There is an ongoing need to review large series of total ankle replacements (TARs) for monitoring of changes in practice and their outcome. 4 national registries, including the Swedish Ankle Register, have previously reported their 5-year results. We now present an extended series with a longer follow-up, and with a 10-year survival analysis.
Records of uncemented 3-component TARs were retrospectively reviewed, determining risk factors such as age, sex, and diagnosis. Prosthetic survival rates were calculated with exchange or removal of components as endpoint-excluding incidental exchange of the polyethylene meniscus.
Of the 780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010. The overall survival rate fell from 0.81 (95% CI: 0.79-0.83) at 5 years to 0.69 (95% CI: 0.67-0.71) at 10 years. The survival rate was higher, although not statistically significantly so, during the latter part of the period investigated. Excluding the STAR prosthesis, the survival rate for all the remaining designs was 0.78 at 10 years. Women below the age of 60 with osteoarthritis were at a higher risk of revision, but age did not influence the outcome in men or women with rheumatoid arthritis. Revisions due to technical mistakes at the index surgery and instability were undertaken earlier than revisions for other reasons.
The results have slowly improved during the 18-year period investigated. However, we do not believe that the survival rates of ankle replacements in the near future will approach those of hip and knee replacements-even though improved instrumentation and design of the prostheses, together with better patient selection, will presumably give better results.
Cites: J Bone Joint Surg Am. 2003 Jul;85-A(7):1321-912851358
Studies from several countries suggest that erecting fences on bridges more commonly used for suicide by jumping may be an effective way of reducing the risk of suicide by jumping from these bridges. Distribution of suicides by jumping off bridges has not yet been studied on a national level in any country. This study included all suicides by jumping from high places registered in the Norwegian Cause of Death Registry (COD) in the period 1999-2010 (n = 319). Combining data from the COD registry and information from police records, 71 cases of suicide by jumping off a bridge were identified involving 36 bridges. This form of suicide constituted approximately 1% of all suicides in Norway in the period 1999-2010. Almost half of these suicides were registered at only 6 bridges. Three Norwegian bridges were secured during the observation period of this study. Two bridges had barriers installed on the full length of the bridge with 11 suicides registered before barriers were installed, and none after. On the 1 bridge that was only partially secured, no change in numbers of suicides was observed after barriers were installed. One-third of jumps from bridges occurred over land. We found that although suicide by jumping off bridges was a relatively rare event, there is a potential for saving lives by installing physical barriers on bridges that are more commonly used for suicide by jumping.
The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) collects data to support the improvement of care for heart disease.
SWEDEHEART collects on-line data from consecutive patients treated at any coronary care unit n = (74), followed for secondary prevention, undergoing any coronary angiography, percutaneous coronary intervention, percutaneous valve or cardiac surgery. The registry is governed by an independent steering committee, the software is developed by Uppsala Clinical Research Center and it is funded by The Swedish national health care provider independent of industry support. Approximately 80,000 patients per year enter the database which consists of more than 3 million patients.
Base-line, procedural, complications and discharge data consists of several hundred variables. The data quality is secured by monitoring. Outcomes are validated by linkage to other registries such as the National Cause of Death Register, the National Patient Registry, and the National Registry of Drug prescriptions. Thanks to the unique social security number provided to all citizens follow-up is complete. The 2011 outcomes with special emphasis on patients more than 80 years of age are presented.
SWEDEHEART is a unique complete national registry for heart disease.
This study aimed to assess the long-term use of health care services in women with abnormal cytology results compared to women with normal cytology results.
We did a nationwide population-based study, using women aged 23 to 59years participating in the national organized cervical cancer screening program. We included a study population of 40,153 women with abnormal cytology (exposed) and 752,627 women with normal cytology (non-exposed). We retrieved data from the Danish Civil Registration System, the Danish Pathology Data Bank, the National Health Service, the National Patient and the National Prescription Register. We calculated the frequencies of contacts to general practitioner (GP), to private psychiatrist and/or psychologist, admissions to hospitals and use of prescription drugs. These frequencies were calculated separately in the 5-year period "before" the cytology result and for the 5-year period "after" the result.
During the "before" period exposed women had more contacts to GPs, more contacts to psychologists/psychiatrist, and more hospital admissions than non-exposed women. In both exposed and non-exposed women, health care use increased from the "before" to the "after" period. This increase was significantly higher for exposed than non-exposed women regarding contacts to GP, admissions to hospitals, and drug use.
Women with abnormal cytology results constitute a selected group with a higher health care use than other women even before they have the abnormal cytology. This difference is further enhanced after the abnormal cytology result.
The aim of the present study was to investigate absence from work in Denmark due to occupational and non-occupational accidents.
Since the beginning of the last decade, political focus has been placed on the population's working capacity and the scope of absence due to illness. Absence from work is estimated at between 3% and 6% of working hours in the EU and costs are estimated at approximately 2.5% of GNP.
Victims of accidents treated at two emergency departments were interviewed regarding absence for the injured, the family and others. All answers were linked to the hospital information on the injury, so that it was possible to examine the relation between absence and injury type, and cause of the accident.
In total, 1,479 injured persons were interviewed. 36% of these reported absence from work by themselves or others. In mean, an injury caused 3.21 days of absence. Based on this the total absence due to injuries in Denmark was estimated to 1,822,000 workdays, corresponding to approximately 6% of the total absence from work due to all types of illness. Non-occupational injuries resulted in more absence than did occupational injuries.
Absence due to accidents contributed to a considerable part of the total absence from work, and non-occupational accidents caused more absence than did occupational accidents.
Abstinence from alcohol has been associated with higher mortality than a moderate consumption of alcohol. However, there is evidence to indicate that the abstainers constitute a select group which is exposed to various psychosocial risk factors.
A population-based sample (N=1978) from the study Young in Norway - longitudinal was followed with repeated surveys from their teens until approaching the age of 30. This data set was linked to various registries. The collection of data included their use of alcohol, social integration and symptoms of anxiety and depression, as well as sexual behaviour. Data on receipt of social benefits were collected from registries.
At age 21, altogether 211 individuals (10.7%) had remained abstinent from alcohol throughout their entire lives. At age 28, their number had fallen to 93 individuals (4.7%). At age 21, abstinence was associated with weak networks of friends, loneliness and a higher likelihood of not yet having had a sexual debut. At age 28, the abstainers also reported a higher prevalence of symptoms of anxiety and depression. They were also more frequent recipients of social benefits.
Abstinence from alcohol in adulthood is associated with psychosocial problems and weak integration. These may introduce confounding factors in studies of the health effects of alcohol consumption.
Comment In: Tidsskr Nor Laegeforen. 2013 Mar 5;133(5):50123463056
Comment In: Tidsskr Nor Laegeforen. 2013 Mar 5;133(5):50123463055
The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care.
The outcome status for 91 elderly (=75 years) and 659 nonelderly (18-74 years) ICU patients treated in the course of a one year period was obtained. A total of 36 of 37 eligible elderly survivors were interviewed about their health related quality of life (HRQOL), social services and their wish for intensive care.
The mortality (54% at follow-up and 64% after one year) was higher in the elderly ICU patients than in non-elderly ICU patients (33% and 37%, respectively, p
Older living kidney donors are regularly accepted. Better knowledge of recipient outcomes is needed to inform this practice. This retrospective cohort study observed kidney allograft recipients from Ontario, Canada between January 2000 and March 2008. Donors to these recipients were older living (= 60 years), younger living, or standard criteria deceased (SCD). Review of medical records and electronic healthcare data were used to perform survival analysis. Recipients received 73 older living, 1187 younger living and 1400 SCD kidneys. Recipients of older living kidneys were older than recipients of younger living kidneys. Baseline glomerular filtration rate (eGFR) of older kidneys was 13 mL/min per 1.73 m² lower than younger kidneys. Median follow-up time was 4 years. The primary outcome of total graft loss was not significantly different between older and younger living kidney recipients [adjusted hazard ratio, HR (95%CI): 1.56 (0.98-2.49)]. This hazard ratio was not proportional and increased with time. Associations were not modified by recipient age or donor eGFR. There was no significant difference in total graft loss comparing older living to SCD kidney recipients [HR: 1.29 (0.80-2.08)]. In light of an observed trend towards potential differences beyond 4 years, uncertainty remains, and extended follow-up of this and other cohorts is warranted.
Equal access to end-of-life care is important. However, social inequality has been found in relation to place-of-death. The question is whether social and economic factors play a role in access to specialist palliative care services.
The study analyzed the association between access to outreach specialist palliative care teams (SPCTs) and socioeconomic characteristics of Danish cancer patients who died of their cancer.
The study was a population-based, cross-sectional register study. We identified 599 adults who had died of cancer from March 1 to November 30, 2006, in Aarhus County, Denmark. Data from health registers were retrieved and linked based on the unique personal identifier number.
Multivariate analysis with adjustment for age, gender, and general practitioner (GP) involvement showed a higher probability of contact with an SPCT among immigrants and descendants of immigrants than among people of Danish origin (prevalence ratio [PR]: 1.55; 95% confidence interval (CI): 1.04;2.31) and among married compared to unmarried patients (PR: 1.25; 95% CI: 1.01;1.54). The trends were most marked among women.
We found an association between females, married patients, and female immigrants and their descendants and access to an SPCT in Denmark. However, no association with the examined economic factor was found. Need for specialized health care, which is supposed to be the main reason for access to an SPCT, may be related to economic imbalance; and despite the relative equality found, SPCT access may not be equal for all Danish residents. Further research into social and economic consequences in palliative care services is warranted.