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PubMed2005

Are cancer patients at higher suicide risk than the general population?

OBJECTIVES: The aims were to test whether suicide is more prevalent among cancer patients than among the general population, whether the association changes over time, and whether the risk depends on the severity of the cancer disease. DESIGN: A register study was carried out, where standardized suicide rates for different cancer sites were analysed by sex, time periods (1965-74, 1975-84, and 1985-94), and five-year survival rates. SETTING: The setting was the Swedish population from 1965 to 1999. SUBJECTS: The cohort studied was 1,031,919 cancer cases and 2,587,152 person-years. MAIN OUTCOME MEASURES: The main outcome measure was the standardized mortality ratio (SMR) with the world population as standard population. RESULTS: Cancer patients run a higher risk of suicide than the general population. The suicide rate ratio between male cancer patients and the general population was about 2.5 in 1965-74, which thereafter reduced to about 1.5 in 1985-94. The suicide rate among female cancer patients was in excess of 2.9 in 1965-74 and 2.3 in 1985-94. In fact, a slightly higher rate for women was observed for 1985-94 than for 1975-84. There is also a strong negative association between survival rates and suicide rates, i.e. suicide rates are higher for severe cancer sites with low survival rates. CONCLUSIONS: Our findings support the hypothesis that cancer patients run greater risks of committing suicide than the general population does. The severity of the cancer increases the suicide risk. More attention to cancer patients' psychological and care situation is called for.

Adolescent↗

PubMed2006

Physical trauma and substance abuse: a comparative study on substance abuse in patients with physical trauma versus general population.

AIM: To evaluate the prevalence of substance abuse in a sample of patients with acute physical trauma in comparison with the general population. METHOD: Prospective study using structured interview based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed) criteria for substance dependence and abuse. SETTING: Hospitals at Shiraz University of Medical Sciences, and the general population in Shiraz. PARTICIPANTS: 1,324 subjects selected randomly (324 subjects from patients with acute physical trauma, and 1,000 subjects from general population). RESULTS: The mean age was 37 (SD=15.5, age range=15-83 yr.) In the general population, the mean age was 36.5 (SD=14.29, age range=15-83). Substance use was much more prevalent among patients with acute physical trauma than in the general population. It should be mentioned that drug use precedes the trauma in the patient population and may contribute to the occurrence of trauma or disease. CONCLUSIONS: Substance use was significantly more prevalent in males than in females. Cultural attitudes toward usage of substances were found to affect the type and amount of the used substance. These findings should be considered when planning preventive and therapeutic programs.

Adolescent↗

PubMed1991

Correlates of DSM-III-R alcohol dependence in treatment and general populations.

This paper describes the correlates of DSM-III-R alcohol dependence in a general population and in a treatment sample. The frequency of drinking 5 or more drinks per occasion is the only significant predictor of alcohol dependence in the general population. This indicator of drinking plus being unemployed are the predictors of alcohol dependence in the treatment sample. Severity of dependence (as assessed by the number of dependence indicators reported) in the general population sample is positively associated with the frequency of drinking 5 or more drinks, with being younger, being unmarried and being a male. In the treatment sample the correlates are the frequency of drinking 5 or more drinks, being unemployed and being older. These results suggest that alcohol dependent individuals in the treatment sample are more severely dependent and more socially marginal than their counterparts in the general population.

Adolescent↗

PubMed1996

Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea.

STUDY OBJECTIVE: To evaluate excessive daytime sleepiness (EDS) at work and effects on reported work performance among men in the general population and male patients suffering from snoring and obstructive sleep apnea syndrome (OSAS). DESIGN AND PARTICIPANTS: A cross-sectional study of Swedish men between the ages of 30 and 64 years in the county of Kopparberg, in mid-Sweden. A random sample of the general population (n = 285) and consecutive patients referred to a sleep laboratory who fulfilled objective diagnostic criteria (snorers = 289, OSAS = 62) responded to a questionnaire. Responders from the general population were divided into 2 groups, nonsnorers (n = 223) and snorers (n = 62). To validate a question on snoring in the questionnaire, 50 men, randomly selected from the sample of the general population, underwent sleep apnea screening in their homes. RESULTS: The specificity of the questions about snoring was 83% and the sensitivity was 42%. The risk ratios for reporting EDS at work were 4-fold for snorers in the general population, 20-fold for snoring patients, and 40-fold for patients with OSAS as compared with nonsnoring men in the general population. Patients with OSAS and snoring patients both showed increased ratios on measures of difficulties with concentration, learning new tasks, and performing monotonous tasks when compared with nonsnorers. CONCLUSION: Snoring and sleep apnea were highly associated with excessive EDS at work and subjective work performance problems. The results provide additional evidence that snoring is not merely a nuisance.

Adult↗

PubMed2006

[Differences and similarities in perception of schizophrenia between physicians and the general population in Quebec].

This paper presents results concerning the perceptions and attitudes of Quebec physicians towards patients with schizophrenia and compares data obtained from a previous poll to data drawn from answers of five common questions asked to the general population. A short questionnaire with 5 items selected earlier from a broader questionnaire submitted to the general population, has been distributed to Quebec physicians. These items inquired about the perceptions and attitudes of physicians towards schizophrenia. A randomized sample of physicians was performed. Three thousand and five hundred (3 500) physicians were selected and distributed questionnaires. A response rate of 29 %, a little more than one thousand (1003 responses) was observed, 46 % women and 54 % men. The authors have found significant differences between physicians and the general population in the tendency of wanting to offer help to those suffering from schizophrenia (physicians = 58 % versus general population : 45 %). Also, a higher percentage of physicians (72 %) have expressed feelings of compassion towards patients with schizophrenia versus 27 % in the general population. Results indicate that physicians, with a family member suffering from schizophrenia, are less comfortable discussing openly about the family member's illness (26 % versus 48 %). With regards to preconception of the severity of schizophrenia, in the field of health, and more specifically mental health, there are no differences observed amongst the physicians and the general population.

Adult↗

PubMed1998

Suicidal ideation and parasuicide in the Finnish general population.

In a sample of the Finnish general population (n=4868), 2.4% of women and 2.3 % of men reported having thought about suicide during the preceding 12 months. The prevalence of parasuicide was correspondingly 0.9% in women and 1.1% in men, higher figures than have previously been found or estimated. Most suicidal individuals (85%) had contacted general practitioners or other primary care services during the previous 12 months, and a minority (20%) had made contact with psychiatric services. General practitioners and other primary care services are thus in a key position to identify suicidal behaviour in the Finnish general population.

Adolescent↗

PubMed2004

Short-period heart rate variability in the general population as compared to patients with acute myocardial infarction from the same source population.

BACKGROUND: Our aim was to compare the distribution and determinants of heart rate variability (HRV) measures in a middle-aged population with patients of the same sex and age after an acute myocardial infarction (AMI), and to show, whether HRV values defined as abnormal from the general population are indicative for a worse prognosis even in AMI patients. METHODS: HRV was studied in a random sample of 149 middle-aged men and 137 women from the general population (45-65 years) as well as 129 consecutive AMI patients (25-74 years). Spectral analysis was used to compute low frequency (LF), high frequency (HF), and total frequency power. To the AMI population of age 45-65 years (N = 85) a sample out of the general population was matched by age and sex by 2:1 matching (N = 149). All AMI patients were followed for a median of 43 months (range 1-47) for death or malignant arrhythmia. RESULTS: All measures of HRV were significantly and substantially lower in AMI patients than the general population (P < 0.001). Expression in relative terms revealed that the proportionate contributions of HF and LF to total power were significantly different in the two populations with relatively lower LF power in AMI patients (P < 0.01). The negative correlation with heart rate and HRV measures was significantly more pronounced in AMI patients (P < 0.01). The 2.5th percentile of the LF power distribution in the general population (3.08 ln ms2) corresponds to the 25th percentile in the AMI population. Subjects of the whole AMI population with values below this LF cutpoint revealed a significant increased risk of death or malignant arrhythmia during follow-up (odds ratio 5.1; 95% confidence interval: 1.3; 23). CONCLUSIONS: AMI patients had strongly diminished HRV compared to the general population. The relatively lower LF power indicates an alteration of the sympathico-vagal balance, and the significantly stronger correlation of heart rate with HRV may be indicative for a more pronounced effect of sympathetic activation on autonomic modulation in the case of myocardial infarction. Finally, a value below the 2.5th percentile of the population LF power distribution may identify subjects at risk and warrant further testing.

Adrenergic beta-Antagonists↗

PubMed2006

Attitudes toward disease and prognosis disclosure and decision making for terminally ill patients in Japan, based on a nationwide random sampling survey of the general population and medical practitioners.

OBJECTIVE: Employing a nationwide cross-sectional survey, we investigated the Japanese general population's attitudes toward disease and prognosis disclosure and related factors. Furthermore, we investigated Japanese medical practitioners' attitudes toward disease and prognosis disclosure for patients and decision making. METHODS: A nationwide anonymous questionnaire survey was conducted. A total of 5000 individuals were randomly sampled from the general population and 3104 physicians and 6059 nurses were randomly sampled in Japan. RESULTS: Finally, 2422 people from the general population (response rate, 48%), 1577 physicians (51%), and 3361 nurses (56%) returned questionnaires. Among the general population, 73% of participants answered that they "want to know" about their disease and prognosis when in an incurable disease state. Ninety percent desired direct disclosure and 8% disclosure through their family. However, few medical practitioners answered "patient himself" (physician 3%, nurses 4%) as the person whom they would primarily notify about the disease and prognosis when in charge of a patient with an incurable disease. On the other hand, physicians answered "family" most frequently (59%), whereas nurses most commonly responded, "depends on patient's condition" (63%). SIGNIFICANCE OF RESEARCH: Several detailed analyses of factors associated with prognosis disclosure were conducted. Japanese physicians need to carefully communicate with the patients individually about whether direct disclosure or disclosure primarily to the family is preferred.

Adult↗

PubMed2006

The relationship of neuroticism and extraversion to symptoms of anxiety and depression in the general population.

Few studies have investigated the relationship of the personality dimensions of neuroticism and extraversion to the symptoms of depression and anxiety in the general population. A random general population sample (ages 20-70 years), from two Finnish cities was surveyed with the Eysenck Personality Inventory (EPI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). In addition, questions regarding diagnosed lifetime mental disorders, health care use for psychiatric reasons in the past 12 months, and history of mental disorders in first-degree relatives were posed. Among the 441 subjects who participated, neuroticism correlated strongly with symptoms of depression (r(s)=.71, P<.001) and anxiety (r(s)=.69, P<.001), and somewhat with self-reported lifetime mental disorder (r(s)=.30, P<.001) and health care use for psychiatric reasons in the past 12 months (r(s)=.24, P<.001). Extraversion correlated negatively with symptoms of depression (r(s)=-.47, P<.001), anxiety (r(s)=-.36, P<.001), self-reported lifetime mental disorder (r(s)=-.17, P<.001), and health care use for psychiatric reasons in the past 12 months (r(s)=-.14, P=.004). In multiple regression models, even after adjusting for gender, age, and education, BDI scores were significantly associated with neuroticism, extraversion, and age, whereas BAI scores were associated only with neuroticism. Neuroticism is strongly associated with depressive and anxiety symptoms, and intraversion is moderately associated with depressive symptoms in the urban general population. The relationship of these personality dimensions to both self-reported lifetime mental disorders and use of health services for psychiatric reasons strengthens the clinical validity of these personality dimensions.

Adult↗

PubMed1975

Risks of mortality of suicide attempters compared with psychiatric and general populations.

This study compares mortality risk among suicide attempters, psychiatric patients, and members of the general population using demographic data from the Monroe County (New York) Psychiatric Case Register for 1960 to 1970. During this 11-year period there were 172 deaths reported for the suicide attempt group, 6, 108 for the Psychiatric Register population, and 58,542 for the general population. The relative risk of death from all causes of the suicide attempt group was nearly twice that of the general population and slightly higher than that of the psychiatric group. High risks of mortality were differentially associated with several demographic and treatment variables. Implications for predictive criteria and interventive strategies are discussed.

Accidents↗

PubMed2004

An extended assessment of bowel habits in a general population.

AIM: Bowel habits are difficult to study, and most data on defecatory behaviour in the general population have been obtained on the basis of recalled interview. The objective assessment of this physiological function and its pathological aspects continues to pose a difficult challenge. The aim of this prospective study was to objectively assess the bowel habits and related aspects in a large sample drawn from the general population. METHODS: Over a two-month period 488 subjects were prospectively recruited from the general population and asked to compile a daily diary on their bowel habits and associated signs and symptoms (the latter according to Rome II criteria). A total of 298 (61%) participants returned a correctly compiled record, so that data for more than 8 000 patient-days were available for statistical analysis. RESULTS: The average defecatory frequency was once per day (range of 0.25-3.25) and was similar between males and females. However, higher frequencies of straining at stool (P=0.001), a feeling of incomplete emptying and/or difficult evacuation (P=0.0001), and manual manoeuvres to facilitate defecation (P=0.046) were reported by females as compared to males. CONCLUSION: This study represents one of the first attempts to objectively and prospectively assess bowel habits in a sample of the general population over a relatively long period of time. The variables we analyzed are coherent with the criteria commonly used for the clinical assessment of functional constipation, and can provide a useful adjunct for a better evaluation of constipated patients.

Adult↗

PubMed2004

Genetic variation in ABC transporter A1 contributes to HDL cholesterol in the general population.

Homozygosity for mutations in ABC transporter A1 (ABCA1) causes Tangier disease, a rare HDL-deficiency syndrome. Whether heterozygosity for genetic variation in ABCA1 also contributes to HDL cholesterol (HDL-C) levels in the general population is presently unclear. We determined whether mutations or single-nucleotide polymorphisms (SNPs) in ABCA1 were overrepresented in individuals with the lowest 1% (n=95) or highest 1% (n=95) HDL-C levels in the general population by screening the core promoter and coding region of ABCA1. For all nonsynonymous SNPs identified, we determined the effect of genotype on lipid traits in 9,259 individuals from the general population. Heterozygosity for ABCA1 mutations was identified in 10% of individuals with low HDL-C only. Three of 6 nonsynonymous SNPs (V771M, V825I, and R1587K) were associated with increases or decreases in HDL-C in women in the general population and some with consistent trends in men, determined as isolated single-site effects varying only at the relevant SNP. Finally, these results were consistent over time. In conclusion, we show that at least 10% of individuals with low HDL-C in the general population are heterozygous for mutations in ABCA1 and that both mutations and SNPs in ABCA1 contribute to HDL-C levels in the general population.

5' Untranslated Regions↗

PubMed2001

Lifestyle risk factors for lower limb venous reflux in the general population: Edinburgh Vein Study.

BACKGROUND: Varicose veins occur commonly in the general population but the aetiology is not well established. Varicosities are associated frequently with reflux of blood in the leg veins due to valvular incompetence. Our aim was to determine in the general population which lifestyle factors were related to reflux and thus implicated in the aetiology of varicose veins. METHODS: In the Edinburgh Vein Study, 1566 men and women aged 18-64 years were sampled randomly from the general population in the city of Edinburgh, Scotland, and had duplex scans to measure reflux in eight venous segments in each leg. A self-administered questionnaire enquired about occupation, mobility at work, smoking, obstetric history, dietary fibre intake and bowel habit. A bowel record form was completed subsequently. RESULTS: In women, venous reflux was associated with decreased sitting at work (odds ratio [OR] = 0.76, 95% CI : 0.61-0.94), previous pregnancy (OR = 1.20, 95% CI : 0.93-1.54), and a lower prior use of oral contraceptives (OR = 0.84, 95% CI : 0.66-1.06). Mean body mass index was greater in women with superficial reflux compared to those with no reflux: 26.2 kg/m(2) (95% CI : 25.5-27.0) versus 25.2 kg/m(2) (95% CI : 24.8-25.6). On age adjustment, sitting at work remained related to reflux (OR = 0.78, 95% CI : 0.63-0.98) and prior use of oral contraceptives to superficial reflux (OR = 0.71, 95% CI : 0.50-1.01). In age-adjusted analyses in men, height was related to reflux, (OR = 1.13, 95% CI : 1.02-1.26) and straining at stool was related to superficial reflux (OR = 1.94, 95% CI : 1.12-3.35). No associations were found in either sex between reflux and social class, lifetime cigarette consumption, dietary fibre intake and intestinal transit time. CONCLUSIONS: This population study did not identify strong and consistent lifestyle risk factors for venous reflux although previous pregnancy, lower use of oral contraceptives, obesity and mobility at work in women and height and straining at stool in men may be implicated.

Adult↗

PubMed2004

Psychosocial correlates with depressive symptoms six years after a first episode of psychosis as compared with findings from a general population sample.

BACKGROUND: Depression is frequently occurring during and after psychosis. The aim of this study was to analyze if the psychosocial characteristics associated with depression/depressive symptoms in the late phase of a first episode psychosis (FEP) population were different compared to persons from the general population. METHODS: A questionnaire was sent out to all individuals six years after their FEP and to a general population sample. Depressive symptoms were recorded using a self-rating scale, the Major Depression Inventory. RESULTS: Formerly FEP persons had a higher representation of depressive symptoms/depression, unemployment, financial problems and insufficient social network. Depressive symptoms/depression were found to be associated with psychosocial problems. An age and gender effect was found in the general population, but not in the FEP sample. When the psychosocial characteristics were taken into account there were no association between having had FEP and depressive symptoms. CONCLUSIONS: The association between having been a FEP patient and depressive symptoms/depression disappeared when negative social aspects were taken into account.

Adaptation, Psychological↗

PubMedDate not supplied

Toxic chlorobiphenyls in adipose tissue and whole blood of an occupationally/accidentally exposed man and the general population.

Individual polychlorinated biphenyl (CB) congeners in adipose and whole blood tissues of a capacitor manufacture worker (occupational/accidental exposure) and of the general population were determined. Nondestructive sample cleanup and multidimensional gas chromatography-electron capture detection (MDGC-ECD) techniques were applied. Special attention was given to the toxicologically relevant congeners CB-77, CB-126, CB-169, CB-105, CB-114, CB-118, CB-156, CB-167, and CB-189 (IUPAC). Lipid-based tissue contents of sigma CBs were higher in the occupationally/accidentally exposed worker (adipose = 7,000 ng/g; whole blood = 11 ng/g) than in the general population (adipose = 300 ng/g; whole blood = 1.9 ng/g). Among the non-ortho Cl CBs, CB-77 was below detection limit (< 1.0 pg/g). The contents of CB-126 for the capacitor manufacture worker were 2,000 and 3 pg/g, and in the general population were 100 and 2 pg/g for adipose and whole blood, respectively. The corresponding data for CB-169 were 3,500 and 4 for adipose and whole blood, respectively, in the exposed worker, and 40 and 2 for adipose and whole blood, respectively, in the general population. Congeners with highest contents were CB-153, CB-138, CB-180, CB-170, and CB-187. These congeners possess chlorine substitution patterns, making them resistant to metabolism. X/153 ratios suggest that both PB and 3-MC type cytochrome P-450 enzymes were induced in the exposed worker, as well as in the general population.

Adipose Tissue↗

PubMed1995

Alcohol use among HMO patients in the emergency room, primary care and the general population.

OBJECTIVE: Although heavy drinking and alcohol-related problems are overpresented among patients seen in some primary care settings compared to the general population, it is not known whether those seen for noninjury problems in emergency rooms (ERs) are similar in demographic and drinking characteristics to those seen in primary care clinics. Nor do we know whether alcohol-related problems are over-represented in both of these settings compared to the general population when equal access to health care services is provided, as by membership in the same HMO. Reported here are data from a single northern California health maintenance organization (HMO). METHOD: Probability samples of noninjured patients seen in the ERs of the HMO (n = 579) are compared on demographic characteristics and drinking patterns and problems to those seen in the primary care clinics of the same HMO (n = 295) and to those in the general population of the same county who reported membership in the HMO (n = 737). RESULTS: No differences in drinking patterns, alcohol-related problems or gender or age distribution were found between the clinic patients and the noninjured ER patients. Both the noninjured ER patients and the clinic patients were less likely to report heavy and problem drinking, or treatment for an alcohol-related problem during the last year, as compared to those in the general population. CONCLUSIONS: The data from this HMO study suggest that noninjured patients seen in these particular emergency rooms resemble those seen in primary care, and that, contrary to the commonly held belief that alcohol-related problems are overrepresented in primary care, primary care patients in this HMO population may be less likely to be problem drinkers than those in the general population from which they come.

Adolescent↗

PubMed2004

Stages of change in smokers with schizophrenia or schizoaffective disorder and in the general population.

This study compared smoking behavior and motivation to quit smoking, assessed with a "stages of change" questionnaire, in outpatients with schizophrenia or schizoaffective disorder and in a representative sample of the general population. We conducted a mail survey in a representative sample of the general population of Geneva, Switzerland, in 1996 (n = 742); and a survey of 151 patients with schizophrenia (84%) or schizoaffective disorder (16%) who attended a Geneva ambulatory psychiatric clinic in 2000. There were more smokers (70% vs. 28%, p < 0.001) in patients with schizophrenia or schizoaffective disorder than in the general population, and fewer ex-smokers (15% vs. 52%, p < 0.001). Patients with schizophrenia or schizoaffective disorder smoked more than smokers in the general population (22 vs. 16 cigarettes per day, p < 0.001). Among current smokers, the distribution of stages of change was similar in patients with schizophrenia or schizoaffective disorder (precontemplation 79%, contemplation 18%, preparation 3%) and in the general population sample (74%, 22%, and 4%, p = 0.6). In both samples, similar proportions of smokers had made an attempt to quit in the previous year (27% vs. 22%, p = 0.3). These results suggest that a substantial minority of smokers with schizophrenia or schizoaffective disorder are motivated to quit smoking, try to quit, and succeed in quitting.

Adolescent↗

PubMed2005

Who calls QUIT? The characteristics of smokers seeking advice via a telephone helpline compared with smokers attending a clinic and those in the general population.

OBJECTIVE: To compare the characteristics of callers to a telephone helpline with those of smokers seeking assistance through a clinic and smokers in a general population sample. STUDY DESIGN: Data were gathered from callers to the Quitline in May and June 2000. Screening data were used for smokers attending the South London & Maudsley NHS Smokers' Clinic from May 2000 to April 2001. The results of the 2000/2001 General Household Survey (GHS) were used to estimate the characteristics of smokers in the general population. METHODS: Callers to the Quitline (n=1162) surveyed during the summer of 2000, smokers attending the Maudsley Hospital Smokers' Clinic between May 2000 and April 2001 (n=1127), and smokers surveyed in the GHS between April 2000 and March 2001 (n=14,089) were compared on demographic characteristics, tobacco dependence and readiness to quit. RESULTS: Women and older smokers are more likely to seek help, but the Quitline attracts more calls from younger smokers. The age profile of helpline callers corresponds more closely to that of the general population of smokers than does the age profile of clinic attenders. Quitline callers are more dependent than the general population of smokers; clinic attenders are even more dependent. In comparison with the general population, the majority of Quitline callers have plans to quit smoking soon or have already stopped smoking. CONCLUSIONS: Telephone helplines reach a more representative sample of smokers in various states of readiness to quit, and provide a service for a population not reached by clinics.

Adult↗