Regional Hospital Discharge Registry Research Articles

Serum vitamin D deficiency and risk of hospitalization for heart failure: Prospective results from the Moli-sani study

Background and aimsEvidence indicates that Vitamin D deficiency may be associated with increased risk of cardiovascular disease, although findings on risk of heart failure (HF) are controversial. We investigated the relationship between serum Vitamin D and the incidence of hospitalization for HF in a large prospective cohort of Italian adults. Methods and results19,092 (49% men, age range 35–99 years) HF-free individuals from the Moli-sani study, with complete data on serum Vitamin D (25-hydroxyvitamin) levels and incident hospitalized HF, were analysed. The cohort was followed up for a median of 6.2 years. Baseline serum Vitamin D levels were categorized in deficient (<10 ng/mL), insufficient (10–29 ng/mL), and normal (≥30 ng/mL) Incident cases of hospitalization for HF were identified by linkage with the regional hospital discharge registry. Hazard ratios (HRs) were calculated using Cox-proportional hazard models. The prevalence of normal, insufficient or deficient levels of Vitamin D was 12.2%, 79.6% and 8.2%, respectively. During follow-up, 562 admissions to hospital for HF were identified. The incidence of HF was 1.6%, 2.9% and 5.3%, respectively in subjects with normal, insufficient and deficient levels of Vitamin D. After multivariable analysis, individuals with deficiency of Vitamin D had a higher risk of hospitalization for HF (HR: 1.61, 95%CI: 1.06–2.43) than those with normal levels. Further adjustment for subclinical inflammation did not substantially change the association between Vitamin D deficiency and HF. ConclusionDeficiency of Vitamin D was associated, independently of known HF risk factors, with an increased risk of hospitalization for HF in an Italian adult population.

Comment on "Incidence of Type 1 Diabetes among Children and Adolescents in Italy between 2009 and 2013: The Role of a Regional Childhood Diabetes Registry".

Background. Surveillance represents a key strategy to control type 1 diabetes mellitus (T1DM). In Italy, national data are missing. This study aimed at evaluating the incidence of T1DM in subjects <18 year olds in Apulia (a large southeastern region, about 4,000,000 inhabitants) and assessing the sensitivity of the regional Registry of Childhood-Onset Diabetes (RCOD) in the 2009–2013 period. Methods. We performed a retrospective study matching records from regional Hospital Discharge Registry (HDR), User Fee Exempt Registry (UFER), and Drugs Prescription Registry (DPR) and calculated T1DM incidence; completeness of each data source was also estimated. In order to assess the RCOD sensitivity we compared cases from the registry to those extracted from HDR-UFER-DPR matching. Results. During 2009–2013, a total of 917 cases (about 184/year) in at least one of the three sources and an annual incidence of 25.2 per 100,000 were recorded, lower in infant, increasing with age and peaked in 5- to 9-year-olds. The completeness of DPR was 78.7%, higher than that of UFER (64.3%) and of HDR (59.6%). The RCOD’s sensitivity was 39.05% (360/922; 95% CI: 34.01%–44.09%). Conclusions. Apulia appeared as a high-incidence region. A full, active involvement of physicians working in paediatric diabetes clinics would be desirable to improve the RCOD performance.

Incidence of Type 1 Diabetes among Children and Adolescents in Italy between 2009 and 2013: The Role of a Regional Childhood Diabetes Registry.

Background. Surveillance represents a key strategy to control type 1 diabetes mellitus (T1DM). In Italy, national data are missing. This study aimed at evaluating the incidence of T1DM in subjects <18 year olds in Apulia (a large southeastern region, about 4,000,000 inhabitants) and assessing the sensitivity of the regional Registry of Childhood-Onset Diabetes (RCOD) in the 2009–2013 period. Methods. We performed a retrospective study matching records from regional Hospital Discharge Registry (HDR), User Fee Exempt Registry (UFER), and Drugs Prescription Registry (DPR) and calculated T1DM incidence; completeness of each data source was also estimated. In order to assess the RCOD sensitivity we compared cases from the registry to those extracted from HDR-UFER-DPR matching. Results. During 2009–2013, a total of 917 cases (about 184/year) in at least one of the three sources and an annual incidence of 25.2 per 100,000 were recorded, lower in infant, increasing with age and peaked in 5- to 9-year-olds. The completeness of DPR was 78.7%, higher than that of UFER (64.3%) and of HDR (59.6%). The RCOD's sensitivity was 39.05% (360/922; 95% CI: 34.01%–44.09%). Conclusions. Apulia appeared as a high-incidence region. A full, active involvement of physicians working in paediatric diabetes clinics would be desirable to improve the RCOD performance.

Further efforts in the achievement of congenital rubella syndrome/rubella elimination

The Italian National Plan of Measles and Rubella Elimination 2010–2015 has deferred the objective to reduce congenital rubella syndrome (CRS) to <1 case per 100 000 live births to 2015 and has highlighted the need to reduce to <5% susceptibility to rubella among women in childbearing-age. In Puglia region, MMR vaccine coverage is 93% in newborns (cohort 2010; one dose), 85% in children 5–6 years old and 77% in adolescents (cohort 2005 and 1997, respectively; two doses). Combining available seroepidemiological data and results of a survey on the attitude towards rubella vaccination and rubella testing before pregnancy, we could estimate that 5.7% of Apulian women in childbearing-age are currently susceptible to rubella infection. The regional infectious disease routine notification system reported no cases of CRS and rubella in pregnancy in 2001–2010 period. The inconsistency among the mentioned data triggered the evaluation of the reliability of disease reporting. We performed a retrospective case-finding for the years 2003–2011. We scanned the regional hospital discharge registry to identify hospitalizations for rubella in pregnancy and CRS and retrieve individual records. We also searched for clinical history of CRS mothers in the delivery assistance certificate registry. We identified one CRS, two confirmed and four suspected congenital infections, and seven cases of rubella in pregnancy. Passive surveillance of CRS and rubella in pregnancy appears not to be reliable in the light of strengthening rubella elimination strategies.

A population based study of hospitalised seriously injured in a region of Northern Italy

BackgroundInjury is a public health problem in terms of mortality, morbidity and disability. The implementation of a regionalised trauma system has been proved to significantly reduce the social impact of severe trauma on population. A population-based registry may be useful to obtain reliable epidemiologic data.AimTo perform an exhaustive analysis of severe trauma patients hospitalised in Lombardia, a region of northern Italy.Materials and methodsThe regional Hospital Discharge Registry (HDR) was used to retrieve data of all patients who suffered from serious injuries from 2008 to 2010. ICD9-CM codes of discharge diagnoses were analysed and patients coded from 800.0 to 939.9 or from 950.0 to 959.9 have been retrieved. Femur fractures in elderly and patients with length of hospital stay less than 2 days were excluded. Patients have been considered seriously injured if discharged dead or any of followings: admission or transit in ICU, need of mechanical ventilation, tracheotomy, invasive hemodynamic monitoring. Average reimbursement based on DRG has been evaluated.StatisticsStudent’s t test, ANOVA for continuous data, chi-square test for categorical data were used, and a p value less than 0.05 was considered significant.ResultsThe severely injured patients hospitalised in Lombardia in three years were 11704, 391 per million per year. Overall mortality was 24.17% and increased with age. Males aging from 18 to 64 years had more occupational injuries, trauma on the road and violence by others. Females were more susceptible to domestic injuries and self inflicted violence, mostly in older ages. Acute mortality was higher after traffic accidents, while late mortality was increased in domestic trauma. Pediatric cases were unusual. A significant increase (+10.18%) in domestic trauma, with a concomitant decrease (-17.76%) in road-related accidents was observed in the three years study period. Reimbursement paid to hospitals for seriously injured was insufficient with regard to estimated costs of care.ConclusionSerious injury requiring hospitalisation in Lombardia is still an healthcare problem, with a trend toward a decrease of traffic accidents, increase in domestic trauma and involvement of older people. These results may help to plan a new regionalised Trauma System.

Thirty-day complications after laparoscopic or open cholecystectomy: a population-based cohort study in Italy

ObjectiveThe objective of the study is to evaluate short-term complications after laparoscopic (LC) or open cholecystectomy (OC) in patients with gallstones by using linked hospital discharge data.DesignPopulation-based cohort study.SettingData were...

Impact of universal vaccination on the epidemiology of varicella in Veneto, Italy

In 2005, universal varicella vaccination was introduced in the Veneto region, Italy. We examined trends in varicella incidence and hospitalization rates before and after vaccine introduction, and applied statistical models to assess vaccine effectiveness. Varicella incidence rates for 2000-2008 were calculated from the mandatory regional surveillance data and from a special surveillance system based on reports from a sample of family pediatricians that during the study period followed more than 40,000 children. To evaluate hospital admission rates, we analyzed the regional hospital discharge registry. The vaccine coverage rate was 6.8% in the 2004 birth-cohort and 78.6% in the 2008 cohort. Varicella incidence in 0-14 year-olds was 6136.8/100,000 person-years in 2000 and 4004.8 in 2008; hospitalization rates were 18.7 and 8.4. Incidence rates significantly decreased 2.5 years after beginning the universal vaccination, while hospitalization rates showed a significant decrease one year earlier. There was a remarkable decline of both varicella incidence and hospitalizations especially in 1-4 year-old children. This study confirms the positive impact of universal vaccination.

The risk of cholecystitis in patients with cancer and the general population in a population-based cohort study in Western Denmark, 1995–2003

20598 Background: Little information is available on the risk of cholecystitis among patients with cancer. Methods: We conducted a population-based retrospective cohort study of 51,350 patients with incident cancer, identified in medical databases of Western Denmark between 1995 and 2003. A general population comparison cohort of 513,500 persons frequency-matched on the age and sex distribution of the cancer cohort was assembled from the Danish Civil Registration System. The incidence of cholecystitis in the two cohorts was determined by linkage to the regional Hospital Discharge Registry covering all hospitals in the region. Results: We identified 230 incident diagnoses of cholecystitis in our cancer cohort during 130,628 person-years of follow-up, corresponding to an incidence rate of 1.8/1000 person-years. After adjustment for potential confounders, the adjusted relative risk (aRR) for cholecystitis among cancer patients compared with the general population cohort was 1.38 (95% confidence interval (CI) 1.20–1.58). Overall, the aRR for cholecystitis was doubled during the first six months after cancer diagnosis (aRR=1.95, 95% CI 1.50–2.54), at which point the aRR declined but remained greater than 1 throughout the rest of the follow-up period (aRR=1.23, 95% CI 1.05–1.45). Age-specific adjusted RRs ranged from 1.44 to 2.11 among cancer patients up to 70 years of age but were only marginally increased in cancer patients aged greater than 70 years. There were no major differences in aRRs between metastatic and non-metastatic cancer patients. Pancreatic cancer (aRR=6.71, 95% CI 3.82–11.76), thyroid cancer (aRR=3.83, 95% CI 1.60–9.22), and colorectal cancer (aRR=2.06, 95% CI 1.33–3.20) conferred the highest adjusted relative risks for subsequent cholecystitis. Conclusions: Cholecystitis occurs more often in cancer patients than in the general population. Pancreatic, thyroid and colorectal cancer seem to confer an especially high relative risk for subsequent cholecystitis, particularly during the first six months following diagnosis and among younger patients. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen Inc. Amgen Inc.

Traffic-Related Air Pollution in Relation to Incidence and Prognosis of Coronary Heart Disease

Long-term air pollution exposure is associated with increased mortality, but the association with incidence of fatal and nonfatal coronary heart disease is less certain. Moreover, it is unknown how chronic exposure to air pollution affects prognosis among survivors of a first coronary event. This study evaluated the association between long-term traffic-related air pollution exposure and incidence of nonfatal and fatal coronary events, as well as subsequent hospital readmission and mortality among myocardial infarction survivors. The study population comprised all residents of Rome aged 35-84 years during the period 1998-2000. Residential nitrogen dioxide (NO2) exposure as a marker of traffic pollution was assessed by a land-use regression model in 1995-1996 (R = 0.69). A total of 11,167 incident coronary events were observed (4654 fatal, including 3598 out-of-hospital coronary deaths, and 6513 nonfatal). The cohort of 6513 survivors was followed 4.0-7.5 years for readmission or mortality, starting 28 days from the date of first event. Relative risks per 10 mug/m of NO2 exposure, adjusted for age, sex, and socioeconomic status, were calculated by Poisson regression (population-based incidence) and Cox regression (cohort analysis). The relative risk for incidence in coronary events per 10 mug/m of NO2 was 1.03 (95% confidence interval = 1.00-1.07). Stronger associations were found for fatal cases (1.07; 1.02-1.12) and out-of-hospital deaths (1.08; 1.02-1.13). Using NO2 exposure at the time of the first event, there was no association of air pollution exposure with either subsequent hospital readmission or mortality among survivors of the first coronary event. Long-term air pollution exposure increases the risk of coronary heart disease, particularly fatal events. Hospital readmission or subsequent mortality among survivors was not associated with traffic air pollution.

Effect Modifiers of the Association Between Air Pollution and Cardiac Readmissions Among Survivors of First Myocardial Infarction

SM4-PD-16 Introduction: A recent study found that, among survivors of a first myocardial infarction, elevated levels of ambient air pollution are associated with increased hospital admissions for cardiac causes. Whether this association occurs uniformly in this group or is modified by other factors is unknown. We analyzed effect modification by gender, area-based socioeconomic status, and chronic comorbidities in a cohort of myocardial infarction survivors with index event in the period 1998 to 2000 and follow-up through the end of 2004. Methods: Hospitalization data were obtained from the regional Hospital Discharge Registry. Persons (aged 35+ years) admitted to the hospital for a first acute myocardial infarction were included in the cohort if they survived for at least 28 days (N = 7382). They were followed up from the 29th day until death, first readmission for a cardiac cause (new myocardial infarction, angina, dysrhythmia, or heart failure), or end of study. Vital status was ascertained and hospital readmissions identified via record linkage. Daily air pollution exposures were calculated as the means from several monitors measuring PM10 and from single monitors for ozone (urban background level, daily maximum 8-hour average, only during summer months) and particle number counts (representing ultrafine particles, estimated for 1998 to March 2001 from other pollutants and meteorologic measurements). Poisson models were applied to stratified datasets, adjusting for trend, temperature, day of week, and holidays. Relative risks were calculated for an increase of one interquartile range of the respective pollutant (PM10 22.03 μg/m3, ozone 39.11 μg/m3, ultrafines 28,350/cm3) for various lags. Results reported are for the mean of lags 0 and 1. Results: Among 5160 men and 2222 women who survived a first myocardial infarction, 1675 and 719, respectively, were subsequently hospitalized for a cardiac cause. The overall relative risk (RR) for ultrafine particles was 1.090 (95% CI, 1.005–1.181), for PM10: 1.039 (95% CI, 0.987–1.094), and for ozone: 1.089 (95% CI, 0.994–1.193). No evidence was found to indicate that area-based socioeconomic status modified these effects. However, gender was an effect modifier (eg, ultrafines, men's RR = 1.045; 95% CI, 0.952–1.148, women's RR = 1.196; 95% CI, 1.058–1.352). There was convincing evidence that diabetes modified the effects of particles (eg, ultrafines, RR = 1.260; 95% CI, 1.107–1.434) versus RR = 1.037 (95% CI, 0.947–1.136) and that chronic obstructive pulmonary disease modified the effect of ozone. Discussion and Conclusions: Various characteristics of post-infarction patients may make them more susceptible to another hospital admission for cardiac causes. These characteristics include gender and comorbidity. In particular, diabetics experience a greater effect of particulate air pollution than other myocardial infarction survivors.

Fracture risk in patients with monoclonal gammopathy of undetermined significance

Little information is available on the risk of fractures in patients with monoclonal gammopathy of undetermined significance (MGUS). We identified 1535 patients with MGUS between 1978 and 2003 in North Jutland County, Denmark. The population control group consisted of 15 350 persons selected from the Danish Central Population Registry, matched by age and sex. Data on fractures in the two groups were obtained from the regional Hospital Discharge Registry. In the MGUS cohort, 187 first-time fractures were identified during 9754 person-years of follow-up, corresponding to an incidence rate of 19/1000 person-years. The adjusted relative risk for fractures among MGUS patients compared with population controls was 1.4 [95% confidence interval (CI), 1.2-1.6]. After 5 years of follow-up, the risk difference was 1.8% (95% CI, 0.5-3.0). Six of the 187 MGUS patients with fractures were later diagnosed with malignant transformation. Relative risks for fractures were increased in IgG-type MGUS [1.3 (95% CI,1.1-1.6)], IgM-type MGUS [1.6 (95% CI, 1.1-2.2)] and MGUS with kappa light chain [1.4 (95% CI, 1.1-1.7)]. MGUS patients had an increased risk of fractures, which could not be explained by comorbidity, advanced age, gender or malignant transformation.

Can hospital discharge diagnoses be used for surveillance of surgical-site infections?

The aim of this study was to assess the data quality of postoperative infections in a hospital discharge registry in the Emilia-Romagna region of Italy. Data from a prospective regional study of postoperative infections in 6158 patients from 31 of the 36 public hospitals of the region were compared with data from the regional hospital discharge registry, using different classes of ICD-9-CM codes. The sensitivity of the hospital discharge database for postoperative surgical infections was 10% when ICD-9-CM codes directly indicative of postoperative infectious complications were used. When non-specific codes of postoperative complications, not necessarily of infectious origin, were added, the sensitivity reached 21%. At present, the hospital discharge registry is not suited for surveillance of hospital-acquired infection.

Pregnancy outcome after suicide attempt by drug use: a Danish population-based study.

It is important to study the side-effects of drugs taken during pregnancy, however the findings are difficult to interpret because of a low exposure level, uncertainty of actual drug consumption and confounding by indication. Experience from accidental or intended drug intoxications may bypass some of these methodological shortcomings. Our aim was to examine reproductive failures and child health following a single drug overdose taken prior to or during pregnancy. Women diagnosed with a drug intoxication during pregnancy were identified in the Regional Hospital Discharge Registry of North, Jutland from 1977 to 1999 by linkage of diagnoses for abortion and delivery with diagnoses for intoxication. Hospital medical records were reviewed to obtain data on drug use, dosage, and pregnancy outcome (legally induced abortion/miscarriages/data on birth outcome). The hospitalization history of the children was followed for a mean of 9 years with a maximum of 20 years. Of 122 women studied, 44 wanted an elective abortion, 17 experienced miscarriage, and 61, exposed mainly to weak analgesics and psychotropic drugs, gave birth to 62 infants. We estimated the proportion of miscarriage to be almost doubled, whereas there was no increased risk of congenital abnormalities or prematurity in women exposed to a drug overdose compared with the background population. A drug overdose shortly before or during pregnancy seems to be associated with a substantially increased risk of miscarriage, but there was no increase in fetal pathology at birth among fetuses surviving till birth.

Pregnancy outcome after suicide attempt by drug use: a Danish population-based study

Background. It is important to study the side-effects of drugs taken during pregnancy, however the findings are difficult to interpret because of a low exposure level, uncertainty of actual drug consumption and confounding by indication. Experience from accidental or intended drug intoxications may bypass some of these methodological shortcomings. Our aim was to examine reproductive failures and child health following a single drug overdose taken prior to or during pregnancy. Methods. Women diagnosed with a drug intoxication during pregnancy were identified in the Regional Hospital Discharge Registry of North, Jutland from 1977 to 1999 by linkage of diagnoses for abortion and delivery with diagnoses for intoxication. Hospital medical records were reviewed to obtain data on drug use, dosage, and pregnancy outcome (legally induced abortion/miscarriages/data on birth outcome). The hospitalization history of the children was followed for a mean of 9 years with a maximum of 20 years. Results. Of 122 women studied, 44 wanted an elective abortion, 17 experienced miscarriage, and 61, exposed mainly to weak analgesics and psychotropic drugs, gave birth to 62 infants. We estimated the proportion of miscarriage to be almost doubled, whereas there was no increased risk of congenital abnormalities or prematurity in women exposed to a drug overdose compared with the background population. Conclusions. A drug overdose shortly before or during pregnancy seems to be associated with a substantially increased risk of miscarriage, but there was no increase in fetal pathology at birth among fetuses surviving till birth.

Smoking, sex of the offspring, and risk of placental abruption, placenta previa, and preeclampsia: a population-based cohort study.

: Placental abruption, placenta previa, and preeclampsia are serious pregnancy complications with an increased risk of perinatal death. Smoking during pregnancy is associated with increased risk of abruption and placenta previa, and it reduces the risk of preeclampsia. We examined the association between mothers' smoking habits during pregnancy, taking the sex of the offspring into consideration, and the risk and prognosis of placental abruption, placenta previa, and preeclampsia : We conducted the study in the County of North Jutland, Denmark. Using the 10-digit personal identification number given to every Danish citizen at birth, we linked data from the Danish Medical Birth Registry, including information on mother and child, to data from the Pharmaco-Epidemiological Prescription Database with data on all reimbursed prescriptions to use selected drugs as a proxy measure for some maternal diseases, and data from the Regional Hospital Discharge Registry, including the discharge diagnoses. Among 47,932 singleton births we included only births for which we had information about the mothers' smoking habits, leaving 46,313 births for analysis. : Smoking was associated with the risk of placental abruption (OR=1.99 (95% CI 1.72-2.30)) and placenta previa (OR=1.88 (95% CI 1.15-3.07)). Smoking was inversely associated with the risk of preeclampsia (OR=0.55 (95% CI 0.48-0.62)). After stratification for the sex of the offspring the risk estimate of smoking as risk factor for placenta previa decreased for male fetuses (OR=1.63 (95% CI 0.75-3.51)) and increased for female fetuses (OR=4.82 (95% CI 1.69-13.75)). : Female fetuses are more vulnerable than male to the negative effect of maternal smoking on placenta previa.

Birth outcomes in pregnant women treated with low-molecular-weight heparin

Pregnancy and puerperium are associated with an increased risk of venous thromboembolism. Low-molecular-weight heparin is the anticoagulant of choice in pregnant women because, unlike warfarin, it does not cross the placenta. However, there are limited data on the risk of adverse birth outcomes following use of low-molecular-weight heparin in pregnancy. We performed a population-based cohort study to examine the safety of low-molecular-weight heparin use in pregnancy using data from the Pharmacoepidemiological Prescription Database, The Danish Medical Birth Registry and the Regional Hospital Discharge Registry in North Jutland County, Denmark. The birth outcomes in a cohort of 66 pregnant women treated with low-molecular-weight heparin between 1991-98 were compared with the birth outcomes of 17,259 pregnant women who did not receive any prescriptive drugs during pregnancy. No increased risk of malformations, low birth weight or stillbirth was found. However, an increased risk of pre-term delivery was found (odds ratio: 2.11, 95%, confidence interval: 0.96-4.65), which could reflect inherited thrombophilia as an indication of low-molecular-weight heparin. We have provided additional evidence of the safety of low-molecular-weight heparin use in pregnancy.

A follow-up study of birth outcome in users of pivampicillin during pregnancy

Pivampicillin is a prodrug which is widely used in Scandinavian countries for oral antibiotic therapy. The pivaloyl moiety has a carnitine depleting effect, which has caused doubts about the safety of administering pivampicillin during pregnancy. The aim of the study was to evaluate the risk of congenital malformations in general, preterm delivery and low birth weight in users of pivampicillin. Seven hundred and ninety-one women who had redeemed a prescription of pivampicillin during their first pregnancy from 1 January 1991 to 31 December 1996 were identified in the North Jutland Pharmaco-Epidemiological Prescription Database. By linkage to the Danish Medical Birth Registry and Regional Hospital Discharge Registry we compared their birth outcomes (malformations, preterm delivery and low birth weight) with the outcomes in 7472 reference pregnancies on which the mother had not redeemed any prescription at all during pregnancy. The prevalence of malformations was 5.5% (11 cases) in offspring of 199 women who had used pivampicillin during the first trimester, and 5.6% (420 cases) in offspring of controls (OR: 0.95, 95% CI: 0.51-1.76). Furthermore, we did not find any significant risk of preterm delivery (OR: 0.75, 95% CI: 0.54-1.05) or low birth weight (OR: 0.93, 95% CI: 0.55-1.57). This study showed no increased risk of congenital malformations, preterm delivery or low birth weight in offspring of women who had redeemed a prescription for pivampicillin during pregnancy.

Birth outcomes in women exposed to anticonvulsant drugs.

To examine the risk of malformations and fetal growth in women treated with anticonvulsant drugs in North Jutland County, Denmark. All women treated with anticonvulsant drugs in the county were identified in a Pharmaco-Epidemiological Prescription Database and linked to the Danish Medical Birth Registry and the Regional Hospital Discharge Registry. We identified 235 pregnancies exposed to anticonvulsants around conception and/or during pregnancy as well as 17,259 unexposed pregnancies where the mother had not received any prescription. There was 1 case of neural tube defect among 15 malformations in the exposed cohort. The overall risk of malformations was 2.2 (95% confidence intervals 1.3-3.8). The risk of low birth weight and preterm delivery was 1.5 (95% confidence intervals 0.6-3.7) and 1.6 (95% confidence intervals 1.0-2.5), respectively. We found an increased risk of congenital malformations and a tendency to growth retardation in children of women exposed to anticonvulsants.

Trend in incidence and case fatality of meningococcal disease over 16 years in Northern Denmark.

The incidence and case fatality rates of meningococcal disease were assessed in the county of Northern Jutland, Denmark, during the 16-year period from 1980 to 1995. A total of 320 patients were identified from the Meningococcal Research Database, which comprises information from the following sources: (i) the Department of Public Health, to whom notification of meningococcal disease is obligatory; (ii) the Regional Hospital Discharge Registry; and (iii) the register of the regional department of clinical microbiology. In order to assess prognostic indicators assessable at admission, information was collected for each patient from hospital records regarding contacts, symptoms and signs on arrival, laboratory data, and course of disease. The mean incidence was 4.3 cases per 100000 persons per year (range, 2.7-7.7). The incidence increased slightly during the period studied. Overall, the case fatality rate was 9.7%, with a significant rise occurring during the period (P=0.016) and a peak occurring in 1992. Advanced age (> or = 50 years), seizures, impaired consciousness, and skin bleeding on arrival at hospital were predictors of death.

Drug use in pregnancy in the county of North Jutland – preliminary analyses based on 6142 pregnancies

This paper comprises results of preliminary analyses from the North Jutland Prescription Database regarding drug consumption among pregnant women. study was conducted in the County of North Jutland (487,000 inhabitants) based on two computerized information systems: the Regional Hospital Discharge Registry and the National Health Service (NHS) described in detail in the paper The Pharmacoepidemiologic Prescription Database of North Jutland. From the Regional Hospital Discharge Registry we identified all women who had given birth in the County in 1994 including date of admission to hospital for giving birth and pregnancy outcome, e.g., induced abortion, preterm or term delivery. For technical reasons we could only use the date of admission to hospital for delivery as time of birth in this pilot study. For all pregnancies time-windows around time of birth were calculated. For preterm and term deliveries, pregnancies were assumed to be of 250 and 280 days of duration, respectively. It was assumed that the date of admission to hospital was nearly equal to the date of delivery. time-windows were calculated as follows: