The effectiveness of BCG vaccination in preventing Mycobacterium tuberculosis infection and disease in Greenland.

BACKGROUND: The BCG vaccine's ability to prevent Mycobacterium tuberculosis infection (MTI) remains highly debated. In Greenland, BCG vaccination was introduced in 1955, but was temporarily discontinued (1991-1996) due to nationwide policy changes. The study aimed to use the transient stop in BCG vaccination to evaluate the effect of vaccination on MTI prevalence and TB incidence. METHODS: MTI study: A cross-sectional study (2012), comprising East Greenlanders born during 1982-2006, evaluated the effect of BCG vaccination on MTI prevalence; a positive interferon γ release assay defined an MTI case. Associations were estimated using logistic regression. TB study: a cohort study covering the same birth cohorts with follow-up until 2012 evaluated the vaccine's effect on TB incidence. A personal identifier allowed for follow-up in the TB notification system. Associations were estimated using Cox regression. RESULTS: MTI study: Included 953 participants; 81% were BCG-vaccinated; 29% had MTI, 23% among vaccinated and 57% among non-vaccinated. BCG vaccination reduced the odds of MTI, OR 0.52 (95% CI 0.32 to 0.85), p=0.01. Vaccine effectiveness against MTI was 20%. TB study: Included 1697 participants followed for 21,148 person-years. 6% were notified with TB, 4% among vaccinated and 11% among non-vaccinated. BCG vaccination reduced the risk of TB, HR 0.50 (95% CI 0.26 to 0.95), p=0.03, yielding a vaccine effectiveness of 50%. CONCLUSIONS: BCG vaccination was effective in reducing both MTI and TB disease among children and young adults in a TB high-endemic setting in Greenland.

Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas.

OBJECTIVES: We evaluated the results of mobile, one stage, bilateral ear surgery conducted in Greenland, where chronic otitis media with and without suppuration is prevalent. The study aimed to increase the number of operations conducted and to reduce the cost of ear surgery in remote areas. MATERIALS AND METHODS: The study was longitudinal and prospective, with a two-year follow up. Seventeen East Greenlandic patients with bilateral chronic suppurative otitis media or chronic otitis media were selected. Their median age was 16 years; 53 per cent were female and 47 per cent male. Hearing was assessed using median air conduction pure tone average gain, and the 'take rate' (i.e. the percentage of total ears with a closed perforation) was evaluated. RESULTS: All patients attended for follow up. Eighty-two per cent had at least one perforation closed, and the overall take rate was 65 per cent of the 34 ears. The median air conduction pure tone average gain after two years was 18 dB and 13 dB for the right and left ears, respectively. Fourteen patients (82 per cent) obtained an air conduction pure tone average hearing level of < or =25 dB in at least one ear. In total, 71 per cent of the patients were satisfied. There were no hearing hazards. CONCLUSIONS: The results of mobile, one stage, bilateral ear surgery conducted in Greenland for long-lasting chronic suppurative otitis media and chronic otitis media were acceptable and safe, and more ears underwent surgery at reduced cost compared with unilateral ear surgery.

Chronic pain following Caesarean section.

BACKGROUND: Chronic postoperative pain is a well-recognized problem after various types of surgery such as amputation, thoracotomy, mastectomy, gallbladder surgery and inguinal hernia repair. However, little is known about chronic pain after gynaecologic surgery. Therefore, the aim was to study the incidence of chronic pain after Caesarean section. METHODS: A questionnaire was sent in February/March 2003 to 244 consecutive patients who underwent Caesarean section in a one-year period from 1 October 2001 to 30 September 2002. Patients were asked about duration of postoperative abdominal scar pain, and if pain was still present to describe the frequency and intensity of pain and its impact on daily life. The questionnaire also included questions about the Caesarean section and about pain problems elsewhere. RESULTS: A total of 220 patients (90.2%) answered the questionnaire. The mean follow-up time was 10.2 months (range 6-17.6). Postoperative pain resolved in most patients within 3 months but 27 patients (12.3%) still had pain at the time of the interview. No patients had constant pain, but in 13 of 27 patients (5.9%) pain was present daily or almost daily. Patients with persistent pain (n = 27) had more often undergone general than spinal anaesthesia for the Caesarean section. Frequencies of pain problems elsewhere and recalls of severe acute postoperative pain were also higher among patients with persistent pain. CONCLUSION: Chronic pain after Caesarean section seems to be a significant problem in at least 5.9% of patients.

[What do we know about the extent of violence against women in Denmark?]. / Hvad ved vi om omfanget af vold mod kvinder i Danmark?

At present, figures about the prevalence of violence against women in Denmark are based upon regional studies from emergency departments and national surveys that included a few questions about violence. In 1995/96, 0.2% of women aged 16-74 reported to have been exposed to domestic violence during the last 12 months, the highest rate was among single mothers, 3.4%. In 1991, 3% of women above the age of 15 reported to have ever been victims of rape, 7% among 15-24 year-olds. In the period 1978-1994, between 1.4 and 4.5 permille of all emergency contacts were female victims of violence. The incidence was 1.6-3.5 per 1000 women, highest in the Copenhagen area and in the western part of Denmark. In other Nordic countries, national surveys have focused upon gender-based violence, and report a higher prevalence of violence than in the less focused Danish studies. Furthermore, these studies contain information about the health sequels of violence. There is an urgent need for similar data including risk factors of violence in Denmark in order to prevent violence and the health consequences of violence against women.

The effect of different storage methods on the mechanical properties of trabecular bone.

The effect of different storage methods on the elastic and viscoelastic properties of trabecular bone was examined using non-destructive compression tests to 0.45% specimen strain. There was a 10% decrease in stiffness during the first 24 h post mortem. Storage by freezing or in ethanol for 100 d did not change the stiffness, and neither did several thawing, testing and refreezing sequences. The viscoelastic properties were more sensitive to storage and showed significant although small changes during 100 d of storage. The effect of defatting the specimens was a 30% increase in stiffness and a 50% decrease in viscoelastic energy dissipation.

[Botulism in Ammassalik]. / Botulisme i Ammassalik.

Botulism is a rare and serious form of food poisoning and was diagnosed for the first time in the East Coast of Greenland. Historical reports suggest that outbreaks of this condition have occurred previously in this region. In 1990, however, the presence of Clostridium botulinum type E could be confirmed with certainty. Eight individuals partook of a meal which consisted of raw seal meat and raw seal intestines. Four of these developed symptoms of botulism and two of these required assisted ventilation. On the basis of this experience, the medical officers of health in Greenland recommend that all hospitals in Greenland should maintain a supply of antitoxin.

Death caused by orphenadine poisoning.

The number of deaths as a consequence of orphenadine poisoning seems to increase, mostly among severely psychotic males. The lethal dose corresponds to the weekly average dose used in the treatment of neuroleptic extrapyramidal side effects. Based on the literature, the serious, rapidly incipient, cardiac, and neurologic symptoms of poisoning are emphasized. The handing out of orphenadine to suicidal persons must be restricted, and even small overdoses (1-2 g) ought to result in the immediate initiation of observation at an intensive care unit.

Dihydrothiamine-like substances as experimental artefacts.

Experimental controls have shown that the dihydrothiamine-like substance previously reported as isolated from animal tissues was an artefact. In addition, no evidence is found for the reduction of thiamine by NADH.