Biomedical subjects
Publications and source records attributed to A Engeland.
We investigated relations between measured body mass index (BMI) and stature and thyroid cancer (3046 cases) in a large Norwegian cohort of more than two million individuals. The risk of thyroid cancer, especially of the papillary and follicular types, increased moderately with increasing BMI and height in both sexes.
The present study aimed at exploring the relations between body mass index (BMI, (weight in kilograms)/(height in meters)(2)) and stature and cancer of the small intestine (1162 cases) in a large Norwegian cohort (of two million) with measured height and weight. Elevated BMI in males and increasing height in both sexes were associated with a moderately increased risk of cancer of the small intestine.
The present study explored body mass index (BMI), height, and risk of prostate cancer in a large Norwegian cohort of 950000 men aged 20-74 years, whose height and weight were measured in a standardised way in the period 1963-1999. These were followed for an average of 21 years. The Cox proportional hazard models were used in the analyses. During follow-up, 33 300 histologically verified cases of prostate cancer were registered. The risk of prostate cancer increased by both BMI and height. The magnitude of the increase by BMI was modest, the relative risk (RR) of obese men (BMI>or=30) compared with normal weighted was 1.09 (95% CI: 1.04-1.15). However, the RR at age 50-59 years was 1.58 (95% CI: 1.29-1.94) in men being obese at about age 45 years compared with normal weighted men. The tallest men had an RR of 1.72 (95% CI: 1.46-2.04) compared with the shortest men. The overall effect of BMI on the incidence of prostate cancer was modest. The larger effect found in men aged 50-59 years might partly explain the previous inconsistent findings.
Human papillomavirus has emerged as the leading infectious cause of cervical and other anogenital cancers. We have studied the relation between human papillomavirus infection and the subsequent risk of anal and perianal skin cancer. A case-cohort study within two large Nordic serum banks to which about 760 000 individuals had donated serum samples was performed. Subjects who developed anal and perianal skin cancer during follow up (median time of 10 years) were identified by registry linkage with the nationwide cancer registries in Finland and Norway. Twenty-eight cases and 1500 controls were analysed for the presence of IgG antibodies to HPV 16, 18, 33 or 73, and odds ratios of developing anal and perianal skin cancer were calculated. There was an increased risk of developing anal and perianal skin cancer among subjects seropositive for HPV 16 (OR=3.0; 95%CI=1.1-8.2) and HPV 18 (OR=4.4; 95%CI=1.1-17). The highest risks were seen for HPV 16 seropositive patients above the age of 45 years at serum sampling and for patients with a lag time of less than 10 years. This study provides prospective epidemiological evidence of an association between infection with HPV 16 and 18 and anal and perianal skin cancer.
BACKGROUND: Suicide attempts (or parasuicides) is an important health problem. A better system for follow-up and surveillance of this group of patients is needed for better prioritization of preventive measures. MATERIAL AND METHODS: All self-inflicted injuries registered at the hospital and emergency ward in Stavanger, Norway, in 1992 were retrieved from the Norwegian National Injury Sample Registry (n = 403). The form for each patient was filled out on the basis of their hospital record; a judgment of whether the case was a parasuicide or not was made. Patients with a parasuicide in 1992 were followed for a period of on average 5.5 years with respect to new parasuicides. RESULTS: Medication was used in 85% of the cases. About 15% of the parasuiciders went through a new episode within one year of the first registered parasuicide. INTERPRETATION: The results from this study are consistent with findings in other epidemiological studies, and the registration used in this study can be carried out in hospitals and emergency wards without much effort. The registration form should be further developed and tested prospectively.
BACKGROUND: One in ten hospital beds in Norway is occupied by a patient with an injury diagnosis. So far, the national injury sample registry has been the most extensive source of information on external causes of injury. From 1 January 1999, the ICD-10 (International Classification of Diseases, 10th version) was implemented as a new system for registration of diagnosis at Norwegian hospitals. The aim of this study was to find out to what extent the codes for external causes of injury were utilised by the hospitals. MATERIAL AND METHODS: Data were collected from the Norwegian Patient Register on all patients in somatic hospitals who were admitted with a new injury in 1999. RESULTS: Of about 60,000 hospital admissions due to injuries at Norwegian hospitals, information on external causes was registered according to chapter XX in ICD-10 for only 39%. The registration was complete for only 23%. INTERPRETATION: Due to the incomplete use of chapter XX in ICD-10, data from this register do not, at present, give a good overview of the incidence of injuries in Norway. Hospitals should put more effects into registration in order to get high quality data.
BACKGROUND: The incidence of childhood home injuries is currently high. A portion of these injuries could be prevented by simple safety precautions. MATERIAL AND METHOD: This study is based on data from the Norwegian National Injury Sample Register. We used this register to estimate the frequency of selected product-related injuries among Norwegian children aged two to three. We also used data from another study of home safety precautions taken by mothers of two-year olds. RESULTS: The most frequently reported injuries were falls from staircases and falls in bathrooms. The most severe were injuries related to stairs, medical drugs, and hazardous substances. The survey showed that a significant portion of parents do not take precautions to reduce the risk of injuries related to staircases, bathroom floor, electric cooker and poisoning with medical drugs. INTERPRETATION: There seems to be a potential for improved use of safety measures against product-related childhood injuries. Previous studies have shown that the interventions that are most effective in changing risk behaviour are a combination of legislation, educational campaigns, information to parents on home hazard reduction, and free supply of security equipment.
BACKGROUND: Injury purposely inflicted by other persons is a potentially significant public health problem in Norway, and the size of the problem has received little attention. MATERIAL AND METHODS: We used data from the Norwegian National Injury Sample Registry from 1990-1997 and investigated occurrence of such injuries. RESULTS: A total of 9,649 injuries were included in this study, or 3.8 injuries per 1,000 person-years. Of these, 16% (0.6 per 1,000 person-years) required inpatient treatment. Injuries due to violence represented 2.4% of all injuries among women and 5.5% of all injuries among men. The incidence rate for men and women was highest in the age group 15-24 years. The incidence rate among men in this age group was 4-5 times the rate among women. Domestic violence caused at least 39% of injuries among women. Weekend injuries were overrepresented; about 64% of the injuries occurred from Friday to Sunday. INTERPRETATION: Figures represented in this study reveal only a portion of the problem of violent injuries. Spouse abuse, mental abuse, maltreatment, and sexual abuse without a physical injury are not represented in our data.
Screening can be defined as the process of identifying preclinical disease in asymptomatic people. The main objective of screening is to reduce the incidence and the mortality from disease. There are several prerequisites for successful screening, and screening has both beneficial and adverse effects. In Norway only screening for cervical and breast cancer are recommended as nation-wide, organised programmes. Screening for colorectal cancer is planned as a pilot project. Also a study on screening for prostate cancer is planned. Screening for other cancers is not recommended.
The Norwegian National Injury Sample Registry is a prospective case register of injuries occurring in the defined population of four cities. All injuries treated in hospitals and emergency wards are recorded in the registry. We used data from this registry to provide an epidemiologic overview of the incidence of injuries among children aged 0-14 in Norway. The study population consisted of approximately 61,500 children annually or approximately 492,000 children-years over the 1990-97 period. A total of 57,000 injuries were registered, or 116 injuries per 1,000 children-years. Approximately 2% of the injuries were classified as severe. 36% of all injuries occurred at home, 13% during sport activities and 13% were caused by accidents at school. Incidence was higher among boys than girls in all age groups. During their first 15 years of life, boys sustained on average 2.0 injuries and girls 1.5 injuries. Data from the Norwegian National Sample Injury Registry may provide useful information for prevention of and research on injuries among children.
In animal models of carcinogenesis, pharmacological doses of dehydroepiandrosterone (DHEA) treatment appear to reduce the incidence of chemically induced thyroid cancers. DHEA and its sulfate (DHEA-S) are secreted in approximately equal amounts, but serum levels of DHEA-S are 300-500 times higher and have no diurnal variation when compared to DHEA. The hypothesis that serum concentrations of DHEA-S may be associated with thyroid cancer risk was tested in a population-based prospective case control study. Data from the practically complete nationwide Cancer Registry of Norway were linked to the data file of a serum bank comprising blood samples from 300,000 Norwegian men and women obtained through national health surveys. A total of 113 donors, who during the years after blood sampling received a diagnosis of thyroid cancer, were identified in the serum bank and were eligible for the study. Each case was matched with 3 controls. Serum levels of DHEA-S were determined blindly. Controls were divided into tertiles, and odds ratios between cases and controls were determined relative to the group with the lowest serum DHEA-S level. The risk of developing thyroid cancer was determined in women 50 years of age or older, in women below age 50, in men, and in the subgroup of 77 cases who had morphologically verified papillary thyroid cancer. No significant association between prediagnostic serum DHEA-S concentrations and thyroid cancer risk was observed. These data indicate that DHEA-S within physiological concentrations does not reduce the risk of thyroid cancer.
Danish lung cancer patients diagnosed during 1983-1987 experienced 5-yr relative survival rates 2-7% inferior to patients in the other Nordic countries, despite the similarity of cancer registration and healthcare systems in the Nordic countries. Is the inferior relative survival in Denmark due to differences in morphology or stage of lung cancers? The present study compared in detail the survival of 92,719 patients diagnosed with lung cancer during 1978-1992 in Denmark, Finland, and Norway. In particular, differences in morphology and extent of disease were studied. A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed. However, this could not explain the relative survival differences observed between countries. Extent of disease was the most important predictor of survival. Part of the observed survival differences could be explained by a less favourable stage distribution in Denmark, combined with a slightly lower relative survival rate for those with metastatic disease. Differences in treatment are unlikely to explain the findings, although delays in diagnosing and treating patients in Denmark compared with neighbouring countries could partially explain the lower patient survival in Denmark. In conclusion, the main factor in the lower survival rate in Denmark is unfavourable stage distribution.
This report presents 20 years' of cancer incidence data by occupational group for the Nordic populations. The study covers the 10 million people aged 25-64 years at the time of the 1970 censuses in Denmark, Finland, Norway, and Sweden, and the 1 million incident cancer cases diagnosed among these people during the subsequent 20 years. The project was undertaken as a cohort study with linkage of individual records based on the personal identification numbers used in all the Nordic countries. In the 1970 censuses, information on occupation for each economically active member of the household was provided in free text in self-administered questionnaires. The data were centrally coded and computerized in the statistical offices. Norway, Sweden, and Finland used the Nordic Classification of Occupations, while Denmark used a national coding scheme. However, all the data could be reclassified into 53 occupational groups and 1 group of economically inactive persons. Person-years at risk were accumulated from 1 January 1971 until the date of emigration, date of death or 31 December 1987 in Denmark, 1989 in Sweden, 1990 in Finland, and 1991 in Norway. The 4 countries all had nationwide registration of incident cancer cases during the entire study period. All incident cancer cases during the individual risk periods were included in the analysis. Despite minor differences between the countries, the International Classification of Diseases, 7th revision, formed the core basis for the diagnostic coding in all 4 countries. For the present study the incident cancer cases have been classified into 35 broad diagnostic groups. The observed number of cancer cases in each group of persons defined by country, gender, and occupation was compared with the expected number calculated from the age-, gender-, and period-specific person-years and the incidence rates for the national population. The result has been presented as a standardized incidence ratio (SIR), defined as the observed number of cases divided by the expected number and multiplied by 100. In the tables of this report, all the SIR values for which the upper limit of the 95% confidence interval is below 100 are printed in green and all those for which the lower limit of the confidence interval is above 100 are printed in red. For all cancers combined, the study showed a wide variation among the men, from an SIR of 79 for farmers to 159 for waiters. The occupations with the highest SIR values also included seamen and workers producing beverages and tobacco. Among the women the SIR values varied from 83 for gardeners to 129 for tobacco workers. Low SIR values were found for farmers and teachers. Outdoor workers such as fishermen and gardeners had the highest risk of lip cancer, while the lowest risk was found among indoor workers such as physicians and artistic workers. Almost all pleural cancers are associated with asbestos exposure. Accordingly, plumbers, welders, mechanics, and seamen were the occupations with the highest risk. There was also an excess risk of pleural cancer in the occupational group of technical, chemical, physical, and biological workers, including, among others, engineers and chemists potentially exposed to asbestos. The wood workers included in the present study had the highest risk of nasal cancer. Most studies of nasal cancer have shown increased risks associated with exposure to wood dust, both for those in furniture making and for those exposed exclusively to soft wood. Nickel refinery workers are also known for their high risk of nasal cancer. In the present study they were included in the occupational group of smelting workers. Lung cancer was the most frequent cancer among men in the present study. Tobacco smoking is the major risk factor for this disease, but occupational exposures also play an important role. Waiters and tobacco workers had the highest risk of lung cancer. Miners and quarry workers also had a high risk of lung cancer, which may be related to
Long-term trends in the incidence, prognosis, and mortality of patients with ovarian cancer and borderline tumours in Norway were examined based on data from the population-based Cancer Registry of Norway. The incidence of ovarian cancer rose continuously from the mid-1950s to the mid-1980s. There was also an increasing trend in the incidence of borderline tumours from the early 1970s to the early 1990s. The prognosis for patients with ovarian cancer has improved since the 1950s. In 1989-93 the five-year relative survival rate was 37%. The prognosis for patients with borderline tumours was very favourable, with a five-year relative survival rate of 93% (1970-93). The mortality from ovarian cancer has been almost constant since the 1960s.
During the last two decades there have been frequent discussions as to whether passive smoking causes cancer, or not. It is difficult to carry out satisfactory studies on this issue, partially because any increased risk of cancer seems modest. The tobacco industry has not only attempted to make the public aware of studies which conclude that passive smoking is harmless, but it has also tried to keep alive the discussion as to whether exposure to passive smoking is harmful, or not. A large number of studies has been carried out on the possible impact passive smoking may have on the risk of lung cancer, and it seems justifiable to conclude that passive smoking does increase the risk of this type of cancer. For other types of cancer too few studies have been performed to draw any firm conclusions.
The Scandinavian countries exhibit some of the highest incidence rates of ovarian cancer in the world. Prognosis is poor, and the crude 5-year relative survival was 36% in the Nordic countries in the 1980s. Histology-specific prognostic trends in 5-year relative survival of patients with ovarian cancer and borderline tumours were examined, based on data from the population-based Cancer Registry of Norway. Relative risks (RRs) of dying were derived from Cox regression models. Logistic regression analysis on the proportion of cases with a localised tumour was performed. The 5-year relative survival rate of patients with ovarian cancer increased steadily from 1954 to 1993, being most pronounced in women below the age of 65 at the time of diagnosis. No improvement was seen for women older than 75. For all patients with ovarian cancer, an RR of dying of 0.48 (95% CI = 0.44-0.53) was estimated in 1989-1993 compared with 1954-1958. For patients with epithelial cancer, an RR of 0.63 (95% CI = 0.57-0.69) was seen in 1989-1993 compared with 1970-1973. Patients with mucinous, endometrioid and clear cell tumours had the highest odds of having a localised tumour. The age-adjusted 5-year relative survival rate of patients with borderline tumours was almost constant between 1970 and 1993, at about 93%. The prognosis of patients with ovarian cancer in Norway has improved since the 1950s. The very favourable prognosis of patients with borderline tumours has remained unchanged since the 1970s.
Lung cancer is the most common cancer in the world today, and the prognosis for lung cancer patients is poor. In the Nordic countries, the five-year relative survival was only seven percent in patients diagnosed in 1983-87. In the present study, the survival of 36,010 lung cancer patients diagnosed in Norway in 1954-93 was examined, based on data from the population-based Cancer Registry of Norway. The variation in survival by gender, age, stage, period of diagnosis, and histologic group was explored. Relative survival rates were calculated and relative risks of dying were obtained from multivariate Cox proportional hazards regression analysis. Only a slight improvement in the prognosis of lung cancer patients was observed during the 40-year study period. More than half the patients died during the first six months after diagnosis. Patients with small cell carcinoma had the lowest frequency of localized tumors and also had the poorest prognosis, even after adjustment for stage. Patients with squamous cell carcinoma had the highest frequency of localized tumors. The patients with a localized tumor also have a poor prognosis, with a crude median survival time of nine months in males and 11 months in females in 1984-93.
OBJECTIVE: The aim of the present study was to elucidate the influence of social, dietary and environmental factors on the incidence of malignant epithelial tumours in the upper digestive tract and on the prognosis of patients with these cancers. DESIGN: A population-based case-control study was carried out, and the patients in the study were included in a survival analysis. SETTING: The study was carried out at the Department of Otorhinolaryngology at Ullevål University Hospital, Oslo, Norway. SUBJECTS: In the case-control study, 84 patients and 89 controls were included. Only the patients were included in the survival analysis. RESULTS: Smoking showed the highest odds ratio (OR) for morbidity (OR = 29). The patients had in general a lower social status, and a higher alcohol intake (OR = 6.6). For both beta-carotene and vitamin C, the ORs decreased with increasing intake (OR = 0.2 and 0.3, respectively). Increased ORs were associated with low values for haemoglobin, iron, TIBC, folic acid, magnesium and especially for albumin (OR = 14), and with high values for ferritin, vitamin B12 and thiocyanate (a marker for smoking). Stage of the disease was an important prognostic factor. The relative risk (RR) of dying for disseminated vs localised tumours being 3.2. A poorer prognosis was linked to higher age, to smoking vs no smoking (RR = 2.3), and to lower levels of haemoglobin, albumin, magnesium and thiocyanate. CONCLUSIONS: Strong beer, liquor, consumption of milk and table fat, low social status and smoking seemed to have a negative impact on both disease and survival. Fruit and vegetables might, however, reduce the risk. Whereas low serum albumin, iron and magnesium indicated a high OR for cancer, vitamin C and beta-carotene had the opposite implication. No significant implications on survival could be detected in blood chemistry beyond the stage of disease.