Thyroid disorders in the general population of Hisayama Japan, with special reference to prevalence and sex differences

Serum triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) and thyroid autoantibodies (TAA) to either microsome or thyroglobulin were measured in 1251 samples from the general population, 546 males and 705 females, aged 40 or over in Hisayama, a Japanese rural town. TAA was positive in 7.7% of men and 15.0% of women, and the male/female ratio was 1:2. This ratio was markedly different from those in hospital patients with thyroid disorders where ratios such as 1:8 for chronic thyroiditis and 1:4 for Graves' disease were found. Among the study subjects, definite hyperthyroidism was found in 0.2%, borderline hyperthyroidism in 0.7%, overt hypothyroidism in 0.3%, latent hypothyroidism in 4.2%, and non-thyroid illness in 2.4%. Overt thyroid dysfunction was more evident in women, while latent thyroid dysfunction or non-thyroidal illness was equally prevalent in men and women. These results indicate that the incidence of immunologically or functionally latent thyroid disorders is rather higher than expected, in both women and men. Some unknown factor(s) might act as a trigger to manifest thyroid dysfunction, mainly in females.     

Alcohol use patterns in a Norwegian general population-based sample with special reference to socio-demographic variables

Aim

The aim of this study was to analyse alcohol use patterns in a general population-based sample in Norway, with special reference to gender and socio-demographic variables.

Methods

The Alcohol Use Disorders Identification Test (AUDIT) was applied to measure alcohol use patterns and to identify hazardous alcohol use and negative consequences. AUDIT is a commonly used screening instrument in general population studies. A random sample was established of 4,000 Norwegian citizens, aged 18 to 79, which was drawn from the National Register held by Statistics Norway. The response rate in this study was 33%.

Results

The results show that males are more likely to consume more alcohol and to experience more drinking-related problems than females. More males (30.0%) than females (12.6%) were found in the hazardously alcohol consuming group (AUDIT total score ≥8). Furthermore, odds ratios for males were significantly higher than the oldest age group (age 66–79, reference category) compared to all other age groups, while for females, only the two youngest age categories (18–35 years) were found to be significantly higher than the reference category. Age was found to be a major factor (confounder), especially for females, in the relationships between alcohol drinking patterns, employment and marital status, level of education and density groups.

Conclusion

The results should be of interest both for health policy makers and health-care professionals in their planning of prevention and interventions concerning the hazardous and harmful alcohol consumption among the youngest age group.     

Frequent attenders in general practice care: a literature review with special reference to methodological considerations

OBJECTIVE: To describe the basis on which our knowledge of frequent attendance in general practice rests and to propose recommendations for further research on frequent attenders (FAs). DESIGN: The literature review (finished February 2004) encompassed peer-reviewed articles in English describing contacts with general practice in terms of frequency. Searches were performed in the Medline, CINAHL, EMBASE, PsycINFO, Social Sciences Expanded Index and ISI Citation databases with additional searches in reference lists and the 'related articles' function in the ISI Citation database and Medline. SETTING: General practice. SUBJECTS: Sixty-one articles (54 studies). MEASURES: The articles were assessed according to the following design variables: setting; definition of FAs; sampling; sample size; control groups; study aim; study design; data sources; effect measure; and main results. RESULTS: There was no generally accepted definition of frequent attendance. Research designs differed substantially. Eight articles gave sufficient information on all design variables. The top 10% of attenders accounted for 30-50% of all contacts, and up to 40% of FAs were still FAs the following year. More than 50% of FAs had a physical disease, more than 50% of FAs suffered from psychological distress, social factors (low social support, unemployment, divorce) were associated with frequent attendance in more than 50% of FAs, multiproblems (physical, psychological and social) were found in one-third of FAs, and frequent attendance was associated with increasing age and female gender. CONCLUSION: The diversity of designs, definitions and methods in the current literature on FAs in general practice hampers comparison of their precision, validity and generalizability, and calls for cautious interpretation and adoption of a common, generally acceptable definition in future studies.     

Naturalistic changes in the readiness to quit tobacco smoking in a German general population sample

BACKGROUND: This study examines naturalistic changes, i.e., changes that occur without formal interventions, in the motivational readiness to quit tobacco smoking. The transtheoretical model (TTM) with the proposed five stages of change (precontemplation, contemplation, preparation, action, maintenance) is used as the theoretical framework. METHODS: Data were collected as part of a representative general population study in Germany. A total of 786 individuals was assessed two times, 6 months apart, with respect to stage of change. Latent Transition Analysis (LTA) was employed as a special statistical method to analyze stage movements over time. RESULTS: The best-fitting model to describe naturalistic stage movements included both forward and backward movements. A high proportion of the sample was in the precontemplation stage across both measurement occasions. There were high rates of stage regressions over the 6-month period. CONCLUSIONS: In a German representative population of smokers, smoking behavior change toward abstinence does not occur naturally in a substantial amount over the 6-month period without intervention. Differing findings in studies for populations in the United States could be due to methodological differences or differences in tobacco-control conditions.     

A general family of distributions for longitudinal dependence with special reference to event histories

Event histories play an increasingly important role in medical studies. Examples include times between recurrences of tumours, as with bladder cancer, and between repeated infections, as with chronic granulotomous disease. A general method for generating new distributions is proposed by introducing an intensity function into a density. This procedure yields, as special cases, several distributions already proposed in the literature. The families of distributions based on the Pareto distribution are of particular interest for event history analysis because of their relationship to the Laplace transform of a gamma distribution. They can yield multivariate distributions, with longitudinal (serial) dependence by a procedure similar to updating in the Kalman filter and with uniform dependence in a similar way to copulas. For longitudinal dependence, several such updating procedures are proposed.     

A dose-response analysis of cadmium in the general environment with special reference to total cadmium intake limit

An epidemiological study on the dose-response relationship of cadmium was performed on 1850 Cd-exposed and 294 nonexposed inhabitants of the Kakehashi River basin in Ishikawa Prefecture. beta 2-microglobulinuria was used as an index of the effect of cadmium on health and the average cadmium concentration in locally produced rice was employed as an indicator of cadmium exposure. Cadmium exposure was found to affect health in a dose-related manner when the subjects were classified according to the average cadmium concentration in their village rice and their length of residence in the polluted area. Based on the available data, the total cadmium intake that produced an adverse effect on health was calculated as approximately 2000 mg for both men and women.     

Epidemiological study of chronic bronchitis with special reference to effect of air pollution

Summary From 1962 to 1969 an investigation on chronic bronchitis was conducted to clarify the chronic influence of air pollution to human health in 9 areas selected from Osaka and Hyogo prefectures showing different degrees of air pollution.Self-administered questionnaire based upon the standard of the British Medical Research Council's Committee was distributed to every residents over 40 years of age in surveyed areas. The questionnaires numbered 36374 with response rate of 85.9%.Cases of chronic bronchitis were diagnosed from the responded following the Fletcher's criteria of chronic bronchitis. Those cases were asked to take further examinations consisting of doctor's direct interview by the standardized questionnaire by the British Medical Research Council's Committee, chest X-ray test, pulmonary function test by McKenson's Vitalor and other optional medical examinations. At the same time, some apparently normal subjects and some other who had less severe symptoms of sputum, cough and/or short breath were likewise medically checked up as the controls.From this investigation, it became clear that the prevalence of chronic bronchitis is influenced by age, smoking and air pollution (sulfur dioxide). The relation among age, smoking and air pollution with the prevalence of chronic bronchitis is mathematically analysed as follows: Y=1.94+10^–4 · 3 · N(x –20)²–3.18 where Y: prevalence of chronic bronchitis, N: smoking quantity per day, : sulfur dioxide, x: age.     

Mortality risks among heavy-smokers with special reference to women: a long-term follow-up of an urban population

Increased mortality risks associated with smoking are well established among men. There are very few population-based studies comprising a sufficient number of heavily smoking women, measuring the direct effect of smoking on mortality risks. Between 1974 and 1992, 8,499 women and 13,888 men attended a health screening programme including reporting of smoking habits. Individuals were followed for total mortality until 2005. All-cause, cancer, cardiovascular, lung cancer and respiratory mortality were calculated in smoking categories <10 g per day, 10–19 g per day, and ≥20 g per day with never-smokers as a reference group and with adjustments for co-morbidities, socio-economic and marital status. For respiratory mortality and lung cancer adjustments for FEV₁, socio-economic and marital status were performed. Smoking was associated with a two to almost threefold increased mortality risk among women and men. The relative risk (RR) with 95% confidence interval, (CI) for women who smoked 10–19 g per day was 2.44 (2.07–2.87), and for those who smoked 20 g per day or more the RR (95% CI) was 2.42 (2.00–2.92). Smoking was a strong risk factor for cardiovascular mortality among women, the RR (95% CI) for women who smoked 10–19 g per day was 4.52 (3.07–6.64). Ex-smoking women showed increased risks of all-cause mortality; RR (95% CI) 1.26 (1.04–1.52) cancer (excluding lung cancer); RR (95% CI) 1.42 (1.07–1.88) and lung cancer RR (95% CI) 2.71 (1.02–7.23) mortality. However, the cardiovascular; RR (95% CI) 1.18 (0.69–2.00) and respiratory; RR (95% CI) 0.79 (0.16–3.84) mortality risks were not statistically significant. This study confirms that as for men, middle-aged heavily smoking women have a two to threefold increased mortality risk. Adjustments for co-morbidity, socio-economic and marital status did not change these results.