Staffan E. Norell

Perforating eye injury in the Stockholm population. An epidemiological study.

We studied the occurrence of perforating eye injury (PEI) during the period 1974–1979 in the population (1.5 million) of Stockholm county. Information was obtained from medical and population registries, medical records and personal interviews. PEI was almost 6 times more common in men than in women, and age specific incidence rates varied from 94.3 per million person years in young men (10–19 years) to 3.9 in elderly women (60–69 years). The risk appeared somewhat increased in the unmarried, but not in foreign citizens. Most injuries occurred during the day with no less than 54% between 10 a.m. and 4 p.m., and only 2% after 9 p.m. The most common activity at the time of injury was paid work (27%) followed by play or sport (23%), while 10% of the cases were due to fight or assault. Among those injuried in paid work, the most common occupation was construction worker or building metal worker. Metal and glass fragments were the most common perforating objects, but thorns from planted bushes caused many perforating injuries in children.

Monitoring Compliance with Pilocarpine Therapy

I used a recording medication monitor to obtain objective information on self-medication by date and hour from a group of 82 patients using pilocarpine three times daily to prevent visual loss from glaucoma. Doses meant to be taken during the day were missed more than twice as often as morning or evening doses. Of the missed doses, 272 (54%) were noon doses, but only 98 (19%) were morning doses. Medication compliance may be substantially improved by choosing a drug that needs to be taken less often than three times daily. The number of missed doses per day increases significantly during a 20-day period between clinic visits. This suggested that shorter intervals between clinic visits may improve adherence to the drug regimen prescribed.

Mortality and social class in Sweden--exploring a new epidemiological tool.

Total mortality, mortality from coronary heart disease (CHD), cerebrovascular disease, and other causes of death, were examined for three social groups and ten socio-economic groups in Sweden. The study included all subjects born in the country between 1896 and 1940 who were economically active in 1960—1.9 million men and 0.7 million women. Information on social and socio-economic status, and other social and demographic characteristics, was obtained from the 1960 Census. Information on cause-specific mortality during the period 1961-68 was obtained from a record linkage with the Cause of Death Registry. The analyses were based on 112469 deaths and 21 million person years at risk. Information on smoking habits was obtained from a sample of 55000 from the Census population. CHD mortality for women was high among manual workers, SMR=110 (95% confidence limits 104-117), and low among non-manual workers, SMR=84 (78-91). CNS-vascular mortality for women was also high among manual workers, SMR=107 (110-115), and low among non-manual workers, SMR=89 (82-97). Heavy smoking was more common among non-manual workers in both sexes, which may have contributed to a reverse social class gradient among men, with non-manual male workers being at higher risk for CHD than manual male workers. Farmers (and agricultural workers) generally had a low mortality. Other self-employed men and women had a high total mortality, a high mortality from CHD and CNS-vascular disease—and a high proportion of heavy smokers. There remain differences in mortality between social and socio-economic groups which cannot be explained by smoking habits, age, gender, urbanization, region of residence and marital status.

A MEDICATION MONITOR AND FLUORESCEIN TECHNIQUE DESIGNED TO STUDY MEDICATION BEHAVIOUR

Methods were developed to study medication behaviour, in order to obtain accurate and detailed information on the patterns of drug‐taking in medication with eye drops. A medication monitor was designed, which recorded the date and hour each time the medication bottle was opened. A fluorescein technique was designed to study the ability of patients to administer the eye drops into the conjunctival sac. Some problems in the measurement of medication behaviour are discussed. In a group of patients with open‐angle glaucoma, for whom pilocarpine eye drops three times daily had been prescribed, 18% of dose intervals had a duration of 12 h or more and 11% had a duration of 4 h or less. Fluorescein tests indicated that the patients were usually able to administer the eye drops correctly.

OESOPHAGEAL CANCER AND VULCANISATION WORK

A tenfold increased risk for oesophageal cancer, more often localised in the upper than in the lower third of the oesophagus, was found in a 13-year follow-up of vulcanisation workers. The risk for laryngeal cancer was also significantly raised. The study was based on a record linkage between the 1960 census and the cancer registry in Sweden. The rise in oesophageal cancer cannot be explained by alcohol consumption or other factors previously known to be associated with this disease.

Hospital care utilization in a 17,000 population sample: 5-year follow-up

The growing utilization of hospital care, especially of the services of Emergency Departments (ED), has been of great concern for many Western countries. The purpose of this study was to relate the amount of hospital care utilization to the frequency of ED visits. The study, based on a computerized medical information system, was carried out at Huddinge hospital which serves a suburban area of Stockholm, Sweden. ED visits were found to predict hospital care utilization in a 5-year follow-up of a 10% population sample. Persons who had made 2 or more ED visits during a period of 15 months before follow-up (less than 1/8 of the population sample) contributed 24% of all hospital outpatient visits, 29% of all hospital admissions and 31% of all hospital days during the 5-year follow-up period. The number of hospital outpatient visits per 100 personyears was more than 3 times higher among those who had 4 or more ED visits as compared to those who were non-visitors at the ED. Hospital admissions and days were 5 times higher. The utilization of medical specialties differed most in psychiatry, where those with 4 or more ED visits had nearly 17 times more admissions per 100 personyears than non-visitors. The difference increased gradually with increasing number of ED visits and was also evident in each age group. The mortality was also significantly increased for those with several ED visits. Higher migration in the latter group may besides indicate social instability.(ABSTRACT TRUNCATED AT 250 WORDS)