Auditory-Perceptual Evaluation of Dysphonia: A Comparison Between Narrow and Broad Terminology Systems.

OBJECTIVE: In auditory-perceptual voice analysis, a multiparameter approach and a more reductionist approach may be compared with narrow and broad phonetic transcription and used interchangeably, depending on the purpose. The aim of this study was to investigate the perspectives of a translation of the terminology used in the multiparameter Danish Dysphonia Assessment (DDA) approach into the five-parameter GRBAS system. METHODS: Voice samples illustrating type and grade of the voice qualities included in DDA were rated by five speech language pathologists using the GRBAS system with the aim of estimating inter- and intrarater reliability. The same samples were then rated using the DDA terminology. RESULTS: Both inter- and intrarater reliability were found to be very high for the GRBAS parameters grade, rough, and breathy, but somewhat lower for asthenic and strained. Further, strong and clear associations were found between the DDA and GRBAS rating for grade, rough, breathy, and strained, whereas the relation between DDA ratings and asthenic was weaker and less clear. CONCLUSION: The data strongly support that the DDA system can be translated into the GRBAS system for auditory-perceptual voice analysis. The consensus discussion prior to the listening test is believed to have contributed to the high degree of inter- and intrarater reliability. We suggest for future use of the GRBAS system that rater reliability for asthenic and strained can increase, if these parameters are defined as behavioral terms and antagonists, reflecting muscular hypo- and hyperfunction.

Alcohol drinking, consumption patterns and breast cancer among Danish nurses: a cohort study.

BACKGROUND: The aim of this study was to analyse the impact of alcohol intake and drinking pattern on the risk of breast cancer. METHODS: A total of 17 647 nurses were followed from 1993 until the end of 2001. At baseline participants completed a questionnaire on alcohol intake and other lifestyle-related factors. Data were analysed using Cox's proportional hazard model. RESULTS: During follow-up 457 women were diagnosed with breast cancer. The relative risk of breast cancer was 2.30 [Confidence interval (CI): 1.56-3.39] for alcohol intake of 22-27 drinks per week, compared to 1-3 drinks per week. Among alcohol consumers, weekly alcohol intake increased the risk of breast cancer with 2% for each additional drink consumed. Weekend consumption increased the risk with 4% for each additional drink consumed friday through sunday. Binge drinking of 4-5 drinks the latest weekday increased risk with 55%, compared with consumption of one drink. A possible threshold in risk estimates was found for consumption above 27 drinks per week. CONCLUSIONS: For alcohol consumption above the intake most frequently reported, the risk of breast cancer is increased. The risk is minor for moderate levels but increases for each additional drink consumed during the week. Weekend consumption and binge drinking imply an additional increase in breast cancer risk.

[Do wine drinkers eat healthier than beer drinkers? A cross sectional study of 3(1/2) million purchases in Danish supermarkets--secondary publication]. / Spiser vindrikkere sundere end øldrikkere? En tvaersnitsundersøgelse af tre en halv millioner indkøb i danske supermarkeder.

In a cross sectional study based on information on the number, type of item and total charge of 3(1/2) million transactions over a period of 6 months in various supermarkets in Denmark we examined whether people who buy wine also buy healthier food items than those who buy beer. We found that wine buyers bought more olives, fruit and vegetables, poultry, cocking oil and low fat cheese, milk and meat than beer buyers who bought more ready cooked meals, sugar, cold cuts, chips, pork, butter or margarine, sausages, lamb and soft drinks than wine buyers.

[Alcohol consumption by middle-aged and elderly Danes from 1987 to 2003]. / Midaldrende og aeldre danskeres alkoholforbrug fra 1987 til 2003.

INTRODUCTION: The trend in alcohol consumption by middle-aged and elderly Danes has received little attention, but earlier studies indicated increased consumption. Social factors may influence the trend. Our objective was to investigate the trend in alcohol consumption by the middle-aged and elderly and inquire about significant trends among specific social subgroups. MATERIALS AND METHODS: In the Danish Health and Morbidity Survey carried out in 1987, 1994, 2000 and 2003, a total of 11,754 people aged 50 and older were asked about their alcohol consumption. The mean alcohol intake and the number of heavy drinkers were compared from year to year. RESULTS: The mean intake per day increased from 1.5 drinks in 1987 to 2.1 drinks in 2003 for men and from 0.5 drink in 1987 to 1.0 drink in 2003 for women. The percentage of elderly drinking above the sensible drinking limits increased from 15.2% to 20.4% for men and from 10.7% to 13.6% for women. The strongest increasing trend in the number of heavy drinkers was in the lowest socio-economic groups and among those married or cohabiting. CONCLUSION: The increased number of heavy drinkers among the middle-aged and elderly is of great importance to their general state of health. The increase has possibly been caused by a social and cultural development which has led to a generation of elderly who used to drink alcohol earlier in their lives and continue drinking in old age. More focus on alcohol consumption among the middle-aged and elderly in health policy initiatives is needed.

Food buying habits of people who buy wine or beer: cross sectional study.

OBJECTIVE: To investigate whether people who buy wine buy healthier food items than those who buy beer. DESIGN: Cross sectional study. SETTING: Supermarkets in Denmark. Data Information on number, type of item, and total charge from 3.5 million transactions over a period of six months. RESULTS: Wine buyers bought more olives, fruit and vegetables, poultry, cooking oil, and low fat cheese, milk, and meat than beer buyers. Beer buyers bought more ready cooked dishes, sugar, cold cuts, chips, pork, butter or margarine, sausages, lamb, and soft drinks than wine buyers. CONCLUSIONS: Wine buyers made more purchases of healthy food items than people who buy beer.

Generalized additive models applied to analysis of the relation between amount and type of alcohol and all-cause mortality.

The J-shaped relation between alcohol intake and mortality is well established, whereas the nadir of the curve is not determined. Due to non-linearity of the relation, categorical alcohol variables have been used to model the relation. In Generalized Additive Models (GAM) non-linear relations can be modelled without the disadvantages of categorization and without assumptions regarding the functional form. The aim of this study was to use GAM to evaluate the relation between alcohol intake, amount and type, and mortality. The relation was investigated using data from the Copenhagen City Heart Study (11,920 participants of whom 5552 died during 20 years follow-up). Using GAM, a smooth J-shaped relation between alcohol and mortality was found. However, if non-drinkers were categorized separately there was a positive association between alcohol and mortality even for low alcohol intake. For equal total alcohol intake, men and women drinking wine or spirits had lower mortality than beer drinkers. The nadir of the relation between alcohol and mortality was sensitive to the handling of non-drinkers. When non-drinkers were categorized separately we found no indication of a beneficial influence of low alcohol intake on mortality.

The influence of duration of follow-up on the association between alcohol and cause-specific mortality in a prospective cohort study.

PURPOSE: To investigate whether duration of follow-up influences the association between alcohol and cause-specific mortality in a prospective cohort study with only baseline assessment of alcohol intake. METHODS: In a cohort of 14,223 men and women participating in the first investigation of the Copenhagen City Heart Study between 1976 and 1978 and followed until 2001, we assessed whether the association between alcohol and mortality was modified by duration of follow-up. The 24 years of follow-up were divided into four intervals, and Cox survival analyses were conducted separately for these four succeeding 6-year periods of follow-up. RESULTS: The authors found differences in the predictive values of alcohol and beverage-specific types of alcohol depending on duration of follow-up both in terms of all-cause mortality and death from coronary heart disease and cancer. The apparent protective effect of a moderate alcohol consumption on coronary heart disease attenuated during prolonged follow-up, whereas high alcohol consumption became associated with higher risk of death from cancer with longer follow-up. CONCLUSIONS: This study accentuates the importance of taking duration of follow-up into consideration when interpreting risk estimates from prospective studies on the association between alcohol and mortality.

Intake of beer, wine and spirits and risk of heavy drinking and alcoholic cirrhosis.

Studies have suggested that wine drinkers are at lower risk of death than beer or spirit drinkers. The aim of this study is to examine whether the risk of becoming a heavy drinker or developing alcoholic cirrhosis differs among individuals who prefer different types of alcoholic beverages. In a longitudinal setting we found that both the risk of becoming a heavy or excessive drinker (above 14 and 21 drinks per week for women and above 21 and 35 drinks per week for men) and the risk of developing alcoholic cirrhosis depended on the individuals preference of wine, beer or spirits. We conclude that moderate wine drinkers appear to be at lower risk of becoming heavy and excessive drinkers and that this may add to the explanation of the reported beverage-specific differences in morbidity and mortality.

Alcohol intake, type of beverage, and risk of breast cancer in pre- and postmenopausal women.

BACKGROUND: Most studies of the relation between alcohol consumption and breast cancer have shown a modestly increased risk, although the results are still conflicting. METHODS: The aim of this prospective population-based cohort study was to assess the influence of alcohol intake and type of beverage (beer, wine, or spirits) on breast cancer risk in relation to menopausal status. Among 13,074 women aged 20 to 91 years, we examined the relationship between breast cancer risk, total alcohol intake, and type of alcohol in relation to menopausal status. The women were classified as premenopausal or as postmenopausal at younger than 70 years or 70 years or more. RESULTS: During follow-up, 76 premenopausal and 397 postmenopausal women developed breast cancer. Premenopausal women who had an intake of more than 27 drinks per week had a relative risk of breast cancer of 3.49 (95% confidence limits, 1.36-8.99) compared with light drinkers (p = 0.011), whereas there were no differences in risk in the lower-intake categories. The increased risk of breast cancer among premenopausal women was independent of the type of alcohol. Postmenopausal women older than 70 years of age who had an intake of more than six drinks per week of spirits had a relative risk of breast cancer of 2.43 (95% confidence limits, 1.41-4.20) compared with women who consumed less than one drink of spirits per week (p = 0.0014). CONCLUSIONS: Total alcohol intake of more than 27 drinks per week increases breast cancer risk in premenopausal women independently of the type of alcohol. Among postmenopausal women, an intake of spirits of more than six drinks per week increases breast cancer risk.

Changes in alcohol intake and mortality: a longitudinal population-based study.

BACKGROUND: Using alcohol intake at one point in time, numerous studies have shown a J- or U-shaped relation with all-cause mortality. Mortality is lowest among the light to moderate drinkers, with the risk of dying from coronary heart disease higher among nondrinkers and the risk of dying from cancer higher among heavy drinkers. We studied whether changes in individual alcohol intake result in corresponding changes in mortality. METHODS: In a longitudinal study of 6644 men and 8010 women, age 25 to 98 years, who had attended at least 2 health surveys with a 5-year interval between them, we addressed the risk of death after combinations of changes in alcohol intake. RESULTS: Mortality after changes in alcohol intake was consistent with the mortality observed among those who reported stable drinking. Stable drinkers showed a U-shaped all-cause mortality, with relative risks of 1.29 (95% confidence interval [CI] = 1.13-1.48) for nondrinkers (< 1 drink per week) and 1.32 (1.15-1.53) for heavy drinkers (> 13 drinks per week) compared with light drinkers (1 to 6 drinks per week). For coronary heart disease mortality, stable nondrinkers had a relative risk of 1.32 (0.97-1.79) compared with stable light drinkers and those who had reduced their drinking from light to none increased their risk (1.40; 1.00-1.95), and those who had increased from nondrinking to light drinking reduced their relative risk ratio (0.71; 0.44-1.14). Cancer mortality was increased in all groups of heavy drinkers. CONCLUSION: Persons with stable patterns of light and moderate alcohol intake had the lowest all-cause mortality. Individual changes in alcohol intake were followed by corresponding changes in mortality.

Intake of beer, wine and spirits and risk of heavy drinking and alcoholic cirrhosis

Studies have suggested that wine drinkers are at lower risk of death than beer or spirit drinkers. The aim of this study is to examine whether the risk of becoming a heavy drinker or developing alcoholic cirrhosis differs among individuals who prefer different types of alcoholic beverages. In a longitudinal setting we found that both the risk of becoming a heavy or excessive drinker (above 14 and 21 drinks per week for women and above 21 and 35 drinks per week for men) and the risk of developing alcoholic cirrhosis depended on the individuals preference of wine, beer or spirits. We conclude that moderate wine drinkers appear to be at lower risk of becoming heavy and excessive drinkers and that this may add to the explanation of the reported beverage-specific differences in morbidity and mortality.

Energy adjustment methods applied to alcohol analyses.

When alcohol consumption is related to outcome, associations between alcohol type and health outcomes may occur simply because of the ethanol in the beverage type. When one analyzes the consequences of consumption of beer, wine, and spirits, the total alcohol intake must therefore be taken into account. However, owing to the linear dependency between total alcohol intake and the alcohol content of each beverage type, the effects cannot be separated from each other or from the effect of ethanol. In nutritional epidemiology, similar problems regarding intake of macronutrients and total energy intake have been addressed, and four methods have been proposed to solve the problem: energy partition, standard, density, and residual. The aim of this study was to evaluate the usefulness of the energy adjustment methods in alcohol analyses by using coronary heart disease as an example. Data obtained from the Copenhagen City Heart Study were used. The standard and energy partition methods yielded similar results for continuous, and almost similar results for categorical, alcohol variables. The results from the density method differed, but nevertheless were concordant with these. Beer and wine drinkers, in comparison with findings for nondrinkers, had lower risk of coronary heart disease. Except for the case of men drinking beer, the effect seemed to be associated with drinking one drink per week. The standard method derives influence of substituting alcohol types at constant total alcohol intake and complements the estimates of adding consumption of a particular alcohol type to the total intake. For most diseases, the effect of ethanol predominates over that of substances in the beverage type, which makes the density method less relevant in alcohol analyses.

Nonlinear relation between alcohol intake and high-density lipoprotein cholesterol level: results from the Copenhagen City Heart Study.

BACKGROUND: It has been suggested that the level of high-density lipoprotein cholesterol (HDL-C) in the blood can be used as a marker of recent alcohol intake. However, before using HDL-C as a predictor of alcoholism, the relation between alcohol intake and HDL-C in the entire range of consumption must be explored. Most studies model the relation between alcohol intake and HDL-C linearly, although a threshold effect is expected. The objective of this study was to evaluate the shape of the relation between intake of alcohol and HDL-C and to determine whether there are differential effects of beer, wine, and spirits on HDL-C and whether they remain after adjusting for total alcohol. METHOD: The relation between alcohol intake and HDL-C was investigated by means of generalized additive models using data from the Copenhagen City Heart Study. RESULTS: A nonlinear effect of alcohol improved the model fit significantly, and the nonlinearity of alcohol was highly significant in both men and women. The relation was concave: HDL-C was stable in men and women who drank more than approximately 35 and 20 drinks per week, respectively. We found a significant nonlinear term of wine on HDL-C in men after adjustment for total alcohol intake. CONCLUSIONS: There was a concave relation between alcohol intake and HDL-C, indicating a threshold effect of alcohol on HDL-C. The association between wine and HDL-C in men after adjusting for total alcohol intake may be due to residual lifestyle confounding.

[Cola as a possible cause of secondary hyperparathyroidism]. / Cola som mulig årsag til sekundaer hyperparatyroidisme.

The consumption of carbonated beverage, especially cola, is increasing. We describe two cases of secondary hyperparathyroidism caused by a massive daily consumption of cola over many years and a low calcium intake.

[The relation between life style, socioeconomic factors, social networks and suboptimal self-assessed health]. / Sammenhaengen mellem livsstil, socioøkonomiske faktorer, socialt netvaerk og suboptimalt selvvurderet helbred.

INTRODUCTION: The aim of the present study was to assess the relation between these life-style factors and suboptimal self-reported health. METHODS: A cross-sectional study was carried out on a random sample of 12,040 men and women from Copenhagen, who had answered a questionnaire regarding smoking, alcohol intake, physical activity, socio-economic status, social network, and self-perceived health. RESULTS: Smoking, high alcohol intake, and physical inactivity are strongly associated with a suboptimal self-reported health. DISCUSSION: The assumption of a correlation between a high quality of life and a shorter life cannot be confirmed by this study.

Lower risk for alcohol-induced cirrhosis in wine drinkers.

Although there is a well-known relationship between total alcohol intake and future risk for cirrhosis, other factors such as the type of alcohol consumed are sparsely studied. The aim of this study was to assess the effects of wine compared with other types of alcoholic beverages on risk for alcohol-induced cirrhosis. In 3 prospective studies, 30,630 participants from the Copenhagen area were followed-up for a total observation time of 417,325 person-years. Information on weekly intake of beer, wine, and spirits, and sex, age, body mass index, smoking habits, and education was obtained from questionnaires. The primary outcome measures were first admission or death, with alcohol-induced cirrhosis obtained from death certificates and from the National Hospital Discharge Register. Data were analyzed by means of multiplicative Poisson regression models. We confirmed the increasing risk for cirrhosis with increasing alcohol intake. Individuals who drank more than 5 drinks per day had a relative risk of 14 to 20 for developing cirrhosis compared with non- or light drinkers. However, compared with individuals who drank no wine (relative risk set at 1.0), individuals drinking 16% to 30% wine of their total intake had a relative risk of 0.4 (95% confidence limits, 0.3-0.6) and those drinking 51% or more of wine had a relative risk of 0.3 (95% confidence limits, 0.2-0.5) for developing cirrhosis. In conclusion, the results suggest that a high intake of all 3 types of alcohol conveys an increased risk for cirrhosis, but wine drinkers are at a lower risk than beer and spirits drinkers.