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H Hamburger

Publications and source records attributed to H Hamburger.

14 recordsLinked to original sources
PubMed2000

[Antibiotic pre-hospital treatment and the course of meningococcal disease].

The aim of the study was to assess the effect of pre-hospital antibiotic treatment given by general practitioners to patients with meningococcal disease. It was carried out as a 16-year population-based historical follow-up study based on referral letters and hospital records in the County of North Jutland, Denmark, and included 320 patients with meningococcal disease, of whom 302 were examined by a general practitioner before admission to hospital. The main outcome measure was death. We found that 44 patients (14.6%) were given antibiotic treatment by the referring general practitioner. Nine of these (20.5%) died, compared with 16 (6.2%) patients who did not receive pre-hospital antibiotic treatment. The presence of skin bleeding, petechiae and impaired consciousness were strongly associated with case fatality. Even after adjustment for these variables the odds ratio for death in patients treated with antibiotics was high (3.2; 95% CI 0.9-10.6). In the 15 patients with skin bleeding (ecchymoses, suggillations) the case fatality rate was 100% in patients treated with antibiotics, and 50% in patients who did not receive antibiotics before hospitalization. It is concluded that pre-hospital treatment is mainly given to the most severe cases with expected high case fatality, and this confounding by indication was probably not fully adjusted for with the available data. The results contradict previous findings and provide reason to doubt the benefit of pre-hospital antibiotic treatment in patients with meningococcal disease.

Adolescent↗
PubMed1998

Trend in incidence and case fatality of meningococcal disease over 16 years in Northern Denmark.

The incidence and case fatality rates of meningococcal disease were assessed in the county of Northern Jutland, Denmark, during the 16-year period from 1980 to 1995. A total of 320 patients were identified from the Meningococcal Research Database, which comprises information from the following sources: (i) the Department of Public Health, to whom notification of meningococcal disease is obligatory; (ii) the Regional Hospital Discharge Registry; and (iii) the register of the regional department of clinical microbiology. In order to assess prognostic indicators assessable at admission, information was collected for each patient from hospital records regarding contacts, symptoms and signs on arrival, laboratory data, and course of disease. The mean incidence was 4.3 cases per 100000 persons per year (range, 2.7-7.7). The incidence increased slightly during the period studied. Overall, the case fatality rate was 9.7%, with a significant rise occurring during the period (P=0.016) and a peak occurring in 1992. Advanced age (> or = 50 years), seizures, impaired consciousness, and skin bleeding on arrival at hospital were predictors of death.

Adolescent↗
PubMed1998

Accessing the embryo interior without microinjection.

For decades it has been assumed that in order to insert macromolecules into the embryo blastocoel for numerous experimental purposes, microinjection was required. Microinjection, however, can be only performed on a few embryos at a time, thus precluding many studies that could involve large populations of embryos. Laser scanning confocal microscopy, with its optical sectioning advantage, showed that fluorochrome-labeled macromolecular lectins and bovine albumin enter the blastocoel of living, swimming sea urchin embryos following a period of incubation without microinjection. A procedure is also described that shows macromolecular entry is substantially accelerated in low calcium seawater. The information gained from this study should greatly facilitate experiments on entire populations of millions of embryos at a time that require access of macromolecules to the embryo interior.

Animals↗
PubMed1998

Outcome of pre-hospital antibiotic treatment of meningococcal disease.

OBJECTIVE: To assess the effect of pre-hospital antibiotic treatment given by general practitioners to patients with meningococcal disease. DESIGN: A 16-year population-based historical follow-up study based on referral letters and hospital records in the County of North Jutland, Denmark. SUBJECTS: 320 patients with meningococcal disease, of whom 302 were examined by a general practitioner before admission to hospital. MAIN OUTCOME MEASURES: Death. RESULTS: 44 patients (14.6%) were given antibiotic treatment by the referring general practitioner. Nine of these (20.5%) died, compared with 16 (6.2%) patients who did not receive pre-hospital antibiotic treatment. The presence of skin bleeding, petechiae, and impaired consciousness were strongly associated with case fatality. Even after adjustment for these variables the odds ratio (OR) for death in patients treated with antibiotics was high (OR = 3.2; 95% CI, 0.9-10.6). In the 15 patients with skin bleeding (ecchymoses, suggillations) the case fatality rate was 100% in patients treated with antibiotics, and 50% in patients who did not receive antibiotics before hospitalization. If skin bleeding was replaced in the models by the presence of disseminated intravascular coagulation on admission, the OR for death in patients with pre-hospital antibiotic treatment was 35.9 (95% CI, 2.9-441.8) in the presence of disseminated intravascular coagulation and 1.9 (95% CI, 0.2-19.5) in its absence. CONCLUSIONS: Pre-hospital treatment is mainly given to the most severe cases with expected high case fatality, and this confounding by indication was probably not fully adjusted for with the available data. The results contradict previous findings but provide reason to doubt the benefit of pre-hospital antibiotic treatment in patients with meningococcal disease.

Adolescent↗
PubMed1997

The Danish strong analgesic surveillance system.

The legal consumption of strong analgesics is increasing and research addressing the complex consequences of this expansion is needed. We describe the Danish strong analgesic surveillance system comprising copies of all prescriptions of strong analgesics purchased at Danish pharmacies. The system is operated by the Public Health officers and has been computerized since 1993. In addition to specific informations about the drugs in question the system comprises personal registration numbers (CPR) of both patients and doctors issuing the prescription. The system therefore allows: 1) a precise and valid identification of the individuals purchasing and prescribing strong analgesics, 2) an option to describe possible changes in consumption over time, and 3) the possibility of a highly reliable record linkage with other Danish population-based data sources. Validation studies are reported and strengths and limitations of the system are discussed.

Analgesics↗
PubMed1996

Identification of patients treated with strong analgesics: an assessment of two Danish information systems with respect to epidemiological research.

Pain is a significant health problem, and there is considerable need for clinical and epidemiological research in this topic. A prerequisite for doing research on patients treated with strong analgesics is that it is possible to identify the patients. We assessed two Danish population-based information systems, in which patients treated with strong analgesics are registered by using the patients' personal registration numbers as identifier. The two systems, which we compared, were (1) a surveillance system administered by the National Board of Health, and (2) the drug prescription register in the Danish National Health Service. During August 1994, 3787 patients were registered in the surveillance system and 3812 in the National Health Service in North Jutland County. Ninety-five persons were registered only in the surveillance system, and 120 only in the National Health Service register. A capture-recapture analysis showed a coverage of 96.9% for the surveillance system and 97.5% for the National Health Service. We thus conclude that the two systems form a valuable study base of patients treated with strong analgesics in epidemiological research.

Adult↗
PubMed1995

[Registration in medical journals of prescriptions for strong analgesics prescribed by general practitioners].

The use of strong analgesics was continuously registered in 90 patients throughout 12 months via the public health authorities, who are responsible for the control of prescription of strong analgesics. After the 12 months, questionnaires were sent to the prescribing doctors about the treatment during that period. Twenty-five patients were excluded mainly due to incomplete data and non-responding GPs. Analysis of validity of the GPs' registration, with the public health authorities' registration used as the reference standard, showed 90% (95% confidence limits (CL):68-99%) agreement concerning continuing treatment with strong analgesics and 98% (CL:88-100%) regarding GPs' registration of patients not being treated with strong analgesics. In all, misclassification occurred in 5% (CL:1-13%) of the patients. Our study suggests that the GPs' information about prescriptions of strong analgesics is valid, and that it can be used in research.

Analgesics↗
PubMed1994

[The role of social factors in the place of death of cancer patients in the county of Nordjylland].

The purpose of this study was to evaluate the importance of social factors on whether cancer deaths occurred at home or in hospitals. The study was based on questionnaires to the patient's general practitioner and to the home nursing service. The study included 241 patients with terminal cancer who were all identified by death certificates via the Department of Public Health in the period of the 1st February, 1992 to the 31st April, 1992. The study demonstrated that significantly more patients died in their own homes when a contact to the home nursing service had been established. The same tendency could be observed for patients with relatives being reimbursed for loss of income while providing care in the home. Significantly more patients died at home in municipalities where 24-hour nursing facilities could be offered. No association between age, sex, or whether the patient lived alone or lived cohabitantly were observed. The study suggest that an intensification of the home nursing facilities would give a greater number of terminal cancer patients the option of dying in their own homes. The possibility of relatives being reimbursed for loss of income while providing care in the home has a positive influence on the development of the number of cases home nursing.

Adult↗
PubMed1992

Diagnostic problems with meningococcal disease in general practice.

Based on general practitioners' referral letters and hospital records, we made a retrospective analysis of a cohort of 177 consecutive cases of meningococcal disease that occurred during a period of 10 years in the County of North Jutland, Denmark. The analysis concerned diagnostic problems in general practice, prognosis, pre-hospital antibiotic treatment and its effect on subsequent cultures, and degree of obligatory notification. The referring doctor suspected meningococcal disease/central nervous infection in 123 patients (69.5%). Neck stiffness and petechiae were related to a correct referral diagnosis, in contrast to the occurrence of a non-petechial rash. The presence of disseminated intravascular coagulation was associated with the mortality rate, which was 0.062. The therapeutic recommendations of the Danish Health Authorities were followed in only 25 of the 98 patients who fulfilled the criteria for pre-hospital parenteral antibiotic treatment. Pre-hospital antibiotic treatment was related to negative culture of spinal fluid or blood. Seven of the 177 patients were not notified according to the rules. Difficulties in pre-hospital diagnosis seem not to influence the lethal course of the disease.

Adolescent↗
PubMed1992

Epidemiology of pain requiring strong analgesics outside hospital in a geographically defined population in Denmark.

Based on obligatory notifications from pharmacies to the National Board of Health about prescription of strong analgesics as well as questionnaires to the prescribing doctors, the occurrence and causes of pain requiring strong analgesics outside hospitals were analysed over a period of one month in Denmark in a limited population (480,000), corresponding to nearly 10% of the Danish population. During one month, strong analgesics were prescribed to 0.2 per cent of the population. The commonest acute conditions were back pain (23%) and trauma (17%). The commonest recurrent acute conditions were headache (25%) and angina pectoris (17%). The commonest chronic non-malignant conditions were back pain (29%) and pancreatitis (7%). The commonest malignant conditions were lung cancer (20%) and colorectal cancer (14%). The commonest conditions indicated under the chronic pain syndrome were headache (33%) and back pain (13%). Conditions requiring strong analgesics reflect to some extent the distribution of painful conditions in the general population.

Ambulatory Care↗