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Andersen TO, Sejling C, Jensen AK, Dissing AS, Severinsen ER, Drews HJ, Sørensen TIA, Varga TV, Rod NH. Self-reported and tracked nighttime smartphone use and their association with overweight and cardiometabolic risk markers. Sci Rep 2024; 14:4861. [PMID: 38418905 PMCID: PMC10902390 DOI: 10.1038/s41598-024-55349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
Nighttime smartphone use is associated with sleep problems, which in turn have a bidirectional association with overweight. We aim to investigate whether nighttime smartphone use and sleep are related to overweight and metabolic dysfunction in adult populations. We used data from three population samples (aged 16-89) from the SmartSleep Study, which included survey data (N = 29,838), high-resolution tracking data (N = 3446), follow-up data (N = 1768), and cardiometabolic risk markers (N = 242). Frequent self-reported nighttime smartphone use was associated with 51% higher odds (95% CI: 1.32; 1.70) of overweight compared with no use. Tracked nighttime smartphone use was also associated with overweight. Similar results were found for obesity as an outcome. No consistent associations were found between nighttime smartphone use and cardiometabolic risk markers in a small subsample of healthy young women. Poor sleep quality (vs. good sleep quality) was associated with overweight (OR = 1.19, 85% CI: 1.10; 1.28). Overall, frequent nighttime smartphone use was consistently associated with overweight and a higher BMI across diverse population samples. The bidirectional interplay between nighttime smartphone use, sleep, and overweight may create a vicious circle of metabolic dysfunction over time. Therefore, nighttime smartphone use may be a potential target point for public health interventions to reduce overweight at the population level.
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Affiliation(s)
- Thea Otte Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Christoffer Sejling
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Agnete Skovlund Dissing
- Real World Evidence & Epidemiology, Department of Value Evidence and Patient Insights, H. Lundbeck A/S, Copenhagen, Denmark
| | - Elin Rosenbek Severinsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henning Johannes Drews
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thorkild I A Sørensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Drews HJ, Sejling C, Andersen TO, Varga TV, Jensen AK, Rod NH. Tracked and self-reported nighttime smartphone use, general health, and healthcare utilization: results from the SmartSleep Study. Sleep 2024:zsae024. [PMID: 38349329 DOI: 10.1093/sleep/zsae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Indexed: 03/21/2024] Open
Abstract
STUDY OBJECTIVES Nighttime smartphone use is an increasing public health concern. We investigated whether nighttime smartphone use is associated with general health and primary healthcare utilization. METHODS 4,520 individuals (age 35.6 ± 9.7 years, 35% male) provided self-reported information on smartphone use frequency, symptoms of depression, and general health (one-item perceived health and cross-symptom composite score). A subset of the study sample (n=3,221) tracked their nighttime smartphone use. Primary healthcare utilization, i.e., the number of weeks in which at least one service from the patient's general practitioner was billed in 2020, was extracted from Danish population registries. Statistical analysis comprised logistic and multiple linear regression, controlling for sociodemographics. RESULTS 319 individuals (7%) reported using their smartphone almost every night or more. More frequent self-reported nighttime smartphone use was associated with poor general health across all measures. Using the smartphone almost every night or more was associated with 2.8 [95CI: 1.9,4.1] fold higher odds of reporting poor health and with an average of 1.4 [95CI: 0.7,2.1] additional GP utilizations per year compared to no use. Associations were also found for the cross-symptom composite score across all symptoms. Further adjustment for symptoms of depression attenuated some associations. Smartphone use towards the end of the sleep period (sleep-offset use) was associated with poorer self-reported general health, but not with healthcare utilization. CONCLUSION Nighttime smartphone use frequency is associated with poor general health and healthcare utilization. Further studies should investigate the underlying causal structure and nighttime smartphone use as a transdiagnostic intervention target.
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Affiliation(s)
| | - Christoffer Sejling
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Thea Otte Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
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Elsenburg LK, Rieckmann A, Bengtsson J, Jensen AK, Rod NH. Application of life course trajectory methods to public health data: A comparison of sequence analysis and group-based multi-trajectory modeling for modelling childhood adversity trajectories. Soc Sci Med 2024; 340:116449. [PMID: 38091856 DOI: 10.1016/j.socscimed.2023.116449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 11/19/2023] [Indexed: 01/23/2024]
Abstract
There is increasing awareness of the importance of modelling life course trajectories to unravel how social, economic and health factors relate to health over time. Different methods have been developed and applied in public health to classify individuals into groups based on characteristics of their life course. However, the application and results of different methods are rarely compared. We compared the application and results of two methods to classify life course trajectories of individuals, i.e. sequence analysis and group-based multi-trajectory modeling (GBTM), using public health data. We used high-resolution Danish nationwide register data on 926,160 individuals born between 1987 and 2001, including information on the yearly occurrence of 7 childhood adversities in 2 dimensions (i.e. family poverty and family dynamics). We constructed childhood adversity trajectories from 0 to 15 years by applying (1) sequence analysis using optimal matching and cluster analysis using Ward's method and (2) GBTM using logistic and zero-inflated Poisson regressions. We identified 2 to 8 cluster solutions using both methods and determined the optimal solution for both methods. Both methods generated a low adversity, a poverty, and a consistent or high adversity cluster. The 5-cluster solution using sequence analysis additionally included a household psychiatric illness and a late adversity cluster. The 4-group solution using GBTM additionally included a moderate adversity cluster. Compared with the solution obtained through sequence analysis, the solution obtained through GBTM contained fewer individuals in the low adversity cluster and more in the other clusters. We find that the two methods generate qualitatively similar solutions, but the quantitative distributions of children over the groups are different. The method of choice depends on the type of data available and the research question of interest. We provide a comprehensive overview of important considerations and benefits and drawbacks of both methods.
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Affiliation(s)
- Leonie K Elsenburg
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Andreas Rieckmann
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Bengtsson
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Andersen TO, Sejling C, Jensen AK, Drews HJ, Ritz B, Varga TV, Rod NH. Nighttime smartphone use, sleep quality, and mental health: investigating a complex relationship. Sleep 2023; 46:zsad256. [PMID: 37758231 DOI: 10.1093/sleep/zsad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
STUDY OBJECTIVES This study investigated the complex relationship between nighttime smartphone use, sleep, and mental health among adult populations in Denmark. METHODS Data from three interconnected samples (aged 16-89 years) from the SmartSleep Study included 5798 individuals with survey and register data; 4239 individuals also provided high-resolution smartphone tracking data. Logistic regression models and causal discovery algorithms, which suggest possible causal pathways consistent with the underlying data structure, were used to infer the relationship between self-reported and tracked nighttime smartphone use, self-reported sleep quality, mental health indicators, and register-based psychotropic medication use. RESULTS Frequent self-reported nighttime smartphone use was associated with high perceived stress (OR: 2.24, 95% CI = 1.42 to 3.55) and severe depressive symptoms (OR: 2.96, 95% CI = 2.04 to 4.28). We found no clear associations between tracked nighttime smartphone use and mental health outcomes, except for the cluster that used their smartphones repeatedly during the sleep period, which was associated with severe depressive symptoms (OR = 1.69, 95% CI = 1.24 to 2.31). Poor sleep quality (vs. good sleep quality) was associated with high perceived stress (OR = 5.07, 95% CI = 3.72 to 6.90), severe depressive symptoms (OR = 9.67, 95% CI = 7.09 to 13.19), and psychotropic medication use (OR = 2.13, 95% CI = 1.36 to 3.35). The causal discovery models suggest that nighttime smartphone use affects mental health through both problematic smartphone use and poor sleep quality. CONCLUSION The complex relationship between nighttime smartphone use, sleep, and poor mental health may create a vicious circle over time, and nighttime smartphone use may constitute a potential leverage point for public health interventions aimed at improving sleep and mental health.
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Affiliation(s)
- Thea Otte Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Sejling
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henning Johannes Drews
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, LA, USA
| | - Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Petersen JF, Friis-Hansen LJ, Bryndorf T, Jensen AK, Andersen AN, Løkkegaard E. A Novel Approach to Predicting Early Pregnancy Outcomes Dynamically in a Prospective Cohort Using Repeated Ultrasound and Serum Biomarkers. Reprod Sci 2023; 30:3597-3609. [PMID: 37640889 PMCID: PMC10692000 DOI: 10.1007/s43032-023-01323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
This study aimed to develop a dynamic model for predicting outcome during the first trimester of pregnancy using baseline demographic data and serially collected blood samples and transvaginal sonographies. A prospective cohort of 203 unselected women with an assumed healthy pregnancy of < 8 weeks' gestation was followed fortnightly from 4-14 weeks' gestation until either miscarriage or confirmed first trimester viability. The main outcome was development of a model to predict outcome from gestational age-dependent hazard ratios using both baseline and updated serial data from each visit. Secondary outcomes were descriptions of risk factors for miscarriage. The results showed that 18% of the women experienced miscarriages. A fetal heart rate detected before 8 weeks' gestation indicated a 90% (95% CI 85-95%) chance of subsequent delivery. Maternal age (≥ 35 years), insufficient crown-rump-length (CRL) and mean gestational sac diameter (MSD) development, and presence of bleeding increased the risk of miscarriage. Serum biomarkers, including hCG, progesterone, and estradiol, were found to impact the risk of miscarriage with estradiol as the most important. The best model to predict miscarriage was a combination of maternal age, vaginal bleeding, CRL, and hCG. The second-best model was the sonography-absent model of maternal age, bleeding, hCG, and estradiol. This study suggests that combining maternal age, and evolving data from hCG, estradiol, CRL, and bleeding could be used to predict fetal outcome during the first trimester of pregnancy.Trial registration ClinicalTrials.gov identifier: NCT02761772.
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Affiliation(s)
| | | | - Thue Bryndorf
- Gynecological Clinic, 10, 3, Ny Østergade, 1101, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
| | - Anders Nyboe Andersen
- The Fertility Clinic 4071, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ellen Løkkegaard
- Department of Obstetrics and Gynecology, North Zealand Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Rod NH, Andersen TO, Severinsen ER, Sejling C, Dissing A, Pham VT, Nygaard M, Schmidt LKH, Drews HJ, Varga T, Freiesleben NLC, Nielsen HS, Jensen AK. Cohort profile: The SmartSleep Study, Denmark, combining evidence from survey, clinical and tracking data. BMJ Open 2023; 13:e063588. [PMID: 37793923 PMCID: PMC10551986 DOI: 10.1136/bmjopen-2022-063588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE The SmartSleep Study is established to comprehensively assess the impact of night-time smartphone use on sleep patterns and health. An innovative combination of large-scale repeated survey information, high-resolution sensor-driven smartphone data, in-depth clinical examination and registry linkage allows for detailed investigations into multisystem physiological dysregulation and long-term health consequences associated with night-time smartphone use and sleep impairment. PARTICIPANTS The SmartSleep Study consists of three interconnected data samples, which combined include 30 673 individuals with information on smartphone use, sleep and health. Subsamples of the study population also include high-resolution tracking data (n=5927) collected via a customised app and deep clinical phenotypical data (n=245). A total of 7208 participants are followed in nationwide health registries with full data coverage and long-term follow-up. FINDINGS TO DATE We highlight previous findings on the relation between smartphone use and sleep in the SmartSleep Study, and we evaluate the interventional potential of the citizen science approach used in one of the data samples. We also present new results from an analysis in which we use 803 000 data points from the high-resolution tracking data to identify clusters of temporal trajectories of night-time smartphone use that characterise distinct use patterns. Based on these objective tracking data, we characterise four clusters of night-time smartphone use. FUTURE PLANS The unprecedented size and coverage of the SmartSleep Study allow for a comprehensive documentation of smartphone activity during the entire sleep span. The study has been expanded by linkage to nationwide registers, which allow for further investigations into the long-term health and social consequences of night-time smartphone use. We also plan new rounds of data collection in the coming years.
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Affiliation(s)
- Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thea Otte Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elin Rosenbek Severinsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Agnete Dissing
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Vi Thanh Pham
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mette Nygaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Tibor Varga
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nina La Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Hvidovre Hospital, Hvidovre, Denmark
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Alomairah SA, Knudsen SDP, Roland CB, Molsted S, Clausen TD, Bendix JM, Løkkegaard E, Jensen AK, Larsen JE, Jennum P, Stallknecht B. Effects of Two Physical Activity Interventions on Sleep and Sedentary Time in Pregnant Women. Int J Environ Res Public Health 2023; 20:5359. [PMID: 37047973 PMCID: PMC10094525 DOI: 10.3390/ijerph20075359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Pregnancy is often associated with poor sleep and high sedentary time (SED). We investigated the effect of physical activity (PA) interventions on sleep and SED in pregnant women. A secondary analysis of a randomized controlled trial (n = 219) explored the effect of structured supervised exercise training (EXE) or motivational counseling on PA (MOT) compared to standard prenatal care (CON) on sleep and SED during pregnancy. Three times during pregnancy, sleep was determined by the Pittsburgh Sleep Quality Index (PSQI) and SED by the Pregnancy Physical Activity Questionnaire (PPAQ). Also, a wrist-worn consumer activity tracker measured sleep and SED continuously. Data from the activity tracker confirmed that sleep time decreases, and SED increases by approx. 30 and 24 min/day, respectively, from baseline (maximum gestational age (GA) week 15) to delivery. Compared to CON, the global PSQI score was better for EXE in GA week 28 (-0.8 [-1.5; -0.1], p = 0.031) and for both EXE and MOT in GA week 34 (-1 [-2; -0.5], p = 0.002; -1 [-2; -0.1], p = 0.026). In GA week 28, SED (h/day) from PPAQ was lower in EXE compared to both CON and MOT (-0.69 [-1; -0.0], p = 0.049; -0.6 [-1.0; -0.02], p = 0.042). In conclusion, PA interventions during pregnancy improved sleep quality and reduced SED.
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Affiliation(s)
- Saud Abdulaziz Alomairah
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh 13316, Saudi Arabia
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | | | - Caroline Borup Roland
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hilleroed, Denmark
| | - Tine D. Clausen
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, 3400 Hilleroed, Denmark
| | - Jane M. Bendix
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hilleroed, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, 3400 Hilleroed, Denmark
| | - Ellen Løkkegaard
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, 3400 Hilleroed, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hilleroed, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jakob Eg Larsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Poul Jennum
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, 2200 Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Severinsen ER, Andersen TO, Dissing AS, Jensen AK, Sejling C, Freiesleben NLC, Nielsen HS, Rod NH. Night-time smartphone use, sleep duration, sleep quality, and menstrual disturbances in young adult women: A population-based study with high-resolution tracking data. Sleep Adv 2023; 4:zpad013. [PMID: 37193274 PMCID: PMC10108640 DOI: 10.1093/sleepadvances/zpad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/29/2022] [Indexed: 05/18/2023]
Abstract
Study Objectives To explore the relationship among night-time smartphone use, sleep duration, sleep quality, and menstrual disturbances in young adult women. Methods Women aged 18-40 years were included in the SmartSleep Study in which they objectively tracked their smartphone use via the SmartSleep app between self-reported sleep onset and offset times (n = 764) and responded to a survey (n = 1068), which included background characteristics, sleep duration, sleep quality (Karolinska Sleep Questionnaire), and menstrual characteristics (International Federation of Gynecology and Obstetrics' definitions). Results The median tracking time was four nights (interquartile range: 2-8). Higher frequency (p = .05) and longer duration (p = .02) of night-time smartphone use were associated with long sleep duration (≥9 h), but not with poor sleep quality or short sleep duration (<7 h). Short sleep duration was associated with menstrual disturbances (OR = 1.84, 95% confidence interval [CI] = 1.09 to 3.04) and irregular menstruation (OR = 2.17, 95% CI = 1.08 to 4.10), and poor sleep quality was associated with menstrual disturbances (OR = 1.43, 95% CI = 1.19 to 1.71), irregular menstruation (OR = 1.34, 95% CI = 1.04 to 1.72), prolonged bleedings (OR = 2.50, 95% CI = 1.44 to 4.43) and short-cycle duration (OR = 1.40, 95% CI = 1.06 to 1.84). Neither duration nor frequency of night-time smartphone use was associated with menstrual disturbances. Conclusions Night-time smartphone use was associated with longer sleep duration, but not with menstrual disturbances in adult women. Short sleep duration and sleep quality were associated with menstrual disturbances. Further investigation of the effects of night-time smartphone use on sleep and female reproductive function in large prospective studies is needed.
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Affiliation(s)
- Elin Rosenbek Severinsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thea Otte Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Agnete Skovlund Dissing
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Value Evidence, Real World Evidence and Epidemology, Valby, Denmark (The contribution to the study was performed prior to the author obtaining this affiliation)
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Sejling
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nina la Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ekstrøm CT, Jensen AK. Having a ball: evaluating scoring streaks and game excitement using in-match trend estimation. Adv Stat Anal 2023; 107:295-311. [PMID: 35730005 PMCID: PMC9205152 DOI: 10.1007/s10182-022-00452-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
Many popular sports involve matches between two teams or players where each team have the possibility of scoring points throughout the match. While the overall match winner and result is interesting, it conveys little information about the underlying scoring trends throughout the match. Modeling approaches that accommodate a finer granularity of the score difference throughout the match is needed to evaluate in-game strategies, discuss scoring streaks, teams strengths, and other aspects of the game. We propose a latent Gaussian process to model the score difference between two teams and introduce the Trend Direction Index as an easily interpretable probabilistic measure of the current trend in the match as well as a measure of post-game trend evaluation. In addition we propose the Excitement Trend Index-the expected number of monotonicity changes in the running score difference-as a measure of overall game excitement. Our proposed methodology is applied to all 1143 matches from the 2019-2020 National Basketball Association season. We show how the trends can be interpreted in individual games and how the excitement score can be used to cluster teams according to how exciting they are to watch. Supplementary Information The online version contains supplementary material available at 10.1007/s10182-022-00452-w.
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Affiliation(s)
- Claus Thorn Ekstrøm
- Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Andreas Kryger Jensen
- Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
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Maaløe N, Housseine N, Sørensen JB, Obel J, Sequeira DMello B, Kujabi ML, Osaki H, John TW, Khamis RS, Muniro ZSS, Nkungu DJ, Pinkowski Tersbøl B, Konradsen F, Mookherji S, Mbekenga C, Meguid T, van Roosmalen J, Bygbjerg IC, van den Akker T, Jensen AK, Skovdal M, L. Kidanto H, Wolf Meyrowitsch D. Scaling up context-tailored clinical guidelines and training to improve childbirth care in urban, low-resource maternity units in Tanzania: A protocol for a stepped-wedged cluster randomized trial with embedded qualitative and economic analyses (The PartoMa Scale-Up Study). Glob Health Action 2022; 15:2034135. [PMID: 35410590 PMCID: PMC9009913 DOI: 10.1080/16549716.2022.2034135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained.Trial registration number: NCT04685668.
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Natasha Housseine
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Jane Brandt Sørensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Josephine Obel
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Sequeira DMello
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
- Comprehensive Community Based Rehabilitation in Tanzania, Dar Es Salaam, Tanzania
| | - Monica Lauridsen Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Haika Osaki
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Thomas Wiswa John
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Rashid Saleh Khamis
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | | | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sangeeta Mookherji
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Columba Mbekenga
- School of Nursing and Midwifery East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Kryger Jensen
- Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Morten Skovdal
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hussein L. Kidanto
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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11
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Mørk FB, Madsen JOB, Pilgaard KA, Jensen AK, Klakk H, Tarp J, Bugge A, Heidemann M, Van Hall G, Pociot F, Wedderkopp N, Johannesen J. The metabolic syndrome is frequent in children and adolescents with type 1 diabetes compared to healthy controls. Pediatr Diabetes 2022; 23:1064-1072. [PMID: 35678773 DOI: 10.1111/pedi.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE There is a rise in overweight and obesity among children and adolescents with type 1 diabetes (T1D) in parallel with the rise in the metabolic syndrome (MetS) among children and adolescents. The aim of the study was to describe the prevalence and characteristics of MetS in children and adolescents with T1D compared to their healthy counterparts. RESEARCH DESIGN AND METHODS The study includes two Danish cohorts; (i) the Copenhagen cross sectional cohort 2016 of 277 children and adolescents with T1D that attend the pediatric outpatient clinic at a large hospital in greater Copenhagen and (ii) the CHAMPS-study DK which is a population-based cohort study of Danish children and adolescents (control cohort). Participants were categorized to have MetS if at least two of the following criteria were met: (i) systolic and/or diastolic blood pressure ≥ 90th percentile, (ii) waist circumference ≥90th percentile, and (iii) triglyceride ≥90th percentile and/or HDL ≤10th percentile. RESULTS The prevalence of children with Mets in the T1D cohort was higher than in the control cohort (p = 0.002). Moreover, participants with T1D had MetS at a lower level of BMI (p < 0.001) and waist circumference (p < 0.001) than participants with MetS from the control cohort (z-scores = 0.90 and 1.51). Participants with MetS were younger than the other T1D participants (median 12.8 [9.9,14.8] vs. median 14.6 [11.2,16.9] years, p = 0.006). CONCLUSIONS Children and adolescents with T1D have an increased risk of MetS compared to healthy controls and clinicians and caretakers should consider early prevention and health promotion strategies.
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Affiliation(s)
- Freja Barrett Mørk
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Jens Otto Broby Madsen
- Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Kasper Ascanius Pilgaard
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Heidi Klakk
- Center for Applied Health Science, University College South, Haderslev, Denmark.,Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Jakob Tarp
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Anna Bugge
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Malene Heidemann
- Odense University Hospital, Hans Christian Andersen Children's Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Gerrit Van Hall
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Clinical Metabolomics Core Facility, Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Flemming Pociot
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Wedderkopp
- Odense Patient Data Explorative Network, Institute of Clinical Research OPEN, Odense University Hospital, Odense, Denmark.,Pediatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Johannesen
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Knudsen SDP, Alomairah SA, Roland CB, Jessen AD, Hergel IM, Clausen TD, Larsen JE, van Hall G, Jensen AK, Molsted S, Bendix JM, Løkkegaard E, Stallknecht B. Effects of Structured Supervised Exercise Training or Motivational Counseling on Pregnant Women's Physical Activity Level: FitMum - Randomized Controlled Trial. J Med Internet Res 2022; 24:e37699. [PMID: 35857356 PMCID: PMC9350815 DOI: 10.2196/37699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 02/06/2023] Open
Abstract
Background Physical activity (PA) during pregnancy is an effective and safe way to improve maternal health in uncomplicated pregnancies. However, compliance with PA recommendations remains low among pregnant women. Objective The purpose of this study was to evaluate the effects of offering structured supervised exercise training (EXE) or motivational counseling on PA (MOT) during pregnancy on moderate-to-vigorous intensity physical activity (MVPA) level. Additionally, complementary measures of PA using the Pregnancy Physical Activity Questionnaire (PPAQ) and gold standard doubly labeled water (DLW) technique were investigated. The hypotheses were that both EXE and MOT would increase MVPA in pregnancy compared with standard care (CON) and that EXE would be more effective than MOT. In addition, the association between MVPA and the number of sessions attended was explored. Methods A randomized controlled trial included 220 healthy, inactive pregnant women with a median gestational age of 12.9 (IQR 9.4-13.9) weeks. A total of 219 women were randomized to CON (45/219), EXE (87/219), or MOT (87/219). The primary outcome was MVPA (minutes per week) from randomization to the 29th gestational week obtained by a wrist-worn commercial activity tracker (Vivosport, Garmin International). PA was measured by the activity tracker throughout pregnancy, PPAQ, and DLW. The primary outcome analysis was performed as an analysis of covariance model adjusting for baseline PA. Results The average MVPA (minutes per week) from randomization to the 29th gestational week was 33 (95% CI 18 to 47) in CON, 50 (95% CI 39 to 60) in EXE, and 40 (95% CI 30 to 51) in MOT. When adjusted for baseline MVPA, participants in EXE performed 20 (95% CI 4 to 36) minutes per week more MVPA than participants in CON (P=.02). MOT was not more effective than CON; EXE and MOT also did not differ. MVPA was positively associated with the number of exercise sessions attended in EXE from randomization to delivery (P=.04). Attendance was higher for online (due to COVID-19 restrictions) compared with physical exercise training (P=.03). Adverse events and serious adverse events did not differ between groups. Conclusions Offering EXE was more effective than CON to increase MVPA among pregnant women, whereas offering MOT was not. MVPA in the intervention groups did not reach the recommended level in pregnancy. Changing the intervention to online due to COVID-19 restrictions did not affect MVPA level but increased exercise participation. Trial Registration ClinicalTrials.gov NCT03679130; https://clinicaltrials.gov/ct2/show/NCT03679130 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-043671
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Affiliation(s)
- Signe de Place Knudsen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Caroline Borup Roland
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Dsane Jessen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida-Marie Hergel
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark
| | - Tine D Clausen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Eg Larsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Gerrit van Hall
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Clinical Biochemistry, Clinical Metabolomics Core Facility, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Copenhagen University Hospital-North Zealand, Hillerod, Denmark
| | - Stig Molsted
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Copenhagen University Hospital-North Zealand, Hillerod, Denmark
| | - Jane M Bendix
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Clinical Research, Copenhagen University Hospital-North Zealand, Hillerod, Denmark
| | - Ellen Løkkegaard
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Otte Andersen T, Skovlund Dissing A, Rosenbek Severinsen E, Kryger Jensen A, Thanh Pham V, Varga TV, Hulvej Rod N. Predicting stress and depressive symptoms using high-resolution smartphone data and sleep behavior in Danish adults. Sleep 2022; 45:6550182. [DOI: 10.1093/sleep/zsac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/03/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study Objectives
The early detection of mental disorders is crucial. Patterns of smartphone behavior have been suggested to predict mental disorders. The aim of this study was to develop and compare prediction models using a novel combination of smartphone and sleep behavior to predict early indicators of mental health problems, specifically high perceived stress and depressive symptoms.
Methods
The data material included two separate population samples nested within the SmartSleep Study. Prediction models were trained using information from 4522 Danish adults and tested in an independent test set comprising of 1885 adults. The prediction models utilized comprehensive information on subjective smartphone behavior, objective night-time smartphone behavior, and self-reported sleep behavior. Receiver operating characteristics area-under-the-curve (ROC AUC) values obtained in the test set were recorded as the performance metrics for each prediction model.
Results
Neither subjective nor objective smartphone behavior was found to add additional predictive information compared to basic sociodemographic factors when forecasting perceived stress or depressive symptoms. Instead, the best performance for predicting poor mental health was found in the sleep prediction model (AUC = 0.75, 95% CI: 0.72–0.78) for perceived stress and (AUC = 0.83, 95%CI: 0.80–0.85) for depressive symptoms, which included self-reported information on sleep quantity, sleep quality and the use of sleep medication.
Conclusions
Sleep behavior is an important predictor when forecasting mental health symptoms and it outperforms novel approaches using objective and subjective smartphone behavior.
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Affiliation(s)
- Thea Otte Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen , Copenhagen , Denmark
| | - Agnete Skovlund Dissing
- Section of Epidemiology, Department of Public Health, University of Copenhagen , Copenhagen , Denmark
- Real World Evidence & Epidemiology, Department of Value Evidence, H. Lundbeck A/S , Copenhagen , Denmark
| | - Elin Rosenbek Severinsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen , Copenhagen , Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen , Copenhagen , Denmark
| | - Vi Thanh Pham
- Section of Biostatistics, Department of Public Health, University of Copenhagen , Copenhagen , Denmark
| | - Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen , Copenhagen , Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen , Copenhagen , Denmark
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14
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Hamann TV, Mørk FCB, Jensen AK, Jørgensen NR, Heidemann MS, Schou AJ, Mølgaard C, Pociot F, Wedderkopp N, Johannesen J. Reference serum percentile values of adiponectin, leptin, and adiponectin/leptin ratio in healthy Danish children and adolescents. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:267-276. [DOI: 10.1080/00365513.2022.2073911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tine Volquartzen Hamann
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Freja Cecilie Barrett Mørk
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Malene Søborg Heidemann
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Anders Jørgen Schou
- Pediatric Research Unit, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center, University of Southern Denmark, Odense, Denmark
| | - Christian Mølgaard
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Pociot
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Wedderkopp
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Johannesen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Schou A, Jørgensen NR, Maro VP, Kilonzo K, Ramaiya K, Sironga J, Jensen AK, Christensen DL, Schwarz P. The circadian rhythm of calcium and bone homeostasis in Maasai. Am J Hum Biol 2022; 34:e23756. [PMID: 35481615 PMCID: PMC9539595 DOI: 10.1002/ajhb.23756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Ethnic groups differ in prevalence of calcium-related diseases. Differences in the physiology and the endogenous circadian rhythm (CR) of calcium and bone homeostasis may play a role. Thus, we aimed to investigate details of CR pattern in calcium and bone homeostasis in East African Maasai. METHODS Ten clinically healthy adult Maasai men and women from Tanzania were examined. Blood samples were collected every 2nd hour for 24 h. Serum levels of total calcium, albumin, parathyroid hormone (PTH), 25(OH)D, creatinine, C-terminal telopeptide (CTX), bone-specific alkaline phosphatase (BSAP), procollagen type 1 N-terminal propeptide (P1NP), and osteocalcin were measured. Circadian patterns were derived from graphic curves of medians, and rhythmicity was assessed with Fourier analysis. RESULTS PTH-levels varied over the 24 h exhibiting a bimodal pattern. Nadir level corresponded to 65% of total 24-h mean. CTX and P1NP showed 24-h variations with a morning nadir and nocturnal peak with nadir levels corresponding to 23% and 79% of the 24-h mean, respectively. Albumin-corrected calcium level was held in a narrow range and alterations were corresponding to alterations in PTH. There was no distinct pattern in 24-h variations of 25(OH)D, creatinine, osteocalcin, or BSAP. CONCLUSIONS All participants showed pronounced 24-h variations in PTH and bone turnover markers CTX and P1NP. These findings support that Maasai participants included in this study have typical patterns of CR in calcium and bone homeostasis consistent with findings from other ethnic populations.
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Affiliation(s)
- Anne Schou
- Diabetes and Bone-Metabolic Research Unit, Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet Glostrup, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Venance Phillip Maro
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kajiru Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kaushik Ramaiya
- Department of Internal Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Joseph Sironga
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Internal Medicine, Monduli District Hospital, Monduli, Tanzania
| | - Andreas Kryger Jensen
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dirk Lund Christensen
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schwarz
- Diabetes and Bone-Metabolic Research Unit, Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Olsen MT, Dungu AM, Klarskov CK, Jensen AK, Lindegaard B, Kristensen PL. Glycemic variability assessed by continuous glucose monitoring in hospitalized patients with community-acquired pneumonia. BMC Pulm Med 2022; 22:83. [PMID: 35264139 PMCID: PMC8905566 DOI: 10.1186/s12890-022-01874-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/25/2022] [Indexed: 01/17/2023] Open
Abstract
Background Glycemic variability (GV) has only been sparsely studied in patients with community-acquired pneumonia (CAP). This study aimed to quantify in-hospital GV in CAP patients, including determining the impact of type 2 diabetes mellitus (T2DM) and glucocorticoid (GC) treatment on GV. Methods This is a prospective cohort study of CAP patients (N = 40) with or without T2DM and treated or not with GCs. The primary endpoint was GV measured as glucose standard deviation (SD), coefficient of variation (CV), and postprandial glucose excursions (PPGE) based on continuous glucose monitoring (CGM). Analysis of glucose data was split into daytime and nighttime when possible. Results Patients included had a mean age of 74 (range 55 to 91) years. SD (95%CI) increased by a factor of 1.93 (1.40 to 2.66) and 2.29 (1.38 to 3.81) in patients with T2DM and not treated with GCs during the daytime and the nighttime, respectively (both P < 0.01), and by a factor of 1.42 (1.04 to 1.97) in patients treated with GCs but without T2DM during the daytime (P = 0.031) compared to patients without T2DM and not treated with GCs. CV (95%CI) increased by 5.1 (0.0 to 10.1) and 8.1 (1.0 to 15.2) percentage points during the daytime and the nighttime, respectively, in patients with T2DM and not treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.046 and P = 0.026, respectively). PPGE (95% CI) increased during lunch by 2.5 (0.7 to 4.3) mmol/L (45 (13 to 77) mg/dL) in patients with T2DM and treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.018). Conclusions CAP patients receiving GCs, especially those with T2DM, are at great risk of developing high GV and therefore require clinical attention to mitigate GV. This applies particularly during the daytime. Results support the 1 to 2-h post-lunch screening procedure for glucocorticoid-induced hyperglycemia in patients without diabetes. SD was positively correlated with hospital length of stay. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01874-7.
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Affiliation(s)
- Mikkel Thor Olsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.
| | - Arnold Matovu Dungu
- Department of Pulmonary- and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Carina Kirstine Klarskov
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Andreas Kryger Jensen
- Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary- and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
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17
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Klarskov CK, Windum NA, Olsen MT, Dungu AM, Jensen AK, Lindegaard B, Pedersen-Bjergaard U, Kristensen PL. Telemetric Continuous Glucose Monitoring During the COVID-19 Pandemic in Isolated Hospitalized Patients in Denmark: A Randomized Controlled Exploratory Trial. Diabetes Technol Ther 2022; 24:102-112. [PMID: 34524009 DOI: 10.1089/dia.2021.0291] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To investigate whether telemetric continuous glucose monitoring (CGM) in hospitalized and isolated patients with diabetes mellitus and coronavirus disease 2019 (COVID-19) is associated with better glycemic outcomes and fewer patient health care worker contacts compared to blood glucose monitoring by traditional point-of-care (POC) glucose testing and to investigate the user aspect of implementing a CGM-system in-hospital. Materials and Methods: A randomized controlled exploratory trial was performed on hospitalized and isolated patients with diabetes and COVID-19 from May 2020 until February 2021 at Nordsjællands Hospital, Denmark. Participants were randomized to nonblinded telemetric CGM (as the only glucose monitoring method) or traditional POC glucose testing + blinded CGM. The primary endpoint was time in range (TIR) based on CGM data in both groups. A questionnaire about the user aspect of the CGM system was answered by health care personnel (HCP). Results: We included 64 participants in the analysis, 31 in the CGM group and 33 in the POC glucose group. TIR median was 46% for the CGM group and 68% for the POC glucose group (P = 0.368). The mean glucose value for the CGM group was 11.1 and 10.8 mmol/L in the POC glucose group (P = 0.372). CGM was associated with fewer POC glucose measurements (P < 0.001). Out of 30 HCPs, 28 preferred telemetric CGM over POC glucose testing. Conclusion: Remote glucose monitoring by CGM did not improve glycemic outcomes compared to traditional POC glucose testing, but was associated with fewer patient-personnel contacts, saving time for HCPs performing diabetes-related tasks. Most HCPs preferred CGM. The study is registered at http://www.clinicaltrials.gov (#NCT04430608).
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Affiliation(s)
- Carina Kirstine Klarskov
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Nicole Avlund Windum
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Mikkel Thor Olsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Arnold Matovu Dungu
- Department of Pulmonary and Infectious Diseases, and Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, and Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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18
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Roland CB, Knudsen SDP, Alomairah SA, Andersen AD, Bendix J, Clausen TD, Molsted S, Jensen AK, Teilmann G, Jespersen AP, Larsen JE, Hall GV, Andersen E, Barrès R, Mortensen OH, Maindal HT, Tarnow L, Løkkegaard ECL, Stallknecht B. Structured supervised exercise training or motivational counselling during pregnancy on physical activity level and health of mother and offspring: FitMum study protocol. BMJ Open 2021; 11:e043671. [PMID: 33741668 PMCID: PMC7986889 DOI: 10.1136/bmjopen-2020-043671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/30/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION A physically active lifestyle during pregnancy improves maternal and offspring health but can be difficult to follow. In Denmark, less than 40% of pregnant women meet physical activity (PA) recommendations. The FitMum study aims to explore strategies to increase PA during pregnancy among women with low PA and assess the health effects of PA. This paper presents the FitMum protocol, which evaluates the effects of structured supervised exercise training or motivational counselling supported by health technology during pregnancy on PA level and health of mother and offspring. METHODS AND ANALYSIS A single-site three-arm randomised controlled trial that aims to recruit 220 healthy, pregnant women with gestational age (GA) no later than week 15 and whose PA level does not exceed one hour/week. Participants are randomised to one of three groups: structured supervised exercise training consisting of three weekly exercise sessions, motivational counselling supported by health technology or a control group receiving standard care. The interventions take place from randomisation until delivery. The primary outcome is min/week of moderate-to-vigorous intensity PA (MVPA) as determined by a commercial activity tracker, collected from randomisation until GA of 28 weeks and 0-6 days, and the secondary outcome is gestational weight gain (GWG). Additional outcomes are complementary measures of PA; clinical and psychological health parameters in participant, partner and offspring; analyses of blood, placenta and breastmilk samples; process evaluation of interventions; and personal understandings of PA. ETHICS AND DISSEMINATION The study is approved by the Danish National Committee on Health Research Ethics (# H-18011067) and the Danish Data Protection Agency (# P-2019-512). Findings will be disseminated via peer-reviewed publications, at conferences, and to health professionals via science theatre performances. TRIAL REGISTRATION NUMBER NCT03679130. PROTOCOL VERSION This paper was written per the study protocol version 8 dated 28 August 2019.
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Affiliation(s)
- Caroline Borup Roland
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Signe de Place Knudsen
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Anne Dsane Andersen
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Jane Bendix
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Nordsjaellands Hospital, Hillerod, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Grete Teilmann
- Department of Paediatrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Astrid Pernille Jespersen
- The Saxo Institute, University of Copenhagen, Centre for Health Research in the Humanities, Copenhagen, Denmark
| | - Jakob Eg Larsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Gerrit van Hall
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Emil Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Romain Barrès
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Ole Hartvig Mortensen
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus Universitet, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lise Tarnow
- Steno Diabetes Center Copenhagen, Holbaek, Denmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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19
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Hald JT, Hesselvig AB, Jensen AK, Odgaard A. Revision for periprosthetic joint infection rate stratified by seasonality of operation in a national population of total and unicompartmental knee arthroplasty patients: a register-based analysis. J Bone Jt Infect 2021; 6:111-117. [PMID: 34084699 PMCID: PMC8129906 DOI: 10.5194/jbji-6-111-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/22/2021] [Indexed: 11/30/2022] Open
Abstract
Aim: The aim of this study was to investigate whether the revision rate for
periprosthetic joint infection (PJI) depends on the season of the primary
procedure using a national population of knee arthroplasty (KA) patients.
Seasonal variation of some surgical procedures has been observed to impact
subsequent infection risks, with a higher risk of revision for surgeries performed during summer, but an analysis of PJI rates based on a national arthroplasty register has yet to be completed. We hypothesized that an
increased risk of revision due to PJI could be demonstrated in a national
population when primary surgery was performed during the summer.
Methods: The Danish Knee Arthroplasty Registry (DKR) was used to determine the risk
of revision due to PJI within 2 years after primary surgery. All primary KA
procedures between 1 January 1997 and 31 December 2014 and revisions until 31 December 2016 were identified. Smoothing spline
regression was used to identify possible seasonal pattern effects of the primary procedure on revision risk, and logistic regression was used to calculate risk of infection differences between seasons.
Results: A total number of 124 809 primary procedures was registered in the study period. After excluding duplicates and matching primary procedures with the first revisions within 2 years after the primary procedure, 3391 were
identified. Of these, 348 cases were recorded with an indication of deep
infection requiring revision. Spline regression analyses did not demonstrate
any clear seasonal pattern of the primary procedure regarding the risk of
revision for infection or any other cause. Logistic regression found a
decreased risk of revision for infection when the primary procedure was
performed during the summer in the years 1997 to 2005, no influence on the risk of revision for infection in 2005 to 2012, and an increased risk of
revision for infection following summer procedures during the years 2013 to
2014.
Conclusion: It was not possible to demonstrate a consistent seasonal variation of the
risk of revision for PJI following primary KA. This is most likely because
the underlying etiologies for PJI are not subject to seasonal variation.
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Affiliation(s)
- Julius Tetens Hald
- Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Anne Brun Hesselvig
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Henrik Harpestrengsvej 4A, 2100 Copenhagen Ø, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Notkin GT, Kristensen PL, Pedersen-Bjergaard U, Jensen AK, Molsted S. Reproducibility of Glucose Fluctuations Induced by Moderate Intensity Cycling Exercise in Persons with Type 1 Diabetes. J Diabetes Res 2021; 2021:6640600. [PMID: 33860058 PMCID: PMC8026306 DOI: 10.1155/2021/6640600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS The purpose was to assess the reproducibility of glucose changes during three sessions of standardized moderate intensity continuous training of cycling on an individual level in people with type 1 diabetes. METHODS Twelve adults (six females) with type 1 diabetes performed three test sessions on an ergometer bicycle (30 min, 67% of predicted heart rate) on three different days. The participants were 36.5 (26.6-45.5) (median, IQR) years old, and their HbA1c was 65 ± 15 mmol/mol (mean ± SD). Two hours before the tests, the participants had a standard meal. Interstitial glucose (IG) and capillary glucose (CG) were measured using an iPro2 Medtronic continuous glucose monitor and the Bayer Contour XT-device, respectively. Prior to the test sessions, resting heart rate was measured using a digital blood pressure monitor to estimate the desired intensity of the exercise. RESULTS The average within-participant relationship between the average slope in glucose during sessions 2 and 1 was in IG -0.29 (95% CI -1.11; 0.58) and in CG -0.04 (-0.68; 0.77). Between sessions 3 and 2, IG is 0.18 (-0.27; 0.64) and in CG 0.13 (-0.25; 0.55). Between sessions 3 and 1, IG was 0.06 (-0.57; 0.71) and in CG 0.06 (-0.39; 0.52). The results indicate low reproducibility at participant levels and remained unchanged after adjustment for baseline glucose values. CONCLUSION On an individual level, the glucose declines during three standardized sessions of PA were not associated with identical responses of the measured IG and CG levels. An overall anticipated decline of glucose concentrations was found in the moderate intensity cycling sessions. This highlights the importance of regular CG measurements during and after physical activity and awareness towards potential exercise-induced hypoglycemia in persons with type 1 diabetes.
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Affiliation(s)
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Nordsjællands Hospital, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Nordsjællands Hospital, Denmark
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21
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Affiliation(s)
- Andreas Kryger Jensen
- Biostatistics, Institute of Public Health University of Copenhagen Copenhagen Denmark
| | - Claus Thorn Ekstrøm
- Biostatistics, Institute of Public Health University of Copenhagen Copenhagen Denmark
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22
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Winckler K, Thorsteinsson B, Wiinberg N, Jensen AK, Lundby-Christensen L, Heitmann BL, Lund SS, Krarup T, Jensen T, Vestergaard H, Breum L, Sneppen S, Boesgaard T, Madsbad S, Gluud C, Vaag A, Almdal TP, Tarnow L. Prediction of carotid intima-media thickness and its relation to cardiovascular events in persons with type 2 diabetes. J Diabetes Complications 2020; 34:107681. [PMID: 32741659 DOI: 10.1016/j.jdiacomp.2020.107681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/09/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
AIMS To investigate measures of carotid intima-media thickness (IMT) and conventional cardiovascular (CV) risk factors as predictors of future carotid IMT, and the prediction of CV events during follow-up based on measures of carotid IMT. METHODS Observational longitudinal study including 230 persons with type 2 diabetes (T2D). RESULTS Mean age at follow-up was 66.7 (SD 8.5) years, 30.5% were women and mean body mass index (BMI) was 31.8 (4.4) kg/m2. Carotid IMT was measured at baseline, after 18 months of intervention in the Copenhagen Insulin and Metformin Therapy (CIMT) trial and after a mean follow-up of 6.4 (1.0) years. Baseline carotid IMT, carotid IMT after 18 months' intervention, and CV risk factors (age, sex and baseline systolic blood pressure) gave the best prediction of carotid IMT (root mean-squared error of prediction of 0.106 and 95% prediction error probability interval of -0.160, 0.204). CONCLUSIONS Measures of carotid IMT combined with CV risk factors at baseline predicts attained carotid IMT better than measures of carotid IMT or CV risk factors alone. Carotid IMT did not predict CV events, and the present results do not support the use of carotid IMT as a predictor of CV events in persons with T2D.
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Affiliation(s)
- Karoline Winckler
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hilleroed, Denmark.
| | - Birger Thorsteinsson
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hilleroed, Denmark; University of Copenhagen, Denmark
| | - Niels Wiinberg
- Department of Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Denmark.
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Denmark; Department of Research, Nordsjaellands Hospital, Hilleroed, Denmark.
| | | | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark; Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark.
| | - Søren S Lund
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Ingelheim, Germany
| | - Thure Krarup
- Department of Endocrinology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Tonny Jensen
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Denmark
| | - Henrik Vestergaard
- University of Copenhagen, Denmark; Department of Endocrinology, Copenhagen University Hospital, Herlev, Denmark,; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Denmark
| | - Leif Breum
- Department of Medicine, University Hospital Koege, Denmark
| | - Simone Sneppen
- Department of Medicine, Copenhagen University Hospital, Gentofte, Denmark
| | | | - Sten Madsbad
- University of Copenhagen, Denmark; Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Thomas P Almdal
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lise Tarnow
- Department of Research, Nordsjaellands Hospital, Hilleroed, Denmark; Steno Diabetes Center Sjaelland, Holbaek, Denmark.
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23
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Friis Petersen J, Friis-Hansen LJ, Jensen AK, Nyboe Andersen A, Løkkegaard ECL. Early pregnancy reference intervals; 29 serum analytes from 4 to 12 weeks' gestation in naturally conceived and uncomplicated pregnancies resulting in live births. Clin Chem Lab Med 2020; 57:1956-1967. [PMID: 31343977 DOI: 10.1515/cclm-2019-0495] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/17/2019] [Indexed: 01/09/2023]
Abstract
Background Pregnancy introduces major physiological changes that also alter biochemical analytes. Maternal and perinatal health can be optimized by early intervention and therefore, pregnancy-specific reference intervals (RIs) for the local population are warranted. While the second and third trimester-specific changes are well described, the first trimester is less well characterized. We therefore wanted to facilitate early detection of abnormalities by generating first trimester reference values for 29 common analytes. Methods In a prospective early pregnancy (PEP) cohort (2016-2017), 203 pregnant women were recruited from 4 to 8 weeks' gestation. Consecutive blood samples were drawn every 2 weeks until an ongoing second trimester pregnancy (n = 164) or a miscarriage (n = 39) occurred. After exclusion of women with complicated pregnancies or deliveries (n = 42), 122 women were included. The serum samples collected at <6, 6-8, 8-10, 10-12 and >12 weeks' gestation were analyzed for 29 common analytes. Subsequently the RIs were calculated according to the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) recommendations (2.5-97.5th percentiles) and compared with the conventional RIs for non-pregnant women. Results Human chorionic gonadotropin (hCG), progesterone (P4), estradiol (E2), pregnancy-associated plasma protein A (PAPP-A), cancer antigen 125 (CA125), thyroid stimulating hormone (TSH), creatinine (CREA) and albumin (ALB) showed an early pregnancy-dependent change compared with conventional limits. For ALB the change was seen at 5.5 weeks' gestation. Conclusions We report gestational age-specific RIs available from the early part of the first trimester applicable to everyday clinical care of pregnant women. Well-known alterations of RIs seen in later trimesters are also observed in the first.
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Affiliation(s)
- Jesper Friis Petersen
- Department of Obstetrics and Gynecology, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
| | - Lennart J Friis-Hansen
- Department of Clinical Biochemistry, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
| | | | - Ellen C L Løkkegaard
- Department of Obstetrics and Gynecology, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
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24
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Clotworthy A, Dissing AS, Nguyen TL, Jensen AK, Andersen TO, Bilsteen JF, Elsenburg LK, Keller A, Kusumastuti S, Mathisen J, Mehta A, Pinot de Moira A, Rod MH, Skovdal M, Strandberg-Larsen K, Tapager IW, Varga TV, Vinther JL, Xu T, Hoeyer K, Hulvej Rod N. 'Standing together - at a distance': Documenting changes in mental-health indicators in Denmark during the COVID-19 pandemic. Scand J Public Health 2020; 49:79-87. [PMID: 32907495 PMCID: PMC7859573 DOI: 10.1177/1403494820956445] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims: There is a need to document the mental-health effects of
the COVID-19 pandemic and its associated societal lockdowns. We initiated a
large mixed-methods data collection, focusing on crisis-specific worries and
mental-health indicators during the lockdown in Denmark.
Methods: The study incorporated five data sources,
including quantitative surveys and qualitative interviews. The surveys included
a time series of cross-sectional online questionnaires starting on 20 March
2020, in which 300 (3×100) Danish residents were drawn every three days from
three population groups: the general population (N=1046),
families with children (N=1032) and older people
(N=1059). These data were analysed by trend analysis.
Semi-structured interviews were conducted with 32 people aged 24–83 throughout
Denmark to provide context to the survey results and to gain insight into
people’s experiences of the lockdown. Results: Absolute level
of worries, quality of life and social isolation were relatively stable across
all population groups during the lockdown, although there was a slight
deterioration in older people’s overall mental health. Many respondents were
worried about their loved ones’ health (74–76%) and the potential long-term
economic consequences of the pandemic (61–66%). The qualitative interviews
documented significant variation in people’s experiences, suggesting that the
lockdown’s effect on everyday life had not been altogether negative.
Conclusions: People in Denmark seem to have
managed the lockdown without alarming changes in their mental health.
However, it is important to continue investigating the effects of the
pandemic and various public-health measures on mental health over time and
across national contexts.
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Affiliation(s)
- Amy Clotworthy
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Agnete Skovlund Dissing
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Tri-Long Nguyen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Andreas Kryger Jensen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Thea Otte Andersen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Josephine Funck Bilsteen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Leonie K Elsenburg
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Amélie Keller
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Sasmita Kusumastuti
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Jimmi Mathisen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Amar Mehta
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark.,Statistics Denmark, Copenhagen, Denmark
| | - Angela Pinot de Moira
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | | | - Morten Skovdal
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Katrine Strandberg-Larsen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | | | - Tibor V Varga
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Johan Lerbech Vinther
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Tianwei Xu
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Klaus Hoeyer
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
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25
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Nilsson F, Madsen JOB, Jensen AK, Olsen BS, Johannesen J. High prevalence of disordered eating behavior in Danish children and adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:1043-1049. [PMID: 32418266 DOI: 10.1111/pedi.13043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/16/2020] [Accepted: 05/04/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE A higher prevalence of disordered eating behavior (DEB) has been demonstrated in children and adolescents with type 1 diabetes (T1D) compared to healthy aged-matched peers. DEB is associated with higher HbA1c levels and increased risk of developing complications to T1D. The aim of this study was to determine the prevalence of DEB in a Danish cohort of children and adolescents with T1D aged 11 to 19 years and to characterize them regarding metabolic control and relevant clinical data. RESEARCH DESIGN AND METHODS In a cross-sectional study, we determined the prevalence of DEB using the revised Diabetes Eating Problem Survey (DEPS-R) questionnaire. HbA1c and relevant clinical data were obtained at the time they filled in the questionnaire. RESULTS Hundred and ninety-two children and adolescents (46% girls) aged 11 to 19 years with T1D were included from the pediatric diabetes outpatient clinic. A total of 40 participants (21%) had DEB. The prevalence was higher among girls compared with boys (34.1% vs 8.9%) and those who had DEB were older (16.7 vs 15.0 years, P < .001), had longer duration of T1D (7.5 vs 4.9 years, P < .001), higher BMI Z-scores (1.2 vs 0.3, P < .001), higher HbA1c (72.8 (8.8%) vs 62.0 (7.8%) mmol/mol, P < .001), higher total cholesterol (4.6 mmol/L vs 4.2 mmol/L, P = .0048), and LDL (2.7 vs 2.3, P = .001) compared with those with no signs of DEB. CONCLUSION As in other countries, the prevalence of DEB is high in Danish adolescents with T1D. Early detection of DEB is essential to prevent short- and long-term complications to T1D.
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Affiliation(s)
- Franciska Nilsson
- Department of Children Adolescents, Copenhagen University Hospital, Herlev, Denmark
| | | | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health , University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - Birthe Susanne Olsen
- Department of Children Adolescents, Copenhagen University Hospital, Herlev, Denmark
| | - Jesper Johannesen
- Department of Children Adolescents, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Winckler K, Wiinberg N, Jensen AK, Thorsteinsson B, Lundby-Christensen L, Heitmann BL, Jensen GB, Tarnow L. Progression in risk factors during 36 years of follow-up and prediction of carotid intima-media thickness in a large cohort of adults with and without diabetes. Scand J Clin Lab Invest 2020; 80:491-499. [PMID: 32692589 DOI: 10.1080/00365513.2020.1793219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Carotid intima-media thickness (IMT) can assess the cumulative effect of atherosclerotic risk factors and provides an independent predictor of future cardiovascular (CV) risk. The aim of this study was to investigate the progression of conventional risk factors in 933 long-term survivors from a Danish cohort with and without diabetes mellitus (DM) as predictors for attained carotid IMT during 35.6 (0.7) years of follow-up. Persons who participated in the first, the last and one of the intermediate rounds of the Copenhagen City Heart Study, and who had had an ultrasound-derived measure of the carotid IMT performed at the last examination were included in the analyses. The risk factors varied between persons with and without DM during the 36 years, but the difference in blood pressure disappeared in the fifth examination, where, in addition, total cholesterol was found to be lower in persons with DM. In this cohort there were no difference in attained carotid IMT between persons with and without DM at the last examination. The following risk factors were found to best predict carotid IMT: age, maximum systolic BP, average systolic BP, average BMI, minimum BMI, sex and years of smoking. The prediction of carotid IMT was clinically poor with a root mean-squared error of prediction (RMSEP) of 0.134 mm and a 95% prediction error probability interval of (-0.22; 0.30). Furthermore, the distribution of prediction errors was skewed to the right indicating that the prediction errors were larger among persons with high carotid IMT.
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Affiliation(s)
- Karoline Winckler
- Department of Endocrinology and Nephrology, Nordsjaellands University Hospital, Hilleroed, Denmark
| | - Niels Wiinberg
- Department of Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Research, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Birger Thorsteinsson
- Department of Endocrinology and Nephrology, Nordsjaellands University Hospital, Hilleroed, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Public Health, Section for General Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Lise Tarnow
- Department of Research, Nordsjaellands Hospital, Hilleroed, Denmark.,Steno Diabetes Center Sjaelland, Holbaek, Denmark
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Svalgaard JD, Juul S, Vester-Glovinski PV, Haastrup EK, Ballesteros OR, Lynggaard CD, Jensen AK, Fischer-Nielsen A, Herly M, Munthe-Fog L. Lipoaspirate Storage Time and Temperature: Effects on Stromal Vascular Fraction Quality and Cell Composition. Cells Tissues Organs 2020; 209:54-63. [PMID: 32580198 DOI: 10.1159/000507825] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/10/2020] [Indexed: 11/19/2022] Open
Abstract
The adipose tissue-derived stromal vascular fraction (SVF) is a promising candidate for use in cell therapy and tissue engineering due to its regenerative and immunomodulatory properties. Some therapies are based on using the complete SVF product, whereas others depend on the expansion of adipose-derived stromal cells (ASCs) in culture. The latter application often involves a time delay between adipose tissue harvest and SVF isolation. This study investigated how storage time and temperature affected cell quality and composition. Aliquots of lipoaspirate were stored cold (4°C), at room temperature (18-20°C), or at 37°C. SVF was isolated on sequential time points over a period of 48 h, and the following were assessed: cell viability, vitality, composition, and the proliferative potential of the ASCs. When the lipoaspirate was stored cold, the viability of the SVF remained stable for up to 48 h; however, the vitality of the SVF decreased significantly after 24 h. When stored at higher temperatures (room temperature or 37°C), the vitality of the SVF decreased after 8 h. The ASC fraction in the SVF decreased rapidly after 8 h when stored at higher temperatures, whereas this change was delayed significantly when the lipoaspirate was stored cold. Tendencies towards increases in the lag phase, population doubling time (PDt), and time to reach confluency were observed when the lipoaspirate was stored at higher temperatures. The vitality of the SVF was correlated significantly with the time of the lag phase and the time required to reach confluence, whereas no correlation was observed with the PDt. Both prolonged storage time and increased temperature during lipoaspirate storage negatively affected the quality of the obtained SVF. Our results suggest that lipoaspirate should be stored for no longer than 24 h at 4°C to maintain the optimal quality for the isolation of SVF and the expansion of ASCs.
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Affiliation(s)
| | - Sarah Juul
- Department of Plastic Surgery and Burns, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Eva Kannik Haastrup
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Olga Rivera Ballesteros
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Duch Lynggaard
- Department of Otorhinolaryngology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne Fischer-Nielsen
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lea Munthe-Fog
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Madsen JOB, Herskin CW, Zerahn B, Jensen AK, Jørgensen NR, Olsen BS, Pociot F, Johannesen J. Unaffected bone mineral density in Danish children and adolescents with type 1 diabetes. J Bone Miner Metab 2020; 38:328-337. [PMID: 31754807 DOI: 10.1007/s00774-019-01058-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022]
Abstract
AIMS Adults with type 1 diabetes mellitus (T1D) have decreased bone mineral density (BMD). Our study aimed at determining BMD and the association to metabolic control in children and adolescents with T1D. METHODS 244 patients (113 girls) with a median age of 14.3 years and T1D duration of 1-16 years were included. A dual-energy X-ray absorptiometry scan assessed BMD Z-scores excluding the head (total body less head, TBLH). TBLH-BMD were then investigated for associations to diabetes relevant variables such as HbA1c, insulin treatment, anthropometry and physical activity. RESULTS In all participants the TBLH-BMD Z-score (0.22 ± 0.96) was significantly higher than the references. Separated by sex, TBLH-BMD Z-score in boys (0.11 ± 0.84) was no different from healthy peers whereas TBLH-BMD Z-score was significantly higher in girls (0.36 ± 1.09). The higher TBLH-BMD Z-score in girls were explained by higher BMI Z-scores. Participants with assumed final height (based on age) had an average TBLH-BMD Z-score of 0.78 ± 1.06, significantly higher than references independent of gender, HbA1c, height- and weight Z-scores. Multiple regression analyses showed that TBLH BMD Z-score associated negatively to HbA1c (P = 0.003), pump treatment (P = 0.019) and screen-time (P = 0.005) and positively to weight Z-score (P < 0.001). Physical activity, sex and puberty did not significantly associate to TBLH-BMD Z-score. CONCLUSION Unlike adults with T1D, BMD is not decreased in children and adolescents with T1D and even elevated after attained final height. As HbA1c negatively associates to BMD, decreased BMD may progress over time. Whether changes in microarchitecture or bone metabolism precede changes in BMD needs further investigation.
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Affiliation(s)
- Jens Otto Broby Madsen
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Camilla Winther Herskin
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Bo Zerahn
- Department of Nuclear Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Birthe Susanne Olsen
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Flemming Pociot
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Jesper Johannesen
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Ostenfeld A, Petersen TS, Futtrup TB, Andersen JT, Jensen AK, Westergaard HB, Pedersen LH, Løkkegaard ECL. Validating the effect of Ondansetron and Mirtazapine In Treating hyperemesis gravidarum (VOMIT): protocol for a randomised placebo-controlled trial. BMJ Open 2020; 10:e034712. [PMID: 32209630 PMCID: PMC7202694 DOI: 10.1136/bmjopen-2019-034712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Current pharmacological treatment options for hyperemesis gravidarum have been introduced based on scarce evidence and are often not sufficiently effective. Several case reports suggest that mirtazapine, an antidepressant, may be an effective treatment for hyperemesis gravidarum, but so far there are no controlled trials investigating the potential effect of mirtazapine on hyperemesis gravidarum. The antiemetic ondansetron is currently widely used to treat hyperemesis gravidarum despite sparse evidence of effect in pregnant women. This study aims to investigate the effect of mirtazapine on hyperemesis gravidarum while also providing data on the effect of ondansetron. METHODS AND ANALYSIS This randomised double-blind placebo-controlled multicentre trial will be conducted in eight Danish hospitals. One hundred and eighty pregnant women referred to secondary care for hyperemesis gravidarum will be randomly allocated to 14-day treatment with either mirtazapine, ondansetron or placebo. Main inclusion criterion will be Pregnancy Unique Quantification of Emesis (PUQE-24) score ≥13 or PUQE-24 score ≥7 if accompanied by weight loss >5% of pre-pregnancy weight or hospitalisation. Participants are eligible regardless of whether other antiemetics, including ondansetron, have been tried. The coprimary outcomes are effects of mirtazapine and ondansetron, respectively, on PUQE-24 score tested hierarchically on day 2 and day 14. Secondary outcomes include, but are not limited to, differences between the three groups in number of daily vomiting episodes, dropout due to treatment failure, use of rescue medication, weight change and side effects. ETHICS AND DISSEMINATION The trial has been approved by the Regional Committees on Health Research Ethics in the Capital Region of Denmark, the Danish Medicines Agency and the Danish Data Protection Agency. Results will be published in peer-reviewed journals and submitted to relevant conferences. TRIAL REGISTRATION NUMBER NCT03785691.
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Affiliation(s)
- Anne Ostenfeld
- Department of Gynecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Department of Research, Nordsjaellands Hospital, Hillerod, Denmark
- Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Henning Pedersen
- Department Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ekstrøm CT, Gerds TA, Jensen AK. Sequential rank agreement methods for comparison of ranked lists. Biostatistics 2020; 20:582-598. [PMID: 29868883 DOI: 10.1093/biostatistics/kxy017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 04/22/2018] [Indexed: 11/14/2022] Open
Abstract
The comparison of alternative rankings of a set of items is a general and common task in applied statistics. Predictor variables are ranked according to magnitude of association with an outcome, prediction models rank subjects according to the personalized risk of an event, and genetic studies rank genes according to their difference in gene expression levels. We propose a sequential rank agreement measure to quantify the rank agreement among two or more ordered lists. This measure has an intuitive interpretation, it can be applied to any number of lists even if some are partially incomplete, and it provides information about the agreement along the lists. The sequential rank agreement can be evaluated analytically or be compared graphically to a permutation based reference set in order to identify changes in the list agreements. The usefulness of this measure is illustrated using gene rankings, and using data from two Danish ovarian cancer studies where we assess the within and between agreement of different statistical classification methods.
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Affiliation(s)
- Claus Thorn Ekstrøm
- Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5 B, DK-1014 Copenhagen K, Denmark
| | - Thomas Alexander Gerds
- Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5 B, DK-1014 Copenhagen K, Denmark
| | - Andreas Kryger Jensen
- Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5 B, DK-1014 Copenhagen K, Denmark
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Sonntag J, Woythal L, Rasmussen P, Branner U, Hølmer P, Jensen AK, Lange KHW, Brorson S. No effect on functional outcome after repair of pronator quadratus in volar plating of distal radial fractures: a randomized clinical trial. Bone Joint J 2019; 101-B:1498-1505. [DOI: 10.1302/0301-620x.101b12.bjj-2019-0493.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to investigate the difference in functional outcome after repair and non-repair of the pronator quadratus muscle in patients undergoing surgical treatment for a distal radial fracture with volar plating. Patients and Methods A total of 72 patients with a distal radial fracture were included in this randomized clinical trial. They were allocated to have the pronator quadratus muscle repaired or not, after volar locked plating of a distal radial fracture. The patients, the assessor, the primary investigator, and the statistician were blinded to the allocation. Randomization was irreversibly performed using a web application that guaranteed a secure and tamper-free assignment. The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) after 12 months. Secondary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) score, pronation strength, grip strength, the range of pronation and supination, complications, and the operating time. Results Of the 72 patients, 63 (87.5%) completed follow-up for the primary outcome measure: 31 (86.1%) from the non-repair group and 32 (88.9%) from the repair group. At the 12-month follow-up, the mean difference in PRWE of 5.47 (95% confidence interval (CI) -4.02 to 14.96) between the repair (mean 18.38 (95% CI 10.34 to 26.41)) and non-repair group (mean 12.90 (95% CI 7.55 to 18.25)) was not statistically significant (p = 0.253). There was a statistically significant difference between pronation strength, favouring non-repair. We found no difference in the other secondary outcomes. Conclusion We found that repairing pronator quadratus made no difference to the clinical outcome, 12 months after volar plating of a distal radial fracture. We conclude that there is no functional advantage in repairing this muscle under these circumstances and advise against it. Cite this article: Bone Joint J 2019;101-B:1498–1505
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Affiliation(s)
- Jesper Sonntag
- Department of Orthopaedic Surgery, Nordsjaellands Hospital, University of Copenhagen, Hilleroed, Denmark
| | - Linn Woythal
- Department of Orthopaedic Surgery, Nordsjaellands Hospital, University of Copenhagen, Hilleroed, Denmark
| | - Per Rasmussen
- Department of Orthopaedic Surgery, Nordsjaellands Hospital, University of Copenhagen, Hilleroed, Denmark
| | - Ulrik Branner
- Department of Orthopaedic Surgery, Nordsjaellands Hospital, University of Copenhagen, Hilleroed, Denmark
| | - Per Hølmer
- Department of Orthopaedic Surgery, Nordsjaellands Hospital, University of Copenhagen, Hilleroed, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Nordsjaellands Hospital and Section of Biostatistics, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kai H. W. Lange
- Department of Anaesthesia and Intensive Care, Nordsjaellands Hospital, University of Copenhagen, Hilleroed, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Department of Clinical Medicine, University of Copenhagen, Koege, Denmark
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Haslund-Krog SS, Schmidt M, Mathot R, Kryger Jensen A, Jørgensen IM, Holst H. Pharmacokinetics of prednisolone in children: an open-label, randomised, two-treatment cross-over trial investigating the bioequivalence of different prednisolone formulations in children with airway disease. BMJ Paediatr Open 2019; 3:e000520. [PMID: 31646194 PMCID: PMC6782035 DOI: 10.1136/bmjpo-2019-000520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION One in three Danish children under 3 years of age experience asthma-like symptoms, and one-third will later be diagnosed with asthma. Oral prednisolone is used in various formulations to treat acute asthma. However, the potential differences in bioequivalence between these formulations have never been examined in children despite interchangeable use in clinical practice. METHODS AND ANALYSIS An open-label, randomised, two-treatment cross-over trial investigating the bioequivalence of different prednisolone formulations in children with airway disease.The included patients (6 months-11 years of age) are admitted to the Department of Paediatric and Adolescent Medicine Nordsjællands University Hospital, Hillerød, with asthma or asthma-like symptoms.The primary objective is to assess the bioequivalence between different prednisolone formulations herein area under the concentration time curve, Cmax and Tmax using saliva samples. The secondary objectives are to evaluate tolerability (five-point face scale), adverse events and severity of the disease. If the patient has an intravenous access for other purposes, the saliva samples will be validated with plasma samples.A total of 66 evaluable patients are needed according to European Medicines Agency Guideline on bioequivalence. ETHICS AND DISSEMINATION Traditional pharmacokinetic trials are burdensome due to the extent of blood samples necessary to capture the time-dependant drug profile. Saliva sampling is far more acceptable for paediatric patients. In addition, this trial adheres to standard dosing strategies. No additional venepunctures are performed, and no additional prednisolone doses are administered.Guidelines for paediatric bioequivalence trials are warranted. TRIAL REGISTRATION NUMBER The Danish Medicines Agency EudraCT: 2017-003590-33, The Ethics Committee case no: H-17027252, and the Danish Data Protection Agency: BFH-2017-103, I-Suite no.: 05935.
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Affiliation(s)
- Sissel Sundell Haslund-Krog
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Paediatric and Adolescent Medicine, Hillerød Hospital, Hillerød, Denmark
| | - Maria Schmidt
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Ron Mathot
- Department of Hospital Pharmacy - Clinical Pharmacology Unit, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Andreas Kryger Jensen
- Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Hillerød Hospital, Hillerød, Denmark
| | - Inger Merete Jørgensen
- Department of Paediatric and Adolescent Medicine, Hillerød Hospital, Hillerød, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helle Holst
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
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Winckler K, Wiinberg N, Jensen AK, Thorsteinsson B, Lundby-Christensen L, Heitmann BL, Jensen GB, Tarnow L. Carotid intima media thickness and ankle brachial index are inversely associated in subjects with and without diabetes. Scand J Clin Lab Invest 2018; 78:464-469. [PMID: 30073874 DOI: 10.1080/00365513.2018.1499124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Carotid intima-media thickness (IMT) and ankle brachial index (ABI) are non-invasive indicators of generalised atherosclerosis. The aim was to determine the association between carotid IMT and ABI in subjects with and without diabetes mellitus (DM), and to analyse specific age change-points. We included 2744 subjects from the Copenhagen City Heart Study (mean age (SD) 56.6 (17.2) years, 56.8% women and body mass index (BMI) 25.4 (4.1) kg/m2). Carotid IMT and ABI measurements were performed during the fifth examination. Of the 2744 subjects, 125 subjects (4.6%) had DM. Average carotid IMT was 0.667 (0.145) mm and ABI was 1.06 (0.14). Subjects with DM were older, had higher BMI and systolic blood pressure (SBP) (all p < .001). Carotid IMT was higher in subjects with DM (0.754 (0.150) mm) compared to subjects without DM (0.662 (0.144) mm) (p < .001), whereas there was no difference in ABI between the two groups. ABI was inversely associated with carotid IMT (slope = -0.17 [-0.207; -0.137] (p < .001). The association remained significant after adjustment for risk factors both in subjects with DM (slope = -0.168 [-0.328; -0.007], p = .040), and in subjects without DM (slope = -0.100 [-0.148; -0.052], p < .001), with a stronger effect of carotid IMT on ABI among subjects with DM. Carotid IMT and ABI were inversely associated in subjects with DM and without DM, but with a stronger effect in subjects with DM. Age and ABI revealed a change-point with a stronger inverse association among subjects aged >60 years.
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Affiliation(s)
- Karoline Winckler
- a Department of Cardiology, Nephrology and Endocrinology , Nordsjællands Hospital-Hillerød , Hillerød , Denmark
| | - Niels Wiinberg
- b Department of Clinical Physiology and Nuclear Medicine , Bispebjerg and Frederiksberg University Hospitals , Copenhagen , Denmark
| | - Andreas Kryger Jensen
- c Section of Biostatistics, Institute of Public Health , University of Copenhagen , Copenhagen , Denmark.,d Department of Clinical Research , Nordsjællands Hospital-Hillerød , Hillerød , Denmark
| | - Birger Thorsteinsson
- a Department of Cardiology, Nephrology and Endocrinology , Nordsjællands Hospital-Hillerød , Hillerød , Denmark.,e Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Louise Lundby-Christensen
- f Department of Pediatric and Adolescent Medicine , Nordsjællands Hospital-Hillerød , Hillerød , Denmark
| | - Berit Lilienthal Heitmann
- g Department of Public Health, Section for Clinical Medicine , University of Copenhagen , Copenhagen , Denmark.,h Research Unit for Dietary Studies, The Parker Institute and the Institute of Preventive Medicine , Bispebjerg and Frederiksberg University Hospitals , Copenhagen , Denmark
| | - Gorm Boje Jensen
- i Copenhagen City Heart Study , Bispebjerg and Frederiksberg Hospital , Frederiksberg , Denmark
| | - Lise Tarnow
- d Department of Clinical Research , Nordsjællands Hospital-Hillerød , Hillerød , Denmark
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Castensøe-Seidenfaden P, Husted GR, Jensen AK, Hommel E, Olsen B, Pedersen-Bjergaard U, Kensing F, Teilmann G. Testing a Smartphone App (Young with Diabetes) to Improve Self-Management of Diabetes Over 12 Months: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e141. [PMID: 29945861 PMCID: PMC6039771 DOI: 10.2196/mhealth.9487] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/22/2018] [Accepted: 03/31/2018] [Indexed: 01/01/2023] Open
Abstract
Background Young people often struggle to self-manage type 1 diabetes during the transition from childhood to adulthood. Mobile health (mHealth) apps may have the potential to support self-management, but evidence is limited and randomized controlled trials are needed. Objective We assessed whether the mHealth app “Young with Diabetes” improved young people’s self-management measured by glycated hemoglobin (HbA1c) and three self-reported psychometric scales. Methods Young people (14-22 years) with inadequate glycemic control and their parents were enrolled in a randomized controlled trial and assigned either to Young with Diabetes and usual care (Young with Diabetes group) or to usual care alone (control). Young with Diabetes use was monitored; functions included a chat room, contact the health care provider, reminders, tips, information about the diabetes department and type 1 diabetes topics, carbohydrate counting, and a parents’ section. Outcomes included HbA1c and three self-reported psychometric scales: Perceived Competence in Diabetes Scale; Health Care Climate Questionnaire; and Problem Areas In Diabetes care survey. Data were collected at baseline and at 2, 7, and 12 months. Results A total of 151 young people were randomized (Young with Diabetes group=76, control=75) and 49 parents agreed to participate. At 12 months, HbA1c was significantly higher (4.1 mmol/mol; 0.4 %) in the Young with Diabetes group, compared to the control group (P=.04); this finding did not occur when comparing app users (Young with Diabetes use ≥5 days) with nonusers. Young people used Young with Diabetes on a mean of 10.5 days. They spent the most time chatting about alcohol and searching for information about sex. Most young people and half of the parents reported that Young with Diabetes helped them. More than 80% would recommend Young with Diabetes to peers. Conclusions Young with Diabetes did not improve HbA1c, but it may be a useful complement to self-management. Qualitative evaluation is needed to explore benefits and shortcomings of Young with Diabetes. Health care providers should address young peoples’ knowledge about sensitive topics, provide them with peer support, and be aware of parents’ need for information about how to support Trial Registration ClinicalTrials.gov NCT02632383; https://clinicaltrials.gov/ct2/show/NCT02632383 (Archived by WebCite at http://www.webcitation.org/6zCK2u7xM)
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Affiliation(s)
| | - Gitte Reventlov Husted
- Nordsjællands Hospital, Pediatric and Adolescent Department, University of Copenhagen, Hillerød, Denmark
| | - Andreas Kryger Jensen
- Institute of Public Health, Biostatistics, University of Copenhagen, Copenhagen, Denmark.,Nordsjællands Hospital, Department of Clinical Research, University of Copenhagen, Hillerød, Denmark
| | - Eva Hommel
- Steno Diabetes Center, Copenhagen, University of Copenhagen, Gentofte, Denmark
| | - Birthe Olsen
- Herlev Hospital, Pediatric and Adolescent Department, University of Copenhagen, Herlev, Denmark
| | - Ulrik Pedersen-Bjergaard
- Nordsjællands Hospital, Department of Cardiology, Nephrology, and Endocrinology, University of Copenhagen, Hillerød, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Grete Teilmann
- Nordsjællands Hospital, Pediatric and Adolescent Department, University of Copenhagen, Hillerød, Denmark
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Schultz H, Pedersen-Bjergaard U, Jensen AK, Engelholm SA, Kristensen PL. The influence on survival of glucocorticoid induced diabetes in cancer patients with metastatic spinal cord compression. Clin Transl Radiat Oncol 2018; 11:19-25. [PMID: 30014043 PMCID: PMC6019865 DOI: 10.1016/j.ctro.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE The influence of glucocorticoid induced hyperglycemia on survival in patients with metastatic spinal cord compression (MSCC) is unknown. MATERIALS AND METHODS In a prospective, observational cohort study 131 patients with MSCC referred to radiotherapy, 30 Gray (Gy) in 10 fractions, and treated with ≥100 mg prednisolone a day were followed with daily blood glucose measurements during radiotherapy. RESULTS During follow-up a total of 56 patients 43% (95% CI = 35-52%) presented plasma glucose values diagnostic of diabetes. Sixteen patients who developed diabetes were treated with insulin, 12% (95% CI = [6%; 18%]) of the total population. The patients developing diabetes with need for insulin therapy during glucocorticoid therapy had a significantly increased mortality compared to those with normal glucose metabolism and with diabetes without need for therapy, hazard ratio = 2.1 (95% CI = 1.08-4.09, p = 0.0285). DISCUSSION To our knowledge this is the first prospective study to describe the influence of glucocorticoid induced diabetes on survival in patients with MSCC from different primary tumors. CONCLUSIONS The results indicate that development of diabetes during high-dose glucocorticoid therapy needing insulin treatment in patients with MSCC from different primary tumors is associated with reduced survival.
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Affiliation(s)
- Helga Schultz
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Denmark
| | - Svend Aage Engelholm
- Department of Oncology, Rigshospitalet, University of Copenhagen, Belgdamsvej 9, 2100 Copenhagen N, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
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Schultz H, Rasmussen BK, Kristensen PL, Jensen AK, Pedersen-Bjergaard U. Early incidence of glucocorticoid-induced diabetes in patients with brain tumors: a retrospective study of the first 7 days of treatment. Neurooncol Pract 2017; 5:170-175. [PMID: 31385948 DOI: 10.1093/nop/npx027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Hyperglycemia or diabetes is a well-known side effect of treatment with glucocorticoids. In patients with brain tumors, glucocorticoids are widely used to treat symptoms of peritumoral edema. We conducted a retrospective study of patients with suspected brain tumor to determine the incidence of and risk factors for glucocorticoid-induced diabetes. Methods This was a retrospective study of patients referred with suspected brain tumor to a neurological department, using data from a clinical database, electronic medical records, the laboratory system, and the pathology information bank. . Nondiabetic patients with a neuroimaging-verified brain tumor treated with high-dose glucocorticoid and monitored with glucose measurements were included in the study. Results Among 809 patients referred with suspected brain tumor, 171 were eligible for the study. Thirty-eight (22%) patients developed glucocorticoid-induced diabetes, defined as 2 glucose measurements ≥200 mg/dl (11.1 mmol/l) within the first week of treatment, and 4 of the patients were treated with insulin. The majority of patients with glucocorticoid-induced diabetes were identified on days 2, 3, and 4, and glucose levels were highest in the afternoon and evening. We were not able to identify any risk factors for glucocorticoid-induced diabetes and glucocorticoid-induced diabetes had no influence on survival in our cohort. Conclusions Glucocorticoid-induced diabetes is frequent in the first 7 days of treatment in patients with brain tumors. The results emphasize the need for screening for glucocorticoid-induced diabetes in this group of patients to avoid comorbidity expected to arise from hyperglycemia.
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Affiliation(s)
- Helga Schultz
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital Hilleroed, Hilleroed, Denmark
| | - Birthe Krogh Rasmussen
- Department of Neurology, Nordsjaellands Hospital Hilleroed, Dyrehavevej, Hilleroed, Denmark
| | - Peter Lommer Kristensen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital Hilleroed, Hilleroed, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital Hilleroed, Hilleroed, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej, Copenhagen N, Denmark
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Castensøe-Seidenfaden P, Jensen AK, Smedegaard H, Hommel E, Husted GR, Pedersen-Bjergaard U, Teilmann G. Clinical, behavioural and social indicators for poor glycaemic control around the time of transfer to adult care: a longitudinal study of 126 young people with diabetes. Diabet Med 2017; 34:667-675. [PMID: 28099760 DOI: 10.1111/dme.13318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/09/2023]
Abstract
AIMS To describe and compare changes in glycaemic control in young people with Type 1 diabetes over time between the last 2 years in paediatric care and the first 2 years in adult care and to identify risk factors for poor glycaemic control. METHODS Our retrospective cohort study followed participants aged 14-22 years from 2 years before to 2 years after transfer from paediatric to adult care. Changes in glycaemic control were calculated using repeated measurements. We adjusted for gender, age at diabetes onset, age at transfer, duration of diabetes at transfer, gap (amount of time) between last paediatric and first adult visit, comorbidity, learning disability and/or mental health conditions and family structure. We examined associations between acute hospital admissions, low visit attendance rate, loss to follow-up and baseline HbA1c level. RESULTS Among 126 participants, the mean HbA1c level was 80 mmol/mol (9.4%) pre-transfer but decreased by an average of 3 mmol/mol (0.3%) each year post-transfer (P = 0.005). Young people with a learning disability and/or a mental health condition had worse glycaemic control (P = 0.041) and the mean HbA1c of those with divorced parents was 14 mmol/mol (1.2%) higher (P = 0.014). Almost one-third of participants were admitted to the hospital for acute diabetes care. Low visit attendance rate, high baseline HbA1c level, learning disability and/or mental health conditions and divorced parents predicted acute hospital admissions. CONCLUSIONS Glycaemic control improved significantly after transfer to adult care, but the mean HbA1c level remained high. Future interventions should focus on young people with divorced parents, those with a learning disability and/or mental health condition and those who do not attend clinical visits to improve HbA1c levels and thereby reduce hospitalization rates.
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Affiliation(s)
| | - A K Jensen
- Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - H Smedegaard
- Paediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
| | - E Hommel
- Steno Diabetes Centre, Gentofte, Denmark
| | - G R Husted
- Steno Diabetes Centre, Gentofte, Denmark
| | - U Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerød, Denmark
| | - G Teilmann
- Paediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
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Cleemann L, Holm K, Kobbernagel H, Kristensen B, Skouby SO, Jensen AK, Gravholt CH. Dosage of estradiol, bone and body composition in Turner syndrome: a 5-year randomized controlled clinical trial. Eur J Endocrinol 2017; 176:233-242. [PMID: 27881458 DOI: 10.1530/eje-16-0582] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 11/11/2016] [Accepted: 11/23/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Reduced bone mineral density (BMD) is seen in Turner syndrome (TS) with an increased risk of fractures, and body composition is characterized by increased body fat and decreased lean body mass. To evaluate the effect of two different doses of oral 17B-estradiol in young TS women on bone mineral density (BMD), biochemical markers of bone turnover and body composition with the hypothesis of a positive effect of the higher dose. DESIGN A double-blind 5-year randomized controlled clinical trial. 20 young TS women participated. Inclusion criteria were diagnosis of TS, age 15-25 years and current treatment with 2 mg oral estradiol daily. METHODS The low-dose (LD) group was administered 2 mg 17B-estradiol/day orally and placebo, the high-dose (HD) group was administered 2 + 2 mg 17B-estradiol/day orally. Main outcome measures were whole body and regional bone mineral density (BMD), lean body mass (LBM), fat mass (FM) measured yearly by DXA scan and resorptive and formative bone markers in serum. RESULTS BMD, whole body and regional, increased over time with an attenuation toward the end of the study, and bone turnover markers decreased over time, both with no differences between the treatment groups (P = 0.2-0.9). LBM increased significantly more in the HD group (P = 0.02). FM remained stable in both groups. CONCLUSIONS A steady increase in BMD over time in TS was found similar to healthy young women. The higher estrogen dose did not differentially affect BMD or bone markers. The positive effect on body composition may have long-ranging health benefits in TS.
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Affiliation(s)
| | | | | | - Bent Kristensen
- Department of RadiologyNordsjællands Hospital, Hillerød, Denmark
| | - Sven Oluf Skouby
- Department of Gynecology and ObstetricsHerlev University Hospital, Herlev, Denmark
| | - Andreas Kryger Jensen
- Center of Research and InnovationNordsjællands Hospital, Hillerød, Denmark
- Department of Public HealthUniversity of Copenhagen, Copenhagen, Denmark
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine and the Medical Research LaboratoriesAarhus Sygehus NBG, Aarhus University Hospital, Aarhus C, Denmark
- Department of Molecular MedicineAarhus University Hospital, Aarhus N, Denmark
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Abstract
BACKGROUND Previous studies of the outcome after perineal stapled prolapse resection (PSPR) have included a limited number of patients with a short follow-up and high recurrence rates. The present study was designed to assess the initial results, complications, recurrence rate, and outcomes up to 4 years after PSPR, as well as the need for a repeated procedure. METHODS Fifty-four consecutive patients with rectal prolapse (mean age 77.2 years, range 46-93 years; n = 3 men) were selected for PSPR between May 2009 and February 2015. Prolapse length was measured at baseline and after surgery. Patients were asked to grade intensity of symptoms as a satisfaction score of 1-10, 10 representing being symptom-free. RESULTS The mean operation time was 45.3 min (SD = 17.5, range 25-95 min). The mean rectal prolapse length was reduced significantly from 9.5 cm (SD = 5.0, range 4-30 cm) to 1.2 cm (SD = 2.6, range 0-10 cm; p < 0.0001). Bleeding requiring surgical intervention occurred in two patients (3.7%). Postoperative satisfaction score increased from a mean of 2.2 (SD = 0.9) to a mean of 6.4 (SD = 2.8, p ≤ 0.0001). After a mean follow-up of 13.4 months (SD = 14.1), six patients with recurrence underwent a new PSPR and five patients underwent colostomy, mainly because of incontinence, resulting in a recurrence rate of 20.4%. There were no complications after redo PSPR, and after a median of 10-month follow-up (range 6-37), there were no recurrences. CONCLUSIONS PSPR is a rather new surgical procedure for external rectal prolapse. Immediate complications are few and not serious. Although recurrences can be treated with a second PSPR, the operation may only be the best option for old and fragile patients with comorbidities and a short life expectancy.
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Affiliation(s)
- D Raahave
- Department of Surgery, North Zealand Hospital, Copenhagen University, 3400, Hillerød, Denmark.
| | - A K Jensen
- Section of Biostatistics, Institute of Public Health, Copenhagen University, Copenhagen, Denmark
| | - L Dammegaard
- Department of Surgery, North Zealand Hospital, Copenhagen University, 3400, Hillerød, Denmark
| | - I K Pedersen
- Department of Surgery, North Zealand Hospital, Copenhagen University, 3400, Hillerød, Denmark
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Jensen AK, Rechnitzer C, Macklon KT, Ifversen MRS, Birkebæk N, Clausen N, Sørensen K, Fedder J, Ernst E, Andersen CY. Cryopreservation of ovarian tissue for fertility preservation in a large cohort of young girls: focus on pubertal development. Hum Reprod 2016; 32:154-164. [PMID: 27816923 DOI: 10.1093/humrep/dew273] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/15/2016] [Accepted: 10/20/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is there an association between the need for medical puberty induction and the diagnosis or treatment received in girls who have undergone cryopreservation of ovarian tissue for fertility preservation? SUMMARY ANSWER There was a clear association between the intensity of treatment received and requirement for medical puberty induction but no association with the diagnosis. WHAT IS KNOWN ALREADY Although it cannot be predicted which girls will become infertile or develop premature ovarian insufficiency (POI) following intensive chemotherapy or irradiation, patients who are at high risk of POI should be offered ovarian tissue cryopreservation (OTC). This includes girls who are planned to receive either high doses of alkylating agents, conditioning regimen before stem cell transplantation (SCT), total body irradiation (TBI) or high radiation doses to the craniospinal, abdominal or pelvic area. STUDY DESIGN, SIZE, DURATION This is a retrospective cohort study. In total, 176 Danish girls under 18 years of age have had OTC performed over a period of 15 years. An overview of the girls' diagnoses and mean age at OTC as well as the number of deceased is presented. Of the 176 girls, 38 had died and 46 girls were still younger than 12 years so their pubertal development cannot be evaluated yet. For the 60 girls who had OTC performed after 12 years of age, the incidence of POI was evaluated and in the group of 32 girls who were younger than 12 years at OTC, the association between the diagnosis and received treatment and the requirement for medical puberty induction was examined. PARTICIPANTS/MATERIALS, SETTING, METHODS The need for medical puberty induction was assessed in 32 girls who were prepubertal at the time of OTC. MAIN RESULTS AND THE ROLE OF CHANCE Indications for OTC were allogeneic SCT for leukaemia, myelodysplastic syndrome or benign haematological disorders, autologous SCT for lymphoma or sarcoma, and irradiation to the pelvis or to the spinal axis. The mean age at OTC of the 176 girls were 11.3 years. The two most prevalent diagnoses of the 176 girls were malignant tumours and malignant haematological diseases. Among the 32 prepubertal girls, 12 received high dose chemotherapy and either TBI prior to SCT or irradiation to the pelvis, abdomen or the spinal axis, 13 received high dose alkylating agents but no irradiation prior to SCT, six received alkylating agents as part of conventional chemotherapy and one patient had a genetic metabolic disorder and did not receive gonadotoxic treatment. Among these 32 girls, 23 did not undergo puberty spontaneously and thus received medical puberty induction. Among the nine girls, who went through spontaneous puberty, four had received high dose alkylating agents and five had received conventional chemotherapy. LIMITATIONS REASONS FOR CAUTION All information was retrieved retrospectively from patient records, and thus some information was not available. WIDER IMPLICATIONS OF THE FINDINGS OTC should be recommended to all young girls, who present a high risk of developing ovarian insufficiency and/or infertility following high dose chemotherapy and/or irradiation. STUDY FUNDING/COMPETING INTERESTS The Childhood Cancer Foundation (2012-2016) and the EU interregional project ReproHigh are thanked for having funded this study. They had no role in the study design, collection and analysis of the data or writing of the report. The authors have no conflict of interest to disclose.
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Affiliation(s)
- A K Jensen
- Laboratory of Reproductive Biology, Juliane Marie Centre, Section 5712, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - C Rechnitzer
- Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K T Macklon
- Fertility Clinic, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M R S Ifversen
- Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N Birkebæk
- Department of Paediatrics, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
| | - N Clausen
- Department of Paediatrics, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
| | - K Sørensen
- Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Growth and Reproduction, Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Fedder
- Fertility Clinic, Odense University Hospital, 5000 Odense, Denmark
| | - E Ernst
- Fertility Clinic, Aarhus University Hospital, Skejby, Denmark
| | - C Yding Andersen
- Laboratory of Reproductive Biology, Juliane Marie Centre, Section 5712, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Dejgaard TF, Frandsen CS, Hansen TS, Almdal T, Urhammer S, Pedersen-Bjergaard U, Jensen T, Jensen AK, Holst JJ, Tarnow L, Knop FK, Madsbad S, Andersen HU. Efficacy and safety of liraglutide for overweight adult patients with type 1 diabetes and insufficient glycaemic control (Lira-1): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 2016; 4:221-232. [PMID: 26656289 DOI: 10.1016/s2213-8587(15)00436-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND The combination of insulin and glucagon-like peptide-1 (GLP-1) receptor agonist therapy improves glycaemic control, induces weight loss, and reduces insulin dose needed in type 2 diabetes. We assessed the efficacy and safety of the GLP-1 receptor agonist liraglutide as an add-on therapy to insulin for overweight adult patients with type 1 diabetes. METHODS We did a randomised, double-blind, placebo-controlled trial at Steno Diabetes Center (Gentofte, Denmark). Patients aged 18 years or older with type 1 diabetes, insufficient glycaemic control (HbA1c >8% [64 mmol/mol]), and overweight (BMI >25 kg/m(2)) were randomly assigned (1:1) to receive insulin treatment plus either liraglutide or placebo (saline solution) by subcutaneous injection once per day. Randomisation was done in blocks of four. Treatment assignment was masked to investigators and patients. Treatment lasted 24 weeks and liraglutide was started at a dose of 0·6 mg per day, escalated to 1·2 mg per day after 1 week, and then again to 1·8 mg per day after another week. Intervals between dose increments could be extended at the discretion of the investigator. The primary endpoint was change in HbA1c from baseline to week 24. Secondary endpoints were changes in hypoglycaemic events, glycaemic variability, glycaemic excursions, insulin dose, bodyweight, postprandial plasma concentrations of glucagon and GLP-1, gastric emptying, blood pressure, heart rate, patient-reported outcome measures, time spent in hypoglycaemia, near-normoglycaemia, and hyperglycaemia, plasma fasting glucose, mean glucose, and cholesterol. Efficacy analyses were calculated by use of a mixed model, whereby a patient's data are used as long as the patient is in the study. The safety analyses were done in the intention-to-treat population, which consisted of all patients who received at least one dose of their randomly assigned study drug. This study is registered with ClinicalTrials.gov, number NCT01612468. FINDINGS Between July 10, 2012, and May 30, 2014, we enrolled 100 patients with type 1 diabetes, with 50 patients allocated liraglutide and 50 to placebo. Four patients from the liraglutide group and six patients from the placebo group discontinued treatment before 24 weeks. At the end of treatment, change in HbA1c from baseline did not differ between groups (-0·5%, 95% CI -0·8 to -0·4 [-6·0 mmol/mol, 95% CI -8·7 to -4·4] with liraglutide vs -0·3%, -0·6 to -0·2 [-4·0 mmol/mol, -6·6 to -2·3] with placebo; between-group difference -0·2% [-0·5 to 0·1; 2·2 mmol/mol, -5·5 to 1·1], p=0·1833). The number of hypoglycaemic events was reduced with liraglutide, with an incident rate ratio of 0·82 (95% CI 0·74 to 0·90). However, we detected no changes in glycaemic variability (continuous overall net glycaemic action per 60 min from 10·3 [95% CI 9·8 to 10·8] to 9·9 [9·2 to 10·6] in the liraglutide treated patients vs 10·2 [9·7 to 10·7] to 9·7 [9·1 to 10·3] in the placebo treated patients). Both bolus insulin (difference -5·8 IU, 95% CI -10·7 to -0·8, p=0·0227) and bodyweight (difference -6·8 kg, 95% CI -12·2 to -1·4, p=0·0145) decreased with liraglutide treatment compared with placebo. Heart rate increased with liraglutide, with a difference between groups of 7·5 bpm (95% CI 2·8-12·2, p=0·0019). Postprandial plasma glucagon and GLP-1 concentrations did not differ between groups (difference between groups at end of treatment: -408 mmol/L per 240 min [95% CI -941 to 125, p=0·1309] for glucagon and -266 mmol/L per 240 min [-1034 to 501, p=0·4899] for GLP-1). Gastric emptying was delayed after 3 weeks of treatment with liraglutide (19·9 min, 95% CI 0·8 to 39·0, p=0·0412), but we detected no difference after 24 weeks of treatment (-1·5 min, -20·5 to 17·6, p=0·8793). Patient-reported outcome measures differed between groups only with respect to perceived frequency of hypoglycaemia, which was higher with placebo, with a difference between groups of -0·6 (95% CI -1·1 to -0·07, p=0·0257). Liraglutide was associated with more frequent nausea (29 [58%] patients with liraglutide vs five [10%] with placebo), dyspepsia (11 [22%] patients with liraglutide vs one [2%] with placebo), diarrhoea (ten [20%] patients with liraglutide vs one [2%] with placebo), decreased appetite (seven patients [14%] with liraglutide vs none with placebo), and vomiting (seven [14%] patients with liraglutide vs one [2%] with placebo). INTERPRETATION In patients with type 1 diabetes, overweight, and insufficient glycaemic control, the reduction in HbA1c did not differ between insulin plus placebo and insulin plus liraglutide treatment. Liraglutide was associated with reductions in hypoglycaemic events, bolus and total insulin dose, and bodyweight, and increased heart rate. FUNDING Novo Nordisk.
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Affiliation(s)
- Thomas Fremming Dejgaard
- Steno Diabetes Center, Gentofte, Denmark; Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
| | | | | | - Thomas Almdal
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Søren Urhammer
- Department of Endocrinology, Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, University of Copenhagen, Hillerød, Denmark
| | - Tonny Jensen
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Nordsjællands Hospital Hillerød, University of Copenhagen, Hillerød, Denmark; Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jens Juul Holst
- The NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Lise Tarnow
- Department of Clinical Research, Nordsjællands Hospital Hillerød, University of Copenhagen, Hillerød, Denmark; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Filip Krag Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; The NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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Jensen AK, Kristensen SG, Macklon KT, Jeppesen JV, Fedder J, Ernst E, Andersen CY. Outcomes of transplantations of cryopreserved ovarian tissue to 41 women in Denmark. Hum Reprod 2015; 30:2838-45. [PMID: 26443605 DOI: 10.1093/humrep/dev230] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/24/2015] [Indexed: 01/07/2023] Open
Abstract
STUDY QUESTION What are the results of transplanting cryopreserved ovarian tissue? SUMMARY ANSWER The transplanted ovarian tissue can last up to 10 years, with no relapses following the 53 transplantations, and the chance of a successful pregnancy is currently around one in three for those with a pregnancy-wish. WHAT IS KNOWN ALREADY Cryopreservation of ovarian tissue is now gaining ground as a valid method for fertility preservation. More than 36 children worldwide have now been born following this procedure. STUDY DESIGN, SIZE, DURATION This is a retrospective cohort study of 41 women who had thawed ovarian tissue transplanted 53 times over a period of 10 years, including 1 patient who was lost to follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS The 41 Danish women, who had in total 53 transplantations, were followed for ovarian function and fertility outcome. Safety was assessed by monitoring relapse in cancer survivors. MAIN RESULTS, AND THE ROLE OF CHANCE Among 32 women with a pregnancy-wish, 10 (31%) had a child/children (14 children in total); this included 1 woman with a third trimester on-going pregnancy. In addition, two legal abortions and one second trimester miscarriage occurred. A total of 24 clinical pregnancies were established in the 32 women with a pregnancy-wish. The tissue remained functional for close to 10 years in some cases and lasted only a short period in others. Three relapses occurred but were unlikely to be due to the transplanted tissue. LIMITATIONS, REASONS FOR CAUTION Self-report through questionnaires with only in-one hospital formalised follow-up of transplanted patients could result in unreported miscarriages. The longevity of the tissue may vary by few months compared with those reported because some patients simply could not remember the date when the tissue became non-functional. WIDER IMPLICATIONS OF THE FINDINGS Cryopreservation of ovarian tissue is likely to become integrated into the treatment of young women, with cancer, who run a risk of losing their fertility. The full functional lifespan of grafts is still being evaluated, because many of the transplanted women have continued to maintain ovarian activity. Some of our first cases have had tissue functioning for ∼ 10 years.
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Affiliation(s)
- A K Jensen
- Laboratory of Reproductive Biology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - S G Kristensen
- Laboratory of Reproductive Biology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - K T Macklon
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - J V Jeppesen
- Laboratory of Reproductive Biology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - J Fedder
- The Fertility Clinic, Odense University Hospital, 5000 Odense, Denmark
| | - E Ernst
- The Fertility Clinic, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
| | - C Y Andersen
- Laboratory of Reproductive Biology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
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Tan Q, B Hjelmborg JV, Thomassen M, Jensen AK, Christiansen L, Christensen K, Zhao JH, Kruse TA. Hierarchical linear modeling of longitudinal pedigree data for genetic association analysis. BMC Proc 2014; 8:S82. [PMID: 25519411 PMCID: PMC4144324 DOI: 10.1186/1753-6561-8-s1-s82] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Genetic association analysis on complex phenotypes under a longitudinal design involving pedigrees encounters the problem of correlation within pedigrees, which could affect statistical assessment of the genetic effects. Approaches have been proposed to integrate kinship correlation into the mixed-effect models to explicitly model the genetic relationship. These have proved to be an efficient way of dealing with sample clustering in pedigree data. Although current algorithms implemented in popular statistical packages are useful for adjusting relatedness in the mixed modeling of genetic effects on the mean level of a phenotype, they are not sufficiently straightforward to handle the kinship correlation on the time-dependent trajectories of a phenotype. We introduce a 2-level hierarchical linear model to separately assess the genetic associations with the mean level and the rate of change of a phenotype, integrating kinship correlation in the analysis. We apply our method to the Genetic Analysis Workshop 18 genome-wide association studies data on chromosome 3 to estimate the genetic effects on systolic blood pressure measured over time in large pedigrees. Our method identifies genetic variants associated with blood pressure with estimated inflation factors of 0.99, suggesting that our modeling of random effects efficiently handles the genetic relatedness in pedigrees. Application to simulated data captures important variants specified in the simulation. Our results show that the method is useful for genetic association studies in related samples using longitudinal design.
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Affiliation(s)
- Qihua Tan
- Institute of Clinical Research, Unit of Human Genetics, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark ; Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, J. B. Winsloews Vej 9B, 5000 Odense C, Denmark
| | - Jacob V B Hjelmborg
- Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, J. B. Winsloews Vej 9B, 5000 Odense C, Denmark
| | - Mads Thomassen
- Institute of Clinical Research, Unit of Human Genetics, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Andreas Kryger Jensen
- Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, J. B. Winsloews Vej 9B, 5000 Odense C, Denmark
| | - Lene Christiansen
- Institute of Clinical Research, Unit of Human Genetics, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark ; Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, J. B. Winsloews Vej 9B, 5000 Odense C, Denmark
| | - Kaare Christensen
- Institute of Clinical Research, Unit of Human Genetics, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark ; Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, J. B. Winsloews Vej 9B, 5000 Odense C, Denmark
| | - Jing Hua Zhao
- MRC Epidemiology Unit and Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Torben A Kruse
- Institute of Clinical Research, Unit of Human Genetics, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
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Hermann A, Ried-Larsen M, Jensen AK, Holst R, Andersen LB, Overgaard S, Holsgaard-Larsen A. Low validity of the Sensewear Pro3 activity monitor compared to indirect calorimetry during simulated free living in patients with osteoarthritis of the hip. BMC Musculoskelet Disord 2014; 15:43. [PMID: 24552503 PMCID: PMC3938645 DOI: 10.1186/1471-2474-15-43] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 02/11/2014] [Indexed: 12/02/2022] Open
Abstract
Background To validate physical activity estimates by the Sensewear Pro3 activity monitor compared with indirect calorimetry during simulated free living in patients diagnosed with osteoarthritis of the hip pre or post total hip arthroplasty. Methods Twenty patients diagnosed with hip osteoarthritis (10 pre- and 10 post total hip arthroplasty; 40% female; age: 63.3 ± 9.0; BMI: 23.7 ± 3.7). All patients completed a 2 hour protocol of simulated free living with 8 different typical physical activity types. Energy consumption (kcal/min) was estimated by the Sense Wear pro3 Armband activity monitor and validated against indirect calorimetry (criterion method) by means of a portable unit (Cosmed K4b2). Bias and variance was analyzed using functional ANOVA. Results Mean bias during all activities was 1.5 Kcal/min 95%CI [1.3; 1.8] corresponding to 72% (overestimation). Normal gait speed showed an overestimation of 2.8 Kcal/min, 95%CI [2.3; 3.3] (93%) while an underestimation of -1.1 Kcal/min, 95%CI [-1.8; -0.3] (-25%) was recorded during stair climb. Activities dominated by upper body movements showed large overestimation with 4.37 Kcal/min, 95%CI [3.8; 5.1] (170%) being recorded during gardening. Both bias and variance appeared to be dependent on activity type. Conclusion The activity monitor generally overestimated the energy consumption during common activities of low to medium intensity in the patient group. The size and direction of the bias was highly dependent on the activity type which indicates the activity monitor is of limited value in patients with hip osteoarthritis and that the results do not express the real energy expenditure.
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Affiliation(s)
- Andreas Hermann
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
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Ravn P, Demissie A, Eguale T, Wondwosson H, Lein D, Amoudy HA, Mustafa AS, Jensen AK, Holm A, Rosenkrands I, Oftung F, Olobo J, von Reyn F, Andersen P. Human T cell responses to the ESAT-6 antigen from Mycobacterium tuberculosis. J Infect Dis 1999; 179:637-45. [PMID: 9952370 DOI: 10.1086/314640] [Citation(s) in RCA: 233] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Human T cell responses to ESAT-6 and eight synthetic overlapping peptides were investigated in tuberculosis (TB) patients and control subjects from regions of high and low endemicity for TB. ESAT-6 was recognized by 65% of all tuberculin purified protein derivative-responsive TB patients, whereas only 2 of 29 bacille Calmette-Guérin-vaccinated Danish healthy donors recognized this molecule. In Ethiopia, a high frequency (58%) of healthy contacts of TB patients recognized ESAT-6. All of the peptides were recognized by some donors, indicating that the molecule holds multiple epitopes. Danish and Ethiopian patients differed in the fine specificity of their peptide responses. Recognition of the C-terminal region (aa 72-95) was predominant in Danish patients, whereas recognition of aa 42-75 was predominant in Ethiopia. The relationship of these differences to the distribution of HLA types in the two populations is discussed. This study demonstrates that ESAT-6 is frequently recognized during early infection and holds potential as a component of a future TB-specific diagnostic reagent.
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Affiliation(s)
- P Ravn
- Department of Tuberculosis Immunology, Statens Serum Institut, 2300 Copenhagen 5, Denmark.
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Melbye M, Wohlfahrt J, Westergaard T, Jensen AK, Koch A, Hjalgrim H, Kristensen A, Aaby P. Births at Christmas are different: population based survey of 2 million deliveries. Christmas Paper Study Group. BMJ 1997; 315:1654-5. [PMID: 9448529 PMCID: PMC2128030 DOI: 10.1136/bmj.315.7123.1654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M Melbye
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen, Denmark.
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Abstract
We have previously demonstrated that genetically modified syngeneic murine tumor cells (KBALB) expressing the herpes simplex virus thymidine kinase gene (HSV-STK) can kill nearby unmodified tumor cells in the presence of ganciclovir (GCV). The killing was mediated by a 'bystander effect' as evidenced by the prolonged animal survival when syngeneic HSV-TK gene-modified tumor cells were inoculated into mice with an intraperitoneal tumor. In this study we investigated whether irradiated xenogeneic HSV-TK gene-modified tumor cells, a human colon carcinoma cell line (HCT) transfected with the HSV-TK gene, can mediate the 'bystander effect' when used in vitro and in vivo. In vitro experiments indicate that irradiated HSV-TK gene-modified xenogeneic cells (HCT) can mediate a bystander effect on the adjacent cells when the tumor population consisted of as few as 10% of the HSV-TK expressing HCT tumor cells. In vivo, animal survival experiments demonstrate that the xenogeneic gene-modified tumor cells could generate the 'bystander effect' in mice with intraperitoneal tumors as evidenced by prolonged animal survival. In addition, histologic examination of the tumors from experimental animals showed extensive tumor necrosis 3 days post HSV-TK/GCV treatment in comparison to control animals. To evaluate the cause of necrosis in vivo, we assayed for cytokines, which may be involved in mediating this process, by performing RT-PCR and immunohistochemistry on tumor RNA and tumor cells, respectively. Production of IL-1 alpha and IL-6 mRNA within the experimental tumors was observed by RT-PCR. However, mRNA expression for other cytokines including IFN-gamma, IL-2 and IL-4 was not present. Immunohistochemical analysis for IL-1 alpha protein showed reactivity within the infiltrating mononuclear cells indicating the release of this soluble factor. These results indicate that the bystander effect can be generated using irradiated xenogeneic cells both, in vitro and in vivo. Furthermore, this process is mediated by the release of cytokines such as IL-1 alpha, IL-6 which enhances the bystander effect in vivo by immunostimulation.
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Affiliation(s)
- S M Freeman
- Department of Pathology and Laboratory Medicine, Tulane University Medical School, New Orleans, LA 70112, USA
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Abstract
Eight commercial kits and an in-house ELISA for detection of IgG antibodies against Helicobacter pylori were evaluated for their use in diagnosis of H. pylori infection and in epidemiological research: Helico-GTM (Porton-Cambridge), G. A. P. test (Bio-Rad), H. pylori antibodies ELISA (Biometra), Anti-H. pylori IgG EIA (Roche), 2nd generation H. pylori EIA (Roche), Anti-H. pylori MTP-assay (Roche), Pylori stat test kit (Whittaker), Pyloriset latex agglutination kit (Orion), and the in-house ELISA based on heat-stable antigens. Fifty-four patients with dyspepsia (31 H. pylori positive by culture or microscopy) and 68 asymptomatic persons were tested. Sensitivities for the eight kits were 71%, 77%, 90%, 84%, 87%, 94%, 90%, 87%, and 87%, specificities were 74%, 65%, 74%, 74%, 83%, 83%, 70%, 65%, and 65%, respectively. For epidemiological use the estimated seroprevalence varied within approximately 15% in all age groups. Sensitivities and specificities obtained in different studies reveal as great differences in the results with the same kit as between results obtained with different kits in the same study. Kits with the highest sensitivities tend to be the same in all studies. It is therefore more important to test a kit in the population to which it is to be applied than to choose a specific kit.
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Affiliation(s)
- A K Jensen
- Department of Clinical Microbiology, University of Copenhagen, Rigshospitalet, Denmark
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Jensen AK, Andersen LP, Gaarslev K, Wachmann CH. Comparison of four second generation kits for detection of IgG antibodies against Helicobacter pylori in adults. Zentralbl Bakteriol 1993; 280:221-6. [PMID: 8280945 DOI: 10.1016/s0934-8840(11)80959-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Four serological kits for detection of IgG antibodies against H. pylori were tested on 132 adult patients with dyspeptic symptoms. Presence of H. pylori infection was established when either culture or microscopy of gastric biopsies were positive. The prevalence of H. pylori infection was 55% in the test population. With Anti-H. pylori MTP-assay (Roche), Pylori stat test kit (Whittaker), HM-CAP (Enteric Products Inc.) and Pyloriset EIA-G (Orion) the sensitivities were 97%, 95%, 81% and 68% respectively, the specificities were 53%, 56%, 71% and 69% respectively, the positive predictive values 72%, 74%, 79% and 74% respectively and the negative predictive values were 94%, 92%, 79% and 64% respectively.
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Affiliation(s)
- A K Jensen
- Department of Bacteriology, Statens Seruminstitute, Copenhagen S, Denmark
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Furberg H, Jensen AK, Salbu B. Effect of pretreatment with 0.9% sodium chloride or insulin solutions on the delivery of insulin from an infusion system. Am J Hosp Pharm 1986; 43:2209-13. [PMID: 3766574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The effect of pretreating a polyvinyl chloride i.v. administration system with sodium chloride or insulin solution on the delivery of insulin was studied. Insulin labeled with iodine 125 was added to human insulin, which was added to 0.9% sodium chloride injection packaged in flexible polyvinyl chloride containers and to 0.9% sodium chloride injection placed in empty ethylene vinyl acetate containers. Samples were tested for insulin content by gamma spectrometry after storage in the bags and after infusion through four different polyvinyl chloride administration sets at different flow rates. Effluent samples were collected at 10 times (6-50 minutes) after the start of the infusion. The 0.9% sodium chloride injection had a conditioning effect on the polyvinyl chloride administration sets, indicating an electrostatic sorption mechanism for insulin. Sorption to the untreated polyvinyl chloride sets and the ethylene vinyl acetate bags was substantial and followed a Langmuir adsorption isotherm. Insulin sorption to the untreated administration sets was greatest from the first 100 mL of effluent and did not differ by flow rate or type of set investigated. Storing the sodium chloride injection in the tubing for one hour or flushing the tubing with 100 mL of sodium chloride injection or 100 mL of the insulin admixture decreased sorption by half. Storing the insulin admixture in the tubing for 30 minutes caused sorption to be reduced by a factor of three. When either of the solutions was stored in the set and then the set was flushed with the solution, sorption was even further suppressed.(ABSTRACT TRUNCATED AT 250 WORDS)
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