Association between alcoholism and diverticulitis.
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Alcoholism↗
Biomedical subjects
G Engholm
Publications and source records attributed to G Engholm.
Evaluation of ultrasound-estimated date of delivery in 17,450 spontaneous singleton births: do we need to modify Naegele's rule?
OBJECTIVE: To compare the size of error in the predicted date of delivery by biparietal diameter (BPD) and last menstrual period (LMP) in different clinical models. MATERIALS AND METHODS: Predicted dates of delivery were calculated in 14,805 spontaneous deliveries with a reliable date of LMP using two assumptions: average length of pregnancy of 280 and of 282 days. Errors in these calculated dates were tested when used alone or combined, i.e. the LMP-predicted date of delivery was used as first choice unless the discrepancy between gestational age calculated by BPD and LMP exceeded 7, 10 or 14 days. RESULTS: The average discrepancy (error) between predicted date of delivery from BPD and LMP and date of spontaneous delivery was 7.96 and 8.63 days, respectively (p < 0.0001). Adding 282 instead of 280 days to the first day of the LMP reduced the error of the LMP method from 8.63 to 8.41 days, reduced the percentage of classified post-term deliveries from 7.9 to 5.2% and increased the preterm births from 3.96 to 4.48%. No models of combined use of LMP and BPD were superior to the use of BPD alone. CONCLUSION: If both BPD and LMP are available, BPD should be used to predict term. If only LMP is available, term should be calculated as the first date of the LMP plus 282.
Delivery, Obstetric↗
Decrease in mortality in patients with a hospital diagnosis of atrial fibrillation in Denmark during the period 1980-1993.
BACKGROUND: Atrial fibrillation is associated with increased mortality. We hypothesized that the death rate in atrial fibrillation patients in Denmark has diminished during the period 1980-1993. METHODS: In a random sample of half of the Danish population, 30 330 patients were found to have a diagnosis of incident atrial fibrillation in the Danish National Hospital Discharge Register 1980-1993. Information on previous and concomitant cardiovascular and metabolic diseases during the period 1977-1993 was sought in the register. The temporal trend in total and cardiovascular mortality in the cohort of atrial fibrillation patients was analysed. RESULTS: A significant decrease in total and cardiovascular mortality was seen, 12-13% for total mortality and 17-18% for cardiovascular mortality. By adjusting for the decreasing cardiovascular mortality rate in the general population, a decrease in the relative risk of total mortality of 8-13% with time was seen for the atrial fibrillation cohort, compared with the population risk, while no reduction in the relative risk of cardiovascular death was seen. CONCLUSION: A significant decrease in mortality with calendar period occurred in the cohort of atrial fibrillation patients.
Aged↗
Fertility rates in Denmark in relation to the sexes of preceding children in the family.
Analysis of the effect of sex combination of previously born children in the family on fertility rates was performed for 363,373 Danish families comprising a total of 613,900 children, to address the questions of sex preference and combination preference. The fertility rates were stratified by parental age, period and latency time to the next child, and fertility rate ratios were estimated using multiplicative Poisson regression models. Our results demonstrate a strong preference for a balanced composition of sexes in Danish families. In families with two or three children the highest fertility rates were seen in families who had same-sexed children. The lowest fertility rates were in families with two children of identical sex followed by a child of the opposite sex. A moderate sex preference for girls was indicated by higher fertility rates in two-boy families than in two-girl families.
Birth Rate↗
A follow-up study of postpartum psychoses: prognosis and risk factors for readmission.
OBJECTIVE: The aim of this study was to describe the prognosis and risk factors for the first readmission after postpartum psychosis. METHOD: Linking the Danish Medical Birth Register and the Danish Psychiatric Central Register from 1 January 1973 to 31 December 1993 revealed 1173 women diagnosed with a psychosis within 91 days of delivery. The relative risk (RR) of readmission was estimated using Cox proportional hazard regression models. RESULTS: An increased risk of readmission was found for women with a diagnosis of schizophrenia (RR = 2.4, 95% CI = 1.9-3.1) and for women with a history of previous psychiatric admission (RR = 1.8, 95% CI = 1.5-2.1) compared to first-admitted women with other functional psychoses. Unmarried women also showed an increased risk of readmission, and only preterm delivery was associated with a reduced risk of readmission. CONCLUSION: Preterm delivery predicts the best prognosis after postpartum psychosis. The majority of readmissions were related to the psychopathology of the patient and to lack of social support.
Adult↗
Risk of testicular cancer with cryptorchidism and with testicular biopsy: cohort study.
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Adolescent↗
Different risk factor patterns for high-grade and low-grade intraepithelial lesions on the cervix among HPV-positive and HPV-negative young women.
Risk factors for cervical intraepithelial neoplasia have most often been studied in high-grade lesions. Furthermore, in a high proportion of the studies, human papillomavirus (HPV), the most significant risk determinant of cervical neoplasia, was not taken into account when evaluating other risk factors. To compare risk factors for ASCUS (atypical cells of undetermined significance), LSIL (low-grade squamous intraepithelial lesion) and HSIL (high-grade squamous intraepithelial lesion), we conducted a case-control study among 20 to 29 year-old women participating in a prospective cohort study in Copenhagen. It included 131 women with ASCUS, 120 women with LSIL, 79 women with HSIL and 1,000 randomly chosen, cytologically normal, control women. All participants had a personal interview and a gynecological examination including a Pap smear and cervical swabs for HPV DNA detection using general primer-mediated polymerase chain reaction. The most significant risk determinant of all 3 disease categories was the presence of genital HPV DNA. The risk factor pattern was nearly identical for ASCUS and LSIL, but differed significantly from that for HSIL. Stratified analysis by HPV-status showed that, apart from, respectively, smoking and parity among HPV-positive women, and smoking and number of sex partners among HPV-negative women, no additional risk factors were observed for ASCUS and LSIL. In contrast, among HPV-negative women with HSIL, long-term use of oral contraceptives was the most important risk factor. However, our result should be taken with great caution as it is based on very small numbers, and as it is unknown whether the HPV-negative lesions constitute a true entity. Among HPV-positive women, the risk of HSIL was associated with e.g., years of sex life without barrier contraceptive use, early age at first genital warts and smoking. Whether the risk factors that are applicable only to HSIL represent factors related to progression remains unknown.
Adult↗
[Lung cancer among asbestos-cement workers in Denmark].
A cohort of 7887 men and 576 women employed between 1928 and 1984 at a Danish asbestos cement factory Dansk Eternit Fabrik A/S was followed up for deaths, immigrations, and incident cancer cases during 1943-90. The observed number of lung cancer cases was compared with the expected number based on incidence rates for the Danish population. Internal comparison was made with Poisson modelling. A total of 226 lung cancer cases was observed; 223 cases among men and three among women. The standardised incidence ratio (SIR) for all lung cancer cases for men was 1.7; for adenocarcinoma 2.6, squamous cell carcinoma 1.7, and anaplastic carcinoma 1.5. Among the 93 excess lung cancer cases, 36 were squamous cell carcinomas, 32 adenocarcinomas and 17 anaplastic carcinomas. During the first 25 years after the start of employment the excess risk was shared almost equally between the different histological types of lung cancer, but the risk of adenocarcinomas was clearly higher after this point.
Adenocarcinoma↗
[Lung cancer, tobacco smoking and environmental factors in Denmark].
In the 1980's the incidence of lung cancer in Copenhagen was nearly twice that of the incidence in the rural areas. A 17 year follow up study of all economically active persons aged 30-64 in Denmark at the census in 1970, supplied with smoking information on a group level from marketing surveys 1970-72, shows that differences in smoking habits was the main factor behind the regional differences in lung cancer. Differences in smoking habits explained about 60% of the excess lung cancer risk for men in Copenhagen and about 90% for women. Occupational risk factors also seemed to have an important role. After control for smoking, workers had twice the lung cancer risk of teachers and academics. There was only a small independent effect of geographical region, which suggests that an influence of outdoor air pollution on lung cancer risk is identifiable only for air pollution levels above that of Copenhagen around 1970.
Adult↗
Smoking and the risk of leukemia, lymphoma, and multiple myeloma (Sweden).
While several epidemiologic studies have indicated a link between smoking and the risk of developing hematolymphoproliferative cancers (chiefly leukemias, lymphomas, and multiple myelomas), in particular myeloid leukemia, the role of tobacco in the etiology of these neoplasms remains unclear. To evaluate the potential impact of tobacco use on development of leukemia, lymphoma, and multiple myeloma, we conducted a cohort study of 334,957 Swedish construction workers using prospectively collected exposure-information with complete long-term follow-up. A total of 1,322 incident neoplasms occurred during the study period, 1971-91. We found no significant association between smoking status, number of cigarettes smoked, or duration of smoking and the risk of developing leukemias, lymphomas, or multiple myeloma. There was a suggestion of a positive association between smoking and the risk of developing Hodgkin's disease, although the rate ratios were not significantly elevated, except for young current smokers. No positive dose-risk trends emerged. Our study provides no evidence that smoking bears any major relationship to the occurrence of leukemias, non-Hodgkin's lymphomas, or multiple myeloma.
Adolescent↗
Hodgkin's disease, pharyngeal cancer, and soft tissue sarcomas in Danish paper mill workers.
Several studies have indicated an increased cancer risk among paper mill workers, based on rather few cancer cases. The authors studied cancer incidence in a large historical cohort of 14,362 Danish paper mill workers, employed at any time between 1943 and 1990, and followed up until December 31, 1993. Men had an increased risk of pharyngeal cancer (15 observed (obs), standardized incidence ratio (SIR) 1.99, 95% confidence interval (CI) 1.11-3.29). With two additional cases among women, 11 of 17 cases were located in the tonsils. Men also had an increased risk of Hodgkin's disease (18 obs, SIR 2.01, 95% CI 1.19-3.18). Women had an increased risk of soft tissue sarcomas (nine obs, SIR 2.33, 95% CI 1.06-4.43), with a high risk among female paper sorters (eight obs, SIR 3.98, 95% CI 1.71-7.84). The study thus supports some studies' observations of an increased risk of Hodgkin's disease in paper mill workers. The detailed reporting of cancer cases in paper mill workers have furthermore revealed a risk of pharyngeal cancer together with a risk of soft tissue sarcomas in paper sorters.
Adult↗
Impact of exposure to insulation wool on lung function and cough in Swedish construction workers.
OBJECTIVES: To investigate whether application of insulation wool adversely affects lung volumes and increases the occurrence of symptoms of airway irritation. METHODS: Data from nationwide health check ups in 1981-93 of male construction workers born in 1955 or later were used to investigate cross sectional (n = 96,004) and longitudinal (n = 26,298) associations between lung volumes, vital capacity (VC), and forced expiratory volume in one second (FEV1) and exposure to insulation wool by combining a job exposure matrix (JEM) and self reported exposure. Data on 12 month prevalence of persistent cough not associated with the common cold was available for the period 1989-92. Potential confounding from smoking, exposure to asbestos, silica, and isocyanates, was considered in the analyses. RESULTS: For those in the highest exposure category (self reported duration of exposure of > or = 11 years, and high exposure according to the JEM) VC was on average 2.5 cl lower (95% CI -6.5 to 1.5) than in those with no exposure. The corresponding figures for FEV1 was -2.4 cl (95% CI -6.1 to 1.3). In the longitudinal analyses, the yearly change in VC between the first and last spirometry for those in the highest exposure category was 0.50 cl (95% CI -0.97 to 1.98) less than in the unexposed category. The corresponding figure for FEV1 was 0.89 cl (95% CI - 0.70 to 2.06). High exposure to insulation wool, asbestos, or silica, during the 12 months preceding the check up was associated with increased odds ratios (ORs) for persistent cough of the same magnitude as current smoking. CONCLUSIONS: The results indicate no effects on VC or FEV1 from exposure to insulation wool. Recent exposure to insulation wool, asbestos, and silica was associated with an increased prevalence of persistent cough.
Adult↗
Body size and prostate cancer: a 20-year follow-up study among 135006 Swedish construction workers.
BACKGROUND: Obesity is associated with endocrine changes (e.g., increased estrogen and decreased testosterone in the blood) that have been implicated in the cause of prostate cancer and, therefore, an association between body weight and the risk of developing prostate cancer would be expected. However, because of bias or low statistical power in previous epidemiologic studies, associations between anthropometric measurements (height and weight), body mass index (BMI), and the risk of prostate cancer may have been inadvertently overlooked. PURPOSE: We performed a large, retrospective cohort study among Swedish construction workers to evaluate possible associations of adult weight, height, BMI, and lean body mass (LBM) by age at entry in the study with the incidence and mortality rate of prostate cancer. METHODS: We analyzed data that had been compiled in a computerized central register on a cohort of approximately 135000 male construction workers. Information on height and weight had been collected with the use of a comprehensive questionnaire filled out by nurses at the time of enrollment in the cohort, from 1971 through 1975. Complete follow-up was achieved through 1991 by means of record linkage to the Swedish National Cancer Register, the Death Register, and the Migration Register. A total of 2368 incident cases and 708 deaths from prostate cancer occurred in the cohort during a follow-up period averaging 18 years. We used only information obtained at the index visit from 1971 through 1975 to determine age-adjusted rate ratios (RRs) in a Poisson-based multiplicative multivariate model with age and the relevant exposure variable (e.g., weight, height, BMI, and LBM) as independent variables. RESULTS: All anthropometric measurements were positively associated with the risk of prostate cancer and were more strongly related to mortality than to incidence. The excess risk of death from prostate cancer was statistically significant in all BMI categories above the reference category: RR = 1.40 (95% confidence interval [CI] = 1.09-1.81) in the highest category compared with the lowest (P for trend = .04). For height and LBM, the excess risk in the highest compared with the lowest categories was somewhat less pronounced: RR = 1.28 (95% CI = 1.02-1.60) and RR = 1.26 (95% CI = 1.02-1.57), respectively. Statistically significant linear dose-response relationships were also found with the incidence of prostate cancer, with the exception of BMI (P for trend = .10). CONCLUSION: Our large cohort study indicates that various aspects of body size are related to the risk of prostate cancer and that future studies are needed to study the role of body size and prostate cancer.
Adult↗
Risk of cancer among paper recycling workers.
OBJECTIVES: Studies in traditional paper mills have indicated an excess cancer risk, and mutagenic compounds have been identified in the industry. No studies have reported on risk of cancer in paper recycling. Therefore the cancer incidence in Danish paper recycling mills was investigated. METHODS: 5377 employees in five paper recycling plants were included in a historical cohort study. The workers had been employed in paper recycling in 1965-90, and the cohort was followed up until 31 December 1993. The expected number of cancer cases was calculated from national rates. RESULTS: There was significantly more pharyngeal cancer among male workers (seven observed (standardised incidence ratio (SIR) 3.33, 95% confidence interval (95% CI) 1.34 to 6.87)). There was slightly more lung cancer among male workers in production (39 observed, SIR 1.21, 95% CI 0.86 to 1.65). Risk of Hodgkin's disease was doubled in male production worker (four observed, SIR 1.90, 95% CI 0.51 to 4.85). CONCLUSIONS: The increased risk of pharyngeal cancer found in this study is interesting but may be influenced by confounders such as smoking and alcohol intake. This study also indicates an excess risk of Hodgkin's disease, which is in accordance with some studies in the traditional paper mills. As this is the first report on risk of cancer in paper recycling, further studies are needed.
Cohort Studies↗
Determinants for genital human papillomavirus (HPV) infection in 1000 randomly chosen young Danish women with normal Pap smear: are there different risk profiles for oncogenic and nononcogenic HPV types?
Most studies of risk factors for human papillomavirus (HPV) DNA detection have focused on overall HPV positivity and have not examined determinants for high-risk and low-risk HPV types separately. We studied risk determinants for genital HPV infection in 1000 randomly chosen women (20-29 years) with normal cervical cytology from Copenhagen, Denmark. All women had a personal interview, a Pap smear, and cervical swabs for HPV DNA detection using a PCR technique. On the basis of their association with cervical cancer, the HPV types were categorized as belonging to a high-risk group ("oncogenic types") or a low-risk group ("nononcogenic types"). The overall HPV detection rate was 15.4%. Of HPV-positive women, 74% had oncogenic HPV types, and 30% had nononcogenic HPV types. Younger age and lifetime measures of sexual activity (notably, number of partners) were the main risk factors for the oncogenic HPV types. Furthermore, a previous Chlamydia infection was associated with the high-risk HPV types. In contrast, the most important determinants for nononcogenic HPV infection were contraceptive variables related to the physical protection of the cervix (condom or diaphragm) and number of partners in the last 4 or 12 months. Our study confirms the venereal nature of HPV infection. We hypothesize that the low-risk HPV infection, which correlates with recent sexual behavior, may be more transient than infection with the oncogenic HPV types, which correlates with lifetime exposure measurements of sexual habits.
Adult↗
Smoking and colorectal cancer: a 20-year follow-up study of Swedish construction workers.
BACKGROUND: Although cigarette smoking has consistently been shown to be positively related to the risk of adenomatous polyp development (benign neoplastic growth of epithelial tissue in the colon), most studies of cigarette smoking and the risk of colorectal cancer have been negative. However, in two large prospective studies in women and men, a statistically significant association between cigarette smoking and an increased risk of colorectal cancer was found, but only after more than 35 years of smoking. PURPOSE: To shed further light on the alleged relationship between long-term smoking and colorectal cancer risk, we performed a retrospective cohort study among Swedish construction workers, with many long-term smokers, complete long-term follow-up, and a large number of observed cases. METHODS: We analyzed the association of smoking with colon cancer and with rectal cancer, using data on a cohort of approximately 135000 male construction workers. High-quality exposure information was collected with the use of a comprehensive questionnaire filled out at the time of enrollment in the cohort, from 1971 through 1975. Complete follow-up was achieved through 1991 and the subjects were observed for an average of 17.6 years, thereby contributing approximately 2375000 person-years of follow-up. We calculated age-adjusted rate ratios (RRs) with the use of Poisson-based multiplicative multivariate models followed by further multivariate modeling that adjusted for other variables. RESULTS: A total of 713 incident colon cancers and 505 rectal cancers were observed. There was no statistically significant association between current smoking status, number of cigarettes smoked or number of years smoking, and risk of colorectal cancer. The age-adjusted RRs were 0.98 (95% confidence interval [CI] = 0.82-1.17) and 1.16 (95% CI = 0.94-1.44) for colon and rectal cancers, respectively, among current smokers, and 1.07 (95% CI = 0.63-1.82) and 1.08 (95% CI = 0.58-2.03) among smokers of 25 or more cigarettes per day, relative to nonsmokers. Among smokers for more than 30 years at the start of follow-up, the age-adjusted RRs were 1.03 (95% CI = 0.85-1.25) and 1.21 (95% CI = 0.96-1.53) for colon and rectal cancers, respectively, relative to nonsmokers. Heavy smokers of cigars and pipes had a statistically nonsignificant tendency toward excess risk for colon cancer, but there was no clear dose-risk trend. CONCLUSION: Our large cohort study did not indicate any excess risk of colon cancer in males who were long-term heavy smokers and provided only weak support for an association with rectal cancer. Our data are thus consistent with the majority of previous reports. The reasons for the discrepancies in comparison with recent U.S. data have yet to be identified.
Adult↗
A prospective study of smoking and risk of prostate cancer.
We evaluated the hypothesis that smoking increases the incidence of and mortality from prostate cancer. High-quality smoking information was collected in 1971-1975 in a nation-wide cohort of 135,006 male construction workers in Sweden. We achieved virtually complete follow-up through record linkages and ascertained as of December 1991 2,368 incident cases of prostate cancer and 709 deaths due to this disease. Rate ratios (RR) of prostate cancer incidence and mortality, with 95% confidence intervals (CI), were estimated in Poisson-based age-adjusted models, with amount and duration of smoking as independent variables. We found no convincing association between current smoking status, number of cigarettes smoked or years since onset and risk of prostatic cancer. The age-adjusted incidence RR among previous smokers was 1.09 and among current smokers 1.11 compared with non-smokers. Weak and inconsistent trends were seen with increasing number of cigarettes smoked per day and increasing duration among current smokers. Smokers of 15 or more cigarettes daily for at least 30 years experienced an incidence RR of 1.30. Mortality in ex-smokers was similar to that in never-smokers; it was, however, slightly increased among current smokers without any trend with amount smoked or duration. The weak and inconsistent associations between smoking and prostate cancer could easily have arisen due to bias or confounding. We therefore conclude that smoking is most likely not causally linked to the occurrence of prostate cancer.
Adult↗
Lung cancer, smoking, and environment: a cohort study of the Danish population.
OBJECTIVE: The almost twofold difference in lung cancer incidence between people living in Copenhagen and in rural area of Denmark in the 1980s led to public concern; this study was undertaken to assess the effects of air pollution and occupation on lung cancer in Denmark, with control for smoking habits. DESIGN: Cohort study of national population. SUBJECTS: People aged 30-64 and economically active in 1970 (927,470 men and 486,130 women). MAIN OUTCOME MEASURES: Relative risks for lung cancer estimated with multiplicative Poisson modelling of incidence rates. RESULTS: Differences in smoking habit explained about 60% of the excess lung cancer risk in Copenhagen for men and 90% for women. After control for smoking, workers had double the lung cancer risk of teachers and academics. There was only a small independent effect of region. CONCLUSION: Smoking is the main factor behind the regional differences in lung cancer incidence in Denmark, and occupational risk factors also seem to have an important role. The outdoor air in Copenhagen around 1970 contained on average 50-80 micrograms/m3 of sulphur dioxide, 80-100 micrograms/m3 total suspended particulate matter, and up to 10 ng/m3 benzo(a)pyrene and had peak values of daily smoke of 120 micrograms/m3. Region had only a small effect on incidence of lung cancer int eh present study, which suggests that an influence of outdoor air pollution on lung cancer is identifiable only above this pollution level.
Adult↗