Perceived cognitive function in coronary artery disease – An unrecognised predictor of unemployment

Objective: We aimed to assess whether perceived cognitive function influences employment and return to work in patients with coronary artery disease (CAD). Design: Prospective longitudinal cohort study. Setting: Health care system of Södertälje, Stockholm County, Sweden. Patients: We included consecutive unselected patients less than 65 years of age with CAD and followed them during 2 years. Main outcome measures: Gainful employment and return to work in patients with CAD. Results: We found that perceived cognitive function predicts both prevalence of unemployment [OR 2.06 (95% CI: 1.36–3.13); p = 0.0006] and early retirement and sick leave due to coronary artery disease [OR 1.59 (95% CI: 1.12–2.25)] both at baseline and 2 years later. Furthermore, perceived cognitive function predicted return to work after an acute coronary event [OR 2.28 (95% CI: 1.08–4.84)]. Covariates such as age, sex, prevalence and degree of angina (CCS grade), cardiovascular risk factors and events did not change the predictive power. Conclusions: Perceived cognitive function is a hitherto unrecognised independent predictor of unemployment, sick leave and return to work in patients with coronary artery disease. Perceived cognitive function adds a new perspective on ability to gainful employment in patients with CAD. The findings might have significance both to individual care and to society.     

Community-based study of cataracts among type 2 diabetics in Kinmen

The purpose of this study was to assess the prevalence and risk factors of each type of cataract among type 2 diabetics in Kinmen, Taiwan. There were 971 type 2 diabetics ascertained from a community-based mass screening between 1991 and 1993. In 1999, a total of 578 (59.5%) patients with type 2 diabetes were examined with an eye screening performed by two senior ophthalmologists using a 45-degree thin slit-lamp biomicroscopy and ophthalmoscopy to examine the lens after dilating the pupils. The overall prevalence, including subjects with or without surgery, was 31.0% (179/578, 95% CI: 27.3–34.7%), and had a statistically significant difference for gender (χ²=8.78, p = 0.003) and age (χ²-trend = 11.89, p < 0.0001). Based on multiple logistic regression, the significant risk factors of all types of cataracts were age (OR = 1.16, 95% CI: 1.12–1.20), lower diastolic blood pressure (DBP) at baseline (OR = 0.47, 95% CI: 0.25–0.88), and higher triglyceride at baseline (OR = 2.19, 95% CI: 1.07–4.45). In conclusion, our results found that in addition to age, lower DBP and higher triglyceride at baseline may increase the risk of prevalent cataracts in type 2 diabetics.     

Prospective Analysis of Factors Associated with Work Reentry in Patients with Accident-Related Injuries

Introduction: The objective of this study was to investigate the influence of accidents, the physical and psychological consequences, the patient’s predisposition as well as work-related cognitions on return to work (RTW) post accident. Despite the costs of time-off from work after accidental injuries, very few investigations have been carried out so far. Method: In a consecutive sample, 163 patients were investigated directly and 12 months after an accident. Results: 32% of the patients had a poor occupational integration 12 months after an accident. As predictors for return to work were found type of prior work: laborer (OR=4.34; 1.79–10.50 CI 95%), type of accident: recreational (OR=0.27; 0.11–0.69 CI 95%) and subjective perception of the accident severity (OR=0.98; 0.96–0.99 CI 95%). Conclusion: Laborers after a traffic or work accident, who estimate the accident as severe, are at greater risk of developping long-term disability. Future efforts should be conducted especially for this target group. Corinna Lange and Markus Burgmer contributed equally to the present work and should therefore both be considered as first authors.     

Respiratory symptoms and obstructive lung diseases in iron ore miners: Report from the obstructive lung disease in northern Sweden studies

This is a population-based study on the prevalence of respiratory symptoms assessed by a mail questionnaire. The objective was to examine if work in an iron mine increased the risk of airway symptoms or obstructive diseases. The exposed group consisted of 114 previous or current male miners. Referents, 2472 males from the province, had never been employed by the mining company or worked as miners. Age, smoking and a family history of asthma were considered as possible confounders. The miners had an increased risk for respiratory symptoms (OR=2.2, 95% CI=1.4–3.1) including recurrent wheeze (OR=2.4, 95% CI=1.5–3.9), longstanding cough (OR=1.8, 95% CI=1.0–3.2), and for physician-diagnosed chronic bronchitis (OR=2.2, 95% CI=1.0–4.5). Attacks of shortness of breath and asthma manifestations were similar between miners and referents. Higher risks in miners were found particularly among the non-smokers for physician-diagnosed chronic bronchitis (OR=9.2, 95% CI=3.0–28) and for symptoms as well. A family history of asthma was less common among miners (9.2% vs. 17%, p < 0.05). We conclude that miners in a modern underground iron mine had an increased risk of respiratory symptoms. In contrast to other studies, this increased risk was particularly found in non-smokers. A family history of asthma may be an important confounder in occupational studies of respiratory diseases.     

Transitions in self-reported musculoskeletal pain and interference with activities among newspaper workers

Active surveillance of symptoms and disability due to musculoskeletal disorders (MSD) in working populations can map individual transitions in symptom intensity or disability level. Using repeat surveys, this study examined if aetiological risk factors for new symptoms or disability, measured by interference with activities, were similar to prognostic risk factors for subsequent outcomes of symptoms and disability. This paper reports on 379 Toronto newspaper workers who completed questionnaires in 1996 and 1997. Questions on pain/discomfort during the last year, episode frequency and duration formed the basis for constructing three mutually exclusive symptom levels: noncases (Level 1); mild cases (Level 2); and more severe or frequent pain cases (Level 3). A similar construction of overall interference levels was based on the frequency with which musculoskeletal pain/discomfort interfered with daily, recreational, social and family activities, or ability to do one's job during the previous 12 months. The last was also examined as work interference alone. Levels of symptoms were cross-tabulated by overall and work interference at the two time points and Markov models of transitions between states were formulated. Results indicate that period prevalence of symptoms and overall interference increased between phases, though only significantly for symptoms (Levels 2 and 3, 65.7–70.7%, p = 0.04), while work interference was unchanged (17.9–17.0%). Equivalent proportions of workers improved as worsened in symptoms (21.1 and 22.4%, respectively), overall interference (16.7 and 17.8%), and work interference (7.4 and 6.6%). The only significant predictor for those without work interference at time one was job tenure, which was protective against work interference (Odds Ratio (OR) 1.06, 95% Confidence Interval (CI) 1.01–1.12). Among those who had more severe/frequent symptoms at time one, lack of improvement over time was predicted by longer job tenure (OR = 0.92 per year, CI: 0.87–0.97), greater psychological demands of work (OR = 0.65 per point, CI: 0.51–0.84) and marginally by greater upper extremity disability score. At time one, women with work interference were more likely to have persistent interference at time two (OR = 7.22, CI: 1.57–33.20). Suggestive findings included opposite effects of social support at work: reduced risk of development of new symptoms but increased risk of persistence at the highest symptom level.     

Consanguinity and advanced maternal age as risk factors for reproductive losses in Alexandria, Egypt

Background: Consanguinity has been a long-standing social habit among Egyptians. Estimates of consanguinity ratios in different parts of Egypt ranged from 29 to 50%. This study aimed at delineating the role of consanguinity and advanced maternal age on reproductive losses in Alexandria, Egypt. Methods: A case-control study, on 730 couples with history of reproductive losses and 2081 normal couples, was done during the period October, 1998 until August, 2000. Results: Of the 730 couples with reproductive losses, consanguinity frequency was 68.8% with 56.2% first cousins. Prenatal loss and infant deaths were highly encountered among consanguineous marriages (p < 0.0001). In a multivariate logistic regression analysis, consanguinity between couples increased the relative risk of repeated abortion (OR: 3.95; 95% CI: 3.04–5.14), stillbirths (OR: 10.6; 95% CI: 6.7–17.0), neonatal death (OR: 17.2; 95% CI: 10.8–27.3), post-neonatal death (OR: 14.5; 95% CI: 10.6–19.9) and total reproductive losses (OR: 8.3; 95% CI: 6.9–10.1). A positive association was found between advanced maternal age and repeated abortion (OR: 3.19; 95% CI: 2.04–4.97) as well as total reproductive losses (OR: 2.37; 95% CI: 1.74–3.2). Conclusion: This study, the largest-reported case-control study on reproductive losses in Alexandria, strongly suggests that consanguinity may play a major role in the high rates of prenatal and infant mortality while advanced maternal age has a significant role in the causation of repeated abortion, and they must be taken into account for genetic counseling in Egypt. Because of the possibility of controlling, the study gives clear indications for prevention.     

Self-Efficacy and Health Locus of Control: Relationship to Occupational Disability Among Workers with Back Pain

Objectives Although self-efficacy and health locus of control (HLC) have been extensively studied in health research, little is known about their contribution to occupational disability among workers with back pain. This 2 year prospective study examined the association between these control belief constructs and “return to work in good health” (RWGH), a four-category, composite index of back pain outcome. Methods The participants (n = 1,007, participation = 68.4%, follow-up = 86%) were workers with occupational disruptions who sought a medical consultation for non specific back pain in primary care and emergency settings in the Quebec City area, Canada. Information about self-efficacy for return to work (SERW) and HLC, as well as potential confounders, was collected during a telephone interview about 3 weeks after the baseline medical consultation. Polytomous logistic regression was used to assess the relationship between the baseline control variables and RWGH at 2 year. Odds ratios (OR) and their 95% confidence intervals were used to quantify the strength of associations. For all analyses, the “success” category was considered the reference group. Results Although bivariate analyses showed a significant association between external HLC and RWGH at 2 year, this relationship was not significant in multivariate analyses. Higher scores on the self-efficacy questionnaire were however protective of “failure to return to work after attempt(s)” (OR: 0.28; 95% CI: 0.14–0.57) and of “failure to return to work” (OR: 0.19; 95% CI: 0.07–0.48) in multivariate analyses. Conclusion Self-efficacy is an important determinant of the occupational outcome of back pain.     

Helicobacter pylori colonization and diarrhoeal illness: results of a population-based cross-sectional study in adults

It has been suggested that Helicobacter pylori colonization may protect against diarrhoeagenic gastrointestinal infections. The aim of this analysis was to investigate the association between H. pylori infection and the frequency of diarrhoeal episodes among adults. Helicobacter pylori infection status was determined by ¹³C-urea breath test. Overall, 784 adults (mean age: 48.7 ± 17.7; range 18–85 years) who participated in two epidemiological studies were included in the analysis. Overall H. pylori prevalence was 25.5%. Episodes of diarrhoea within prior 3 months were less often reported for H. pylori infected subjects compared with H. pylori negative subjects (40.2 vs. 51.6%, p = 0.016). Compared to H. pylori negative subjects the odds ratio (OR) for the occurrence of diarrhoea within the prior 3 months was 0.63 (95% CI: 0.45–0.87) for H. pylori infected subjects. After adjustment for covariates the OR was 0.67 (95% CI: 0.47–0.95). These results support the hypothesis that colonization with H. pylori may protect from gastrointestinal infections that cause diarrhoea.     

Occupational hand dermatitis in food industry apprentices: results of a 3-year follow-up cohort study

Objective: The aim of this prospective follow-up study was to quantify the impact of hand dermatitis (HD) in bakers, confectioners and bakery shop assistants, and to investigate related risk factors. Method: Bakers', confectioners' and bakery-shop assistants were included in a prospective follow-up study in the region of East Thuringia starting in August 1996. At the beginning of their vocational training 91 apprentices were interviewed and examined in a standardised way. Follow-up examinations and interviews were done after 6 months (n=79), 12 months (n=63) and at the end of the training (n=69) after 36 months. Results: In their case histories 3.3% (n=3) of the apprentices reported previous HD in childhood and adolescence. The first assessment after 2 to 4 weeks of vocational training revealed HD in 17.5% (n=16) of the individuals. At the follow-up examination after 6 months, point prevalence of HD was 29.1% (n=23), after 12 months 27.0% (n=17) and after 36 months 27.5% (n=19). Mild to moderate irritant contact dermatitis was the most frequent finding. Finally, an atopic skin diathesis (>10 points, “atopy score”) (OR=4.89; CI 95% 1.15–20.79), previous HD (OR=41.1; CI 95% 4.99–339.13) as well as flexural dermatitis (OR=6.8; CI 95% 1.72–27.22) proved to be predictive factors for the development of HD. No association was found to respiratory atopy (OR=1.29; CI 95% 0.35–4.7) and metal sensitisation (OR=1.1; CI 95% 0.29–4.35). Exogenous irritant factors did not show a strong association towards a risk increase. Wet work in general, as well as distinct occupational tasks showed only a tendency for being a risk factor for HD. However, leisure time activities, especially house building and rebuilding (OR=5.4; CI 95% 1.05–27.81), were associated with an elevated risk. Conclusions: Endogenous and exogenous factors contribute to the development of HD in bakers' and confectioners' apprentices. Received: 25 September 2000 / Accepted: 20 February 2001     

Hepatitis C virus infection in injection drug users in Bavaria: risk factors for seropositivity

Background: Hepatitis C Virus (HCV) infection is the most common disease among intravenous drug users (IDUs). Patients and method: All patients admitted to the detoxification unit 1991–1997 and meeting ICD-10 diagnosis of opioid dependency were tested for anti-HCV serology. Results: Thousand and forty nine patients were included in the study. About 61.3% of the IDUs were anti-HCV positive. Increasing age (PR: 1.46; 95% CI: 1.34–1.60), living with a significant other drug user (PR: 1.17; 95% CI: 1.05–1.31), history of therapy (PR: 1.62; 95% CI: 1.50–1.74), history of imprisonment (PR: 1.48; 95% CI: 1.36–1.61), history of emergency treatment (PR: 1.23; 95% CI: 1.12–1.35), additional daily consumption of benzodiazepines (PR: 1.10; 95% CI: 1.00–2.21) or alcohol (PR: 1.26; 95% CI: 1.14–1.38), frequency of injecting heroin (daily: PR: 0.86; 95% CI: 0.78–0.96; previously: PR: 1.14; 95% CI: 1.03–1.26) and type of opioid dependency (methadone: PR: 1.26; 95% CI: 1.13–1.41) were significant factors, considered as individual factors, for positive anti-HCV serology. Using multiple logistic regression we found that older age (OR: 3.54, 95% CI: 1.30–9.67), longer duration of opioid use (OR: 5.74; 95% CI: 1.82–18.13), living with a significant other drug user (OR: 1.47; 95% CI: 1.01–2.16), history of therapy (OR: 4.87; 95% CI: 1.67–14.20), history of imprisonment (OR: 1.92; 95% CI: 1.12–3.28), history of emergency treatment (OR: 1.45; 95% CI: 1.06–1.99) and additional daily consumption of alcohol (OR: 1.49; 95% CI: 1.04–2.13) remained independently associated with positive anti-HCV serology. Conclusions: These data support the need for early prevention strategies, namely, education of teachers in schools and further training of counsellors informing IDUs of what they can do to minimise the risk of becoming infected or of transmitting infectious agents to others.     

Familial related risk-factors in the development of chronic bronchitis/emphysema as compared to asthma assessed in a postal survey

There is a lack of knowledge to which extent heredity or familial risk factors are involved in the development of chronic bronchitis/emphysema (CBE). Smoking is regarded as the most important risk factor, but only about 15% of smokers develop airway obstruction. We evaluated the importance of familial risk factors compared to smoking and ex-smoking using an epidemiological approach. In 1992, a postal questionnaire was distributed to a study sample. In all, 43 questions were asked, in a previously evaluated questionnaire, regarding respiratory symptoms, self-reported lung diseases, smoking habits and familial occurrence of chronic bronchitis and asthma. The questionnaire was sent to 12,073 adults living in the southernmost part of Sweden. The age range was 20–59 years with an equal gender distribution. The study sample was drawn from the population records. The questionnaire was answered by 8469 subjects (70.1%), of whom 392 subjects (4.6%) stated that they had or had had CBE and 469 subjects (5.5%) stated that they had or had had asthma. In a model with logistic regression using the five explanatory variables gender, age, familial occurrence for asthma, familial occurrence for CBE and current or ex-smoking the most important risk factors for CBE were familial occurrence for chronic bronchitis [Odds ratios (OR): 5.19, 95% confidence interval (CI): 4.09–6.60, p = 0.000] and current or ex-smoking (OR: 1.74, 95% CI: 1.41–2.14, p = 0.000). The most important risk factors for asthma were familial occurrence for asthma (OR: 3.71, 95% CI: 3.06–4.51, p = 0.000) and current or ex-smoking (OR: 1.33, 95% CI: 1.09–1.61, p = 0.004). We have found that familial occurrence for CBE in first degree relatives together with smoking is a stronger risk factor for the development of CBE than is smoking.     

Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: Prospective study with clinical implications

Study Design: Prospective cohort study with 18-month follow-up. Objective: To investigate if long-term sick listed persons’ own predictions of their future return to work (RTW) have an impact on their RTW when controlling for other established factors. Method: Postal questionnaires at baseline were sent to persons who had been on sick leave for more than 90 days, and were employed in five municipalities and four county councils in Sweden. A follow-up regarding their RTW was performed 18 months later. Results: After 18 months 135 out of 508 persons (27%) had returned to work, full or part-time. In a multivariate logistic regression, the sick listed persons’ own prediction of their RTW proved to be highly significant (OR=8.28, 95% CI: 3.31–20.69). Only six out of 132 persons with a negative view of their RTW did return to wok. Other predictive factors that were found for RTW were: being on sick leave for a period of less than 1 year (OR=2.09, 95% CI: 1.19–3.67), having less pain than persons in the quartile with most pain (OR=2.65, 95% CI: 1.21–5.81), perceiving that one was welcome back to work (OR=1.98, 95% CI: 1.10–3.58), and being under 55 years of age (OR=2.37, 95% CI: 1.07–5.23 for age between 45 and 54 years and the same trend for age below 45 years OR=1.85, 95% CI: 0.82–4.20). Conclusion: Persons with a positive prediction should get help to realise their potential for RTW. Offering traditional rehabilitation measures to a person with a negative prediction of his/her RTW, could be a waste of resources if done ahead of improving self-confidence and view of what is possible. The problems in this group might decrease or be easier to handle if decisions about the future are taken within a year.     

Review of the utilisation of a university hospital in Barcelona (Spain): evolution 1992-1996

Background: To test the applicability of the appropriateness evaluation protocol (AEP) as a tool for reviewing hospital utilisation. To quantify and to compare the rate of inappropriate admissions and amount of in-hospital days, emphasising the main causes and factors in the hospital associated with inappropriateness during the studied periods of time. Patients and methods: Two retrospective studies were carried out, the first one in 1992, when 2048 clinical histories were analysed, and the second in 1996, with 1099 reviewed histories. The tool used for the evaluation of the level of hospital utilisation is the AEP. Results: The proportion of admissions considered to be inappropriate was 25% (95% CI: 20.8–24.5) in 1992, and 16% (95% CI: 13.8–18.2) in 1996. Premature admission was the most frequent cause of inappropriateness in both periods. The logistic regression model built for the dependent variable admission showed the following variables to be associated to inappropriateness: scheduled admission (OR: 15; 95% CI: 10.8–20.7) and (OR: 10; 95% CI: 6–16.5), weekend admission (OR: 2; 95% CI: 1.3–1.2) and (OR: 2; 95% CI: 1.2–2.3), for 1992 and 1996, respectively. The rate of inappropriate in-hospital stays in 1992 was 29% (95% CI: 28.3–29.6), and 13.5% (95% CI: 12.7–14.3) in 1996. Hospital organisational problems were the main cause of inappropriate in-hospital days in 1992, and diagnostic/therapeutical tests that could be performed ambulatorily ranked first in 1996. The logistic regression model built for the dependent variable in-hospital days had the following independent variables associated to its inappropriateness: discharge on week-days (OR: 1.4; 95% CI: 1.2–1.8) and (OR: 0.6; 95% CI: 0.5–0.8) and length of stay (OR: 2; 95% CI: 1.8–2.4) and (OR: 2.4; 95% CI: 2.3–2.5), for 1992 and 1996 respectively, among other variables. Conclusion: Periodic checking of the utilisation levels with the application of methods such as the AEP will contribute towards adapting hospital management in the more competitive current setting.     

Excess cardiac mortality on Monday: the importance of gender,age and hospitalisation

Background: Available evidence suggests a peak in the incidence of cardiovascular events on Mondays compared to other days of the week. The underlying mechanism may be summarised as naturally occurring rhythmic fluctuations in human physiology, and socially determined rhythms in human behaviour. Change in these rhythms may lead to attenuation of the peak on Mondays. Objective: To quantify the excess risk associated with the Monday peak in cardiovascular mortality and to explore the role of age, gender and hospitalisation. Methods: Details on time and cause of all deaths which occurred in the city of Rotterdam between November 21, 1988 and November 21, 1990 were obtained by sending a questionnaire to the physician who signed the death certificate. We studied the weekly distribution of 1828 confirmed cases of sudden cardiac death, for the group as a whole and in subgroups according to gender, age (<65 years/≥65 years) and hospitalisation. Results: The odds ratio (OR) of sudden cardiac death on Monday compared to other days of the week was 1.20 (95% CI: 1.06–1.36). The excess mortality due to the Monday peak amounted to 4.9 per 1000 deaths. The Monday peak was more pronounced in non-hospitalised (OR: 1.25; 95% CI: 1.08–1.44) than in hospitalised patients (OR: 1.06; 95% CI: 0.83–1.37), in men (OR: 1.25; 95% CI: 1.06–1.48) than in women (OR: 1.14; 95% CI: 0.95–1.36), and in those younger than 65 (OR: 1.29; 95% CI: 0.95–1.74) compared to those aged 65 years or over (OR: 1.18; 95% CI: 1.03–1.35). Yet, the confidence limits overlap. Conclusion: The incidence of sudden cardiac death is markedly increased on Monday, more pronounced in non-hospitalised patients. Our results may point to the relevance of naturally occurring rhythmic fluctuations in human physiology, and socially determined rhythms in human behaviour as underlying mechanism.     

Respiratory symptoms and diseases among construction painters

Objective: To study the self-reported prevalence of respiratory symptoms and diseases among construction painters and estimate the potential risk for this group compared with a representative group of carpenters sharing the construction work environment but without significant exposure to paint. Methods: A questionnaire study was conducted on 1,000 male Finnish construction painters and 1,000 carpenters (mean response rate 60.5%). Symptoms and diseases of the respiratory tract were studied, by logistic regression modelling, in relation to occupation and duration of painting experience. Age, atopy and smoking habits were taken into account. Results: The painters reported more asthma-like, rhinitis, laryngeal and eye symptoms than the carpenters [odds ratio (OR) 1.4–1.8]. The difference in the prevalence of asthma between the occupations was not statistically significant, but the painters with 1–10 years of painting experience had a threefold risk of asthma compared with the carpenters. Chronic bronchitis was linked to painting occupation [OR 1.9, 95% confidence interval (CI) 1.2–3.0] and to the duration of exposure; OR (CI) for over 30 years of painting was 2.2 (1.2–4.0). Occupation was not associated with allergic rhinitis or conjunctivitis. Conclusions: The results indicate a higher risk for respiratory symptoms and chronic bronchitis among construction painters than among carpenters.     

Relation between overweight, diabetes, stress and hypertension: A case–control study in Yarumal – Antioquia, Colombia

Aims: The aim of this study was to assess the association between overweight, diabetes, stress and other postulated risk factors for a high blood pressure, on the risk of hypertension. Methods and Results: This matched case–control study included 228 cases randomly selected in a rural adult population in Yarumal – Antioquia, Colombia. For every case, one control, individually matched by age (± 5 years), sex and residence, was selected from the general population. Conditional logistic regression was used to estimate odds ratios (OR). Obese people (body mass index (BMI) 30 kg/m²) showed an increased OR of hypertension compared to those with a BMI < 25 kg/m², OR: 3.83 [95% confidence interval (CI): 1.83–8.00]. A high level of psychological stress was associated with hypertension (measured on a tension–anxiety scale), OR: 5.02 (95% CI: 2.25–11.19). A positive association was also observed for diabetes although it was of borderline significance, OR: 2.58 (95% CI: 0.88–7.55). Having a family member with hypertension or myocardial infarction was related to a higher risk of hypertension (p < 0.05). Conclusions: This study provides evidence that BMI, stress (feelings of anxiety or tension), and diabetes are independently associated with an increased risk of hypertension in a rural area of Colombia.     

Working time and upper limb musculoskeletal symptoms: a longitudinal study among assembly line workers

This study followed assembly line workers during 7 months, comprising a 4-wk season holidays. The main purposes were to determine the potential effect of working time on the presence and intensity of upper limb musculoskeletal symptoms, as to verify the effect of 4 wk of job interruption in the upper limb musculoskeletal symptoms presence and intensity. Data was collected during 6 moments. Generalized estimating equations analyses were used. For the effect estimates, odds ratio with corresponding 95% confidence intervals were reported for each outcome/model. The upper limb musculoskeletal symptoms showed a significant increase (p=0.001), especially after the 4 wk off. In all data collection points there was a significant positive association between the upper limb musculoskeletal symptoms and general health status (p<0.001). Considering symptoms’ intensity, significant relations were found (p<0.001). Work time had a negative effect on the work-related upper limb musculoskeletal symptoms over 7 months (OR 0.909, 95% CI 0.861–0.960, p=0.001). For the intensity of upper limb symptoms, the effect of time was also statistical significant (OR 0.115, 95% CI 1.031–1.220, p=0.008). A 4-wk job interruption did not show an immediately positive effect on upper limb musculoskeletal symptoms presence.     

Atherogenic lipid profile and elevated lipoprotein (a) are associated with lower bone mineral density in early postmenopausal overweight women

Epidemiological studies have reported that women with osteoporosis present an increased risk of cardiovascular events and that lipid lowering therapy (statins) could be associated with a decreased risk of fracture. We investigated whether women with atherogenic lipid profile have lower lumbar and femoral bone mineral density (BMD) and higher prevalence of osteopenia than those with normal lipid levels. The study included 52 overweight early postmenopausal women, with no history of hormone replacement therapy, or any current or past pathology or treatment that could alter bone or lipid metabolism. Atherogenic lipid profile or hyperlipidemia was defined as hypercholesterolemia (⩾240 mg/dl) or high low-density lipoprotein cholesterol (high-LDLc ⩾160 mg/dl) or high lipoprotein (a) [high-Lp (a) ⩾25 mg/dl], and low-BMD as t-score <−1 SD at lumbar o femoral site. The results show that women with hyperlipidemia had lower mean-adjusted BMD (mean ± SEM) at lumbar (0.865 ± 0.020 vs. 0.958 ± 0.028 g/cm², p=0.007) and femoral neck (0.712 ± 0.015 vs. 0.796 ± 0.021, p=0.004 g/cm²) than those with normal lipid levels. Hypercholesterolemia group had higher prevalence of low-BMD at lumbar spine (82.6% vs. 55.2%, p=0.04, or 3.8; 95% CI: 1.04–14.2) and femoral neck (65.2% vs. 37.9%, p=0.05, OR: 3.1; 95% CI: 0.98–9.6). The high-LDLc group had also higher prevalence low-BMD at femoral neck (75% vs. 39%, p=0.01, OR: 4.7; 95% CI: 1.26–17.5), and the high-Lp (a) group at lumbar spine (87% vs. 51.7% p=0.007, OR: 6.2; 95% CI: 1.5–25.6). Women with hyperlipidemia had higher prevalence of low BMD at lumbar spine (81.8% vs. 42.1%, p=0.003, OR: 6.2; 95% CI: 1.7–22) and femoral neck (60.6% vs. 31.6%, p=0.04, OR: 3.3; 95% CI: 1.01–11.0). In conclusion, early postmenopausal women with atherogenic lipid profile, defined as cholesterol ⩾240 mg/dl or LDLc ⩾160 mg/dl or Lp(a) ⩾25 mg/dl have lower lumbar and femoral BMD and have an increased risk of osteopenia than those with normal lipid profile, suggesting that hyperlipidemia could be associated with osteoporosis and bone status should be evaluated in women with hyperlipidemia. Presented in part at International Osteoporosis Foundation World Congress on Osteoporosis, Lisbon, Portugal, May 9–14, 2002.     

Comorbidity of hospital-treated psychiatric and physical disorders with special reference to schizophrenia: a 28 year follow-up of the 1966 Northern Finland general population birth cohort

We studied the comorbidity of psychiatric and physical disorders in a sample (n = 11017) from the unselected, general population, Northern Finland 1966 Birth Cohort. During the period 1982–1994, hospital-treated psychiatric patients were more likely than people without psychiatric diagnoses to have been treated for physical disease in hospital wards, 298 out of 387 (77.0%) vs 6687 out of 10 630 (62.9%) (OR = 2.0, 95% CI = 1.6−2.5). Injuries, poisonings and indefinite symptoms were a more common reason for hospital treatment in people with schizophrenia or other psychiatric disorder as compared with people without a psychiatric disorder. Men with psychiatric disorder had more than a 50-fold risk for poisoning by psychotropic drugs (OR = 52.6, 95% CI = 27.7−99.8), women with psychiatric disorder a 20-fold risk (OR = 19.0, 95% CI = 9.5–38.1) and schizophrenics more than a 30-fold risk (OR = 37.5, 95% CI = 19.1–73.8). Men with psychiatric disorders were more commonly hospitalised for a variety of gastrointestinal disorders and circulatory diseases (OR = 2.3, 95% CI = 1.2–4.4), as compared with men with no psychiatric disorder. Respiratory diseases (OR = 2.2, 95% CI = 1.2–4.2), vertebral column disorders (OR = 4.2, 95% CI = 1.8–9.9), gynaecological disorders (OR = 2.1, 95% CI = 1.2–3.6) and induced abortions (OR = 1.8, 95% CI = 1.2–2.7) were more prevalent in women with psychiatric disorder than in other women. Epilepsy was strongly associated with schizophrenia (OR = 11.1, 95% CI = 4.0–31.6). Nervous and sensory organ diseases in general (OR = 2.5, 95% CI = 1.1–5.8) and inflammatory diseases of the bowel (OR = 12.8, 95% CI = 3.8–42.7) were also overrepresented in schizophrenia when compared with people without a psychiatric disorder. Our results indicate that physicians must be alert for psychiatric disorder, and mental health professionals must be aware of the considerable physical morbidity in their patients.     

Effect of Interpregnancy Interval on Infant Low Birth Weight: A Retrospective Cohort Study Using the Michigan Maternally Linked Birth Database

Objective: To examine the relationship between interpregnancy interval and low birth weight (LBW), using the retrospective cohort design. Methods: We used the maternally linked Michigan livebirth data documented between 1989 and 2000 to evaluate LBW in relation to interpregnancy (i.e., delivery-to-conception) interval, overall and at levels of other reproductive risk factors. We fit separate logistic regression models for pairs of first-second, second-third, third-fourth, and fourth-fifth births to control for confounding. Results: Of the 565,911 infants identified, 5.5% had LBW. Univariate and stratified analyses showed that the risk for LBW was lowest when the interpregnancy interval was 18–23 months, and increased with shorter or longer intervals. This J-shaped relationship persisted after controlling for all risk factors simultaneously. For example, among the first-second birth pairs, the adjusted odds ratios (AORs) for LBW associated with interpregnancy intervals <6, 24–59, 60–95, and 96–136 months were 1.4 (95% confidence interval [CI] = 1.3–1.5), 1.5 (95% CI = 1.3–1.6), 1.1 (95% CI = 1.0–1.1) and 1.5 (95% CI = 1.3–1.8), respectively, compared with an interval of 18–23 months. Among the second-third birth pairs, the AORs were 1.5 (95% CI = 1.3–1.6), 1.3 (95% CI = 1.2–1.4), 1.1 (95% CI = 1.0–1.1), and 1.6 (95% CI = 1.3–2.0), respectively. Among the third-fourth birth pairs, the AORs were 1.2 (95% CI = 1.1–1.4), 1.3 (95% CI = 1.1–1.5), 1.0 (95% CI = 0.9–1.1), and 1.4 (95% CI = 1.0–2.0), respectively. Among the fourth-fifth birth pairs, the AORs were 1.3 (95% CI = 1.1–1.6), 1.2 (95% CI = 0.9–1.5), 1.1 (95% CI = 1.0–1.4), and 1.3 (95% CI = 0.8–2.3), respectively. The population attributable risk associated with interpregnancy intervals shorter than 18 months or longer than 23 months was 9.4%. Conclusion: These data suggest that spacing pregnancies appropriately could be used as a strategy for preventing LBW.