Nationwide Study (nationwide + study)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Authors' reply: Nationwide study of the outcome of popliteal artery aneurysms treated surgically (Br J Surg 2007; 94: 970,977)

M. Björck
No abstract is available for this article. [source]

Nationwide study of the outcome of popliteal artery aneurysms treated surgically

H. Ravn
Background: The aim was to study the epidemiology and outcomes of popliteal artery aneurysm (PA) treated surgically. Methods: Among 110 000 procedures registered prospectively in the Swedish Vascular Registry (Swedvasc), there were 717 primary operations for PA among 571 patients. Patient records were reviewed and data validated against other registries. Results: The median age of the patients was 71 years; 5·8 per cent were women. Among 264 legs treated urgently, 235 had acute ischemia and 24 had rupture. Of patients with unilateral PA, 28·1 per cent had an aortic aneurysm, 8·4 per cent an iliac aneurysm and 9·4 per cent a femoral aneurysm. Extra-popliteal aneurysms were more common when the PAs were bilateral (P = 0·004). The rate of limb loss within 1 year of operation was 8·8 per cent; 12·0 per cent for symptomatic and 1·8 per cent for asymptomatic limbs (P < 0·001). Risk factors for amputation were symptomatic disease, poor run-off, urgent treatment, age over 70 years, prosthetic graft and no preoperative thrombolysis when the ischaemia was acute. Amputation rates decreased over time (P = 0·003). Crude survival was 91·4 per cent at 1 year and 70·0 per cent at 5 years. Conclusion: Multiple aneurysm disease was common when PAs were bilateral. Preoperative thrombolysis of acute thrombosis and the use of vein grafts for bypass improved outcome. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Nationwide study of recurrent invasive pneumococcal infections in a population with a low prevalence of human immunodeficiency virus infection

H. M. Einarsdóttir
Abstract Recurrent invasive infections caused by Streptococcus pneumoniae are rare, and often considered to be indicative of serious underlying illness. However, the prevalence of this problem, and the relevance of specific predisposing conditions, can be hard to assess, since many of the studies are based on specific risk groups. A population-based study of recurrent invasive pneumococcal disease in Iceland during the 30-year period 1975,2004 was performed. Clinical information, including mortality and vaccine use, was analysed retrospectively. Invasive pneumococcal isolates were serotyped and susceptibility testing was performed. During this period, 36 (4.4%) of 819 patients who survived an initial infection experienced recurrence, with a median time between episodes of 9.7 months. Pneumonia with bacteraemia was the most common clinical diagnosis (48% of cases), followed by bacteraemia without a clear focus (21%) and meningitis (13%). Most (94%) of the patients had identifiable predisposing conditions, most commonly, multiple myeloma in adults, and antibody deficiencies in children. Compared with children, adults were more likely to present with pneumonia (65% vs. 18%; p 0.0001). No significant change in the 30-day mortality rate was observed during the three decades of the study. Only 26% of eligible patients received pneumococcal vaccination. Patients with recurrent invasive pneumococcal disease should be investigated thoroughly for underlying diseases. Greater use of pneumococcal vaccines should be encouraged among high-risk patients. More effective preventive and therapeutic measures are needed to improve outcomes. [source]

Increased Mortality Associated With Low Use of Clopidogrel in Patients With Heart Failure and Acute Myocardial Infarction Not Undergoing Percutaneous Coronary Intervention

Scott Harris DO
We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI). Background. Use of clopidogrel after AMI is low in patients with HF, despite the fact that clopidogrel is associated with absolute mortality reduction in AMI patients. Methods. All patients hospitalized with first-time AMI (2000 through 2005) and not undergoing PCI within 30 days from discharge were identified in national registers. Patients with HF treated with clopidogrel were matched by propensity score with patients not treated with clopidogrel. Similarly, 2 groups without HF were identified. Risks of all-cause death were obtained by the Kaplan,Meier method and Cox regression analyses. Results. We identified 56,944 patients with first-time AMI. In the matched cohort with HF (n=5050) and a mean follow-up of 1.50 years (SD=1.2), 709 (28.1%) and 812 (32.2%) deaths occurred in patients receiving and not receiving clopidogrel treatment, respectively (P=.002). The corresponding numbers for patients without HF (n=6092), with a mean follow-up of 2.05 years (SD=1.3), were 285 (9.4%) and 294 (9.7%), respectively (P=.83). Patients with HF receiving clopidogrel demonstrated reduced mortality (hazard ratio, 0.86; 95% confidence interval, 0.78,0.95) compared with patients with HF not receiving clopidogrel. No difference was observed among patients without HF (hazard ratio, 0.98; 95% confidence interval, 0.83,1.16). Conclusions. Clopidogrel was associated with reduced mortality in patients with HF who do not undergo PCI after their first-time AMI, whereas this association was not apparent in patients without HF. Further studies of the benefit of clopidogrel in patients with HF and AMI are warranted.,Bonde L, Sorensen R, Fosbol EL, et al. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study. J Am Coll Cardiol. 2010;55:1300,1307. [source]

Prevalence of social phobia and its comorbidity with psychiatric disorders in Iran

Mohammad-Reza Mohammadi M.D.
Abstract This study explored the prevalence of social phobia (SP) in the general population of Iran, the sociodemographic characteristics of subjects with SP, and its comorbidity with the other lifetime psychiatric disorders. Our study was part of the nationwide study on the prevalence of psychiatric disorders in Iran. Overall, 25,180 Iranian subjects, age 18 years and over, from urban and rural areas of Iran were selected by a clustered random sampling method and interviewed face-to-face by 250 trained clinical psychologists using DSM-IV diagnostic criteria. Out of 12,398,235 households, 7,795 households in the form of 1,559 clusters of five households were selected. The statistical framework was based on the household lists available from the Department of Health in the provinces. The response rate was 90%. The lifetime prevalence of SP was 0.82%. The rate was 0.4% in males and 1.3% in females. The rate was higher in younger age groups and widows/widowers. It was not related to educational level and residential area. Specific phobia (66.7%), obsessive,compulsive disorder (17.4%), major depressive disorder (15%), and panic disorder (12.1%) were the most common lifetime psychiatric disorders among subjects with SP. The rate of SP in Iran is more similar to that in other Asian countries, and it is lower than that in Western countries. The rate of other psychiatric disorders among subjects with SP is more than that in the general population, and the most common psychiatric disorders were the other anxiety disorders and major depressive disorder. Depression and Anxiety 23:405,411, 2006 © 2006 Wiley-Liss, Inc. [source]

The incidence of dyslexia among young offenders in Kuwait

DYSLEXIA, Issue 2 2009
Gad Elbeheri
Abstract This paper investigates the incidence of dyslexia among young offenders in Kuwait. A total of 91 children/young adults from 8 juvenile delinquent welfare centres across Kuwait were interviewed and tested. A measure of non-verbal reasoning ability was used to exclude those with low general ability. The remaining 53 participants were tested on their ability to identify alliteration and rhyme, retain and manipulate sequences of digit and letter names, decode novel letter strings and identify words within letter chains. Participants' reading accuracy, rate of reading, reading comprehension and ability to spell correctly dictated text were also assessed. These measures were used to determine those with indicators of dyslexia. The results indicated that the percentage of individuals presenting evidence of dyslexia was much larger (greater than 20%) in this population of young offenders than would be expected based on the national average (around 6%) of dyslexics in Kuwait derived from a nationwide study (A survey study of dyslexia in Kuwait, Kuwait Dyslexia Association: Kuwait City; 2002). These findings replicate previous evidence for an increased frequency of dyslexia among young offenders. The implications of such findings are discussed in terms of dyslexia awareness, socio-cultural factors, education and intervention, particularly in Kuwait juvenile delinquent welfare centres. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Educational level and occupation as risk factors for inflammatory bowel diseases: A nationwide study based on hospitalizations in Sweden

Xinjun Li MD
Abstract Background: The aim of this study was to investigate possible associations between educational level, occupation, and hospitalization for inflammatory bowel disease. Methods: A nationwide database was constructed by linking the Swedish Census to the Hospital Discharge Register in order to obtain data on all first hospitalizations for Crohn's disease (CD) and ulcerative colitis (UC) in Sweden during the study period (1970,2004). Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated by educational level and occupation for men and women ,30 years. Three cohorts were defined based on occupational titles recorded in the Swedish census data in 1970 and 1980. Results: Significantly decreased SIRs for CD were observed for both men and women who had an educational level of >12 years. Among men, significantly increased SIRs for CD were present in all 3 cohorts among "drivers." Male "religious, juridical, and other social-science-related workers," "textile workers," and "glass, ceramic, and tile workers," and female "clerical workers," "mechanics and iron and metalware workers," and "printers and related workers" had a significantly increased SIR for CD that was present in 1 of the 3 cohorts. For UC, male "postal and communication workers," "smelters and metal foundry workers," and "chemical process workers," and female "wood workers" had a significantly increased SIR for UC that was present in at least 1 of the 3 cohorts. Conclusions: Educational level and occupation seem to have a minor effect on the population's likelihood of hospitalization for CD and UC. (Inflamm Bowel Dis 2008) [source]

Risk of cancer among children of cancer patients,a nationwide study in Finland

Laura-Maria S. Madanat-Harjuoja
Abstract Cancer treatments have the potential to cause germline mutations that might increase the risk of cancer in the offspring of former cancer patients. This risk was evaluated in a population-based study of early onset cancer patients in Finland. Using the nationwide registry data, 26,331 children of pediatric and early onset cancer patients (diagnosed under age 35 between 1953 and 2004) were compared to 58,155 children of siblings. Cancer occurrence among the children was determined by linkage with the cancer registry, and the standardized incidence ratios (SIRs) were calculated comparing the observed number of cancers with that expected, based on rates in the general population of Finland. Among the 9,877 children born after their parent's diagnosis, cancer risk was increased (SIR 1.67; 95% CI 1.29,2.12). However, after removing those with hereditary cancer syndromes, this increase disappeared (SIR 1.03; 95% CI 0.74,1.40). The overall risk of cancer among the offspring of siblings (SIR 1.07; 95% CI 0.94,1.21) was the same as among the offspring of the patients with nonhereditary cancer. Risk of cancer in offspring, born before their parents cancer diagnosis, was elevated (SIR 1.37, 95% CI 1.20-1.54), but removing hereditary syndromes resulted in a diminished and nonsignificant association (SIR 1.08, 95% CI 0.93-1.25). This study shows that offspring of cancer patients are not at an increased risk of cancer except when the patient has a cancer-predisposing syndrome. These findings are directly relevant to counseling cancer survivors with regard to family planning. [source]

Why do primary care doctors diagnose depression when diagnostic criteria are not met?

Michael Höfler
Abstract This study examines predictors of false positive depression diagnoses by primary care doctors in a sample of primary care attendees, taking the patients' diagnostic status from a self-report measure (Depression Screening Questionnaire, DSQ) as a yardstick against which to measure doctors' correct and false positive recognition rates. In a nationwide study, primary care patients aged 15,99 in 633 doctors' offices completed a self-report packet that included the DSQ, a questionnaire that assesses depression symptoms on a three-point scale to provide diagnoses of depression according to the criteria of DSM-IV and ICD-10. Doctors completed an evaluation form for each patient seen, reporting the patient's depression status, clinical severity, and treatment choices. Predictor analyses are based on 16,909 patient-doctor records. Covariates examined included depression symptoms, the total DSQ score, number and persistence of depression items endorsed, patient's prior treatment, history of depression, age and gender. According to the DSQ, 11.3% of patients received a diagnosis of ICD-10 depression, 58.9% of which were correctly identified by the doctor as definite threshold, and 26.2% as definite subthreshold cases. However, an additional 11.7% of patients not meeting the minimum DSQ threshold were rated by their doctors as definitely having depression (the false positive rate). Specific DSQ depression items endorsed, a higher DSQ total score, more two-week depression symptoms endorsed, female gender, higher age, and patient's prior treatment were all associated with an elevated rate of false positive diagnoses. The probability of false positive diagnoses was shown to be affected more by doctors ignoring the ,duration of symptoms' criterion than by doctors not following the ,number of symptoms' criterion for an ICD or DSM diagnosis of depression. A model selection procedure revealed that it is sufficient to regress the ,false positive diagnoses' on the DSQ-total score, symptoms of depressed mood, loss of interest, and suicidal ideation; higher age; and patient's prior treatment. Further, the total DSQ score was less important in prediction if there was a prior treatment. The predictive value of this model was quite good, with area under the ROC-curve = 0.86. When primary care doctors use depression screening instruments they are oversensitive to the diagnosis of depression. This is due to not strictly obeying the two weeks duration required by the diagnostic criteria of ICD-10 and DSM-IV. False positive rates are further increased in particular by the doctor's knowledge of a patient's prior treatment history as well as the presence of a few specific depression symptoms. Copyright © 2000 Whurr Publishers Ltd. [source]

Demography and clinical course of ulcerative colitis in a multiracial Asian population: A nationwide study from Malaysia

OBJECTIVE: To establish the clinical course of ulcerative colitis (UC) in the Malaysian population, comparing the three major ethnic groups: Malay, Chinese and Indian. METHODS: Patients who were diagnosed with UC from seven major medical referral centers in Malaysia were recruited. Their baseline characteristics, and the extent of the disease, its clinical course and complications were recorded. RESULTS: A total of 118 patients was included. The extent of disease was as follows: proctitis alone in 22 (18.6%), sigmoid colon in 23 (19.5%), descending colon in 16 (13.6%), transverse colon in 11 (9.3%), ascending colon and pancolitis 46 (39%). Most patients had chronic intermittent disease. Extra-intestinal complications were seen in 27 (22.9%) patients and fulminant colitis was seen in four (3.4%). None developed colorectal cancer. The overall cumulative colectomy rates at 1, 5 and 10 years were 3.4% (CI: 0.9,8.5), 5.9% (CI: 1.9,13.2) and 15.6% (CI: 6.5,29.4), respectively. There was a higher prevalence of extra-intestinal manifestations and a trend towards more extensive disease among Indian patients. However, no significant differences were seen in the age of onset, the severity of disease (fulminant colitis, refractory disease) and the colectomy rate. CONCLUSION: As in developed countries, most of our patients have a remitting and relapsing pattern of disease but the clinical course appears to be milder, with lower rates of colectomies. There are differences in clinical presentation among the three major ethnic groups, with Indians having a higher prevalence of extra-intestinal manifestations and a trend towards more extensive disease. [source]

Morphometric analysis of CD34-positive vessels in salivary gland adenoid cystic and mucoepidermoid carcinomas

H. Luukkaa
Background:, Carcinomas of the salivary glands are uncommon and morphologically a diverse group of malignancies. To evaluate the prognostic value of CD34 immunostaining of the vessels in adenoid cystic carcinoma (AdCC) and mucoepidermoid carcinoma (MEC), an automated image analysis method was used. Method:, In a nationwide study, covering salivary gland cancer (SGC) patients in Finland 1991,1996, 37 AdCC and 18 MEC patients (M 25, F 30, age 25,90, mean 63) were included. In addition to clinical characteristics the size, shape, staining intensity and vessel density in CD34 immunostained histologic samples were measured. Results:, Altogether 4433 vessels were measured from AdCC and 2615 from MEC tumor. Of the total tumor vessels measured, 2651 were from patients who deceased with disease (Group I) and 4397 were from specimens derived from those who did not die of disease (Group II) during the 10-year follow-up. The staining intensity was significantly higher in MEC than in AdCC tumor (P = 0.0005). In MEC, the Group I patients had a higher staining intensity among high-grade patients compared with patients with low grade disease, whereas the tumors in Group II had a lower staining intensity among the high-grade compared with the low grade tumors (P = 0.018). A higher vessel density was found in patients with MEC in group II compared with group I (P = 0.017). Conclusions:, The staining intensity of CD34 positive vessels in MEC was higher than in AdCC. In MEC, higher staining intensity of vessels in high-grade tumors and lower vessel density in all MEC patients, predicted poor survival. [source]

Heritability of diurnal type: a nationwide study of 8753 adult twin pairs

Summary Twin studies suggest a genetic component in diurnal types. In 1981, a questionnaire sent to the Older Finnish Twin Cohort yielded responses from 2836 adult monozygotic (MZ) and 5917 like-sexed dizygotic (DZ) twin pairs with four category self-report on diurnal type. We used structural equation modelling to estimate genetic and environmental components of variance in morningness and eveningness. The model fitting was best when the morningness and the eveningness were analysed together. The ADE-model (including additive genetic, dominant genetic and non-shared environmental effects) fitted best to the data. ADE-models for men and women separately did not differ in a statistically significant manner from the combined model, and similarly ADE-models for young and old age groups separately did not differ either. The estimate for overall genetic effect (broad sense heritability) was 49.7% (95% confidence interval 46.4,52.8), with the remainder accounted for by environmental factors not shared by siblings. The variance component estimates for the underlying liability to diurnal type were 11.7% (95% CI 0,23.7) for additive genetic factors, 38.0% (24.7,51.3) for genetic factors due to dominance. Genetic effects thus account for about one-half of the interindividual variability in diurnal type in adults. [source]

Prevalence and genotype distribution of hepatitis C virus among apparently healthy individuals in Mongolia: a population-based nationwide study

Oidov Baatarkhuu
Abstract Background and Aims: Hepatitis C virus (HCV) is one of the major causes of liver cirrhosis and hepatocellular carcinoma (HCC) in Mongolia. However, there are no data concerning nationwide prevalence of HCV infection in Mongolia. We intended to investigate the population-based prevalence of HCV infection and genotype distribution among 1512 apparently healthy individuals in this country. Methods: Between April 2003 and December 2005, sera from 1512 residents of Ulaanbaatar and 12 provinces were collected by two-stage cluster random sampling, and anti-HCV was tested. Anti-HCV-positive samples were tested for HCV RNA by reverse transcription polymerase chain reaction, and HCV genotype was determined. Results: The mean age of the subjects was 46.2±17.8 years, and 812 (53.7%) were male. Overall, the prevalence of anti-HCV was 15.6% (236/1512) and HCV RNA was detected in 167 subjects (11.0%), with the most common genotype being 1b (165/167, 98.8%). When the HCV RNA-positive subjects were categorized by decade of age, the prevalence in each age group was as follows: 2.5% in subjects ,10 years of age, 4.5% in teens, 10.1% in 20's, 12.5% in 30's, 24.2% in 40's, 29.0% in 50's and 32.6% in subjects ,61 years of age. The seroprevalence of anti-HCV in a risk group, nurses, was not significantly different from the general population in each decade of age (P>0.05). Conclusions: Approximately 11.0% of apparently healthy population had detectable HCV RNA in Mongolia, and the predominant genotype of HCV was 1b. Preventive and therapeutic strategies for chronic hepatitis C are urgently warranted in this HCV-endemic area. [source]

Antiepileptic drugs and risk of suicide: a nationwide study

Jonas Bjerring Olesen MB
Abstract Purpose Patients with epilepsy or psychiatric diseases have increased risk of suicide, but whether the risk is influenced by antiepileptic drug (AED) treatment is unclear. Studies have suggested that AEDs in general increase the risk of suicidal behaviour shortly after initiation. This study investigated possible differences in suicide risk associated with different AEDs. Methods The use of AEDs in the Danish population from 1997 to 2006 was determined by prescription claims. The risk of suicide associated with use of AEDs was estimated by case-crossover analyses, where each case serves at its own control during different periods. For sensitivity, the risk of suicide was estimated by a time-dependent Cox proportional-hazard analysis in AED treatment-naïve patients. Results There were 6780 cases committing suicide in the 10-year study period, of which 422 received AED treatment at the time of suicide. The case-crossover analysis estimated AED treatment initiation to increase the risk of suicide (odds ratio (OR): 1.84, 95% confidence interval (CI): 1.36,2.49). Clonazepam (OR: 2.01, CI: 1.25,3.25), valproate (OR: 2.08, CI: 1.04,4.16), lamotrigine (OR: 3.15, CI: 1.35,7.34) and phenobarbital (OR: 1.96, CI: 1.02,3.75) were associated with a significant increased risk, while the remaining examined AEDs did not significantly influence the risk. In the cohort comprising of 169,725 AED treatment-naïve patients, the Cox proportional-hazard analysis yielded similar results. Conclusions This study suggests that clonazepam, valproate, lamotrigine and phenobarbital relatively shortly after treatment initiation may increase the risk of suicide. The increased risk of suicide associated with these AEDs appears to be a consistent finding. Copyright © 2010 John Wiley & Sons, Ltd. [source]

The pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) from 1997 to 2005: a nationwide study on 4.6 million people,,

Emil Loldrup Fosbøl
Abstract Purpose To describe the nationwide pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) in the Danish population. Methods All Danish citizens aged 10 or above 1 January 1997 were included in the study. The national prescription registry was used to identify all claimed prescriptions for NSAIDs by the cohort until 2005. By individual-level-linkage of nationwide registries, information was acquired concerning hospitalizations, comorbidity, concomitant pharmacotherapy and socioeconomic factors. Results The population consisted of 4,614,807 individuals, of which 2,663,706 (57.8%) claimed at least one prescription for NSAID from 1997 to 2005. Ibuprofen and diclofenac were the most frequently used non-selective NSAIDs, whereas rofecoxib and celecoxib were the most frequently used selective cyclooxygenase-2 (COX-2) inhibitors. The usage was similar across all age groups. Female sex and increasing age was associated with increased use of NSAID. Factors predicting extensive NSAID use were: rheumatic disease (odds ratio (OR),=,1.79, 95% confidence interval (CI): 1.69,1.90), gout agents (allopurinol) (OR,=,2.54, CI: 2.44,2.64) and other pain medication (OR,=,3.27, CI: 3.23,3.31). NSAIDs were most often prescribed for use for one distinct treatment interval and for a short period (overall inter-quartile range [IQR]: 9,66 days). High doses were used in a relatively large proportion of the population (8.9% for etodolac to 19.5% for celecoxib) and 54,373 (2.0%) claimed prescriptions for more than one NSAID at the same time. Conclusion NSAIDs were commonly used in the Danish population. Since NSAIDs have been associated with increased cardiovascular risk, further research on the overall risk associated with these drugs on a national scale is needed. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Regulating Contested Local Hazards: Is Constructive Dialogue Possible Among Participants in Community Risk Management?

Angela C. Halfacre
This article uses focus group data to explore the connection between scientific uncertainty about environmental risks and the emergence of distrust among local populations, regulators, and technical experts affected by those risks. With data from a nationwide study of issues associated with the cleanup of U.S. nuclear weapons facilities, the article uses "dialogue theory" and focus group data from three locations to identify the sources of miscommunication and distrust among these actors. The authors conclude that, despite problems with perception and communication among these groups, enough common ground exists to be optimistic about expanding participation for all affected groups in the policymaking process. In fact, expanded participation should diminish the distrust developed from previous regulatory regimes. [source]

Transfers in Planned Home Births Related to Midwife Availability and Continuity: A Nationwide Population-Based Study

BIRTH, Issue 1 2008
Helena E. Lindgren RNM
ABSTRACT: Background: Planning a home birth does not necessarily mean that the birth will take place successfully at home. The object of this study was to describe reasons and risk factors for transfer to hospital during or shortly after a planned home birth. Methods: A nationwide study including all women who had given birth at home in Sweden between January 1, 1992, and July 31, 2005. A total of 735 women had given birth to 1,038 children. One questionnaire for each planned home birth was sent to the women. Of the 1,038 questionnaires, 1,025 were returned. Reasons for transfer and obstetric, socioeconomic, and care-related risk factors for being transferred were measured using logistic regression. Results: Women were transferred in 12.5 percent of the planned home births. Transfers were more common among primiparas compared with multiparas (relative risk [RR] 2.5; 95% CI 1.8,3.5). Failure to progress and unavailability of the chosen midwife at the onset of labor were the reasons for 46 and 14 percent of transfers, respectively. For primiparas, the risk was four times greater if a midwife other than the one who carried out the prenatal checkups assisted at the birth (RR 4.4; 95% CI 2.1,9.5). A pregnancy exceeding 42 weeks increased the risk of transfer for both primiparas (RR 3.0; 95% CI 1.1,9.4) and multiparas (RR 3.4; 95% CI 1.3,9.0). Conclusions: The most common reasons for transfer to hospital during or shortly after delivery were failure to progress followed by the midwife's unavailability at the onset of labor. Primiparas whose midwife for checkups during pregnancy was different from the one who assisted at the home birth were at increased risk of being transferred. (BIRTH 35:1 March 2008) [source]

A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcome

Rolf AA Pelleboer
Abstract Aims: To estimate the incidence and clinical characteristics in hospital admissions due to dehydration or undernutrition and their laboratory evaluation and treatment outcome in exclusively breastfed infants. Methods: All hospital admissions during the first 3 months of life assessed by the Dutch Paediatric Surveillance Unit (DPSU) between mid 2003 and mid 2005. Results: Nationwide 158 cases reported, correspond to an incidence of 58/y/100 000 breastfed infants; it is lower for severe dehydration at risk for hypernatraemia; 20/y/100 000. Sixty-five per cent of cases were <2 weeks old, their median weight loss was 9.3% and median age at admission 5 days; Serum sodium value was measured in only 12% of all cases. Insufficient volume intake and inadequate growth were most frequently reported (61% and 41%). Lethargy, jaundice or clinical dehydration was scored in 11,25%, seizures or shock in 3%. A breast pump at home was used in only 31%. In the hospital breast pumps were available (82%) as lactation consultants (73%). For treatment 65% was offered formula, in 30% by nasogastric drip. Most admissions lasted up to 3 days, all recovered fully and 33% were breastfed exclusively at discharge. Conclusion: The incidence of severe dehydration in the Netherlands is relatively low. With extended use of breast pumps at home it could be lower. To prevent complications, we recommend applying a reference weight chart, a full clinical examination and more extensive screening of serum sodium and glucose. [source]

Prevalence of germline mutations in the TSH receptor gene as a cause of juvenile thyrotoxicosis

L Lavard
Aim: To ascertain the prevalence of germline mutations in the TSH receptor gene as a cause of juvenile thyrotoxicosis (JT) in non-autoimmune patients. TSH receptor gene mutations are not seen in autoimmune-active patients. Methods: In a nationwide study on JT, 123 patients were re-examined 10 y (range 4 to 21 y) after diagnosis. Two patients with toxic adenoma were excluded. In 25 patients, no TPO, TG or TSH-R antibodies were found. In 17 patients, DNA material was available for TSH receptor gene analysis. The entire TSH receptor gene was sequenced in five patients. TSH receptor "hot spots" for mutations in exon 9 and 10 were sequenced in the remaining 12 patients. Results: A TSH receptor gene germline mutation was identified in only one patient of a total number of 121 patients with JT, of which 17 patients were presumed to have non-autoimmune JT by the lack of thyroid autoantibodies. Conclusion: In Denmark the prevalence of germline mutations in the TSH receptor gene is one in 121 patients with JT (0.8%; 95% CI: 0.02,4.6%) and one in 17 patients with presumed non-autoimmune JT (6%; 95% CI: 5.88% (0.15,28.69)). [source]

Treatment of hypopharyngeal carcinoma: analysis of nationwide study in the Netherlands over a 10-year period

A. Sewnaik
Objective:, To analyse different treatment strategies and treatment results of hypopharyngeal carcinoma in the Netherlands. Design:, Retrospective study. Setting:, Eight head and neck centres in the Netherlands. Participants:, A total of 893 patients were treated between 1985 and 1994. Patients were mostly treated with radiotherapy alone, combined surgery and radiotherapy and surgery alone. Results:, The 5-year survival for the whole group was 26%. The 5-year survival for patients treated with curative intention was 32% and treated with palliative intention was 5%. The 5-year disease-free survival after radiotherapy alone was 37%, after surgery alone 41% and after combined therapy 47%. The role of chemotherapy could not be investigated because of a small number of patients treated with chemotherapy in this period. Conclusion:, Combined therapy with surgery and radiotherapy has a better survival for patients with a hypopharyngeal carcinoma in comparison with radiotherapy alone. The N-stage is more important for the prognosis than the T-stage. [source]