-3.46). We excluded 56 families with genetic syndromes linked to cancer, which reduced this ratio from 1.7 to 1.0 (0.7-1.3) for siblings younger than 20 years and from 1.3 to 1.0 (0.8-1.3) for those aged 20-29 years. We found no new patterns of familial cancer that indicated inherited susceptibility, or evidence that recessive conditions might contribute to cancers not explained by syndromes. 40% of cancers in siblings that occurred before age 20 years could be attributed to known genetic factors, whereas 60% remained unexplained. DISCUSSION: Apart from rare cancer syndromes, paediatric cancer is not an indicator of increased risk in siblings.
The purpose of this work is to address future possibilities for avoiding cancer. We elucidate the most important known causes of cancer in the Nordic countries during the second half of this century and provide estimates of the numbers of cancer cases that might be avoided by the year 2000 if those causes were effectively eliminated. Information on the pattern of carcinogenic exposures in each of the five Nordic countries and the associated relative risk estimates from the scientific literature were obtained. The numbers of avoidable cancers were assessed on the basis of this information together with the associated population attributable risk percent, PAR%, i.e. the proportion of a given cancer that can be avoided upon elimination of the causative factor. The main causes of cancer include smoking, alcohol consumption, exposure to occupational carcinogens, radiation, obesity and infection with human papillomavirus (HPV) and Helicobacter pylori. Annually, more than 18,000 cancers in men and 11,000 in women in the Nordic populations could be avoided by eliminating exposure to known carcinogens which is equivalent to 33 percent and 20 percent of all cancers arising in men and women, respectively, around the year 2000. Smoking habits account for a little more than half of these avoidable cases. Exposure to solar radiation, HPV and Helicobacter pylori, diagnostic and therapeutic radiation and consumption of alcohol play important roles in the causation of cancer, as each of these factors is linked with 1-5 percent of all cancers in men and women. Occupational exposures are also substantial causes in men (3 percent), and obesity is important in women (1 percent). In contrast, current knowledge is insufficient to give reliable estimates of the numbers of cancers that could be avoided by well-described modifications of dietary habits. These figures indicate that the most efficient way of reducing cancer morbidity would be to reduce the prevalence of exposure of the population to cancer-causing agents.
A critical review of Nordic literature on fibromyalgia (FMA), undertaken to test the hypothesised inadequacy of the diagnosis, shows the diagnostic criteria to be entirely subjective and arbitrary, and their use to give rise to problems even in controlled studies. Studies have not only shown even small differences in the diagnostic criteria to have profound impact on prevalence figures and to produce apparent fluctuations on the patient population, but also that the prevalence is higher in areas where many cases have already been diagnosed. No common aetiology or pathogenetic mechanism can be identified, and the massive overrepresentation of women remains unexplained. The patient group is characterised by heterogeneity, and no treatment has shown to be specifically beneficial. Papers offering alternative explanations of FMA are concerned with the reasons why FMA is diagnosed, rather than its cause.
Endocarditis caused by pneumococci represents 1-5% of all cases of endocarditis according to publications from different western countries. Necropsy studies show frequencies of up to 14% of all cases of endocarditis. It usually occurs as a complication to a pneumococcal pneumonia but other foci might be seen. Concomitant meningitis is seen in 20-85% of patients suffering from pneumococcal endocarditis. By knowing this disease entity there is a good possibility for treatment with antibiotics and valve replacement, but if overlooked the mortality is high. The frequency of pneumococcal endocarditis might be underestimated. Careful stethoscopic examination for heart murmurs should be a part of the clinical examination in case of invasive pneumococcal disease, especially with concomitant meningitis. Since bacteriaemia due to pneumococci is diagnosed with increasing frequency in many Northern European countries, special attention should be paid to pneumococcal endocarditis. The literature is reviewed with reference to pathology, pathogenesis, frequency, clinical presentation, diagnosis, treatment and prognosis.
Vitamin D deficiency, often complicated by osteomalacia, among Asian immigrants (especially females) is now also recognized in the Nordic countries. The article reviews the history of vitamin D featuring its discovery as well as a contemporary perspective, and describes the complex etiology of the disease. The symptoms, diagnostic approach and recommended treatment are also summarized.
The suspicion that Hodgkin's lymphoma, previously known as Hodgkin's disease, may have an infectious etiology has existed for many years. The assumption rests on epidemiological characteristics, in particular a strong correlation between socio-economic status and risk of Hodgkin's lymphoma in young adults, as well as both serological and molecular biological evidence that the Epstein-Barr virus is involved in the development of up to 50% of all cases of Hodgkin's lymphoma. We present the current epidemiological, serological and molecular biological evidence for an infectious etiology to Hodgkin's lymphoma with emphasis on the association with Epstein-Barr virus.
Seasonal affective disorder is a syndrome of classical depressive symptoms such as reduced energy, initiative and mood combined with atypical symptoms of increased appetite, weight and sleep duration. The symptoms recur each winter and disappear again in spring or early summer. The prevalence ranges from 1% to 10% in Scandinavian populations. Reduced light exposure, melatonergic and serotonergic disturbances are suggested pathogenetic factors. Light therapy offers convincing effect with minimal adverse effects and remains first-line treatment along with selective serotonin reuptake inhibitors.
A questionnaire investigation was undertaken among 18 female Nordic athletic gymnasts in the teams from their respective countries. The median occurrence of injury was three injuries per 1,000 hours (variation 0-7) with uniform distribution between acute and overexertion injuries. The percentage regional localization were: Upper limbs 24%, lower limbs 65% and trunk 11%. In the age group 18-21 years, the frequency of injury was 46% higher than that in the 14-17 year age group and gymnasts with the greatest duration of training had relatively low incidence of injuries (2.7 as compared with 5.2 injuries per 1,000 hours). Treatment consisted of visits to the general practitioner, casualty department and sport specialist or other specialist comprized 16%, 13% and 16% of all the therapeutic contacts. 5% of the injuries involved hospitalization and 50% were not treated by doctors.