Infections in patients hospitalized for fever as related to duration and other predictors at admittance.

PURPOSE: To find the underlying diagnoses of patients admitted to a medical department with symptoms of fever to ascertain whether the duration of fever, temperature readings, and common laboratory tests could give a clue to the final diagnosis. METHODS: A retrospective study of the records of 299 patients admitted to the Medical Department, Haukeland University Hospital from July 1st, 2001 until June 30th, 2004 for fever without any diagnosis suggesting the cause of the fever. RESULTS AND CONCLUSIONS: Infections were the most common diagnoses, but the proportion of patients with infections declined with increasing duration of fever before admission (63.7 % when <7 days, 45.8 % when >21 days). A group of patients on immunosuppressive therapy were all hospitalized within 1 week from the debut of fever, and their causes of fever were comparable to those of non-immunocompromised patients with fever of the same duration. With fever <7 days, patients with bacterial or viral infection had higher maximum temperatures (medians 39.2 and 38.9 °C, respectively) than those without infection (median 38.0 °C). Patients with bacterial infection had higher C-reactive protein (CRP) levels than patients in the other groups, whereas viral infection was associated with higher lymphocyte counts. The neutrophil:lymphocyte ratio was higher in patients with fever due to bacterial infections than in those with viral infections. For patients with fever for <1 week, neutrophil [area under the curve (AUC) 0.723], white blood cell (WBC, AUC 0.692), and monocyte (AUC 0.691) counts and CRP levels (AUC 0.684) were the best single indicators of bacterial infection.

Reproductive factors and fatal hip fractures. A Norwegian prospective study of 63,000 women.

STUDY OBJECTIVE: The aim of the study was to investigate the impact of reproductive variables (age at menarche, menopause, first and last birth as well as parity, lactation, and abortions) on hip fracture mortality. DESIGN AND SETTING: A prospective study in Norway with more than 60,000 women followed up for 29 years. A total of 465 deaths as a result of hip fracture were recorded. MAIN RESULTS: Statistically significant linear relations (p < or = 0.02) were found between both age at menarche and length of reproductive period (defined as age at menopause to age at menarche) and the mortality of hip fractures in women aged less than 80. The death rate for women with a late menarche (> or = 17 years) was twice that of the women with relatively early menarche (< or = 13 years). Compared with women with less than 30 years between menopause and menarche, the mortality rate ratio in women with more than 38 reproductive years was 0.5. We also found an inverse relation with age at first birth. CONCLUSIONS: This study supports by hypothesis that an early menarche and a long reproductive period protect against hip fracture mortality. High age at first birth may also be protective.

Does age at natural menopause affect mortality from ischemic heart disease?

We examined the relationship between age at natural menopause and mortality of ischemic heart disease in 19,309 Norwegian postmenopausal women. A total of 2767 fatal infarctions occurred during 29 years of follow up. Overall, a relatively weak inverse relationship was seen with approximately 10% lower ischemic heart disease mortality in women aged > or = 47 years at the menopause compared to women with an early menopause (< 44 years). Risk estimates were similar for women aged 47 and more at menopause. However, the inverse relationship was stronger and statistically significant (p = 0.01) in women aged less than 70 years. In this group of women, we observed a nearly 60% reduction in the ischemic heart disease mortality in women with a late menopause (> or = 53 years) compared to women aged < 44 years at menopause (mortality rate ratio = 0.42; 95% confidence interval 0.25-0.72). This protective effect of a late menopause is reduced with advancing age, however, and is of minor significance in the age groups where the great proportion of the ischemic heart disease deaths occur.

Breast feeding, other reproductive factors and rheumatoid arthritis. A prospective study.

The evidence regarding reproductive events as risk factors for rheumatoid arthritis (RA) is not conclusive. In the present study a population-based cohort consisting of 63,090 women were followed from 1961 to 1989. Detailed data on reproductive factors were collected through personal interviews in the period 1956-9. The endpoint used was mention of RA on the death certificate. Mortality rate ratios were estimated by Poisson regression, controlling for various demographic variables. During 1,485,400 person-yr of observation, a total of 355 cases with RA mentioned on the death certificate were identified. Total time of lactation was associated with a decreased mortality of RA, with an approximate dose-response relationship. The results did not support a role of parity, age at first and last birth, or age at menarche and menopause in the development of RA. This protective effect of lactation on the development of RA has not previously been described, and since a definite biological explanation is lacking, the association should be confirmed in other populations.

The snout and palmomental reflexes in HIV disease in Tanzania.

Following earlier observations on the snout (SR) and palmomental(PMR) reflexes in AIDS in Tanzania, a series of 1127 adults, 649 HIV-positive and 478 HIV-negative, from 4 groups at different risk of HIV infection were examined neurologically between 1987 and 1992. The prevalence of SR and PMR was calculated according to HIV status, HIV stage, demographic factors and neurologic findings. In the total series of HIV positives the prevalence ranged from SR 39.3% and PMR 22.6% in asymptomatic HIV disease to SR 87% and PMR 69% in terminal AIDS. In HIV negatives the prevalence of SR was 19.2% and PMR 15.3%, and increased with age. There was no relationship with age in the HIV positives and no gender differences. SR and PMR were also associated with neuropathy, myelopathy and AIDS dementia complex independent of HIV stage. This study shows a strong association between SR and PMR and HIV disease in Africa. The prevalence increased with HIV stage and related neurological disorders.

Prevalence of HIV-1 infection in urban, semi-urban and rural areas in Arusha region, Tanzania.

OBJECTIVE: To estimate HIV-1 prevalence among the adult population in the Arusha region, northern Tanzania. DESIGN: Cross-sectional study. METHODS: Clusters of 10 households were randomly selected from urban, semi-urban and rural areas in the Arusha region. Informed verbal consent for participation in the interview and HIV-1 test were obtained from the respondents. HIV-1 antibodies were tested using enzyme-linked immunosorbent assay (ELISA) and all ELISA-positive sera were confirmed using Western blot. Approximately 66.0% of the eligible registered adults (aged 15-54 years) participated in the interview, of whom 56.6% provided blood samples for HIV-1 testing. RESULTS: HIV-1 prevalence rates among the study population from the low and high socioeconomic status urban areas, semi-urban area and rural village were 10.7, 5.2, 2.2 and 1.6%, respectively. HIV-1 prevalence was significantly higher among women (6.5%) than men (1.7%), and infection rates were consistently higher among women than men in all areas studied except in the rural village. Divorced and separated individuals had significantly higher HIV-1 prevalence (14.8%) compared with married and cohabiting individuals (4.0%). Significantly more individuals with multiple sexual partners reported regular condom use (19.3%) than those with one sexual partner (6.4%). CONCLUSION: HIV-1 prevalence in the Arusha region was higher among the urban population than among the rural population. Women living in urban areas with low socioeconomic status appeared to be associated with increased risk of HIV-1 infection.

Parity in relation to mortality and cancer incidence: a prospective study of Norwegian women.

BACKGROUND: Few prospective studies relating childbearing to total and cause-specific mortality and cancer incidence have been published. The purpose of this paper was to examine these relations in a large cohort of Norwegian women. METHODS: Information on reproductive factors was obtained through interviews with 63,090 women. All deaths and cancer cases during follow-up, 1961-1980, were obtained by linkage to the files at the Central Bureau of Statistics and the Cancer Registry of Norway, respectively. Associations with parity were assessed by stratified logistic regression. RESULTS: For cerebrovascular and ischaemic heart disease, moderate but highly significant positive trends of increasing mortality with increasing parity were observed in the older part of the cohort. Deaths from diseases of the respiratory system and suicide were most common among nulliparous women. Inverse associations with parity were observed for cancers of the breast, corpus uteri and ovaries as well as for melanoma and non-melanoma skin cancers. Positive associations were observed for cancer of the cervix uteri in all age groups, for cancer of the respiratory system among older women and for pancreatic cancer and multiple myelomas in the younger part of the cohort. The results gave no support to previous reports of positive associations with cancer of the liver or gallbladder. CONCLUSIONS: The study supports evidence of an increased risk of ischaemic heart disease in multiparous women, which had been observed previously in three smaller prospective studies. It confirms earlier observations of low risks of cancer of the breast, corpus uteri and ovaries in women with high parity.

Decline in FEV1 and airflow limitation related to occupational exposures in men of an urban community.

The purpose of this survey was to evaluate the effects of smoking and occupational exposures on the decline in forced expiratory volume in one second (FEV1), and the presence of airflow limitation (FEV1 x100/forced vital capacity (FVC) being < 65) at follow-up. A random sample of 1,933 men aged 22-54 years in Bergen, Norway, were invited into the survey. Smoking habits and measurements of FEV1 were recorded at the initial survey in 1965-1970 (n = 1,591) and at follow-up in 1988-1990 (n = 951). Past or present self-reported occupational exposures to eleven airborne agents (dusts, gases, vapours and fumes) and measurements of FVC were recorded at follow-up only. The decline in FEV1 was associated (p < 0.001) with age, body height and smoking. Smoking cessation reduced the decline to the level of lifetime nonsmokers. Accelerated decline in FEV1 was observed in subjects exposed to sulphur dioxide gas and to metal fumes. The adjusted decline in FEV1 increased progressively in subjects exposed to increasing numbers of occupational agents (test for trend: p < 0.01). Airflow limitation was observed in 9.5% at follow-up, and increased with age and cigarette consumption. In this community follow-up survey in men, smoking and occupational exposures to sulphur dioxide gas, metal fumes and the numbers of specific agents were found to be important predictors for accelerated decline in FEV1.

Reproductive factors and risk of thyroid cancer. A prospective study of 63,090 women from Norway.

This prospective study of 63,090 Norwegian women with 124 cases of thyroid cancer diagnosed during 1961-1989 revealed no strong associations with reproductive factors. Late last birth was related to increased risk, whereas no association was noted with parity. A long reproductive period was related to increased risk of papillary carcinomas, whereas a decreased risk of follicular carcinomas and other adenocarcinomas was observed in women with early menarche and late menopause. The risk of thyroid cancer was significantly increased among women in the occupational category 'fishing, ships officers and crew'. Our results are consistent with a modest effect of certain reproductive factors upon thyroid cancer development.

Reproductive factors and cancers of the breast and genital organs--are the different cancer sites similarly affected?

Relationships between reproductive factors and cancer of the breast and genital organs were investigated in a prospective study of 63,090 Norwegian women. During followup from 1961 through 1980 1565 cases of breast cancer, 422 cases of cancer of the corpus uteri, and 471 cases of ovarian cancer were diagnosed. High parity was associated with low risk of cancer of the breast, corpus uteri, and ovary in analyses with adjustment for age at first birth. Age at first birth and age at last birth were positively associated with risk of breast cancer and inversely associated with endometrial cancer, whereas no clear associations were observed with ovarian cancer. Results suggest that the effect of a pregnancy on cancer risk is mediated, at least in part, by different mechanisms for these three sites. Age at menarche was inversely and age at menopause positively related to risk of breast and endometrial cancer, whereas no association was observed for ovarian cancer. In analyses of squamous cell carcinoma of the cervix uteri, an association with reproductive factors was expected from the known relationships with sexual habits. However, this cannot account for the high risk observed in this study in women with early age at first birth.

Reproductive factors and risk of cervical cancer by cell type. A prospective study.

Relationships between reproductive variables and risk of cervical cancer were examined in a follow-up of 62,079 women in Norway from 1961 through 1980. For the 342 cases classified as squamous cell carcinomas, a higher risk was observed in ever married than in never married women. The risk was especially high among women married more than once and women who were widowed or divorced before start of follow-up. High age at first birth was associated with low risk. The estimated odds ratio for women with first birth at age 35 years or later versus 19 years or earlier was 0.18 (P less than 0.001) in analyses with adjustment for age, urban-rural place of residence and parity. In analyses with adjustment for age at first birth, neither parity or age at first marriage, nor age at menarche or menopause showed significant associations with squamous cell carcinoma. For the 30 cases classified as adenocarcinomas, no significant associations emerged with reproductive factors. The effects of marital status as well as age at first birth differed significantly between adenocarcinomas and squamous cell carcinomas, suggesting dissimilar aetiologies. Although associations between reproductive factors and squamous cell carcinoma may largely be secondary to relationships with sexual habits, there are indications that the association with age at first birth cannot be entirely explained in this way.

Reproductive factors and risk of ovarian cancer: a prospective study.

Associations between reproductive factors and risk of ovarian cancer were examined in a prospective study of 60,565 women in Norway. A total of 445 women were diagnosed as having ovarian cancer during follow-up, from 1961 through 1980. The highest risk was observed among nulliparous women, and the risk decreased significantly with increasing parity. The estimated odds ratio for women with 5 or more births compared with one birth was 0.46, after adjustment for age, urban/rural place of residence and occupational class. Neither age at first or last birth, nor age at menarche or menopause, nor marital status, showed significant associations with ovarian cancer risk after adjustment for parity. The apparent protective effect of high parity was observed for epithelial as well as non-epithelial cancers, and for the separate histological types of epithelial cancer except mucinous cystadenocarcinomas.