In this study, we assessed the prevalence of self-rated post-traumatic stress in relation to reported trauma in an unselected primary care population. A total of 1,113 out of 1,378 consecutive attenders (response rate 81%) to 10 health centres completed the self-report instruments Impact of Event Scale (IES), and Post Traumatic Symptom Scale (PTSS-10). A horizontal visual analogue scale (VAS; 0-100 mm) resembling the EuroQoL (quality of life) health barometer was used for evaluating well-being. Trauma was reported by 325 attenders (29.2%) when applying DSM-IV trauma criteria. Prevalence of possible post-traumatic stress disorder (PTSD) was 6.5% (n=72) using cut-off scores of >35 for IES and >5 for PTSS-10. The two most common traumas in the PTSD group were accidents (2.0%, n=22), followed by cancer (1.3%, n=15). When excluding diseases and unspecified death as trauma, the rate of possible PTSD was 3.5% (n=39). Mean VAS-QoL score was 39.6 mm in the PTSD group (n=72), and 64.7 mm in the non-PTSD group with a reported trauma (n=253). In a multiple logistic regression analysis low self-rated well-being showed the strongest association with possible PTSD, followed by sexual assault, female gender, immigrant status and less than 2 years since trauma.
Objectives: Environmental factors might be of importance for the dramatically increasing incidence of osteoporotic fractures. Persistent organochlorine compounds (POCs) have, in animal studies, impaired normal bone metabolism and resulted in increased bone fragility. The goal of this study was to assess whether a high dietary intake of POCs through fatty fish from the Baltic Sea may result in an increased incidence of osteoporotic fractures. Methods: Fishermen and their wives from the Swedish east coast on the Baltic Sea (exposed) and west coasts (unexposed) constituted the study base. Information on vital status and hospitalization of persons with fractures from 1987 to 1996, classified according to the ninth revision of the International Classification of Diseases, was retrieved for 17,823 subjects through register linkages. The impact of coastal stretch on fracture incidence was assessed by Poisson regression models, with age and calendar year also being taken into account. Results: There was a significantly increased incidence rate ratio (IRR: 2.29, 95% confidence intervals (CI): 1.23-4.28) for vertebral fractures among east-coast women, and a similar, but non-significant, similar tendency in men (IRR 1.45, 95% CI 0.74-2.84). Such cohort differences were not seen for any other fracture type. Conclusions: The results give some indirect support for the notion that a high dietary intake of POCs through fatty fish from the Baltic Sea might be a risk factor for vertebral fractures, but it cannot be excluded that confounding from differences in smoking habits might explain part of the observed effects. To clarify this, detailed individual information on exposure and potential confounders has to be ascertained.
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