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Biomedical subjects

H Trier

Publications and source records attributed to H Trier.

At least 19 recordsLinked to original sources
PubMed1993

[The MMR vaccination: no effect of feedback of vaccination scores in general practice].

The purpose of this study was to assess the effect of graphic feed-back of vaccination scores (VS) for vaccination against measles, mumps and rubella (MMR) at the age of 15 months among practices in a Danish county. The study was designed as an intervention study, comparing VS for each practice with VS for the other practices in the county. The feed-back was evaluated qualitatively by use of a postal questionnaire. A majority of the 73 responding practices welcomed the graphic feed-back, regarded it as easily understood and requested similar information on an annual basis in the future. In 13 (18%) of the practices, the calculated VS was lower than the doctors had expected. The most frequent explanation for this discrepancy, given by 4 practices, was incorrect registration of the vaccination. Twenty-one percent of the practices had taken action to improve their performance after receiving the feed-back, but there was no significant improvement in VS in this group. In practices with low VS (< 70%) before intervention, there was no significant change in VS. The total VS for all practices in the county was 89% before and 88% after intervention. In conclusion, the feed-back had no observable effect on VS. Registration errors may explain why some practices had low VS. Feed-back with performance indicators may have better quantitative effect if accompanied by qualitative measures.

Denmark↗
PubMed1993

[Prehospital service in Denmark].

In Denmark, emergency ambulances are dispatched by 41 centres manned either by trained firemen (in Copenhagen) or policemen (outside Copenhagen). In 1990, emergency ambulance calls totalled 284,000. Utilisation of emergency ambulance services increases with urbanisation. A doctor-manned ambulance is in operation in Copenhagen, and in some other large towns anaesthesiology and intensive care teams can be dispatched from hospital to give on-the-spot care. In less populated areas, some general practitioners give advanced life-support. Although many areas are serviced by ambulances equipped with defibrillators, the majority of patients receive only basic life-support from ambulance personnel. New initiatives resulting from a recent report by a commission appointed by central authorities, and focused on prehospital treatment, are expected to improve the service by raising the level of training given to ambulance personnel.

Aged↗
PubMed1992

[Significance of sleeping position on the occurrence of sudden, unexplained infant death. An epidemiological review].

The cause of the sudden infant death syndrome (SIDS) is, according to the definition, unknown. Epidemiological research during recent years has identified a series of probable risk factors. One of these is the use of prone position as sleeping position. In the Western European countries, Australia and New Zealand, a total of 14 case-control studies illustrate a possible connection between the prone position and SIDS. Eleven of the studies revealed a significantly increased relative risk (RR) of between 1.4 and 12.5 for SIDS when using the prone position, while the three remaining studies did not demonstrate increased RR. A meta-analysis of the results of the 14 case-control studies showed an RR of 2.4 for SIDS in the prone position as compared with other sleeping positions. In a single prospective cohort study from Australia, an RR of 3.1 was found for SIDS in the prone position. Interventions in which parents are advised not to place the infants in the prone position during sleep appear to have resulted in considerable reduction in the number of cases of SIDS according to preliminary reports from Great Britain, the Netherlands, Norway and New Zealand. A series of methodological problems can be demonstrated in the published results of these studies, including limited size of study populations, inadequate matching of control groups and absent confounder control. Nevertheless, the total epidemiological evidence, also where Denmark is concerned, speaks in favour of altered recommendations for sleeping positions of infants, particularly because there is no documentation to suggest that the prone position offers any advantages to health.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed1992

[Favourite sleeping positions among infants in the county of Roskilde. Is there a connection with sudden, unexplained infant death?].

The purpose of this study was to investigate the distribution of the favourite sleeping positions and other possible risk factors for SIDS among infants in a Danish county, and to compare the distribution af sleeping positions with the sleeping positions reported in SIDS-cases from the same district. Information about favourite sleeping positions at the age of one month and four months was collected by interviews with parents, performed consecutively by health visitors at the routine examinations of 174 infants aged eight months. Information about sex, birthweight, gestational age, complications of delivery, mother's age and maternal smoking in pregnancy was collected for each child from the Birth Registration form. Thirty-two SIDS-cases from the 10 year period 1982-91, mostly based on police reports, were analysed retrospectively as regards sleeping positions and other possible risk factors. The distribution of different sleeping positions at the age of one month/four months was: prone 59%/52%, lateral 39%/41%, supine 2%/6%. There was a significant negative correlation between birthweight and use of the prone position. Among the SIDS-cases, the prone sleeping position was reported in 18 of 21 cases (86%), where this information was available. In conclusion, the prone sleeping position seemed to be associated with an increased risk of SIDS (estimated OR 4.1) but some of this difference can be accounted for by the more frequent use of this position among children with low birthweight and other risk factors.

Denmark↗
PubMed1992

[Duration of immunity and occurrence of secondary vaccine failure following vaccination against measles, mumps and rubella].

The present article illustrates the extent of secondary vaccine failure after vaccination for measles, mumps and rubella (MMR). Secondary vaccine failure means loss of the immunity induced by vaccination to such an extent that infection becomes possible. Serological investigations carried out with follow-up periods of up to 16 years after vaccination for measles, 21 years after vaccination for rubella and 12 years after vaccination for mumps reveal that loss of antibodies occurs with the elapse of time but that the clinical significance of this is probably very limited. Where all three types of vaccination are concerned, secondary vaccine failure has hitherto been very seldom. Infection with measles after secondary vaccine failure is generally described as running a milder course. In rare cases, rubella re-infection has resulted in infection in utero, so that a slight risk of congenital rubella cannot be entirely excluded after successful vaccination. No extensive systematic investigations of the effect of revaccination have been carried out and, similarly, the optimal interval between two or more vaccinations has not been illustrated in more detail in the literature. Subclinical infection is not uncommon after all three vaccines. Where measles is concerned, immunity may possibly be regarded as a continuum which, depending upon the antibody level, protects the individual from various degrees of clinical disease. If wild virus can be spread via individuals with subclinical infections, it is doubtful whether population immunity (herd immunity), which is necessary to eliminate the three diseases, can be attained in large populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Changes in measles, mumps and rubella (MMR) immunity until the year of 2002 after the introduction of MMR vaccination].

In order to decide whether vaccination for measles, mumps and rubella should be introduced at the age of five years, calculations of the immunities in various age groups were performed until the year 2002 with and without vaccination at the age of five years. These calculations are based on the knowledge of immunity in the various age groups before the MMR vaccination programme was instituted in 1987 and knowledge of the compliance with vaccination obtained to date. Future predictions reveal that it is of decisive significance that compliance with vaccination among 12-year-olds is increased as rapidly as possible to 0.7 and to 0.8 in the subsequent year, if the level of immunity present prior to institution of the vaccination programme is to be maintained. The second vaccination given at a shorter interval after the first would prevent about 150 cases of illness in all per annum among 6-12 years-old. However, this should not be introduced at the expense of vaccination at the age of 12 years, which should be continued for at least 10-15 years yet. Possible abandoning of vaccination at the age of 12 years 10-15 years hence presupposes that adequate numbers of the children have been vaccinated twice at an early age and that it is sufficiently certain that secondary failure of vaccination does not occur to any significant extent.

Adolescent↗
PubMed1992

[Epiphysiolysis in the distal femur as a birth injury in Cesarean section].

A case of fracture-separation of the distal femoral epiphysis complicating cesarean section for delivery of an infant in breech presentation is described. Femoral fracture is a rare birth injury, particularly at cesarean section. The lesion can interfere with the growth of the bone, especially if overlooked.

Adult↗
PubMed1992

[Ambulance services in Copenhagen, Odense and Ringkøbing County. Results of the spot test conducted by the Ministry of Health and the County Councils Association in 1990. 1. Epidemiological data].

In 1990, The Danish Ministry of Health and the County Council Association undertook a spot test investigation of the activities in connection with 3,182 emergency ambulance services (AU) in the Municipality of Copenhagen (a city), the Odense district (a large provincial town) and the County of Ringkøbing (a mixed rural and urban region). The investigation included data collected by the ambulance staff before hospitalization and the diagnoses on discharge from casualty and hospital departments. The frequency of AU per 1,000 population was found to be 101 annually in Copenhagen, 44 in Odense and 19 in the County of Ringkøbing. More than 10% of the services in all three regions did not result in transport of the patient to hospital treatment. The average age of the patients was 52 years in Copenhagen compared with 44 years in the other two regions. The age-specific frequency of AU for patients aged 0-4 year-old was nine times as great in Copenhagen than in Odense and the County of Ringkøbing and, where patients aged more than 80 years were concerned, the frequency was 4-10 times as great. In all three regions, the activities of ambulance services were most numerous between 6-16 hours and lowest during the period 0-6 hours. Services to patients' homes constituted 44-46% and to traffic regions 32-40%. Services on account of illness constituted 41-45% and, on account of accidents, 27-35%. In cases of rapid emergency transport (using signals), 78% of the ambulances had reached the patient within five minutes in Copenhagen as compared with 44% in Odense and the County of Ringkøbing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Ambulance services in Copenhagen, Odense and Ringkøbing County. Results from the spot test conducted by the Ministry of Health and the County Councils Association in 1990. 2. Treatment by ambulance staff, medical support and pattern of diagnoses].

In this investigation, the results from a spot test investigation comprising 3182 emergency ambulance services (AU) from three geographical regions with different degrees of urbanization are presented: The Danish capital (Municipality of Copenhagen), a large provincial town (Odense) and a rural district with smaller towns (the County of Ringkøbing). The conditions of the patients were assessed by the ambulance staff: 7-12% of the patients transported had visible haemorrhage, 5-8% were unconscious, 4-7% were cyanotic, 2-3% had seizures and 1-2% had pareses. The serious cases tended to be most frequent in the least urbanized regions. Registration of the therapeutic efforts by the ambulance staff prior to and during transport revealed that 15-33% of the patients did not receive any treatment. The commonest forms of treatment consisted of oxygen treatment (13-18%), treatment for shock (8-12%), Nato position (4-16%) and stopping of haemorrhage (7-12%). No differences were observed between the three geographic regions except that fewer patients in the capital received treatment. In cases of emergency ambulance services employing signals, medical support was available in 22% of the cases in Copenhagen, mainly by means of medically staffed ambulances. In the County of Ringkøbing, doctors, usually the doctor-on-call, participated in 27% of these services while medical support was only available in 2% of the cases in Odense. Registration of the diagnoses by the hospitals which received the patients revealed that the commonest group of diagnoses were injuries (36-44%) and cardiovascular disease (14-21%).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗
PubMed1991

[Occurrence of colds and coughs among adult Danes. Epidemiological data from the DIKE (Danish Institute for Clinical Epidemiology) population study].

The occurrence of upper respiratory symptoms among adult Danes was examined by the use of data from the Danish Health and Morbidity Survey 1986-1987. In this study, 14.0 per cent of 6,672 individuals reported complaints of colds or coughs (CC) during the two-week period preceding the interview. Reporting of CC decreased with age, but there was no sex difference. A multivariate analysis, including a number of suspected exposure variables, showed that CC was reported significantly more frequently (OR 1.42) by individuals also reporting exposure to external health risks in their homes. The reporting of CC was not associated with occupational exposure, psychological stress, spare time physical activity or smoking habits. Using bivariate analysis, it was shown that exposure to external health risks in the home was reported more frequently among women than men. The results indicate, that exposure to external health risks in dwellings contributes significantly to the total morbidity among adult Danes. However, improvement of the validity of information about exposure by means of more objective methods is required.

Adult↗
PubMed1991

[Prevention of athletic injuries by changing the regulations. Experiences with a military obstacle track].

During a period of 12 months of military conscription, all of the injuries occurring on the obstacle track at the Antvorskov Barracks in Slagelse were registered. During the period of investigation, the regulations for employing the track were altered so that the heights of jumping down from obstacles were considerably reduced. The object of this investigation was to demonstrate any possible effect on the pattern of injuries. During the period, a total of 26 injuries were registered (3.78 injuries/conscript/1,000 hours activity). As compared with previous investigations, the frequency of injuries was reduced and practically all of the serious injuries were prevented. The proposed alterations in the techniques are recommended in future when conscripts employ the military obstacle track.

Adult↗
PubMed1991

Doctors' attitudes and MMR-vaccination.

97 general practices, representing 171 practitioners, were asked about attitudes and certain procedures in relation to vaccination against measles, mumps, and rubella (MMR). Answers were correlated with their actual vaccination rate, calculated from the National Health Service Computer System. All practices expressed a positive attitude towards the usefulness of MMR vaccination, but only 56% of the respondents expressed a whole-hearted positive attitude. The average vaccination rate in practices with unreservedly positive attitudes was 85%, compared with 69% in practices with more guarded attitudes. All practices offered MMR-vaccination with the routine health examinations at the age of 15 months, and all except three practices recommended vaccination. The vaccination was usually done by a doctor. Differences in vaccination rates were not associated with the way of presentation of MMR, the profession of the person who carried out the vaccinations, or the average number of years of postgraduate experience of the doctors in a practice. Unreservedly positive attitudes among general practitioners are necessary, if sufficient vaccine coverage is to be achieved.

Attitude of Health Personnel↗
PubMed1987

The nursing home patient--a burn-prone person. An epidemiological study.

During the 6 years between 1980 and 1985, 39 nursing home patients were admitted to the Hvidovre Burns Unit in Copenhagen with accidental burns. These patients accounted for 20 per cent of all burn patients above the age of 69 years admitted during this period. The median age of the patients was 80 years. Two-thirds of them suffered from burns of less than 15 per cent of their total body surface area. The mortality rate was 64 per cent. All patients were burned in single-person accidents, most often while sitting alone in their own living room, and smoking materials were involved in 85 per cent of the injuries. Senility, hemiplegia and other neurological diseases with tremor or paresis were frequently present in the victims. Several preventive measures are proposed, including smoking under supervision, use of flame-resistant aprons of adequate size, flame-resistant materials in chairs, etc., and installation of smoke detectors in rooms where patients smoke. A possible relation between the marked incidence of these accidents during weekends or holidays, at a time when staff numbers are reduced in the nursing homes, is discussed.

Aged↗