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Mutation in the gene responsible for cystic fibrosis and predisposition to chronic rhinosinusitis in the general population.

CONTEXT: Chronic rhinosinusitis (CRS) is a common condition in the US general population, yet little is known about its underlying molecular cause. Chronic rhinosinusitis is a consistent feature of the autosomal recessive disorder cystic fibrosis (CF). OBJECTIVE: To determine whether mutations in the cystic fibrosis transmembrane regulator (CFTR) gene, which is responsible for CF, predispose to CRS. DESIGN: Case-control study conducted from 1996 to 1999 in which the DNA of CRS patients and controls was typed for 16 mutations that account for 85% of CF alleles in the general population. Chronic rhinosinusitis patients with 1 CF mutation were evaluated for a CF diagnosis by sweat chloride testing, nasal potential difference measurement, and DNA analysis for additional mutations. SETTING: Otolaryngology-head and neck clinic of a US teaching hospital. PARTICIPANTS: One hundred forty-seven consecutive adult white patients who met stringent diagnostic criteria for CRS and 123 CRS-free white control volunteers of similar age range, geographic region, and socioeconomic status. MAIN OUTCOME MEASURES: Presence of CF mutations by DNA analysis among CRS patients vs controls. RESULTS: Eleven CRS patients were found to have a CF mutation (DeltaF508, n = 9; G542X, n = 1; and N1303K, n = 1). Diagnostic testing excluded CF in 10 of these patients and led to CF diagnosis in 1. Excluding this patient from the analyses, the proportion of CRS patients who were found to have a CF mutation (7%) was significantly higher than in the control group (n = 2 [2%]; P =.04, both having DeltaF508 mutations). Furthermore, 9 of the 10 CF carriers had the polymorphism M470V, and M470V homozygotes were overrepresented in the remaining 136 CRS patients (P =.03). CONCLUSION: These data indicate that mutations in the gene responsible for CF may be associated with the development of CRS in the general population. JAMA. 2000;284:1814-1819.

Adult↗

Improvement in mental health over time in northern Norway- a prospective study of a general population followed for 9 years, with special emphasis on the influence of darkness in winter.

BACKGROUND: There are very few prospective studies of mental distress in the general population. Two studies of general health in Finnmark county in northern Norway, performed 9 years apart, contained questions about depression and sleeping problems, which made it possible to study change in mental distress over time in the general population. METHODS: In a self-administered questionnaire, the subjects were asked about depression and sleeping problems, both generally and related to the dark period in winter, at two points in time: in 1987/88 and 1996/97. The persons participating in the two surveys were partly the same and partly new individuals. More than 12000 persons responded in 1987/88 and more than 7000 people in 1996/97. The cohort that answered questions about sleeping problems and depression at both time-points consisted of 3318 and 3682 persons, respectively. RESULTS: The prevalence of depression and sleeping problems, both generally and related to winter,decreased significantly in the course of the 9-year time-span. The decrease was also true for the cohort that answered at both time-points, except for sleeping problems related to winter, which were unchanged. The pattern of changes was identical for both genders and all age groups. CONCLUSIONS: Mental health in the general population seems to have improved during the period studied. The findings are also relevant for the discussion of the validity of the concept Seasonal Affective Disorder, and the presumed connection to light-deprivation.

Adult↗

Prevalence of carpal tunnel syndrome in a general population.

CONTEXT: Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling in the hands and is an important cause of work disability. Although high prevalence rates of CTS in certain occupations have been reported, little is known about its prevalence in the general population. OBJECTIVE: To estimate the prevalence of CTS in a general population. DESIGN: General health mail survey sent in February 1997, inquiring about symptoms of pain, numbness, and tingling in any part of the body, followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the hands, as well as of a sample of those not reporting these symptoms (controls). SETTING: A region in southern Sweden with a population of 170000. PARTICIPANTS: A sex- and age-stratified sample of 3000 subjects (age range, 25-74 years) was randomly selected from the general population register and sent the survey, with a response rate of 83% (n = 2466; 46% men). Of the symptomatic responders, 81% underwent clinical examination. MAIN OUTCOME MEASURES: Population prevalence rates, calculated as the number of symptomatic responders diagnosed on examination as having clinically certain CTS and/or electrophysiological median neuropathy divided by the total number of responders. RESULTS: Of the 2466 responders, 354 reported pain, numbness, and/or tingling in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI, 3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%). Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically examined, electrophysiological median neuropathy was found in 23 (18.4%; 95% CI, 12.0%-26.3%). CONCLUSION: Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing.

Adult↗

[Child maltreatment: social representation of the general population and the professionals working with children in the Caribbean area of Colombia].

OBJECTIVE: The main objective was to know social representations about child maltreatment (severity, etiology, and intervention strategies) of the general population and the professionals working with children in the Caribbean area of Colombia. METHOD: Sample was composed for 402 participants. From this pool of participants, 111 of them were working in child protection, 95 worked with children but not in the child protection system and 196 pertained to the general population. All participants answered to a questionnaire composed by 86 items. The questionnaire was developed to assess (1) the perceived severity of different typologies of child abuse, (2) opinions about risk factors for child maltreatment and sexual abuse, and (3) opinions about the most adequate ways of intervention with perpetrator of child abuse. RESULTS: Sexual abuse is considered as the most severe typology of child maltreatment and emotional abuse is considered as more severe than physical abuse. No differences between groups were found in perceived severity of typologies of child maltreatment. Differences in the social representation about the etiology of child maltreatment were found. Professionals working in the child protection system give more value to characteristics of parents and to the socio-economic and familiar environment in the etiology of child maltreatment than participants from the general population. Prevention and treatment programs for abusers were considered as the more relevant strategies against child maltreatment. DISCUSSION: Findings of present study suggest that social representations about child maltreatment of general population and professionals from the Caribbean area of Colombia are similar than social representation observed in other regions and countries. It is important to take into account that child labor and child poverty were considered as non-severe typologies of child maltreatment. Moreover, findings suggest that people from general population in the Caribbean area of Colombia have a relevant knowledge about agencies working for child protection.

Caribbean Region↗

Asbestos: toxicology and risk assessment for the general population in The Netherlands.

Within the scope of the preparation of Integrated Criteria Documents for priority compounds in The Netherlands, the possible health effects of oral and inhalatory exposure to asbestos for the general population were evaluated. It was concluded from the results of experiments in animals that exposure to asbestos by the oral route is not carcinogenic and is not expected to present a health risk to the general population. Inhaled asbestos, however, is distinctly carcinogenic to man, giving rise to lung tumours, and mesotheliomas of the pleura and peritoneum. Chrysotile asbestos appears to be less potent in inducing mesotheliomas than the amphiboles, but all types of asbestos appear to have a similar potency for inducing lung cancer. The risk of mesothelioma is not expected to be influenced by smoking, whereas the risk of lung cancer is expected to be ten times higher in smokers than in non-smokers exposed to the same asbestos concentrations. Risk-assessment models for the inhalatory route, for the general population, are based on linear non-threshold extrapolation of occupational exposure to much lower environmental concentrations. These models give only a rough approximation of the risk of environmental exposure to asbestos. In accordance with the Air Quality Guidelines of the World Health Organization (World Health Organization, 1987), it was estimated that an extra risk of lung cancer of one in 10(6) (in the general population, with 30% smokers) may be presented by lifetime exposure to asbestos fibres longer than 5 microns, measured by electron microscopy, at concentrations of 100-1000/m3. It was further estimated that an extra risk of mesothelioma of one in 10(6) may be presented by lifetime exposure to 10-100 amphibole fibres/m3 or to a range of 100-10000 chrysotile fibres/m3 (fibres longer than 5 microns). From the current asbestos concentrations, the risk of mesothelioma for the general population in The Netherlands appears to be negligible; the extra risk of lung cancer is expected to be higher than 1 in 10(6) near asbestos sources, whereas it appears to be negligible in background areas and in most large cities and industrial areas. However, it must be borne in mind that the validity of the risk figures given is difficult to judge.

Asbestos↗

Body image and weight consciousness among South Asian, Italian and general population women in Britain.

Italians in Britain have low rates of coronary heart disease while South Asians have high rates, which correspond to a tendency to central abdominal fat deposition and overweight. World variations in attitudes to body size are thought to be related to economic security. This cross-sectional study employed a range of measures including photographic silhouettes of known BMI to investigate the attitudes of 259 South Asian, Italian and general population women (aged 20-42 years) towards body size. Migrants are compared with British-born minority members. Our results indicate that although migrant South Asians were less happy with their weight than migrant Italians, fewer had tried to lose weight in the past or had experienced external pressures to change their bodies. More migrant South Asians than Italians or general population women equated one of the four largest shapes (BMI 28-38) with health and successful reproduction. All groups wanted to resemble one of the two thinnest shapes, equating them with longevity, likelihood of marriage and job success. British-born South Asians generally showed a considerable degree of convergence towards general population women's negative attitudes to large body size, but British-born Italians' attitudes were significantly more negative even than general population women. The study's conclusions were that South Asian health beliefs are an important focus of resistance to slimness. The tendency of migrant South Asians to equate large size with health contrasts with the opposing views of Italian and general population women. British-born South Asians' views are modifying from those of migrants, but significant differences remain when compared with general population women and British-born Italians. Present differences in economic security offer only a partial explanation; South Asian attitudes may be explained by economic insecurity in the past.

Adult↗

Prostate-specific symptoms of prostate cancer in a German general population.

Predominant symptoms in prostate cancer patients are erectile dysfunctions and urinary problems. As decreases of these functions can be attributed to disease and treatment but also to age-related decreases, we conducted a study on a German reference population measuring general quality of life (QoL) as well as prostate-specific symptoms. In cooperation with a German health insurance company, 3000 questionnaires were mailed to a randomly selected sample of men aged 45-75 years. Questionnaires used were the EORTC QLQ-C30 and a prostate-specific module (PSM). One thousand one hundred and fifty questionnaires were returned (response rate: 37.6%). QoL data from this reference population were compared to QoL data from a historical cohort study of prostate cancer patients following either prostatectomy or radiotherapy. In terms of general QoL, the reference population showed similar QoL scores as prostatectomy patients, but better scores than radiotherapy patients. On the PSM, the reference sample showed better overall QoL, but a surprisingly high extent of erectile dysfunction, urinary problems and psychic strain. Taking into account the sensitive topic of this study (sexuality and urinary problems), the response rate is more than satisfying. Older men in our randomly selected, population-based sample do not show perfect erectile and urinary function. These findings should be considered when interpreting QoL data of prostate cancer patients.

Adult↗

The proportional Venn diagram of obstructive lung disease in the Italian general population.

STUDY OBJECTIVES: The Venn diagram of obstructive lung disease (OLD) has been recently quantified. We aimed to quantify the proportion of the general population with OLD, and the intersections of physician-diagnosed asthma, chronic bronchitis (CB), and emphysema in two Italian general population samples, in relationship to airflow obstruction (AO) determined through spirometry. DESIGN AND PARTICIPANTS: We analyzed data from two prospective studies (4,353 patients) carried out in the rural area of Po River delta from 1988 to 1991 and in the urban area of Pisa from 1991 to 1993. RESULTS: Prevalence rates of asthma, CB, and emphysema were 5.3%, 1.5%, and 1.2% in the Po delta, and 6.5%, 2.5%, and 3.6% in Pisa. A double Venn diagram, which was used to quantify the distribution of CB, emphysema, and asthma in relation to the presence/absence of AO, identified 15 categories. Isolated AO was the most frequent category (Po delta, 11.0%; Pisa, 6.7%), followed by asthma only without AO (Po delta, 3.3%; Pisa, 4.3%). The combination of the three OLD conditions was the only category that always showed higher prevalence rates for those with AO (Po delta, 0.20%; Pisa, 0.16%) than for those without AO (Po delta, 0.04%; Pisa, 0.05%). Of those with either OLD or AO, there were 61.4% in Po delta and 38.2% in Pisa with isolated AO, 24.8% and 41.9%, respectively, with an OLD without AO, and 13.8% and 19.9%, respectively, with simultaneous OLD and AO. For both genders, the frequency of isolated asthma decreased with age, while that of isolated AO, CB-emphysema, and the combination of asthma and CB-emphysema increased. CONCLUSION: About 18% of the Italian general population samples either reported the presence of OLD or showed spirometric signs of AO. We confirmed that the Venn diagram of OLD can be quantified in the general population by extending the mutually exclusive disease categories (including a concomitant diagnosis of asthma, CB, or emphysema) to 15.

Adolescent↗

The Alcohol Use Disorder and Associated Disabilities Interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample.

Using a representative sample of the general population, the test-retest reliability of the alcohol and drug modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) was examined. The AUDADIS showed good to excellent reliability for measures of alcohol consumption and use of sedatives, tranquilizers, amphetamines, opioids (other than heroin), cannabis and cocaine. Equally good reliability was demonstrated for diagnoses of alcohol, cannabis, cocaine and heroin abuse or harmful use and dependence defined in terms of the International Classification of Diseases-Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders-Third Edition-Revised (DSM-III-R) and Fourth Edition (DSM-IV). Results are discussed in terms of the need for future research on the psychometric properties of the AUDADIS in clinical and general population samples.

Adolescent↗

[Dietary knowledge: a comparative study between health professionals and the general population].

BACKGROUND: The aim of the study was to assess physicians knowledge about salt and cholesterol content of selected foods, compared with general population knowledge. METHODS: A cross-sectional study made in Ciudad Sanitaria y Universitaria de Bellvitge (Barcelona). 106 physicians (66% of total) and 71 students were surveyed voluntarily. The general population sample was chosen from Hospital outpatients by systematic random sampling method. RESULTS: A self-administered questionnaire about salt and cholesterol high or low content of some foods demonstrated statistically significant differences (p < 0.001) when the average score was compared between health care professionals and the general population group, but in many cases right answer percentage did not arise 60 percent. CONCLUSIONS: Although health care professionals knowledge about salt and cholesterol content of diet is higher than among general population, they need a better and continuous formation in this issue.

Adult↗

Prevalence and risk factors of morning headaches in the general population.

OBJECTIVE: To determine the prevalence of chronic morning headaches (CMH) in the general population and their relationship to sociodemographic characteristics, psychoactive substance use, and organic, sleep, and mental disorders. METHODS: A telephone questionnaire was submitted to 18 980 individuals 15 years or older and representative of the general populations of the United Kingdom, Germany, Italy, Portugal, and Spain. It included a series of questions about morning headaches, organic disorders, use of psychoactive substances, and sleep and mental disorders in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS: Overall, the prevalence of CMH was 7.6% (n = 1442); CMH were reported to occur "daily" by 1.3% of the sample, "often" by 4.4%, and "sometimes" by 1.9%. Rates were higher in women than in men (8.4% vs 6.7%) and in subjects aged between 45 and 64 years (about 9%). The median duration for CMH was 42 months. Various conditions and disorders were found positively associated with CMH. The most significant associated factors were comorbid anxiety and depressive disorders (28.5% vs 5.5%), major depressive disorder alone (21.3% vs 5.5%), dyssomnia not otherwise specified (17.1% vs 6.9%), insomnia disorder (14.4% vs 6.9%), and circadian rhythm disorder (20.0% vs 7.5%). Sleep-related breathing disorder (15.2% vs 7.5%), hypertension (11.0% vs 7.2%), musculoskeletal diseases (14.1% vs 7.1%), use of anxiolytic medication (20.1% vs 7.3%), and heavy alcohol consumption (12.6% vs 7.7%) were also significantly associated with CMH. CONCLUSIONS: Morning headache affects 1 individual in 13 in the general population. Chronic morning headaches are a good indicator of major depressive disorders and insomnia disorders. Contrary to what was previously suggested, however, they are not specific to sleep-related breathing disorder.

Adolescent↗

Survival rates among Seventh Day Adventists compared with the general population in Poland.

The purpose of the work was to test the hypothesis that the survival rate is higher among the Seventh Day Adventists (SDA) than in the general population of Poland, because of the strictly respected customs adhered to by members of this church community, such as abstinence from smoking and from alcohol. The data on life expectancy in the SDA community covered a total of 236 members of this denomination in Kraków (86 males and 150 females). The survival probability rates were estimated by the life table method, for both men and women separately, and were subsequently compared with the corresponding parameters of the Polish Life Tables. Over a period of 10 years, in which these data were studied, there were 11 deaths in males and 24 deaths in females. Mean age at death was 71.9 years among men and 75.1 among women. The survival curves traced over the age groups of both sexes of SDA members were fairly similar, but they were markedly higher than in the general population of Poland. In the general population the survival rates for people over 40 years old were higher in females than in males, whereas no corresponding sex differences in rates concerning SDA members were observed. The greater benefit in life expectancy is gained in the SDA group in comparison with men in the general population. This is attributable to their abstinence from very harmful habits, otherwise more widespread in this sex group.

Adult↗

Is chrysotile asbestos exposure a significant health risk to the general population?

The main unresolved issues concerning environmental exposure to chrysotile asbestos of the general population are discussed. A review of the results of the measurement of airborne chrysotile fibres in buildings is presented showing that the results have been consistently low with the exception of buildings with damaged friable asbestos-containing material. Quantitative risk assessments are presented indicating that the lifetime risk is small compared to many other environmental risks. Possible adverse health effects of paraoccupational exposures in the case of high domestic airborne asbestos levels cannot be excluded. Both on the basis of electron microscopy analyses of asbestos exposures at locations with heavy traffic, and the very shallow slopes in the exposure-response relationships for increased lung cancer risk, the conclusion is drawn that exposure to airborne asbestos-containing friction materials has not been proven to pose a significant health risk to the general population. Reviewing animal ingestion studies published and all the available epidemiological studies related to asbestos in drinking water, the conclusion is drawn that the carcinogenic risk in the general population is low even in the case of drinking water containing elevated concentrations of chrysotile asbestos.

Asbestos, Serpentine↗

Psychiatric disorders and medical care utilization among people in the general population who report fatigue.

OBJECTIVE: To study the prevalence of fatigue in the general population and its association with psychiatric disorders, somatization, and medical utilization. SETTING: The public-use data tape from the 1984 National Institute of Mental Health Epidemiologic Catchment Area Study. PARTICIPANTS: Household sample of 18,571 subjects. INTERVENTIONS: Structured psychiatric interviews were reviewed to study the prevalence of complaints of current and lifetime fatigue and their relationship to selected psychiatric disorders. RESULTS: Fatigue has high current (6.7%) and lifetime (24.4%) prevalences in the general population. Medically unexplained fatigue also has high current (6.0%) and lifetime (15.5%) prevalences. When compared with those reporting no current fatigue, subjects who reported current (one-month) fatigue were significantly more likely to have experienced current and lifetime episodes of major depression, dysthymic disorder, panic disorder, and somatization disorder. They also had significantly higher mean numbers of lifetime and current DSM-III psychiatric diagnoses, medically unexplained physical symptoms (not just fatigue-related symptoms), and visits to health care providers than did patients without current episodes of fatigue. CONCLUSIONS: The high prevalence of fatigue in the general population appears to be significantly associated with increased lifetime and current risk for affective, anxiety, and somatoform disorders, as well as increased utilization of medical services. These data suggest that assessment of both medical and psychological health may be essential for the proper care of patients with fatigue.

Adult↗

Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis.

We studied the use of prenatal care and pregnancy outcome in 4,148 deliveries among members of a well-established health maintenance organization (HMO) and 19,116 births among the 1973-1974 White birth cohort in the Portland, Oregon area. Mothers in the HMO were almost one year older on the average, slightly better educated, and less frequently unmarried, but had virtually identical past pregnancy histories when compared with the general population cohort. HMO members began prenatal care one month later and had three fewer visits than the general population (p less than .01); 78 per cent of the general population and only 64 per cent of HMO members began prenatal care in the first trimester (p less than .01). With maternal risk held constant, low birthweight, neonatal mortality, and infant mortality were 1.5 to 5 times greater with late, less frequent prenatal care than with early, frequent care. Multivariate analysis demonstrated a positive relationship between prenatal care and birthweight. Although this relationship was independent of risk factors recorded on birth certificates, it is not necessarily a causal relationship. Unadjusted prematurity, neonatal and infant mortality rates did not differ between the HMO and general populations. Multivariate analyses indicated that, independent of all maternal risk factors, HMO membership was associated with an increase of 30 grams in the predicted birthweight (P less than .01), but had no effect on mortality. The data suggest that, in Portland, Oregon, pregnancy outcome for HMO members is comparable to that of the general population.

Adult↗

Components of social support and quality of life in severely mentally ill, low income individuals and a general population group.

Satisfaction with social support and quality of life (QOL) were assessed for 60 psychiatric patients, 79 welfare recipients and 266 people of the general population using the Social Provisions Scale (SPS) and the Satisfaction with Life Domains Scale (SLDS). Psychiatric patients reported less satisfaction than the general population on all components of social support. They have a comparable level of satisfaction with welfare recipients on most of the components, with the exception of emotional integration and opportunity for nurturance. However, patients satisfaction with QOL was quite similar to the general population, although higher than welfare recipients on some dimensions. Their lower satisfaction with the personal-intimate dimension suggest deficiencies in social support. All components of social support were consistently related to QOL in the general population. Attachment and reassurance of worth was significant for psychiatric patients but only attachment was related to QOL for the welfare recipients group. The pairing of SPS and SLDS scales seem to be good instruments for discriminating the majority of psychiatric patients.

Adult↗

Prevalence and factors associated with social avoidance of recovered SARS patients in the Hong Kong general population.

The study investigated the general population's perceived infectivity of asymptomatic and recovered severe acute respiratory syndrome (SARS) patients and factors associated with avoidance and discriminatory attitudes, including demographic background, SARS-related perceptions and emotional response to the SARS epidemic. A population-based survey was conducted in Hong Kong during 3 December 2003 through 4 January 2004; 475 Hong Kong Chinese adults participated in the survey. Perceptions of the infectivity and health conditions of recovered SARS patients and avoidance and discrimination towards them were measured. Of the respondents, 75.7% and 16.2%, respectively, believed that SARS could be transmitted via asymptomatic SARS patients and those patients who have recovered from SARS for 18 months; 72.7% of the respondents believed that the health of SARS patients would severely and permanently be damaged; 16.6% showed some tendency of avoiding recovered SARS patients and 35.7% expressed some sort of job-related discriminatory attitudes. Perceived infectivity of asymptomatic and recovered SARS patients, health sequelae and emotional distress from SARS were independently associated with avoidance and discriminatory attitudes. The study showed that misconceptions about the infectivity of asymptomatic and recovered SARS patients were common. Recovered SARS patients may also be facing avoidance and discrimination.

Adolescent↗