Search

A set of three teacher-prepared Learning Activity Packages (LAPs) in geometry, the units cover the topics of distance, lines, planes, separation; angles and triangles; and congruences. The units each include a rationale for the material, a list of behavioral objectives, a list of resources including texts (with reading assignments and problem sets specified) and tape recordings, a student self-evaluation sheet, suggestions for advanced study, and references. For other documents in this series, see SE 015 193, SE 015 194, SE 015 195, and SE 015 196. (DT)

A series of ten teacher-prepared Learning Activity Packages (LAPs) in advanced algebra and trigonometry, the units cover logic; absolute value, inequalities, exponents, and complex numbers; functions; higher degree equations and the derivative; the trigonometric function; graphs and applications of the trigonometric functions; sequences and series; permutations, combinations, and probability; descriptive statistics; and special theorems and functions. The units each contain a rationale for the material being covered; lists of behavioral objectives; a list of reading assignments, problem sets, tape recordings, and filmstrips that go with the unit; a student self-evaluation problem set, suggestions for advanced study, and references. For other documents in this series, see SE 015 193, SE 015 194, SE 015 195, and SE 015 197. (DT)

Background: Hyponatremia has recently been associated with subsequent cancer risk. This population-based nationwide study assessed whether the diagnosis of hyponatremia can predict a cancer diagnosis within most common cancers. Material and methods: Using Danish medical registries, we identified 16,220 patients with a first-time diagnosis of hyponatremia, without a cancer diagnosis, from January 2006 through November 2013. We quantified the relative risk of a subsequent cancer diagnosis by standardized incidence ratios (SIRs), comparing observed cancer incidence among patients diagnosed with hyponatremia to that expected, based on national cancer incidence during that period. Results: During 40,207 person-years of follow-up, we observed 1546 cancer diagnoses compared to 956 expected (SIR: 1.62; 95% confidence interval (CI), 1.54–1.70). The increase in risk of a cancer diagnosis following a hyponatremia diagnosis was most pronounced within 0–6 months of follow-up (SIR 4.16; 95% CI, 3.85–4.48) and in the younger age group; 0–29 years (SIR 8.71; 95% CI, 2.82–20.28), 30–49 years (SIR 3.16; 95% CI, 2.26–4.31), 50–69 years (SIR 2.29; 95% CI, 2.10–2.48) and 70 + years (SIR 1.35; 95% CI, 1.27–1.44). Within six months after a hyponatremia diagnosis, the SIRs increased 10-fold for cancers of the lung (SIR 17.14; 95% CI, 15.15–19.32), brain (SIR 13.52; 95% CI, 8.90–19.66) and liver (SIR 13.26; 95% CI, 7.57–21.53) and increased 5 to 10-fold for cancers of the pancreas (SIR 8.25; 95% CI, 5.72–11.53), esophagus (SIR 6.59; 95% CI, 3.15–12.12), kidney (SIR 6.36; 95% CI, 3.39–10.88), pharynx (SIR 6.15; 95% CI, 1.27–17.97) and non-Hodgkin lymphoma (SIR 6.10; 95% CI, 4.17–8.61). The rate increased across virtually all types of cancers, except melanoma and basal cell carcinomas. Conclusions: A diagnosis of hyponatremia may be a marker of occult neoplasms, especially cancers of the lung, brain, liver, pancreas, esophagus, kidney, pharynx and non-Hodgkin lymphoma. Hyponatremia may aid in early detection of cancer.

OBJECTIVE: To examine the risks of myocardial infarction, stroke (ischaemic and haemorrhagic), peripheral artery disease, venous thromboembolism, atrial fibrillation or atrial flutter, and heart failure in patients with migraine and in a general population comparison cohort.DESIGN: Nationwide, population based cohort study.SETTING: All Danish hospitals and hospital outpatient clinics from 1995 to 2013.PARTICIPANTS: 51 032 patients with migraine and 510 320 people from the general population matched on age, sex, and calendar year.MAIN OUTCOME MEASURES: Comorbidity adjusted hazard ratios of cardiovascular outcomes based on Cox regression analysis.RESULTS: Higher absolute risks were observed among patients with incident migraine than in the general population across most outcomes and follow-up periods. After 19 years of follow-up, the cumulative incidences per 1000 people for the migraine cohort compared with the general population were 25v17 for myocardial infarction, 45v25 for ischaemic stroke, 11v6 for haemorrhagic stroke, 13v11 for peripheral artery disease, 27v18 for venous thromboembolism, 47v34 for atrial fibrillation or atrial flutter, and 19v18 for heart failure. Correspondingly, migraine was positively associated with myocardial infarction (adjusted hazard ratio 1.49, 95% confidence interval 1.36 to 1.64), ischaemic stroke (2.26, 2.11 to 2.41), and haemorrhagic stroke (1.94, 1.68 to 2.23), as well as venous thromboembolism (1.59, 1.45 to 1.74) and atrial fibrillation or atrial flutter (1.25, 1.16 to 1.36). No meaningful association was found with peripheral artery disease (adjusted hazard ratio 1.12, 0.96 to 1.30) or heart failure (1.04, 0.93 to 1.16). The associations, particularly for stroke outcomes, were stronger during the short term (0-1 years) after diagnosis than the long term (up to 19 years), in patients with aura than in those without aura, and in women than in men. In a subcohort of patients, the associations persisted after additional multivariable adjustment for body mass index and smoking.CONCLUSIONS: Migraine was associated with increased risks of myocardial infarction, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, and atrial fibrillation or atrial flutter. Migraine may be an important risk factor for most cardiovascular diseases.

ObjectiveWe aimed to investigate the impact of hyponatremia severity on mortality risk and assess any evidence of a dose–response relation, utilizing prospectively collected data from population-based registries.DesignCohort study of 279 508 first-time acute admissions to Departments of Internal Medicine in the North and Central Denmark Regions from 2006 to 2011.MethodsWe used the Kaplan–Meier method (1 – survival function) to compute 30-day and 1-year mortality in patients with normonatremia and categories of increasing hyponatremia severity. Relative risks (RRs) with 95% CIs, adjusted for age, gender and previous morbidities, and stratified by clinical subgroups were estimated by the pseudo-value approach. The probability of death was estimated treating serum sodium as a continuous variable.ResultsThe prevalence of admission hyponatremia was 15% (41 803 patients). Thirty-day mortality was 3.6% in normonatremic patients compared to 7.3, 10.0, 10.4 and 9.6% in patients with serum sodium levels of 130–134.9, 125–129.9, 120–124.9 and ConclusionsHyponatremia is highly prevalent among patients admitted to Departments of Internal Medicine and is associated with increased 30-day and 1-year mortality risk, regardless of underlying disease. This risk seems independent of hyponatremia severity.

BACKGROUND:: Hyponatremia is associated with increased mortality and is frequently induced by diuretic use. It is uncertain whether diuretic use is linked to mortality risk in patients with hyponatremia. STUDY QUESTION:: To measure the prognostic impact of diuretic use on 30-day mortality among patients hospitalized with hyponatremia. STUDY DESIGN:: Using population-based registries, we identified all patients with a serum sodium measurement

Summary Background Bleeding is a serious and frequent complication of peptic ulcer disease. Hepatic dysfunction can cause coagulopathy and increases the risk of peptic ulcer bleeding. However, whether chronic liver disease increases mortality after peptic ulcer bleeding remains unclear. Aim To examine the prognostic impact of chronic liver disease on mortality after peptic ulcer bleeding. Methods We used population-based medical registries to conduct a cohort study of all Danish residents hospitalised with incident peptic ulcer bleeding from 2004 through 2011. We identified patients diagnosed with liver cirrhosis or non-cirrhotic chronic liver disease before their admission for peptic ulcer bleeding. We then computed 90-day mortality after peptic ulcer bleeding based on the Kaplan–Meier method (1 – survival function) and used a Cox regression model to estimate mortality rate ratios (MRRs), controlling for potential confounders. Results We identified 21 359 patients hospitalised with peptic ulcer bleeding. Among these, 653 (3.1%) had a previous diagnosis of liver cirrhosis and 474 (2.2%) had a history of non-cirrhotic chronic liver disease. Patients with liver cirrhosis and non-cirrhotic chronic liver disease had a cumulative 90-day mortality of 25.3% and 20.7%, respectively, compared to 18.3% among patients without chronic liver disease. Liver cirrhosis was associated with an adjusted 90-day MRR of 2.38 (95% CI: 2.02–2.80), compared to 1.49 (95% CI: 1.22–1.83) among patients with non-cirrhotic chronic liver disease. Conclusion Patients with chronic liver disease, particularly liver cirrhosis, are at increased risk of death within 90 days after hospitalisation for peptic ulcer bleeding compared to patients without chronic liver disease.

OBJECTIVE: To examine the validity of the International Classification of Diseases, 10th revision (ICD-10) codes for hyponatraemia in the nationwide population-based Danish National Registry of Patients (DNRP) among inpatients of all ages.DESIGN: Population-based validation study.SETTING: All somatic hospitals in the North and Central Denmark Regions from 2006 through 2011.PARTICIPANTS: Patients of all ages admitted to hospital (n=819 701 individual patients) during the study period. The patient could be included in the study more than once, and our study did not restrict to patients with serum sodium measurements (total of n=2 186 642 hospitalisations).MAIN OUTCOME MEASURE: We validated ICD-10 discharge diagnoses of hyponatraemia recorded in the DNRP, using serum sodium measurements obtained from the laboratory information systems (LABKA) research database as the gold standard. One sodium value RESULT: An ICD-10 code for hyponatraemia was recorded in the DNRP in 5850 of the 2 186 642 hospitalisations identified. According to laboratory measurements, however, hyponatraemia was present in 306 418 (14%) hospitalisations. Sensitivity of hyponatraemia diagnoses was 1.8% (95% CI 1.7% to 1.8%). For sodium values CONCLUSIONS: ICD-10 codes for hyponatraemia in the DNRP have high specificity but very low sensitivity. Laboratory test results, not discharge diagnoses, should be used to ascertain hyponatraemia.