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BMJ No 7121 Volume 315 Papers - Abstracts Saturday 6 December 1997
Relation of smoking and alcohol and coffee consumption to active
Helicobacter pylori infection: cross sectional study Relation of smoking and alcohol and coffee consumption to active Helicobacter pylori infection: cross sectional studyHermann Brenner, Dietrich Rothenbacher, Günter Bode, Guido Adler See Editorial by Jenkins, p 1481 AbstractObjective: To assess the relation of smoking and alcohol and coffee consumption to active Helicobacter pylori infection.Design: Cross sectional study of patients attending a general practitioner. Active H pylori infection was measured by the 13C-urea breath test and detailed quantitative information on smoking and on alcohol and coffee consumption was obtained by a standardised self administered questionnaire. Setting: One general practice in Germany. Subjects: 447 patients aged 15-79 who had not had peptic ulcer disease or treatment for H pylori infection. Main outcome measures: Prevalence of H pylori infection according to smoking and alcohol and coffee consumption. Results: Overall prevalence of infection was 21% (94/447). There was no significant relation between smoking and active H pylori infection. Alcohol consumption showed a negative dose-response relation and coffee consumption a positive dose-response relation with active infection. After adjustment for potential confounders, the odds ratios for patients who drank |LZ75 g and g75 g of ethanol a week compared with non-drinkers were 0.90 (95% confidence interval 0.55 to 1.59) and 0.33 (0.16 to 0.68), respectively (P value for trend 0.005, assuming that 1 litre of beer and 0.5 l of wine contain on average 50 g of ethanol in south Germany). Adjusted odds ratios for patients who drank <3 cups and |LX3 cups of coffee per day compared with those who did not drink coffee were 1.49 (0.71 to 3.12) and 2.49 (1.23 to 5.03), respectively (P value for trend 0.007). Conclusion: These results suggest a protective effect of alcohol consumption against active infection with H pylori and an opposite effect of coffee consumption.
Departments
of Epidemiology and of Internal Medicine I, Correspondence to: Dr Brenner
Impact of surgery for stress incontinence on morbidity: cohort studyNick Black, Joanne Griffiths, Catherine Pope, Ann Bowling, Paul Abel
AbstractObjectives: To describe the impact of surgery for stress incontinence on the severity of symptoms, other mental and physical symptoms, and overall health. To describe the incidence of postoperative complications.Design: Prospective cohort study; questionnaires completed by patients before and 3, 6, and 12 months after surgery. Questionnaires completed by surgeons both before and after surgery. Setting: 18 hospitals in the North Thames region. Subjects: 442 women treated surgically for stress incontinence between January 1993 and June 1994. 367 women returned the 3 month questionnaire; 364 returned the 6 month questionnaire; and 359 returned the 12 month questionnaire. 49 surgeons provided perioperative information on 285 of the 442 women and postoperative information on 278. Main outcome measures: Stress incontinence symptom severity index, other urinary symptoms, bowel function, mental health, complications, global measures. Results: Most women (288; 87%) reported an improvement in the severity of their stress incontinence, though only 92 (28%) were cured (continent). These improvements persisted for at least 12 months. The likelihood of improvement was similar regardless of whether urodynamic pressure studies had been conducted before surgery. Following surgery, women were less likely to suffer from urinary frequency, nocturia, postvoid fullness, dysuria, and urgency. While mental health improved for 194 (71%), a quarter of women reported deterioration. Only 37 (10%) were satisfied with postoperative pain control. A third experienced one or more complications while in hospital, most commonly difficulty urinating. This problem affected 1 in 11 women after discharge. A year after surgery two thirds of women reported feeling better (251; 72%), that the outcome met or exceeded their expectations (230; 66%), and that they would recommend the operation to a friend in a similar situation (239; 68%). Surgeons tended to be more optimistic about the effects of surgery; they were satisfied with the outcome in 176 (85%) cases and would again treat 245 (94%) of the women as they had done previously. Conclusions: Although surgery reduces the severity of stress incontinence it is not as effective as current textbooks suggest. Women considering surgery should be provided with more accurate information on the likelihood of an improvement in symptoms and the occurrence of complications, including postoperative pain. Urgency and urge incontinence should not be considered contraindications to surgery. The need for urodynamic assessment before surgery should be reappraised. Health Services Research Unit, Department of Surgery, Correspondence to: Professor Black email: n.black@lshtm.ac.uk Change in social status and risk of low birth weight in Denmark: population based cohort studyOlga Basso, Jørn Olsen, Anne Mette T Johansen, Kaare ChristensenAbstractObjective: To estimate the risk of having a low birth- weight infant associated with changes in social, environmental, and genetic factors.Design: Population based, historical cohort study using the Danish medical birth registry and Statistic Denmark's fertility database. Subjects: All women who had a low birthweight infant (<2500 g) (index birth) and a subsequent liveborn infant (outcome birth) in Denmark between 1980 and 1992 (exposed cohort, n=11 069) and a random sample of the population who gave birth to an infant weighing 2500 g or under and to a subsequent liveborn infant (unexposed cohort, n=10 211). Main outcome measures: Risk of having a low birthweight infant in the outcome birth as a function of changes in male partner, area of residence, type of job, and social status between the two births. Results: Women in the exposed cohort showed a high risk (18.5%) of having a subsequent low birthweight infant while women in the unexposed cohort had a risk of 2.8%. After adjustment for initial social status, a decline in social status increased the absolute risk of having a low birthweight infant by about 5% in both cohorts, though this was significant only in the unexposed cohort. Change of male partner did not modify the risk of low birth weight in either cohort. Conclusion: Having had a low birthweight infant and a decline in social status are strong risk factors for having a low birthweight infant subsequently. Danish Epidemiology Science Centre, Danish National Board of Health, Centre for Health and
Social Policy, Correspondence to: Dr Basso email: ob@soci.aau.dk Case-control study of oral contraceptives and risk of thromboembolic stroke: results from international study on oral contraceptives and health of young womenLothar A J Heinemann, Michael A Lewis, Margaret Thorogood, Walter O Spitzer, Irene Guggenmoos-Holzmann, Rudolf Bruppacher, and the Transnational Research Group on Oral Contraceptives and the Health of Young WomenAbstractObjective: To determine the influence of oral contraceptives (particularly those containing modern progestins) on the risk for ischaemic stroke in women aged 16-44 years.Design: Matched case-control study. Setting: 16 centres in the United Kingdom, Germany, France, Switzerland, and Austria. Subjects: Cases were 220 women aged 16-44 who had an incident ischaemic stroke. Controls were 775 women ( at least one hospital and one community control per case) unaffected by stroke who were matched with the corresponding case for 5 year age band and for hospital or community setting. Information on exposure and confounding variables were collected in a face to face interview. Main outcome measures: Odds ratios derived with stratified analyses and unconditional logistic regression to adjust for potential confounding. Results: Adjusted odds ratios (95% confidence intervals) for ischaemic stroke (unmatched analysis) were 4.4 (2.0 to 9.9), 3.4 ( 2.1 to 5.5), and 3.9 (2.3 to 6.6) for current use of first, second, and third generation oral contraceptives, respectively. The risk ratio for third versus second generation was 1.1 (0.7 to 2.0) and was similar in the United Kingdom and other European countries. The risk estimates were lower if blood pressure was checked before prescription. Conclusion: Although there is a small relative risk of occlusive stroke for women of reproductive age who currently use oral contraceptives, the attributable risk is very small because the incidence in this age range is very low. There is no difference between the risk of oral contraceptives of the third and second generation; only first generation oral contraceptives seem to be associated with a higher risk. This small increase in risk may be further reduced by efforts to control cardiovascular risk factors, particularly high blood pressure.
ZEG-Centre for
Epidemiology and Health Research Berlin, EPES Epidemiology Pharmaco-epidemiology and Systems
Research, Health Promotion Sciences Unit, Department of
Epidemiology and Biostatistics, Institute of Medical Statistics, University Basle, Correspondence to: Professor Heinemann The influence of patients' hopes of receiving a prescription on doctors' perceptions and the decision to prescribe: a questionnaire surveyNicky Britten, Obioha UkoumunneSee Editorial by Greenhalgh and Gill, p 1482
AbstractObjectives: To measure patients' expectations of receiving prescriptions and general practitioners' perceptions of these expectations and to determine the factors most closely associated with the decision to prescribe.Design: Questionnaires were completed by patients waiting to see their general practitioners, and by their doctors immediately after the consultations. Setting: Four non-fundholding group practices in southeast London. Subjects: 544 unselected patients consulting 15 general practitioners. Main outcome measures: Doctors' perceptions of patients' expectations; doctors' decisions to prescribe. Results: 67% (354/526) of patients hoped for a prescription; doctors perceived that 56% (305/542) of patients wanted prescriptions; and doctors wrote prescriptions in 59% (321/543) of consultations. Despite the close agreement between patients' hopes and doctors' perceptions, 25% (89/353) of patients hoped for a prescription but did not receive one. In 22% (68/313) of consultations in which prescriptions were written, they were not strictly indicated on purely medical grounds, and in only 66% (202/306) of consultations in which prescriptions were written were they both indicated and hoped for. Doctors' perceptions of patients' expectations were the strongest predictor of the decision to prescribe, but the final regression model also included patients' hopes and ethnic group, and the doctor's feeling of being pressurised. Conclusions: In an area of low prescribing and high expectations the decision to prescribe was closely related to actual and perceived expectations, but the latter was the more significant influence.
Department of General Practice, Correspondence to: Dr Britten email: n.britten@umds.ac.uk
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