Self-rated health (SRH) in young people and causes of death and mortality in young adulthood. A prospective registry-based Norwegian HUNT-study

Background: Self-rated health (SRH), which is frequently used in epidemiological research, has consistently been shown to be a strong predictor of morbidity and mortality, even after controlling for demographic, social and medical risk factors. However, less is known about the relationship between SRH and all-cause and cause-specific mortality in young adulthood. Objective: To investigate SRH in young people (13–35 years-old) as a predictor of all-cause mortality in young adulthood (deaths before age 54) and examine the associated causes of death. Methods: We used data from two large population-based cohort studies (N = 23,679): Young-HUNT1 (1995–1997, persons 13 to 20 years old, participation rate = 90%) and HUNT2 (1995–1997, persons 20 to 35 years old, participation rate = 70%). These data were linked to the Norwegian Cause of Death Registry up to 2014, and 247 deaths were identified. Other predictors we examined included age, gender, baseline smoking, physical activity and physical and mental disability. Results: Participants reporting ‘not so good’/‘poor’ SRH had approximately twice the risk of death compared to those reporting ‘good’ or ‘very good’ SRH at baseline. The association between low SRH and risk of death was attenuated when the models were adjusted for other predictors, but remained statistically significant. The causes of death differed somewhat between SRH levels. Most of the deaths for people reporting ‘very good’ SRH at baseline were mostly due to neoplasms (34%) and other external causes (30%). The causes of death were more varied for people reporting ‘not so good’/‘poor’ SRH, with suicide (23%), other external causes (21%) and other/unknown causes of death (17%) being the most frequent causes. Conclusion: SRH predicts all-cause mortality in young adulthood, with poor SRH being associated with death in young adulthood. The findings also indicate different causes of death for different SRH. This knowledge is important for identifying groups at risk for later disease, which can potentially be used to prevent morbidity in the adult population.publishedVersio

Role of parents in adolescent self-rated health: Norwegian Nord-Trøndelag Health Study

Background: Self-rated health (SRH) is a known important predictor of later mortality, morbidity, and health service attendance. From adolescence onwards, this multifactorial composite seems to be relatively stable. Therefore, it is important to study how SRH is also shaped and influenced by parental factors. Methods: Analyses were based on data from the Nord-Trøndelag Health studies in Norway during 1995–1997 among adolescent children aged 13–19 years and their parents. Cross-table analyses were made for parental and adolescent SRH. Proportional odds logistic regression analyses with parental SRH and a broad spectrum of other parental covariates were conducted, with adolescent SRH as the dependent variable, both unadjusted and adjusted. Results: Lower level of education, living alone, smoking, low general well being, and low life satisfaction were the most important parental factors associated with lower SRH in adolescents. However, the associations between parental SRH and adolescent SRH were rather weak, and in adjusted multivariable analyses lost significance for both genders. The net effect of genetics and early vertical family influence on adolescents’ SRH thus seems to be moderate. Notably, the association between more specific health-related and lifestyle variables in parent and adolescent SRH was rather weak. Conclusion: SRH in adolescents seems to be shaped only partly by parental influence, and is less “deterministic” than might be expected from some genetic studies. SRH may therefore be modifiable by health-promoting efforts in early life.publishedVersio

Truar skilnadene i tilvisingsratar målet om likeverdige helsetenester?

BAKGRUNN - Sogn og Fjordane fylke har i landsmålestokk, og serleg i høve til dei andre fylka i Helse Vest, hatt eit høgt forbruk av spesialisthelsetenester. Utover det at fylket har to små lokalsjukehus, har lite vore kjent som kunne forklare det høge forbruket, og serskilt ikkje om det eksisterer kontrastar i forbruk mellom kommunane i fylket. MATERIALE OG METODE - Med utgangspunkt i data frå Norsk pasientregister og journalsystemet DIPS for 2009 har vi samanlikna alders- og kjønnsjusterte forbruksratar på kommunenivå, saman med ujusterte tilvisingsratar til spesialisthelsetenesta på kommune- og enkeltlegenivå. RESULTAT - Det var store skilnader i forbruk mellom kommunane både i kontaktratar og DRG-poeng. Skilnaden mellom kommunen med høgaste og lågaste forbruk var om lag 90 DRG-poeng per 1 000 innbyggjarar. Kommunen med det høgaste forbruket brukar 36 DRG-poeng per 1 000 innbyggjarar i året meir enn gjennomsnittet for Sogn og Fjordane. Ei nøyare samanlikning av tre kommunar med ulikt forbruk viser store og samanfallande skilnader i tilvisingsratar mellom kommunane og mellom enkeltlegar. TOLKING - Det høge og sprikande kommunale forbruket av spesialisthelsetenester i Sogn og Fjordane ser ut til å ha samanheng med tilsvarande høge og enno meir sprikande tilvisingsratar frå primærlegar i dei same kommunane

PSA-måling og prostatakreft – overdiagnostisering og overbehandling?

BAKGRUNN - PSA-testing og risiko for overdiagnostisering av prostatakreft har fått økende oppmerksomhet. Vi undersøker her hvordan antallet PSA-prøver har utviklet seg over tid i norske fylker og relaterer denne utviklingen til den fylkesvise kreftinsidensen samt ratene for prostatacancerkirurgi. MATERIALE OG METODE - Data for insidens, overlevelse og dødelighet ble innhentet fra offentlige registre. Antallet utførte PSA-tester ble samlet inn fra norske laboratorier. Fylkesvise rater av PSA-prøver og korrelasjon med insidensrater for prostatakreft og kirurgirater ble undersøkt. Utviklingen for Sogn og Fjordane, som har landets høyeste forekomst av prostatakreft, ble kartlagt særskilt. Det ble gjennomført en nettbasert utspørring om fastlegenes holdninger og praksis. RESULTATER - Antallet PSA-tester økte betydelig i perioden 1999 – 2011 og tilsvarte testing av 45 % av den samlede mannlige befolkningen over 40 år i Norge i 2011. Antallet PSA-tester i 2011 korrelerte med fylkesvis forekomst av prostatakreft i tidsperioden forut (Pearsons r = 0,41). Korrelasjonen mellom kreftforekomst og kirurgiske inngrep var 0,66. I Sogn og Fjordane er forekomst og overlevelse av prostatakreft sterkt økende, mens dødeligheten er på nivå med dødeligheten i landet for øvrig. Fastlegene etterkommer ofte pasientenes ønske om PSA-testing og finner det vanskelig ikke å henvise videre der det er forhøyede verdier. FORTOLKNING - Den økte forekomsten av prostatakreft har trolig sammenheng med omfanget av PSA-testingen. Etterlevelse av retningslinjene for testing bør bli bedre, og klinikere kan praktisere en mer avventende holdning til videre behandling ved forhøyet PSA-verdi

Subjective health legacy of the Chornobyl accident: a comparative study of 19-year olds in Kyiv

<p>Abstract</p> <p>Background</p> <p>Since the Chornobyl accident in 1986, the physical health of exposed children in Ukraine has been monitored, but their perceived health has not been studied. This study examines health perceptions of Ukrainian adolescents exposed to radioactive fallout <it>in utero </it>or as infants, and the epidemiologic and Chornobyl-related influences on self-reported health.</p> <p>Method</p> <p>We assessed three groups of 19-year olds in Kyiv: 262 evacuees from contaminated areas near the plant; 261 classmate controls; and 325 population-based controls. The evacuees and classmates were previously assessed at age 11. Structured interviews were conducted with the adolescents and their mothers (N = 766), followed by general physical examinations (N = 722) and blood tests (N = 707). Proportional odds logistic regression and multi-group path analysis were the major statistical tests.</p> <p>Results</p> <p>The examination and blood test results were similar across groups except for a significantly elevated rate of thyroid enlargement found by palpation in evacuees (17.8%) compared former classmates (8.7%) and population-based controls (8.0%). In addition, four evacuees and one population control had had a thyroidectomy. Compared to controls, the evacuees rated their health the least positively and reported more medically diagnosed illnesses during the 5 years preceding the interview, particularly thyroid disease, migraine headache, and vascular dystony. The consistent risk factors (p < 0.001) for these subjective health reports were evacuee status, female gender, multiple hospitalizations, and health risk perception regarding Chornobyl. All three groups of mothers rated their children's health more negatively than the adolescents themselves, and maternal ratings were uniquely associated with the adolescents' health reports in the adjusted models. In the longitudinal evacuee and classmate subsamples, path analysis showed that mothers' health ratings when the children were age 11 predicted their later evaluations which in turn were associated with the adolescent self-reports.</p> <p>Conclusion</p> <p>The more negative self-evaluations of the evacuees were linked to a number of risk factors, including multiple hospitalizations, health risk perceptions, and epidemiologic risk factors. The increased rate of thyroid cancer and other diagnoses no doubt contributed to the evacuees' less positive subjective health. The strong effect of the mothers' perceptions argues in favor of developing risk communication programs for families rather than for mothers or adolescents as separate target groups.</p

Factors associated with internalizing or somatic symptoms in a cross-sectional study of school children in grades 1-10

<p>Abstract</p> <p>Background</p> <p>School related factors that may contribute to children's subjective health have not been extensively studied. We assessed whether factors assumed to promote health and factors assumed to have adverse effects were associated with self-reported internalizing or somatic symptoms.</p> <p>Methods</p> <p>In a cross-sectional study, 230 boys and 189 girls in grades 1-10 from five schools responded to the same set of questions. Proportional odds logistic regression was used to assess associations of school related factors with the prevalence of sadness, anxiety, stomach ache, and headache.</p> <p>Results</p> <p>In multivariable analyses, perceived loneliness showed strong and positive associations with sadness (odds ratio, 1.94, 95% CI 1.42 to 2.64), anxiety (odds ratio, 1.78, 95% CI 1.31 to 2.42), and headache (odds ratio, 1.47, 95% CI 1.10 to 1.96), with consistently stronger associations for girls than boys. Among assumed health promoting factors, receiving necessary help from teachers was associated with lower prevalence of stomach ache in girls (odds ratio, 0.51, 95% CI 0.30 to 0.87).</p> <p>Conclusions</p> <p>These findings suggest that perceived loneliness may be strongly related to both internalizing and somatic symptoms among school children, and for girls, the associations of loneliness appear to be particularly strong.</p

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p