Historical cohort study of in utero exposure to uterotonic drugs and cognitive function in young adult life.
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Biomedical subjects
Publications and source records attributed to S Sabroe.
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The objective was to examine the relation between birth weight and cognitive function in young adult life. The study includes 4300 Danish conscripts born between 1973 and 1975, and the main outcome measure was the mean score in the Børge Prien IQ test at drafting. The score is the number of correct answers to 78 questions and it correlates with full scale intelligence quotient (IQ). Data on birth weight were collected from the birth registry. The mean score in the Børge Prien test increased from 39.9 at a birth weight of < or = 2500 g to 44.6 at a birth weight of 4200 g after adjustment for gestational age and length at birth, maternal age and parity, and other variables. Above a birth weight of 4200 the test score decreased slightly. Birth weight is associated with cognitive performance in young adult life and factors that interference with foetal growth may influence adult cognitive performance.
The aim of the study was to examine the effect of 24-hour nicotine patches in smoking cessation among over-the-counter customers in Denmark based on a randomized, double-blind, placebo-controlled trial. Participants were consecutive customers to whom nicotine patches were offered free of charge and as the only treatment. Forty-two pharmacies in the areas of Aarhus and Copenhagen in Denmark participated in the trial, and 522 customers who smoked 10 or more cigarettes per day were randomized to either nicotine or placebo patches from January to March 1994. Twenty-four-hour patches were offered for a three-month period. Those smoking 20 or more cigarettes per day started on 21 mg/day patches. Customers who smoked less started on 14 mg/day patches and all the participants were gradually reduced to 7 mg/day patches during the study period. Smoking behaviour and compliance were recorded by means of self-administered question-naires and telephone interviews. Smoking status was recorded following each four-week treatment period, and 26 weeks after inclusion. There was a significant increase in smoking cessations rates, but only among smokers who started on 21 mg/day patches after eight weeks of follow-up. No significant differences in smoking cessation rates were seen among smokers who started with the low dose nicotine or placebo patches.
The aim of this present study was to compare the use by smokers and non-smokers of pamphlets about smoking as delivered from different settings. The study was a nation-wide cross-sectional survey of 1924 randomly selected, Danish men and women, aged 14-77 y, who had answered a mailed questionnaire in 1994. Of these 71% also participated in a telephone interview enquiring about the use of health education material, smoking status and socio-demographic variables, 39% of readers of household-delivered anti-smoking pamphlets reported having gained information from them and 22% reported having made changes in their own smoking behaviour such as avoiding smoking in the presence of non-smokers. In general practice settings, these percentages were higher among smokers. Smokers who were thinking of stopping smoking in the near future were in addition more likely to take and to read smoking related health education materials from other places. Non-smokers received (3 49%) and read pamphlets about smoking as frequently as did smokers who did not intend to quit. In conclusion, written health education material was well received by readers, but, when distributed in a more open setting it needs to be targeted towards smokers who are considering stopping smoking. In general practice, smokers not thinking of stopping were open to health education, and pamphlets used in this setting should also target this group. Non-smokers contribute indirectly to smokers quitting by providing support to smokers and pamphlets for non-smokers need to be more targeted towards this social role.
Studies of long-term consequences of birth in breech presentation are sparse. Therefore, we conducted a cohort study linking birth registry data with data collected during evaluation for military service in 4,298 conscripts born between 1973 and 1976. The cognitive functions were measured with the Boerge Prien IQ test. A total of 164 conscripts were born in breech presentation and 70 (42.7%) of these were delivered after Caesarean section. The mean Boerge Prien test score was 43.2 among men born in cephalic presentation and 39.9 among those born in breech presentation for a difference of 3.3 (95% confidence interval = 1.8-4.7). The negative association between breech presentation and cognitive outcome persisted after stratifying by Caesarean section and after adjustment for confounders. It also persisted when we restricted the analyses to term singleton pregnancies.
Our aim was to estimate the risk of specific histological types of testicular cancer associated with perinatal factors. We conducted a case-control study with 357 cases and 704 controls born between 1950 and 1968. Cases were identified through a patient registry of all patients treated in Denmark. Data on parents' age, mothers' parity, birth weight, gestational age and undescended testes were extracted from midwives' records written shortly after delivery. The risk of testicular cancer was highest for those who has the oldest mothers (30-45 years) and for those who had the lowest parity (primipara). For newborns with 2 or more signs of prematurity (born before 8 months of gestation, birth weight below 2,500 g, birth length 40-49 cm, soft nails and undescended testis) the OR was 1.62. The association between undescended testis at birth and testicular cancer was not present for boys born after 1955. The high risk of testicular cancer among primipara was mainly seen for seminomas. All cancer types were associated with mother's age, but only the OR for teratomas was statistically significant.
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A population-based descriptive investigation of housefire accidents in Denmark was carried out for the two five year periods 1953-58 and 1988-93, based on death certificates, police reports and autopsy reports. The number of deaths due to housefire accidents in Denmark has increased (1953-58: 136 (66 men and 70 women), 1988-93: 363 (212 men and 150 women), mostly due to an increase in tobacco-smoking related fire accidents. In 1988-93 the three common causes of housefire deaths were tobacco-smoking, often in combination with alcohol intoxication or handicap (51%), cooking-accidents (10%) and accidents with candles (9%). The largest risk groups were chronic alcoholics, handicapped and elderly people. In conclusion, warnings should be issued against smoking in bed and use of loose-fitting clothing while cooking on an open fire. Protective aprons and devices for use while smoking, self-extinguishing cigarettes and use of fireproof materials in furniture and clothing may prevent ignition. Smoke-alarms may secure early warning.
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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.
Reported high immunization coverage achieved in Nepal over the last ten years is expected to reduce child mortality in the country. The present study, carried out in hill district in mid-west Nepal, aimed to assess the quality of immunization data in Nepal. The number of children who received different vaccines during one year was obtained from three sources: 1) the Immunization REgister of three Primary Health Care Service Outlets (PHCSOs) where each immunized child is recorded; 2) monthly PHC Reports, which are based on the Immunization Register; 3) monthly DHO Reports, which are based on the above PHC Reports (the DHO reports are the source of official statistics). The number of children in the PHC Reports was higher than the number in the Immunization REgisters for all vaccines. The number of immunizations in the DHO Reports was higher than the number in the PHC Reports for BCG, DPT, and measles; the number was lower for poliomyelitis. The overall number of immunizations was higher in the DHO Reports than in the Immunization Registers, by 31% for BCG, 44% for DPT, 155% for polio, and 71% for measles. We conclude that the official report overestimates the immunization coverage in the district. The immunization programme, therefore, might not result in the expected reduction of morbidity and mortality despite the investment in the programme and reported high coverage.
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OBJECTIVE: To examine the relation between birth weight and cognitive function in young adult life. DESIGN: Retrospective cohort study based on birth registry data and cognitive function measured during evaluation for military service. SUBJECTS: 4300 Danish conscripts born between 1973 and 1975. MAIN OUTCOME MEASURES: Mean score in the Boerge Prien test of cognitive function; score is the number of correct answers to 78 questions and correlates with full scale intelligence quotient (IQ). RESULTS: Mean score in the Boerge Prien test increased from 39.9 at a birth weight of < or = 2500 g to 44.6 at a birth weight of 4200 g even after adjustment for gestational age and length at birth, maternal age and parity, and other variables. Above a birth weight of 4200 g the test score decreased slightly. CONCLUSION: Birth weight is associated with cognitive performance in young adult life. Interference with fetal growth may influence adult cognitive performance.
This is a descriptive study of thymomas notified to the national Danish Cancer Registry and registered by the departments of pathology during the years 1943-1993. A total of 433 cases of benign and malignant thymomas were included over these 50 years with an increase of the incidence to a stable rate of 2.5/million/year from start to 1973. The male:female ratio is 1:1. While the age-specific incidence rate for persons below 40 years is constantly low throughout the period of investigation, a doubling of the rate is registered for persons between 70 and 79 during the period 1978-1993. The incidence rate in Copenhagen is much higher compared to other regions of Denmark. The above-mentioned increase in incidence is due mainly to an underreporting of benign thymomas during the first period of investigation (1943-1977), but may also be due to improved diagnostic capabilities and to more uniform methods of registration during the last period (1978-1993).
The authors examined the effect of 24-hour nicotine patches in smoking cessation among over-the-counter customers in Denmark, based on a randomized double-blind placebo-controlled trial. Participants were consecutive customers to whom nicotine patches were offered as the only treatment. Forty-two pharmacies in the areas of Aarhus and Copenhagen in Denmark participated in the trial, and 522 customers who smoked 10 or more cigarettes per day were randomized to either nicotine patches or placebo from January to March 1994. Customers with chronic diseases and pregnant or breastfeeding women were excluded from the trial. Twenty-four-hour patches were offered free of charge during a 3-month period. Those smoking 20 or more cigarettes per day started on a dose of 21-mg/day patches. Customers who smoked less started on patches of 14 mg/day; and for all of the participants, the dose was gradually reduced to 7-mg/day patches during the study period. Smoking behavior and compliance were recorded by means of self-administered questionnaires and telephone interviews. Smoking status was recorded in intervals of 4 weeks, which was fixed to be a treatment period, and 26 weeks after inclusion. There was a significant increase in smoking cessation rates after 8 weeks of follow-up but only among smokers who started on 21-mg/day patches. There was a marked placebo effect at each time of contact during the trial, especially in those smoking fewer than 20 cigarettes per day. Although the noncompliance rate was high overall due to discontinuation in the use of patches by relapsed smokers, noncompliance among successful quitters was low. More side effects were seen in the nicotine group than in the placebo group, but none of the reported side effects were serious. It appears that regular healthy smokers who were customers of nonprescribed nicotine patches and who received 21-mg/day nicotine patches benefited from the active treatment (44.1% stopped smoking after 4 weeks), but almost as many stopped smoking in the placebo group (37.3% after 4 weeks). No significant differences in smoking cessation rates were seen among smokers who started with the low-dose nicotine or placebo patches.
PURPOSE: This study was designed to describe the frequency and severity of colorectal problems among patients with spinal cord lesions and to determine whether these problems are associated with age, gender, time since the lesion, and level and severity of the lesion. PATIENTS AND METHODS: A detailed questionnaire describing colorectal and bladder function was sent to all 589 members of The Danish Paraplegic Association; 424 responded (72 percent). RESULTS: Only 19 percent felt a normal desire to defecate, whereas the remaining patients felt no desire to defecate (38 percent) or a combination of abdominal discomfort (37 percent) and headache, physical uneasiness, and perspiration (25 percent). Digital stimulation of the anal canal before defecation or digital evacuation of the rectum was used regularly by 65 percent of patients. Fecal incontinence was experienced by 75 percent of patients; however, most patients only had a few episodes of fecal incontinence each month (15 percent) or each year (56 percent). Overall, 39 percent of patients reported that colorectal dysfunction caused some or major restrictions on social activities or on their quality of life, and 30 percent regarded colorectal complaints to be worse than both bladder and sexual dysfunction. The severity of most symptoms was significantly correlated with the severity of the lesion, and the self-reported impact on social activities or quality of life was significantly more severe among women than men. CONCLUSION: Colorectal dysfunction is very common among spinal cord-injured patients, often causing restriction on social activities and quality of life. Therefore, these problems deserve more attention in the treatment of spinal cord-injured patients.
The study aimed to determine whether a consistent dose-response association can be demonstrated, after adjustment for maternal age and White classification, between glycosylated hemoglobin (HbA1c) values before conception and in the first trimester of pregnancy of insulin-dependent diabetic mothers and adverse fetal outcome (abortions and major malformations). This is a historical follow-up study based on medical records in a geographically defined catchment area. The study comprised 60 pregnancies with HbA1c determinations before pregnancy and 161 with HbA1c in the first trimester in women with type 1 diabetes admitted between 1980 and 1992. Relative risk calculations indicated a highly significant and consistent correlation between HbA1c values above 6.6% and adverse fetal outcome after adjustment for differences in maternal age and White classification. Our data support a clinically significant and consistent relationship between adverse fetal outcome and HbA1c in the first trimester of pregnancy of type 1 mothers, without any indication of a cut-off level below which further improvement in HbA1c was of minor importance.