1
|
Thorsted AB, Thygesen LC, Jezek AH, Pedersen MM, Jorgensen MG, Vinding K, Kannegaard PN, Pedersen SGH. The De Morton Mobility Index (DEMMI) in hospitalized geriatric patients is associated with risk of readmission, mortality, and discharge to a post-acute care facility: A nationwide register-based cohort study. Arch Gerontol Geriatr 2024; 120:105325. [PMID: 38237375 DOI: 10.1016/j.archger.2024.105325] [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: 11/05/2023] [Revised: 12/15/2023] [Accepted: 01/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To examine the association between the de Morton Mobility Index (DEMMI) score on admission in geriatric patients and readmission and mortality within 30, 180, and 365 days after discharge, and discharge to a post-acute care facility. METHODS A nationwide register-based cohort study including 23,941 geriatric in-patients aged ≥65 years admitted to a geriatric ward between 2014 and 2017 and included in the Danish National Database for Geriatrics. The DEMMI score was categorized into four subcategories: very low mobility (DEMMI=0-24), low mobility (DEMMI=27-39), moderately reduced mobility (DEMMI=41-57), and independent mobility (DEMMI=62-100). Patients were followed 30, 180 and 365 days after discharge for readmission and mortality. Their risk of being discharged to a post-acute care facility was examined. Adjusted hazard ratios (HRs) and odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated. RESULTS HRs for readmission within 30-days were 1.36 (1.24-1.48) for very low mobility, 1.30 (1.20-1.42) for low mobility and 1.17 (1.08-1.28) for moderately reduced compared with independent mobility. Similar results were seen for readmission within 180- and 365-days. For mortality, HR for 30-day mortality ranged from1.93 and 5.66, 180-day mortality between 1.62 and 3.19, and 365-day mortality between 1.54 and 2.81 compared with patients with independent mobility. OR for discharge to a post-acute care facility was 8.76 (7.29-10.53) for lowest compared with the highest DEMMI mobility subcategory. CONCLUSION In geriatric in-patients, lower DEMMI scores on hospital admission are associated with increased rates of discharge to a post-acute care facility, and for readmission, and mortality within one year.
Collapse
Affiliation(s)
- Anne B Thorsted
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Andrea H Jezek
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Mette M Pedersen
- Department of Clinical Research and Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital at Amager and Hvidovre, Kettegaard alle 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin G Jorgensen
- Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Vinding
- Diagnostic Center, Department of Medicine, Odense University Hospital, Baagøes Alle 31, 5700 Svendborg, Denmark
| | - Pia N Kannegaard
- Department of Geriatric and Palliative Medicine, Bispebjerg-Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Solvejg G H Pedersen
- Department of Medicine 2, Geriatric section, Holbaek University Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark.
| |
Collapse
|
2
|
Algren MH, Gazibara T, Valentiner-Branth P, Timmermann A, Thygesen LC, Tolstrup JS. Characteristics associated with non-initiation and non-completion of human papillomavirus vaccination among Danish girls: a nationwide register-based cohort study. Scand J Public Health 2024:14034948241232462. [PMID: 38418848 DOI: 10.1177/14034948241232462] [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] [Indexed: 03/02/2024]
Abstract
AIM The aim was to identify maternal and paternal socioeconomic and demographic characteristics for non-initiation and non-completion of the human papillomavirus (HPV) vaccination among Danish girls including time-trends. METHODS This nationwide register-based cohort study included all girls residing in Denmark who were offered free-of-charge HPV vaccination as a part of the childhood vaccination program between 2009 and 2018 (birth cohorts 1996-2005). The study samples included 296,461 daughter-mother dyads and 291,025 daughter-father dyads. Data from the Danish Vaccination Register were linked with socioeconomic and demographic data from Statistics Denmark. HPV vaccination status was classified as 'non-initiation' for girls who received no HPV vaccine and as 'non-completion' for girls who initiated the HPV vaccination program but did not receive all the scheduled HPV vaccines. Data were analyzed using logistic regression models. RESULTS Non-initiation of HPV vaccination was 13.7%, and non-completion was 24.2% among girls who initiated the HPV vaccination program. Girls of parents who were descendants of immigrants (adjusted odds ratio: 1.50; 95% confidence interval: 1.35-1.68), were at least 35-years old at time of birth, had basic or no education, had a low income, were not in the labor market, and were unmarried had the highest non-initiation and non-completion odds. The associations between socioeconomic and demographic characteristics and HPV vaccination uptake were similar for mothers and fathers. CONCLUSIONS Despite free-of-charge availability to HPV vaccination in Denmark, we found disparities in non-initiation and non-completion of HPV vaccination among Danish girls by both mothers' and fathers' socioeconomic and demographic characteristics.
Collapse
Affiliation(s)
- Maria H Algren
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Tatjana Gazibara
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Amalie Timmermann
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
3
|
Rosenkilde S, Sørensen TIA, Algren MH, Thygesen LC. Changes in weight status during the COVID-19 pandemic: impact of educational level and mental health. Eur J Public Health 2024; 34:190-195. [PMID: 37968230 PMCID: PMC10843948 DOI: 10.1093/eurpub/ckad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in a disruption of daily routines and changes in health behaviors leading to widespread concerns about unfavorable changes in weight status and a potential increase in the prevalence of obesity. This study examined the long-term impact of the COVID-19 pandemic on changes in weight status and its possible dependency on educational level and mental health. METHODS The study utilizes the Danish Health and Well-being Survey with repeated self-reported information on weight status collected before the COVID-19 pandemic (autumn of 2019) and twice during the pandemic (autumns of 2020 and 2021). Information on educational level was derived from registers, whereas mental health was measured using validated scales. Generalized estimating equations were performed to investigate changes in mean weight and body mass index (BMI) category (BMI < 30 to BMI ≥ 30) between 2019 and 2021 and to investigate potential differences in changes in weight status by pre-pandemic educational level and mental health. RESULTS Mean weight significantly increased by 0.34 kg [95% confidence interval (CI): 0.16-0.51] in 2020 and by 0.46 kg (95% CI: 0.26-0.66) in 2021 compared with pre-pandemic weight status. The increase was greater among individuals with lower educational levels and poorer mental health. There were no significant changes in BMI category during the pandemic. CONCLUSION The results showed a significant increase in mean weight among the Danish population, particularly among individuals with lower educational levels and poorer mental health, but without detectable differences in obesity, supporting a long-term but minor impact of the COVID-19 pandemic on weight status.
Collapse
Affiliation(s)
- Siri Rosenkilde
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
| | - Thorkild I A Sørensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
- Department of Public Health, Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Maria H Algren
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
| |
Collapse
|
4
|
Kjeld SG, Thygesen LC, Danielsen D, Jensen MP, Krølner RF, Pisinger C, Andersen S. Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial. BMJ Open 2024; 14:e070176. [PMID: 38191253 PMCID: PMC10806711 DOI: 10.1136/bmjopen-2022-070176] [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: 11/15/2022] [Accepted: 11/27/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES Public health interventions are designed to improve specific health-related outcomes; however, they may also produce negative side effects, such as substitution use, psychological or social harms. Knowledge about the unintended effects of school-based smoking preventive interventions is sparse. Hence, this study examined these potential unintended effects of the smoking-reducing intervention, Focus, among students in the vocational education and training setting. DESIGN Cluster randomised controlled trial stratified by school type with 5 months follow-up. SETTING AND PARTICIPANTS Across Denmark, eight schools were randomised to the intervention group (n=844 students, response proportion 76%) and six schools to the control group (n=815 students, response proportion 75%). This study focused solely on students who smoked at baseline (N=491). INTERVENTIONS The intervention was developed systematically based on theory and a thoroughly mixed-methods needs assessment. Intervention components included a comprehensive school tobacco policy (smoke-free school hours) supported by a 3-day course for school staff and launched by an edutainment session for students; class-based lessons and a quit-and-win competition; and individual telephone smoking cessation support. OUTCOMES Alternative tobacco and nicotine products (regular use of smokeless tobacco, hookah and e-cigarettes), regular cannabis use, boredom and loneliness at school, stress and perceived stigmatisation among smokers. RESULTS We found no statistically significant unintended effects of the intervention. Nonetheless, insignificant findings indicated that students in the intervention group were less likely to be bored during school hours (OR 0.59, 95% CI 0.32 to 1.10) and experience stress (OR 0.62, 95% CI 0.35 to 1.10), but more likely to report feeling stigmatised compared with the control group (OR 1.55, 95% CI 0.71 to 3.40). CONCLUSIONS Overall, findings suggested no unintended effects of the Focus trial with respect to substitution use, psychological, nor group or social harms. Future research is encouraged to report potential harmful outcomes of smoking preventive interventions, and interventions should be aware of the possible stigmatisation of smokers. TRIAL REGISTRATION NUMBER ISRCTN16455577.
Collapse
Affiliation(s)
- Simone G Kjeld
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Lau C Thygesen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Dina Danielsen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Marie P Jensen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Rikke F Krølner
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Charlotta Pisinger
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Frederiksberg University Hospital, Frederiksberg, Denmark
- Tryg Foundation, Virum, Denmark
| | - Susan Andersen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| |
Collapse
|
5
|
Jarlstrup NS, Thygesen LC, Pisinger C, Vestbo J, Grønbæk M, Tolstrup JS. Trends in smoking-related diseases by socioeconomic position following a national smoking ban in 2007: a nationwide study in the Danish population. BMC Public Health 2023; 23:1648. [PMID: 37641031 PMCID: PMC10463393 DOI: 10.1186/s12889-023-16456-3] [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: 08/12/2022] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND National comprehensive smoke-free legislation has been found to decrease the incidence of several smoking-related diseases. In 2007, Denmark introduced a national smoking ban, which banned smoking indoor in workplaces and public places, although only partial restrictions were applied in certain settings. We examined the impact of the smoking ban on smoking-related diseases and whether this differed across socioeconomic groups. METHODS Interrupted time series analyses of nationwide register data were performed using Poisson regression models to examine the differential impact of the smoking ban on monthly incidence rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers from 2002 to 2015. Immediate changes in incidence rates after the smoking ban and long-term changes in disease trends were estimated by comparing data from the pre- and post-ban period. Models were stratified by socioeconomic position. RESULTS Overall, we found neither immediate changes in rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers following the smoking ban nor long-term post-ban changes in disease trends as compared to before the ban. Results did not differ across socioeconomic groups. A pronounced socioeconomic gradient in incidence rates was observed for all outcomes both before and after the smoking ban. CONCLUSION The national smoking ban was not associated with a lower incidence of smoking-related diseases in the post-ban period compared to pre-ban levels and no differences between socioeconomic groups were observed. Future tobacco control in Denmark should consider which measures most effectively target the low socioeconomic groups to decrease the current strong socioeconomic inequality in health.
Collapse
Affiliation(s)
- Nanna Schneekloth Jarlstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Jørgen Vestbo
- University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
| |
Collapse
|
6
|
Mair CA, Thygesen LC, Aldridge M, Tay DL, Ornstein KA. End-of-Life Experiences Among "Kinless" Older Adults: A Nationwide Register-Based Study. J Palliat Med 2023; 26:1056-1063. [PMID: 36893217 PMCID: PMC10440640 DOI: 10.1089/jpm.2022.0490] [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] [Accepted: 01/25/2023] [Indexed: 03/11/2023] Open
Abstract
Background: The population of older adults who are unpartnered and childless (i.e., "kinless") is increasing across the globe, and may be at risk for lower quality end-of-life (EoL) experiences due to lack of family support, assistance, and advocacy. Yet, little research exists on the EoL experiences of "kinless" older adults. Objectives: To document associations between family structure (i.e., presence or absence of partner or child) and intensity of EoL experiences (i.e., visits to medicalized settings before death). Design: The study design is a cross-sectional population-based register study of the population of Denmark. Subjects: Participants include all adults age 60 years and older who died of natural causes in Denmark from 2009 to 2016 (n = 137,599 decedents). Results: "Kinless" older adults (reference = has partner, has child) were the least likely group to visit the hospital (two or more times; odds ratio [OR] = 0.74, confidence interval [CI] = 0.70-0.77), emergency department (one or more times; OR = 0.90, CI = 0.86-0.93), and intensive care unit (one or more times; OR = 0.71, CI = 0.67-0.75) before death. Conclusions: "Kinless" older adults in Denmark were less likely to experience medically intensive care at the EoL. Further research is needed to understand factors associated with this pattern to ensure that all individuals receive high quality EoL care regardless of their family structure and family tie availability.
Collapse
Affiliation(s)
- Christine A. Mair
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Lau C. Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Melissa Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Djin L. Tay
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
7
|
Larsen C, Kirchhoff KS, Saltbæk L, Thygesen LC, Karlsen RV, Svendsen MN, Høeg BL, Horsbøl TA, Bidstrup PE, Christensen HG, Johansen C, Dalton SO. The association between education and fear of recurrence among breast cancer patients in follow-up - and the mediating effect of self-efficacy. Acta Oncol 2023; 62:714-718. [PMID: 37039679 DOI: 10.1080/0284186x.2023.2197122] [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: 10/15/2022] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Major restructuring of surveillance after breast cancer treatment with less follow-up consultations may result in insecurity and fear of recurrence (FCR) among the less resourceful breast cancer patients. We investigate the association between breast cancer patients' education and FCR and if self-efficacy mediates the associations between education and FCR. MATERIAL AND METHODS A questionnaire survey was conducted from 2017 to 2019, among 1773 breast cancer patients shortly after having their follow-up switched from regular outpatient visits with an oncologist to either nurse-led or patient-initiated follow-up, with a subsequent questionnaire after 12 months. Data on disease and treatment characteristics were extracted from medical records and the Danish Breast Cancer Group Database. Logistic regression analyses were used to examine the association between education and FCR. Separate analyses were conducted for patients ≤ and >5 years since diagnosis and all models were adjusted for age and cohabitation status. To explore potential mediation by self-efficacy, we conducted regression analyses on education and FCR further adjusting for self-efficacy. RESULTS The participation rate was 57%, and after the exclusion of patients due to missing data, 917 were included in analyses. Patients with long education had significantly less FCR compared to patients with short education (OR (95% CI) 0.71 (0.51;0,99)). When separated by time since diagnosis, there was no association among patients >5 years since diagnosis while the OR was 0.51 (95% CI, 0.30;0.85) for patients ≤5 years since diagnosis. Further adjusting for self-efficacy among patients <5 years since diagnosis resulted in an OR of 0.56 (95% CI, 0.33;0.95) among patients with long compared to short education. CONCLUSION Up to 5 years after diagnosis, breast cancer patients with long education are less likely to experience FCR than patients with short education. Self-efficacy mediated only a very small part of this association, indicating that other factors play a role in socioeconomic differences in FCR among breast cancer patients.
Collapse
Affiliation(s)
- Cecilie Larsen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Surgery and Center of Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Kirstine S Kirchhoff
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Emergency Department, Zealand University Hospital, Køge, Denmark
| | - Lena Saltbæk
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Randi V Karlsen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mads N Svendsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Beverley L Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Trine A Horsbøl
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Helle G Christensen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Christoffer Johansen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- CASTLE, Danish Cancer Society Research Center for Late Effects after Cancer, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| |
Collapse
|
8
|
Berg SK, Birk NM, Thorsted AB, Rosenkilde S, Jensen LB, Nygaard U, Bundgaard H, Thygesen LC, Ersbøll AK, Nielsen SD, Christensen AV. Risk of body weight changes among Danish children and adolescents during the COVID-19 pandemic. Pediatr Obes 2023; 18:e13005. [PMID: 36695546 DOI: 10.1111/ijpo.13005] [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: 08/02/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Knowledge of COVID-19 and the pandemic's effects on Danish children's body weight is limited. OBJECTIVE Objectives were to investigate (I) risk of weight changes among Danish children with and without SARS-CoV-2, (II) associations between weight changes, psychological symptoms, and long COVID symptoms, and (III) weight distribution pre- and post-pandemic. METHODS A national survey was administered to all Danish children aged 0-18 years, with prior COVID-19 (cases) and matched references including questions on weight, weight changes during the pandemic and long COVID-related symptoms. Descriptive statistics and logistic regression were used. Weight distribution was compared with a pre-pandemic database. RESULTS In all, 17 627 cases and 54 656 references were included. The 4-18-year-old cases had lower odds of unintended weight gain. The 2-3-year-old cases had higher odds and the 15-18-year-old cases lower odds of weight loss compared to references. Regardless of COVID-19 status, any reported long COVID-related symptom was associated with a change in body weight. No sign of increasing obesity rates was found among Danish children post-pandemic. CONCLUSION COVID-19 was associated with higher odds of weight loss in 2-3-year-olds and lower odds of unintended weight gain in 4-18-year-olds. Any long COVID-related symptom was associated with higher odds of weight changes regardless of COVID-19 status.
Collapse
Affiliation(s)
- Selina K Berg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Nina M Birk
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Pediatrics and Adolescent Medicine, University Hospital Herlev, Herlev, Denmark
| | - Anne B Thorsted
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Siri Rosenkilde
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Louise B Jensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrikka Nygaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark.,Department of Paediatrics and Adolescents Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Annette K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susanne D Nielsen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark.,Department of Infectious Disease, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne V Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
9
|
Kjeld SG, Thygesen LC, Danielsen D, Jakobsen GS, Jensen MP, Holmberg T, Bast LS, Lund L, Pisinger C, Andersen S. Effectiveness of the multi-component intervention 'Focus' on reducing smoking among students in the vocational education setting: a cluster randomized controlled trial. BMC Public Health 2023; 23:419. [PMID: 36864450 PMCID: PMC9979485 DOI: 10.1186/s12889-023-15331-5] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Social inequality in smoking remains an important public health issue. Upper secondary schools offering vocational education and training (VET) comprise more students from lower socioeconomic backgrounds and have higher smoking prevalence than general high schools. This study examined the effects of a school-based multi-component intervention on students' smoking. METHODS A cluster randomized controlled trial. Eligible participants were schools offering VET basic courses or preparatory basic education in Denmark, and their students. Schools were stratified by subject area and eight schools were randomly allocated to intervention (1,160 invited students; 844 analyzed) and six schools to control (1,093 invited students; 815 analyzed). The intervention program comprised smoke-free school hours, class-based activities, and access to smoking cessation support. The control group was encouraged to continue with normal practice. Primary outcomes were daily cigarette consumption and daily smoking status at student level. Secondary outcomes were determinants expected to impact smoking behavior. Outcomes were assessed in students at five-month follow-up. Analyses were by intention-to-treat and per protocol (i.e., whether the intervention was delivered as intended), adjusted for covariates measured at baseline. Moreover, subgroup analyses defined by school type, gender, age, and smoking status at baseline were performed. Multilevel regression models were used to account for the cluster design. Missing data were imputed using multiple imputations. Participants and the research team were not blinded to allocation. RESULTS Intention-to-treat analyses showed no intervention effect on daily cigarette consumption and daily smoking. Pre-planned subgroup analyses showed statistically significant reduction in daily smoking among girls compared with their counterparts in the control group (OR = 0.39, 95% CI: 0.16, 0.98). Per-protocol analysis suggested that schools with full intervention had higher benefits compared with the control group (daily smoking: OR = 0.44, 95% CI: 0.19, 1.02), while no marked differences were seen among schools with partial intervention. CONCLUSION This study was among the first to test whether a complex, multicomponent intervention could reduce smoking in schools with high smoking risk. Results showed no overall effects. There is a great need to develop programs for this target group and it is important that they are fully implemented if an effect is to be achieved. TRIAL REGISTRATION https://www.isrctn.com/ISRCTN16455577 , date of registration 14/06/2018.
Collapse
Affiliation(s)
- Simone G Kjeld
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark.
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Dina Danielsen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Gitte S Jakobsen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Marie P Jensen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Lotus S Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Lisbeth Lund
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark.,Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Danish Heart Foundation, Copenhagen, Denmark
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| |
Collapse
|
10
|
Hellmann SS, Møller SP, Ersbøll AK, Santini ZI, Nielsen MBD, Grønbæk MK, Ekholm O, Thygesen LC. Labor force participation during COVID-19 and risk of depression: a Danish register study. Eur J Public Health 2023; 33:80-86. [PMID: 36399090 PMCID: PMC9897998 DOI: 10.1093/eurpub/ckac168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND COVID-19 caused economic insecurity for businesses and their employees. Understanding effects of changes in labor force participation on depression risk during economic recession is fundamental for early diagnosis. The study evaluates if changes in labor force participation are associated with depression risk during COVID-19 in Denmark. METHODS A register-based longitudinal study of Danes aged 25-67 years without depression 2 years prior to baseline defined as February 2020. An eight-level categorical variable on stable or changing labor force participation was defined from monthly employment percentage gradients in the Danish Register-based Evaluation and Marginalization Database from February 2020. The cohort was followed until 31 December 2020 for depressions overall and mild-, moderate- and severe depression. Sex-stratified cox regression models with hazard ratios (HR) and 95% confidence intervals (95% CI) were performed accounting for important confounders. RESULTS In total, 1 619 240 (50.3%) men of mean age 45.6 years and 1 598 587 (49.7%) women of mean age 45.9 years were included. Becoming unemployed implied an increased HR of depression in men (HR 2.02; 95% CI 1.94-2.10) and women (2.19; 2.12-2.26) compared to a steady-state full-time employment. Being outside the labor force or employed part-time implied an elevated HR in men (3.02; 2.82-3.23 and 2.41; 2.35-2.48) and women (3.13; 2.30-3.31 and 2.30; 2.26-2.35), respectively, compared to a steady-state full-time employment. CONCLUSIONS Changes in labor force participation were associated with higher risk of depression relative to a steady-state full-time employment particularly among individuals with low labor force participation during COVID-19.
Collapse
Affiliation(s)
- Sophie S Hellmann
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sanne P Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Annette K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ziggi I Santini
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Maj Britt D Nielsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Morten K Grønbæk
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
11
|
Skou ST, Nyberg M, Dideriksen M, Overgaard JA, Bodilsen C, Soja AMB, Attarzadeh AP, Bieder MJ, Dridi NP, Heltberg A, Gæde PH, Reventlow JL, Arnfred S, Bodtger U, Thygesen LC, Jäger M, Bricca A. Study protocol for a multicenter randomized controlled trial of personalized exercise therapy and self-management support for people with multimorbidity: The MOBILIZE study. J Multimorb Comorb 2023; 13:26335565231154447. [PMID: 36762033 PMCID: PMC9903016 DOI: 10.1177/26335565231154447] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 12/01/2022] [Accepted: 01/15/2023] [Indexed: 02/04/2023]
Abstract
Background Despite the great individual and societal burden associated with multimorbidity, little is known about how to effectively manage it. Objective The aim of this multicenter randomized controlled trial (RCT) is to investigate the 12-month effects of a personalized exercise therapy and self-management support program in addition to usual care in people with multimorbidity. Design This is a protocol for a pragmatic, parallel-group (1:1 ratio), superiority RCT conducted at five intervention sites (two hospitals, a private practice physiotherapy clinic and two municipal rehabilitation centers) in Region Zealand, Denmark. A total of 228 persons with multimorbidity aged 18 years or older, will be randomly allocated to one of two groups. Both groups will receive usual care, defined as routine care for multimorbidity at the discretion of the treating doctor, while the intervention group will also participate in a 12-week exercise therapy and self-management support program tailored to people with multimorbidity at one of the intervention sites. The primary outcome will be the between-group difference in change in EQ-5D-5L from baseline to the follow-up at 12 months. Secondary outcomes include objectively-measured physical function and physical activity, inflammatory markers, disease and treatment burden, anxiety, depression, stress, sleep, pain and other self-reported parameters. In parallel with the RCT, an observational cohort will follow persons aged ≥18 years with multimorbidity not adhering to all eligibility criteria, as well as people fulfilling all eligibility criteria, but unwilling to participate in the RCT. This study was approved by the Regional Committee on Health Research Ethics for Region Zealand (SJ-857) and results will be communicated in scientific papers, at relevant conferences and to a broader audience. Discussion Exercise therapy and self-management support is safe and effective in people with single conditions. However, it is still unclear whether this holds true for individuals with multimorbidity. This pragmatic, multicenter RCT will provide high-quality evidence on the benefits and harms of exercise therapy and self-management support and, if the results support it, lead to the development of a plan for implementation in clinical practice.
Collapse
Affiliation(s)
- Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark,Søren T Skou, Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark.
| | - Mette Nyberg
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Mette Dideriksen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Jan A Overgaard
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark,Department of Rehabilitation, Lolland Municipality, Maribo, Denmark
| | - Christine Bodilsen
- Department of Exercise and Health, Roskilde Municipality, Roskilde, Denmark
| | - Anne MB Soja
- Department of Internal Medicine 1, Section of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Amir P Attarzadeh
- Centre for Evidence-Based Orthopaedics, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Manuel J Bieder
- Department of Orthopaedic Surgery, Næstved Hospital, Næstved, Denmark
| | - Nadia P Dridi
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Andreas Heltberg
- Department of General Practice, Institute of Public Health, University of Copenhagen, København K, Denmark
| | - Peter H Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark,Institute for Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | | | - Sidse Arnfred
- Psychiatric Research Unit, Copenhagen University Hospital – Psychiatry Region Zealand, Slagelse, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Institute for Regional Health Research, University of Southern Denmark, Odense M, Denmark.,Pulmonary Research Unit Region Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital Næstved, Næstved, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
| | - Madalina Jäger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark,Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense M, Denmark
| | - Alessio Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| |
Collapse
|
12
|
Rosenkilde S, Ekholm O, Møller SP, Nielsen MBD, Thygesen LC. Factors related to COVID-19 vaccine hesitancy in Denmark: A national study in the autumn of 2021. Scand J Public Health 2023:14034948221144661. [PMID: 36609202 PMCID: PMC9829505 DOI: 10.1177/14034948221144661] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS The novelty of the COVID-19 pandemic and fast-developed vaccines may increase concerns about the safety and effectiveness of the COVID-19 vaccine and thereby influence vaccine hesitancy. The aims of this study were to examine (a) the main reasons for COVID-19 vaccine hesitancy and (b) factors associated with COVID-19 vaccine hesitancy. METHODS A nationwide survey was conducted in the autumn of 2021 when most Danes had received at least one dose of a COVID-19 vaccine. The sample (N=13,570) was based on a random selection of individuals (⩾15 years), and data were collected via self-administered mailed questionnaires (digital and physical). The participants were asked whether they had been vaccinated against COVID-19, and if they had not, they were asked about their reasons for vaccine hesitancy. Logistic regression models were used to determine factors associated with vaccine hesitancy. RESULTS In all, 5,384 (39.7%) individuals completed the questionnaire. The main reasons for vaccine hesitancy were worries about adverse effects (57.6%) and the belief that natural immunity is better than vaccination (43.8%). Factors associated with vaccine hesitancy included female sex, younger age, being divorced, a country of origin other than Denmark, lower educational level, being unemployed, previously infected with COVID-19 and being worried to a greater extent about oneself and others getting infected. Mental health indicators were not associated with vaccine hesitancy. CONCLUSIONS
COVID-19 vaccine hesitancy is likely to pose a challenge for population immunity. To reduce vaccine hesitancy and increase vaccination uptake, future vaccination programmes should focus on specific socio-demographic subgroups identified in this study.
Collapse
Affiliation(s)
- Siri Rosenkilde
- Siri Rosenkilde, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen K, Denmark. E-mail:
| | | | | | | | | |
Collapse
|
13
|
Tay DL, Thygesen LC, Kozlov E, Ornstein KA. Serious Mental Illness Exacerbation Post-Bereavement: A Population-Based Study of Partners and Adult Children. Clin Epidemiol 2022; 14:1065-1077. [PMID: 36164496 PMCID: PMC9508997 DOI: 10.2147/clep.s372936] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The death of a close family member is commonly accompanied by intense grief, stress, and loss of social support. We hypothesized that recent bereavement would be associated with an increase in symptom exacerbations among adults with serious mental illness (SMI) whose partners or parents had died. Patients and Methods Adults whose partners and parents had died in Denmark between January 1, 2010, and June 30, 2016, were identified using linked population-based registries. History of SMI was defined as having a diagnosis of schizophrenia and schizoaffective disorders, major depression, and bipolar disorder in the five years preceding their family member's death in the Danish Psychiatric Central Research Register using International Classification of Diseases-10 codes. The odds of SMI exacerbation (ie, attempt or completion of suicide or psychiatric hospitalization) among partners and children in the first two years after death in 3-month intervals were estimated with generalized estimating equations. Results 12.8% of partners and 15.0% of adult children with a history of SMI experienced any SMI exacerbation two years after bereavement. Among bereaved partners, older age (80+ years) was associated with a lower risk of experiencing an SMI exacerbation compared with partners aged 18-49 years (ORadj=0.29, [0.18-0.45]). Partners with a history of SMI had significantly increased odds of SMI exacerbations three months after their partners' death compared to prior to their partners' death (ORadj = 1.43, [1.13-1.81]). There was no evidence that adult children with SMI experience increased SMI exacerbations after the death of their parents compared to prior to death. Conclusion Adults with a history of SMI whose partners had died are at increased risk for an SMI exacerbation post bereavement. Additional bereavement resources and support should be provided to those with a history of SMI, especially in the period immediately after death.
Collapse
Affiliation(s)
- Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Elissa Kozlov
- Department of Health Behavior, Society and Policy, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | | |
Collapse
|
14
|
So R, Andersen ZJ, Chen J, Stafoggia M, de Hoogh K, Katsouyanni K, Vienneau D, Rodopoulou S, Samoli E, Lim YH, Jørgensen JT, Amini H, Cole-Hunter T, Mahmood Taghavi Shahri S, Maric M, Bergmann M, Liu S, Azam S, Loft S, Westendorp RGJ, Mortensen LH, Bauwelinck M, Klompmaker JO, Atkinson R, Janssen NAH, Oftedal B, Renzi M, Forastiere F, Strak M, Thygesen LC, Brunekreef B, Hoek G, Mehta AJ. Long-term exposure to air pollution and mortality in a Danish nationwide administrative cohort study: Beyond mortality from cardiopulmonary disease and lung cancer. Environ Int 2022; 164:107241. [PMID: 35544998 DOI: 10.1016/j.envint.2022.107241] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The association between long-term exposure to air pollution and mortality from cardiorespiratory diseases is well established, yet the evidence for other diseases remains limited. OBJECTIVES To examine the associations of long-term exposure to air pollution with mortality from diabetes, dementia, psychiatric disorders, chronic kidney disease (CKD), asthma, acute lower respiratory infection (ALRI), as well as mortality from all-natural and cardiorespiratory causes in the Danish nationwide administrative cohort. METHODS We followed all residents aged ≥ 30 years (3,083,227) in Denmark from 1 January 2000 until 31 December 2017. Annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (warm season) were estimated using European-wide hybrid land-use regression models (100 m × 100 m) and assigned to baseline residential addresses. We used Cox proportional hazard models to evaluate the association between air pollution and mortality, accounting for demographic and socioeconomic factors. We additionally applied indirect adjustment for smoking and body mass index (BMI). RESULTS During 47,023,454 person-years of follow-up, 803,881 people died from natural causes. Long-term exposure to PM2.5 (mean: 12.4 µg/m3), NO2 (20.3 µg/m3), and/or BC (1.0 × 10-5/m) was statistically significantly associated with all studied mortality outcomes except CKD. A 5 µg/m3 increase in PM2.5 was associated with higher mortality from all-natural causes (hazard ratio 1.11; 95% confidence interval 1.09-1.13), cardiovascular disease (1.09; 1.07-1.12), respiratory disease (1.11; 1.07-1.15), lung cancer (1.19; 1.15-1.24), diabetes (1.10; 1.04-1.16), dementia (1.05; 1.00-1.10), psychiatric disorders (1.38; 1.27-1.50), asthma (1.13; 0.94-1.36), and ALRI (1.14; 1.09-1.20). Associations with long-term exposure to ozone (mean: 80.2 µg/m3) were generally negative but became significantly positive for several endpoints in two-pollutant models. Generally, associations were attenuated but remained significant after indirect adjustment for smoking and BMI. CONCLUSION Long-term exposure to PM2.5, NO2, and/or BC in Denmark were associated with mortality beyond cardiorespiratory diseases, including diabetes, dementia, psychiatric disorders, asthma, and ALRI.
Collapse
Affiliation(s)
- Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Matija Maric
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bergmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Shadi Azam
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Denmark Statistics, Copenhagen, Denmark
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Richard Atkinson
- Population Health Research Institute, St George's University of London, London, UK
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bente Oftedal
- Department of Air Quality and Noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
| | - Maciek Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Denmark Statistics, Copenhagen, Denmark
| |
Collapse
|
15
|
Voldby AW, Aaen AA, Loprete R, Eskandarani HA, Boolsen AW, Jønck S, Ekeloef S, Burcharth J, Thygesen LC, Møller AM, Brandstrup B. Perioperative fluid administration and complications in emergency gastrointestinal surgery-an observational study. Perioper Med (Lond) 2022; 11:9. [PMID: 35189974 PMCID: PMC8862386 DOI: 10.1186/s13741-021-00235-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/19/2021] [Accepted: 11/11/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The fluid balance associated with a better outcome following emergency surgery is unknown. The aim of this study was to explore the association of the perioperative fluid balance and postoperative complications during emergency gastrointestinal surgery. METHODS We retrospectively included patients undergoing emergency surgery for gastrointestinal obstruction or perforation. A perioperative fluid balance of 2.5 L divided the cohort in a conservative and liberal group. Outcome was Clavien-Dindo graded complications registered 90 days postoperatively. We used logistic regression adjusted for age, sex, American Society of Anesthesiologists' classification, use of epidural analgesia, use of vasopressor, type of surgery, intraabdominal pathology, and hospital. Predicted risk of complications was demonstrated on a continuous scale of the fluid balance. RESULTS We included 342 patients operated between July 2014 and July 2015 from three centers. The perioperative fluid balance was 1.6 L IQR [1.0 to 2.0] in the conservative vs. 3.6 L IQR [3.0 to 5.3] in the liberal group. Odds ratio of overall 2.6 (95% CI 1.5 to 4.4), p < 0.001, and cardiopulmonary complications 3.2 (95% CI 1.9 to 5.7), p < 0.001, were increased in the liberal group. A perioperative fluid balance of 0-2 L was associated with minimal risk of cardiopulmonary complications compared to 1.5-3.5 L for renal complications. CONCLUSION We found a perioperative fluid balance above 2.5 L to be associated with an increased risk of overall and cardiopulmonary complications following emergency surgery for gastrointestinal obstruction or perforation. A perioperative fluid balance of 0-2 L was associated with the lowest risk of cardiopulmonary complications and 1.5-3.5 L for renal complications.
Collapse
Affiliation(s)
- Anders W Voldby
- Department of Surgery, Holbæk Hospital, part of Copenhagen University Hospitals, Smedelundsgade 60, 4300, Holbaek, Denmark
| | - Anne A Aaen
- Department of Anesthesiology and Intensive Care Medicine, Holbæk Hospital, Holbæk, Denmark
| | | | - Hassan A Eskandarani
- Department of Anesthesiology and Intensive Care Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Anders W Boolsen
- Department of Surgery, Holbæk Hospital, part of Copenhagen University Hospitals, Smedelundsgade 60, 4300, Holbaek, Denmark
| | - Simon Jønck
- Department of Emergency Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Sarah Ekeloef
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - Jakob Burcharth
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - Lau C Thygesen
- Department of Population Health and Morbidity, University of Southern Denmark, Odense, Denmark
| | - Ann M Møller
- Department of Anesthesiology and Intensive Care Medicine, Herlev Hospital, Herlev, Denmark.,Institute for Clinical Medicins, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Brandstrup
- Department of Surgery, Holbæk Hospital, part of Copenhagen University Hospitals, Smedelundsgade 60, 4300, Holbaek, Denmark. .,Institute for Clinical Medicins, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
16
|
Tang LH, Andreasson KH, Thygesen LC, Jepsen R, Møller A, Skou ST. Persistent pain and long-term physical and mental conditions and their association with psychological well-being; data from 10,744 individuals from the Lolland-Falster health study. J Multimorb Comorb 2022; 12:26335565221128712. [PMID: 36386291 PMCID: PMC9659769 DOI: 10.1177/26335565221128712] [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] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Persistent pain (PP) and long-term conditions are all associated with psychological well-being. Less is known about their associations with reduced psychological well-being when co-occurring. We investigated how PP and long-term physical and mental conditions relate to psychological well-being when occurring together. METHOD Data collected in the Danish population-based Lolland-Falster Health study were used in this cross-sectional study. Participants aged ≥18 years completing questions concerning PP, long-term conditions and psychological well-being were included. PP and long-term conditions were defined as conditions lasting 6 months or longer. Psychological well-being was assessed by the World Health Organization Well-Being Index (WHO-5). Multiple linear regression investigated combinations of PP and physical and mental long-term conditions and their associations with WHO-5. RESULTS Of 11,711 participants, 10,744 had available data. One third had PP (n = 3250), while 6144 (57%), 213 (2%) and 946 (9%) reported having only physical conditions, only mental conditions or both, respectively. All combinations of PP and long-term conditions were negatively associated with WHO-5. PP in combination with mental (-23.1 (95% CI -28.3 to -17.8)) or both physical and mental conditions (-25.1 (-26.7 to -23.52) yielded the strongest negative associations. Two or more pain sites together with long-term physical and mental conditions was associated with a lower WHO-5 score (-6.2 (-8.9 to -3.5) compared to none or one pain site. CONCLUSION The presence of PP and long-term conditions, in particular mental conditions, were strongly associated with worse psychological well-being. This highlights the importance of assessing psychological well-being in individuals with PP and long-term conditions.
Collapse
Affiliation(s)
- Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Karen H Andreasson
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Centre for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing F., Denmark
| | - Anne Møller
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
17
|
Kristensen MS, Thygesen LC, Tay DL, Kumar R, Grønvold M, Aldridge M, Ornstein KA. Size and composition of family networks of decedents: A nationwide register-based study. Palliat Med 2021; 35:1652-1662. [PMID: 33823696 DOI: 10.1177/0269216321998602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND Seriously ill individuals rely heavily on family caregivers at the end of life. Yet many do not have family support. AIM To characterize the size and composition of decedents' family networks by cause of death, demographic, clinical, socioeconomic, and geographic characteristics. DESIGN A cross-sectional population-level study with data collected from nation-wide registers. SETTING/PARTICIPANTS All adults in Denmark born between 1935 and 1998 who died of natural causes between 2009 and 2016 were linked at the time of death to living adult spouses/partners, children, siblings, parents, and grandchildren. RESULTS Among 175,755 decedents (median age: 68 years, range: 18-81 years), 61% had a partner at the time of death and 78% had at least one adult child. Ten percent of decedents had no identified living adult family members. Decedents with family had a median of five relatives. Males were more likely to have a spouse/partner (65%) than females (56%). While 93% of decedents dying of cancer had adult family, only 70% of individuals dying of dementia had adult family at the time of death. The majority of cancer decedents co-resided or lived within 30 km of family (88%), compared to only 65% of those dying from psychiatric illness. CONCLUSIONS While the majority of adults had an extensive family network at the time of death, a substantial proportion of decedents had no family, suggesting the need for non-family based long-term service and support systems. Assessment of family networks can expand our understanding of the end-of-life caregiving process and inform palliative care delivery.
Collapse
Affiliation(s)
- Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Raj Kumar
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mogens Grønvold
- Department of Public Health, University of Copenhagen, Denmark
| | - Melissa Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
18
|
Jørgensen SE, Thygesen LC, Michelsen SI, Due P, Bidstrup PE, Høeg BL, Andersen A. Why Do Some Adolescents Manage Despite Parental Illness? Identifying Promotive Factors. J Adolesc Health 2021; 69:335-341. [PMID: 34024713 DOI: 10.1016/j.jadohealth.2020.12.139] [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: 08/18/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to examine the association between social support, leisure time, school experience, and well-being among adolescents with an ill parent. Moreover, we explored the cumulative effect of promotive factors in relation to well-being. METHODS The population included a subsample of 676 students reporting serious or chronic parental illness, selected from a nationwide Danish survey, the Well-being Despite Study. Well-being was measured by the five-item World Health Organization Well-Being Index. Social support included support from parents, siblings, and friends. A positive school experience encompassed trust in teachers, classroom community, and overall judgment of the school. Leisure time included frequency of activities and having enough time for friends and oneself. We performed multilevel logistic regression analyses using SAS 9.4. RESULTS Social support, a positive school experience, and leisure time were positively associated with well-being. For instance, for boys and girls who felt they had enough time to themselves, the odds ratio of moderate to high well-being was 3.7 (95% confidence interval [CI]: 1.8-7.7) and 2.9 (95% CI: 1.9-4.3) respectively, compared with boys and girls who did not. Cumulative analyses showed increasing odds of moderate to high well-being with increasing number of promotive factors, the odds ratio being 39.7 (CI 95%: 11.6-136.2) among adolescents with 10 promotive factors compared with adolescents with 0-5 promotive factors. CONCLUSIONS Social support, a positive school experience, and satisfying leisure time may be important promotive factors, and the results point toward a more ecological approach to improve well-being among adolescents with ill parents.
Collapse
Affiliation(s)
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susan I Michelsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Beverly Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
19
|
Thygesen LC, Zinckernagel L, Dalal H, Egstrup K, Glumer C, Gronbaek M, Holmberg T, Kober L, La Cour K, Nakano A, Nielsen CV, Sibilitz KL, Tolstrup JS, Zwisler AD, Taylor RS. Cardiac rehabilitation for patients with heart failure: a national Danish register-based study of predictors of referral and outcomes. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.071] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
Background
Heart failure (HF) places a large burden on patients and society as a major cause of morbidity, mortality and healthcare costs. Participation in exercise-based cardiac rehabilitation (CR) in people with HF is a clinically and cost-effective strategy and recommended in international clinical guidelines.
Purpose
The aims of this study were to: (1) examine the temporal trends and predictors of national CR referral, and (2) compare the risk of hospital readmission and mortality in those referred for CR compared to no referral.
Methods
All patients in Denmark with incident HF were identified by the Danish Heart Failure Register in the period 2010 to 2018 (n = 33,257) and CR referral assessed within 120 days of hospital admission. Multivariable logistic regression models were used to evaluate the association between CR referral and predictors and to compare risk of hospital readmission and mortality until 1 year between referred and not referred patients.
Results
Overall, 45.0% of HF patients were referred to exercise-based CR, increasing from 31.7% in 2010 to 52.2% in 2018. Factors independently associated with higher CR referral were: NYHA functional class II, LVEF <50%, diagnosis of myocardial infarction and use of ACE inhibitor. Male gender, older age, region, unemployment, retirement, living alone, non-Danish ethnic origin, lower educational level, NYHA class IV, treatment for hypertension, existing chronic obstructive lung disease and stroke were associated with lower CR referral. CR referral was associated with lower risk of readmission (adjusted odds ratio: 0.90;95%CI: 0.85-0.95), HF-specific mortality (0.61; 0.39-0.95) and all-cause mortality (0.61; 0.55-0.69) as compared to no referral.
Conclusions
Although CR referral has increased over time, only some 1 in 2 diagnosed HF patients in Denmark are referred to exercise-based CR. CR referral is associated with lower risk in readmissions and mortality. Strategies to promote CR referral including healthcare professional education on the benefits of CR and alternative methods of CR delivery are urgently needed to improve access to CR, especially for high-risk groups.
Collapse
Affiliation(s)
- LC Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - L Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - H Dalal
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, United Kingdom of Great Britain & Northern Ireland
| | - K Egstrup
- Department of Cardiovascular Research, Odense University Hospital, Svendborg, Denmark
| | - C Glumer
- Center for diabetes in the city of Copenhagen, Copenhagen, Denmark
| | - M Gronbaek
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - T Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - L Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - K La Cour
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - A Nakano
- The Danish Clinical Registries (RKKP), Aarhus, Denmark
| | - CV Nielsen
- DEFACTUM, Regional Hospital West Jutland, Central Denmark Region, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - KL Sibilitz
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - JS Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - AD Zwisler
- REHPA The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - RS Taylor
- Institute of Health and Well Being, University of Glasgow, Glasgow, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
20
|
Hoffmann SH, Pisinger VSC, Norredam M, Tolstrup JS, Thygesen LC. Does Class Proportion of Students with Non-Western Origin in High Schools Affect Drinking Habits Among Ethnic Danish Students? Alcohol Alcohol 2021; 56:443-450. [PMID: 32734284 DOI: 10.1093/alcalc/agaa069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 11/12/2022] Open
Abstract
AIM the objective was to test the hypothesis that a higher proportion of students with non-Western origin in high school classes is associated with lower and less frequent alcohol consumption among ethnic Danish students. METHOD data on country of origin was obtained from the Danish Civil Registration System, while information on drinking habits were derived from the Danish National Youth Study 2014. Multilevel zero-inflated binominal regression was used to assess the association between class proportion of students with non-Western origin and odds of non-drinking and mean weekly alcohol consumption, while multilevel logistic regression was used to assess the association with frequent binge drinking. RESULTS a higher proportion of students with non-Western origin in class was associated with higher odds of non-drinking among ethnic Danish student in the same class. For example, ethnic Danish boys in classes with more than 15% of the students of non-Western origin had 77% higher odds of being non-drinkers, compared to ethnic Danish boys in classes where 0-5% had non-Western origin (OR: 1.77, 95% CI; 1.42-2.20). Among ethnic Danish students that did consume alcohol, class proportion of students with non-Western origin was not associated with weekly alcohol consumption, while a higher proportion of students with non-Western origin in class was associated with lower odds of frequent binge drinking. CONCLUSION the downward drinking trend among adolescents in Western countries may be partly explained by the higher proportion of youth with non-Western origin, influencing the prevalence of drinking and frequency of binge drinking among adolescents in the ethnic majority population.
Collapse
Affiliation(s)
- Sofie H Hoffmann
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen K, Denmark
| | - Veronica S C Pisinger
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen K, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen K, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen K, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen K, Denmark
| |
Collapse
|
21
|
Siercke M, Jørgensen LP, Missel M, Thygesen LC, Møller SP, Sillesen H, Berg SK. Cardiovascular Rehabilitation Increases Walking Distance in Patients With Intermittent Claudication. Results of the CIPIC Rehab Study: A Randomised Controlled Trial. Eur J Vasc Endovasc Surg 2021; 62:768-776. [PMID: 34092489 DOI: 10.1016/j.ejvs.2021.04.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/17/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine whether a cardiac rehabilitation programme in a community based setting for patients with intermittent claudication (IC) affects walking ability, quality of life, and changes in health behaviour. The trial investigated a cross sector cardiovascular rehabilitation programme compared with usual care for patients having non-operative management. METHODS The trial allocated 118 patients, with 1:1 individual randomisation to either an intervention or control group. Data were collected at a department of vascular surgery and at a healthcare centre in Denmark. The rehabilitation intervention consisted of usual care plus 12 weeks of exercise training, pedometer, health education, and text messages. The primary outcome was maximum walking distance at six months measured by treadmill walking test. The secondary outcomes were maximum walking distance at 12 months and pain free walking distance measured by treadmill walking test, healthy diet, level of physical activity, and quality of life (QoL) at six and 12 months. RESULTS In the intervention group, 46 participants were analysed, with 47 in the control group. Following three months of rehabilitation, a 37% difference (95% CI 1.10 - 1.70; p = .005) was found between groups in maximum walking distance at six and 12 months, in favour of the intervention group. The same positive effect was found in physical activity, QoL, and healthy diet, but was not statistically significant in pain free walking distance and smoking. CONCLUSION A specialised community based cardiac rehabilitation programme for patients with IC showed statistically and clinically significant effects on maximum walking distance, physical activity, quality of life, and healthy diet, but not on pain free walking distance and smoking, compared with usual care without rehabilitation.
Collapse
Affiliation(s)
- Maj Siercke
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark.
| | - Lise P Jørgensen
- Department of Pathology, Herlev Hospital, Copenhagen University Hospital, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sanne P Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Selina K Berg
- Institute of Clinical Medicine, University of Copenhagen, Denmark; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark
| |
Collapse
|
22
|
Santini ZI, Pisinger VSC, Nielsen L, Madsen KR, Nelausen MK, Koyanagi A, Koushede V, Roffey S, Thygesen LC, Meilstrup C. Social Disconnectedness, Loneliness, and Mental Health Among Adolescents in Danish High Schools: A Nationwide Cross-Sectional Study. Front Behav Neurosci 2021; 15:632906. [PMID: 33927599 PMCID: PMC8078177 DOI: 10.3389/fnbeh.2021.632906] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/12/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Previous research has suggested that social disconnectedness experienced at school is linked to mental health problems, however, more research is needed to investigate (1) whether the accumulation of various types of social disconnectedness is associated with risk for mental health problems, and (2) whether loneliness is a mechanism that explains these associations. Methods: Using data from the Danish National Youth Study 2019 (UNG19), nation-wide cross-sectional data from 29,086 high school students in Denmark were analyzed to assess associations between social disconnectedness experienced at school (lack of classmate support, lack of teacher support, lack of class social cohesion, and not being part of the school community) and various mental health outcomes, as well as the mediating role of loneliness for each type of disconnectedness. Multilevel regression analyses were conducted to assess the associations. Results: Descriptive analyses suggest that 27.5% of Danish high school students experience at least one type of social disconnectedness at school. Each type of social disconnectedness was positively associated with mental health problems (depression symptoms, anxiety symptoms, stress, sleep problems, suicidal ideation, non-suicidal self-injury, eating disorder, body dissatisfaction, and low self-esteem) and negatively associated with mental well-being. In all cases, loneliness significantly mediated the associations. We found a clear dose-response pattern, where each addition in types of social disconnectedness was associated with (1) stronger negative coefficients with mental well-being and (2) stronger positive coefficients with mental health problems. Conclusion: Our results add to a large evidence-base suggesting that mental health problems among adolescents may be prevented by promoting social connectedness at school. More specifically, fostering social connectedness at school may prevent loneliness, which in turn may promote mental well-being and prevent mental health problems during the developmental stages of adolescence. It is important to note that focusing on single indicators of school social connectedness/disconnectedness would appear to be insufficient. Implications for practices within school settings to enhance social connectedness are discussed.
Collapse
Affiliation(s)
- Ziggi Ivan Santini
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Veronica S. C. Pisinger
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Line Nielsen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Katrine Rich Madsen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental, Dr. Antoni Pujadas, 42, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Vibeke Koushede
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sue Roffey
- Educational Psychology, University College London, London, United Kingdom
- School of Education, Western Sydney University, Penrith, NSW, Australia
| | - Lau C. Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | |
Collapse
|
23
|
Jørgensen SE, Michelsen SI, Andersen A, Tolstrup JS, Thygesen LC. Identifying and Characterizing Children of Parents with a Serious Illness Using Survey and Register Data. Clin Epidemiol 2021; 13:253-263. [PMID: 33833582 PMCID: PMC8021136 DOI: 10.2147/clep.s294919] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the prevalence and characterize children and adolescents aged 0–21 years with a physically or mentally ill parent based on registers. Further, to explore the use of register and survey data to identify parental serious illness. Methods The study is based on: 1) a 20% register sample of children and adolescents aged 0–21 in 2014; and 2) survey data from the Danish Youth Profile 2014 including 63,437 youth education students linked to registers. In registers, parental physical illness comprised hospital diagnoses included in the Charlson Comorbidity Index, and parental mental illness encompassed all mental diagnosis in the registers. Information about socioeconomic and demographic characteristics and use of health care services was retrieved from national registers. In the survey, students were asked if they had experienced serious illness of a parent. Results In the register sample of 0–21-year-olds, 25.3% had a parent with a physical or mental diagnosis, the prevalence increasing with age of the child. Compared to children without parental illness, children with an ill parent more frequently had unemployed parents, lower parental educational level, and a chronic medical condition. Analyses of the discrepancies between register and survey data revealed that 9% of the adolescents were identified as having an ill parent in both data sources and 64.1% had no identified ill parents. Moreover, a higher frequency of parental primary health care service use was seen for adolescents with an ill parent, across identification method, indicating that both methods identify adolescents with an ill parent. Conclusion The social inequality and elevated frequency of health problems among children and adolescents with an ill parent, underline the vulnerability of this population. Parental illness can be identified from both parental hospital diagnoses as well as self-reported by adolescents, however the two methods detect different populations. Both methods have several limitations and would benefit from further refinement and validation.
Collapse
Affiliation(s)
| | - Susan I Michelsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, 1455, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, 8200, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, 1455, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, 1455, Denmark
| |
Collapse
|
24
|
Estrup S, Thygesen LC, Poulsen LM, Gøgenur I, Mathiesen O. Health care use before and after intensive care unit admission-A nationwide register-based study. Acta Anaesthesiol Scand 2021; 65:381-389. [PMID: 33174207 DOI: 10.1111/aas.13737] [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: 04/07/2020] [Revised: 07/23/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to describe healthcare utilization of patients admitted to ICU before and after ICU admission. METHODS Register-based study including adult patients discharged from ICU between January 1st, 2011 and December 31st, 2014. Reference group was a sex- and age-matched population not admitted to an ICU in the study period. Outcomes were hospital admissions, contacts to general practitioner or emergency services and municipality services from 1 year before ICU admission and up to 3 years after. RESULTS The study included 82 384 patients and an equal number of reference persons. Of patients with ICU admission, 48% were married (reference group 57%), 48% had elementary school education (reference group 38%) and 18% had a Charlson co-morbidity score of 5+ (4% in reference group). We found that 51% of patients with an ICU admission had been admitted to hospital in the year before ICU admission (reference group 15%) and 97% had a contact to a general practitioner (reference group 89%) in the same period. CONCLUSIONS Patients admitted to an ICU had increased use of both primary and secondary health care both before and for years after ICU treatment, even after adjustment for comorbidities and socio-economic factors.
Collapse
Affiliation(s)
- Stine Estrup
- Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Køge Denmark
| | - Lau C Thygesen
- National Institute of Public HealthUniversity of Southern Denmark København Denmark
| | - Lone M Poulsen
- Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Køge Denmark
| | - Ismail Gøgenur
- Department of Gastrointestinal Surgery Center for Surgical ScienceZealand University Hospital Køge Køge Denmark
| | - Ole Mathiesen
- Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Køge Denmark
- Department of Clinical Medicine Copenhagen University København Denmark
| |
Collapse
|
25
|
Kleif J, Thygesen LC, Gögenur I. Moving from an era of open Appendectomy to an era of Laparoscopic Appendectomy: A Nationwide Cohort Study of Adult Patients Undergoing Surgery for Appendicitis. Scand J Surg 2021; 110:512-519. [PMID: 33563095 DOI: 10.1177/1457496921992615] [Citation(s) in RCA: 4] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS During the last decades, laparoscopic surgery has been introduced as an alternative to open surgery. We aimed to examine to what extent laparoscopic surgery has replaced open surgery for appendicitis in an entire nation during the last two decades. Second, we examined the effects of shifting to laparoscopic surgery for appendicitis on different quality indicators such as length of postoperative stay and mortality. We also examined age as a predictor of 30-day mortality. MATERIALS AND METHODS During the period 2000 to 2015, all adult patients with appendicitis and surgical removal of the appendix were identified in the Danish National Patient Register. Demographics, type of surgery, time of surgery, and duration of postoperative stay were retrieved form Danish National Patient Register. Vital status was retrieved from the Danish Civil Registration System. RESULTS A total of 58,093 patients underwent surgery for appendicitis. In 2000, a total of 274 out of 3717 (7.4%) had a laparoscopic appendectomy, and the postoperative stay was 55 (iqr: 35-88) h and 30-day mortality was 0.91%. In 2015, a total of 3995 out of 4296 (93.0%) had a laparoscopic appendectomy, and the postoperative stay was 16 (iqr: 9-56) h and 30-day mortality was 0.40%. Age as a predictor of 30-day postoperative mortality had an area under the curve of 0.93 (95% confidence interval: 0.92; 0.94). CONCLUSION In Denmark, the standard surgical procedure for appendicitis has changed from open surgery to laparoscopic surgery during the period 2000-2015. At the same time, duration of postoperative stay and 30-day mortality has decreased.
Collapse
Affiliation(s)
- J Kleif
- Department of Surgery, North Zealand Hospital, Copenhagen University Hospital, Hillerød, Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Køge, Denmark
| |
Collapse
|
26
|
Gamst-Jensen H, Jensen AN, Christensen EF, Lippert F, Brabrand M, Egerod I, Thygesen LC, Tolstrup JS, Huibers L. Socioeconomic inequality in telephone triage on triage response, hospitalization and 30-day mortality. Eur J Public Health 2021; 31:703-705. [PMID: 33421054 DOI: 10.1093/eurpub/ckaa242] [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] [Indexed: 11/13/2022] Open
Abstract
We investigated socioeconomic inequality (measured by the indicators highest attained education level and household income) in telephone triage on triage response (face-to-face contact), hospitalization and 30-day mortality among Danish citizens calling the medical helpline 1813 between 23 January and 9 February 2017. The analysis included 6869 adult callers from a larger prospective cohort study and showed that callers with low socioeconomic status (SES) were less often triaged to a face-to-face contact and had higher 30-day mortality than callers with high SES.
Collapse
Affiliation(s)
- Hejdi Gamst-Jensen
- Department of Clinical Research and Department of Emergency Medicine, University of Copenhagen, Amager and Hvidovre Hospital, Hvidovre, Denmark.,Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | | | - Erika Frischknecht Christensen
- CPER, Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Trauma and Emergency Center, Aalborg University Hospital, Aalborg, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Rigshopitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lau C Thygesen
- Department of Population Health and Morbidity, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Janne S Tolstrup
- Department of Population Health and Morbidity, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | |
Collapse
|
27
|
Cromhout PF, Thygesen LC, Moons P, Nashef S, Damgaard S, Christensen AV, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Juel K, Berg SK. Supplementing prediction by EuroSCORE with social and patient-reported measures among patients undergoing cardiac surgery. J Card Surg 2020; 36:509-521. [PMID: 33283356 DOI: 10.1111/jocs.15227] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/28/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The risk of poor outcomes is traditionally attributed to biological and physiological processes in cardiac surgery. However, evidence exists that other factors, such as emotional, behavioral, social, and functional, are predictive of poor outcomes. Objectives were to evaluate the predictive value of several emotional, social, functional, and behavioral factors on four outcomes: death within 90 days, prolonged stay in intensive care, prolonged hospital admission, and readmission within 90 days following cardiac surgery. METHODS This prospective study included adults undergoing cardiac surgery 2013-2014, including information on register-based socioeconomic factors and self-reported health in a nested subsample. Logistic regression analyses to determine the association and incremental value of each candidate predictor variable were conducted. Multiple regression analyses were used to determine the incremental value of each candidate predictor variable, as well as discrimination and calibration based on the area under the curve (AUC) and Brier score. RESULTS Of 3217 patients, 3% died, 9% had prolonged intensive care stay, 51% had prolonged hospital admission, and 39% were readmitted to hospital. Patients living alone (odds ratio, 1.19; 95% confidence interval, 1.02-1.38), with lower educational levels (1.27; 1.04-1.54) and low health-related quality of life (1.43; 1.02-2.01) had prolonged hospital admission. Analyses revealed living alone as predictive of prolonged intensive care unit (ICU) stay (Brier, 0.08; AUC, 0.68), death (0.03; 0.71), and prolonged hospital admission (0.24; 0.62). CONCLUSION Living alone was found to supplement EuroSCORE in predicting death, prolonged hospital admission, and prolonged ICU stay following cardiac surgery. Low educational level and impaired health-related quality of life were, furthermore, predictive of prolonged hospital admission.
Collapse
Affiliation(s)
- Pernille F Cromhout
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lau C Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
| | - Sune Damgaard
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne V Christensen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine B Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte B Thorup
- Department of Cardiology, Cardiac Surgery & Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke E Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Knud Juel
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Selina K Berg
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
28
|
Ornstein KA, Aldridge M, Gillezeau C, Kristensen MS, Gazibara T, Groenvold M, Thygesen LC. New antidepressant utilization pre- and post-bereavement: a population-based study of partners and adult children. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1261-1271. [PMID: 32185418 PMCID: PMC7494560 DOI: 10.1007/s00127-020-01857-1] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Bereavement is associated with increased morbidity and mortality, but few studies have examined the specific timing of depression onset. This study examines the risk of developing new-onset depression in adult children and partners by month, 1 year before and after death. METHODS Using population-based registers in Denmark, we assembled a cohort of 236,000 individuals who died a natural death (2010-2016). Partners and adult children of the deceased were identified and demographic and prescription data were collected. GEE logistic regression was used to model whether the bereaved received a new antidepressant prescription around the death of their loved one across 24 time intervals (12 months before and after death). RESULTS Male and female partners had an increase in receipt of new antidepressant prescriptions in the 11 months after the death of their partner, with a peak increase 2 or 3 months after death. Partners also increased new antidepressant prescription use 2 months before death. Characteristics of the decedents including cause of death were not associated with new antidepressant prescription in the surviving partner. Adult children did not have increased odds of being prescribed new antidepressants at any time. CONCLUSION Both male and female partners have increase in new antidepressant utilization before and after the death of their partner. Our work points to the importance of supporting partners not only after the death of their partner, but also in the period before death when families may be actively engaged in caregiving for the seriously ill.
Collapse
Affiliation(s)
- Katherine A Ornstein
- Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Melissa Aldridge
- Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Christina Gillezeau
- Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tatjana Gazibara
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | | | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
29
|
Helgstrand F, Thygesen LC, Bisgaard T, Jørgensen LN, Friis-Andersen H. Differential recurrence after laparoscopic incisional hernia repair: importance of a nationwide registry-based mesh surveillance. Br J Surg 2020; 107:1130-1136. [PMID: 32239495 DOI: 10.1002/bjs.11562] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/26/2019] [Accepted: 01/28/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Identification of suboptimal mesh products is essential to improve the outcome after hernia surgery. This study investigated whether a national clinical database combined with administrative registries may serve as a tool for postmarketing evaluation of mesh products for hernia surgery. METHODS This was a propensity score-matched case-control cohort study comparing outcomes in patients undergoing laparoscopic incisional hernia repair with either one particular mesh or any other synthetic mesh. Data on patients registered in the Danish Ventral Hernia Database between 2010 and 2016 were combined with administrative data from the Danish National Patient Registry. The primary outcome was operation for recurrence. Secondary outcomes were 30-day readmission, 30-day reoperation for complications (excluding hernia recurrence), and mortality after 30 and 90 days. RESULTS In total, 740 patients who underwent repair with one particular mesh were matched with 1479 patients who received any other synthetic mesh. The rate of repair for hernia recurrence was significantly higher in the particular mesh group than in the reference group: 12·8 versus 6·3 per cent respectively (hazard ratio 2·09, 95 per cent c.i. 1·57 to 2·79; P < 0·001). Use of the particular mesh increased the risk of readmission (odds ratio (OR) 1·53, 1·16 to 2·01; P = 0·002) and reoperation for a complication (OR 1·60, 1·03 to 2·47, P = 0·030). No difference in mortality was found. CONCLUSION Clinical registries with prospectively collected data can provide long-term surveillance of commercial mesh. Laparoscopic incisional hernia repair with one particular mesh was associated with an increased rate of short-term complications and double the risk of repair for recurrence.
Collapse
Affiliation(s)
- F Helgstrand
- Centre of Surgical Science, Department of Surgery, Zealand University Hospital, Koege
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark
| | - T Bisgaard
- Department of Surgery, Hvidovre Hospital, University of Copenhagen
| | - L N Jørgensen
- Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen
| | - H Friis-Andersen
- Department of Surgery, Horsens Regional Hospital, University of Aarhus, Aarhus, Denmark
| |
Collapse
|
30
|
Toftlund SA, Gögenur I, Thygesen LC. Descriptive study of all Danish patients undergoing emergency exploratory laparotomies in the period 2003-2014. Scand J Public Health 2020; 48:243-249. [PMID: 31973622 DOI: 10.1177/1403494819875271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Aim: Emergency exploratory laparotomy is a high-risk procedure, but most studies are based on small sample sizes, and no nationwide studies have reported the number of patients and the mortality risk. This descriptive study reports the prevalence, incidence and 30- and 365-day mortality of all patients undergoing emergency exploratory laparotomies in Denmark from 2003 to 2014. Methods: The study population is based on the Danish National Patient Register, which includes all patient contacts with Danish hospitals, including patients undergoing emergency surgery. All patients were followed in registers on mortality. Rates and proportions were estimated using Poisson and logistic regression models. Results: The number of prevalent patients was 15,330 through the period (2003-2014) of whom 13,795 were incident patients. Prevalence increased with age and peaked at 1% for the 80- to 84-year-old age group. The overall incidence was 27 per 100,000 person-years, which strongly increased with age (87 per 100,000 person-years among men and 85 per 100,000 person-years among women). The 30-day mortality was 16.5% and the 365-day mortality was 23.1%. Both increased strongly with age and did not improve over the study period. Both 30- and 365-day mortality were higher among unmarried patients compared to married patients. Conclusions: Emergency exploratory laparotomies are common high-risk procedures especially for the elderly population. These results can be used to focus on better postoperative care to reduce the mortality.
Collapse
Affiliation(s)
- Sarah A Toftlund
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark.,Institute for Clinical Medicine, Copenhagen University, Denmark.,Danish Colorectal Cancer Group, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| |
Collapse
|
31
|
Watt SK, Fransgaard T, Degett TH, Thygesen LC, Benfield T, Knudsen JD, Fuursted K, Jensen TG, Dessau RB, Schønheyder HC, Møller JK, Gögenur I. Associations between blood cultures after surgery for colorectal cancer and long-term oncological outcomes. Br J Surg 2019; 107:310-315. [PMID: 31755092 DOI: 10.1002/bjs.11372] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/11/2019] [Accepted: 08/27/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Systemic inflammation following curative surgery for colorectal cancer may be associated with increased risk of recurrence. [Correction added on 29 November 2019, after first online publication: text amended for accuracy.] This study investigated whether a clinically suspected infection, for which blood cultures were sent within 30 days after surgery for colorectal cancer, was associated with long-term oncological outcomes. METHODS This register-based national cohort study included all Danish residents undergoing surgery with curative intent for colorectal cancer between January 2003 and December 2013. Patients who developed recurrence or died within 180 days after surgery were not included. Associations between blood cultures taken within 30 days after primary surgery and overall survival, disease-free survival and recurrence-free survival were analysed using Cox regression models adjusted for relevant clinical confounders, including demographic data, cancer stage, co-morbidity, blood transfusion, postoperative complications and adjuvant chemotherapy. RESULTS The study included 21 349 patients, of whom 3390 (15·9 per cent) had blood cultures taken within 30 days after surgery. Median follow-up was 5·6 years. Patients who had blood cultures taken had an increased risk of all-cause mortality (hazard ratio (HR) 1·27, 95 per cent c.i. 1·20 to 1·35; P < 0·001), poorer disease-free survival (HR 1·22, 1·16 to 1·29; P < 0·001) and higher risk of recurrence (HR 1·15, 1·07 to 1·23; P < 0·001) than patients who did not have blood cultures taken. CONCLUSION A clinically suspected infection requiring blood cultures within 30 days of surgery for colorectal cancer was associated with poorer oncological outcomes.
Collapse
Affiliation(s)
- S K Watt
- Department of Surgery, Zealand University Hospital Køge/Roskilde, Køge, Denmark
| | - T Fransgaard
- Department of Surgery, Zealand University Hospital Køge/Roskilde, Køge, Denmark
| | - T H Degett
- Department of Surgery, Zealand University Hospital Køge/Roskilde, Køge, Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - T Benfield
- Department of Infectious Diseases, Copenhagen University Hospital, Amager/Hvidovre, Hvidovre, Denmark
| | - J D Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital Amager/Hvidovre Hospital, Hvidovre, Denmark
| | - K Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark
| | - T G Jensen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - R B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - H C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - J K Møller
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital Køge/Roskilde, Køge, Denmark
| |
Collapse
|
32
|
Mikkelsen S, Pedersen EB, Brauer C, Møller KL, Alkjaer T, Koblauch H, Simonsen EB, Thygesen LC. Knee osteoarthritis among airport baggage handlers: A prospective cohort study. Am J Ind Med 2019; 62:951-960. [PMID: 31452223 DOI: 10.1002/ajim.23044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/15/2019] [Accepted: 08/12/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Knee osteoarthritis is a common and often disabling disorder, which has been related to knee-straining work. However, exposure response relations are uncertain and there are few prospective studies. We studied prospectively if incident knee osteoarthritis is associated with cumulative exposure as an airport baggage handler, lifting on average 5000 kg/d. METHODS The study is based on the Copenhagen Airport Cohort, a historical cohort of male baggage handlers and a reference group of unskilled men from the greater Copenhagen area, followed from 1990 to 2012. Cumulative years of employment as a baggage handler was based on information from company employment and union registers. Outcome was first hospital admission with a discharge diagnosis of knee osteoarthritis and/or knee replacement, ascertained from the Danish National Patient Register. RESULTS The cohort contained 3442 baggage handlers and 65 511 workers in the reference group. The unadjusted incidence rate ratio (IRR) of knee osteoarthritis increased steeply with cumulative years as a baggage handler. Although the exposure-response pattern became weaker and statistically nonsignificant (P ≈ .10) when adjusting for age, the risk of knee osteoarthritis was still increased in baggage handlers at the highest exposure level. Additional analyses showed that the association between age and osteoarthritis was stronger for baggage handlers (IRR = 2.09; 95% CI: 1.68-2.60) than for referents (IRR = 1.58; 95% CI: 1.53-1.63), indicating that knee osteoarthritis occurred at a younger age among baggage handlers than in the reference group. CONCLUSIONS The results of this prospective cohort study support that long-term heavy lifting increases the risk of knee osteoarthritis.
Collapse
Affiliation(s)
- Sigurd Mikkelsen
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Ellen B Pedersen
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Karina L Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Tine Alkjaer
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen N, Denmark
- The Department of Physical and Occupational Therapy, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Henrik Koblauch
- Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Erik B Simonsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen N, Denmark
- Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
33
|
Lembeck MA, Thygesen LC, Sørensen BD, Rasmussen LL, Holm EA. Effect of single follow-up home visit on readmission in a group of frail elderly patients - a Danish randomized clinical trial. BMC Health Serv Res 2019; 19:751. [PMID: 31653219 PMCID: PMC6815031 DOI: 10.1186/s12913-019-4528-9] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 09/11/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Unplanned hospital admissions are costly and prevention of these has been a focus for research for decades. With this study we aimed to determine whether discharge planning including a single follow-up home visit reduces readmission rate. The intervention is not representing a new method but contributes to the evidence concerning intensity of the intervention in this patient group. METHODS This study was a centrally randomized single-center controlled trial comparing intervention to usual care with investigator-blinded outcome assessment. Patients above the age of 65 were discharged from a single Danish hospital during 2013-2014 serving a rural and low socioeconomic area. For intervention patients study and department nurses reviewed discharge planning the day before discharge. On the day of discharge, study nurses accompanied the patient to their home, where they met with the municipal nurse. Together with the patient they reviewed cognitive skills, medicine, nutrition, mobility, functional status, and future appointments in the health care sector and intervened if appropriate. Readmission at any hospital in Denmark within 8, 30, and 180 days after discharge is reported. Secondary outcomes were time to first readmission, number of readmissions, length of stay, and readmission with Ambulatory Care Sensitive Conditions, visits to general practitioners, municipal services, and mortality. RESULTS One thousand forty-nine patients aged > 65 years discharged from medical, geriatric, emergency, surgical or orthopedic departments met inclusion criteria characteristic of frailty, e.g. low functional status, need of more personal help and multiple medications. Among 945 eligible patients, 544 were randomized. Seven patients died before discharge. 56% in the intervention group and 54% in the control group were readmitted (p = 0.71) and 23% from the intervention group and 22% from the control group died within 180 days. There were no significant differences between intervention and control groups concerning other secondary outcomes. CONCLUSIONS There was no effect of a single follow-up home visit on readmission in a group of frail elderly patients discharged from hospital. TRIAL REGISTRATION https://clinicaltrials.gov (identifier NCT02318680), retrospectively registered December 11, 2014.
Collapse
Affiliation(s)
- Maurice A Lembeck
- Department of Internal Medicine, Nykøbing Falster Hospital, Fjordvej 15, 4800, Nykøbing Falster, Denmark.
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
| | | | | | - Ellen A Holm
- Department of Internal Medicine, Nykøbing Falster Hospital, Fjordvej 15, 4800, Nykøbing Falster, Denmark
| |
Collapse
|
34
|
Højskov IE, Thygesen LC, Moons P, Egerod I, Olsen PS, Berg SK. The challenge of non-adherence to early rehabilitation after coronary artery bypass surgery: Secondary results from the SheppHeartCABG trial. Eur J Cardiovasc Nurs 2019; 19:238-247. [PMID: 31630532 DOI: 10.1177/1474515119883454] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attending and maintaining a cardiac rehabilitation programme is a challenge. AIMS The purpose of this study was to explore associations between non-adherence to early coronary artery bypass graft rehabilitation and sociodemographic and clinical baseline data. METHODS Coronary artery bypass graft patients were randomised 1:1 to either four weeks of comprehensive early rehabilitation or usual care. Outcomes were assessed at three time-points points: baseline, discharge and four weeks post-coronary artery bypass graft. Differences in sociodemographic and clinical baseline data in adherent versus non-adherent patients were tested using the Pearson χ2 test for categorical variables. To test associations between non-adherence to exercise training and sociodemographic and clinical baseline data, multivariate logistic regression was used to estimate the odds ratio for in-hospital training and post-discharge training adjusted for age, sex and left ventricular ejection fraction. RESULTS Non-adherence to in-hospital versus post-discharge exercise training was 31% (n=48) versus 53% (n=81). Female non-adherence was 20% versus 70%. Non-adherence to in-hospital versus post-discharge mindfulness was 87% versus 70%. Male non-adherence to mindfulness was 85% versus 70%. Non-adherence to psycho-educational consultations was 3%, most of whom were men. Patients with university level education were more adherent to in-hospital exercise training than patients with lower educational level (odds ratio=3.14 (95% confidence interval; 1.16-8.51), p=0.02). Diabetic patients were more non-adherent to exercise training after discharge (3.74 (1.54-9.08), p=0.004) as were overweight patients (0.37 (0.17-0.80), p=0.01). CONCLUSIONS This study demonstrated wide acceptance of psycho-educational consultations in post-coronary artery bypass graft patients. Adherence to physical rehabilitation was low especially after discharge from hospital and the opportunity to attend a mindfulness programme was not used.
Collapse
Affiliation(s)
- Ida E Højskov
- The Heart Centre, University of Copenhagen, Denmark.,Department of Nursing and Nutrition Education. The Faculty of Health Sciences, University College, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, University of Leuven, Belgium.,Department of Pediatrics and Child Health, University of Cape Town, South Africa
| | - Ingrid Egerod
- Department of Intensive Care Unit, Rigshospitalet, University of Copenhagen, Denmark
| | | | | |
Collapse
|
35
|
Berg SK, Rasmussen TB, Herning M, Svendsen JH, Christensen AV, Thygesen LC. Cognitive behavioural therapy significantly reduces anxiety in patients with implanted cardioverter defibrillator compared with usual care: Findings from the Screen-ICD randomised controlled trial. Eur J Prev Cardiol 2019; 27:258-268. [PMID: 31575299 DOI: 10.1177/2047487319874147] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to investigate the effect of a cognitive behavioural therapy intervention provided by trained cardiac nurses plus usual care compared with usual care alone in patients with an implanted cardioverter defibrillator who, prior to randomization, had presented with symptoms of anxiety measured by the Hospital Anxiety and Depression Scale. BACKGROUND Around 20-25% of all patients with an implanted cardioverter defibrillator experience anxiety. Among these patients anxiety is associated with mortality, presumably explained by risk behaviour and activation of the autonomic nervous system. We hypothesised that cognitive behavioural therapy provided by cardiac nurses in an out-patient setting would be an effective treatment of anxiety. METHODS This was an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive behavioural therapy plus usual care or to usual care. The primary outcome was Hospital Anxiety and Depression Scale-Anxiety mean score at 16 weeks. Secondary outcomes included Hospital Anxiety and Depression Scale-Depression, Becks Anxiety Inventory, HeartQoL and Hamilton Anxiety Scale. Primary outcome analysis was based on the intention-to-treat principle. RESULTS A total of 88 participants were included, 66% men, mean age 64.3 years and 61% had primary indication implantable cardioverter defibrillator. A significant difference after 16 weeks was found between groups: intervention group (Hospital Anxiety and Depression Scale-A mean (standard deviation) 4.95 points (3.30) versus usual care group 8.98 points (4.03) (p < 0.0001)). Cohen's d was -0.86, indicating a strong clinical effect. The effect was supported by secondary outcomes. CONCLUSION Cognitive behavioural therapy provided by cardiac nurses to patients with a positive screening for anxiety had a statistically and clinically significant effect on anxiety compared with patients not receiving cognitive behavioural therapy.
Collapse
Affiliation(s)
- Selina K Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Denmark.,National Institute of Public Health, University of Southern Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | | | | | - Jesper H Svendsen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Anne V Christensen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| |
Collapse
|
36
|
Ekeloef S, Thygesen LC, Gögenur I. Short- and long-term mortality in major non-cardiac surgical patients admitted to the intensive care unit. Acta Anaesthesiol Scand 2019; 63:639-646. [PMID: 30656639 DOI: 10.1111/aas.13319] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/12/2018] [Accepted: 12/16/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this register-based cohort study was to characterize patients admitted to the intensive care unit (ICU) following non-cardiac surgery and identify risk factors associated with 30-days, 90-days and 1-year mortality after ICU admission. METHODS Patients aged 18+ years admitted to the intensive care unit within 30-days of non-cardiac surgery at four Capital Region hospitals in Denmark between January 2005 and December 2014 were included. Patients were identified through the Danish National Patient Register. The outcomes were 30-days, 90-days and 1-year mortality after ICU admission. Unadjusted and multivariate logistic regression analyses were performed to identify independent risk factors of mortality. RESULTS The study included 3311 ICU patients. Gastrointestinal surgery accounted for 71.3%, orthopaedic surgery for 18.4% and urologic surgery for 10.2% of the population. For the total population, the median length of stay in hospital was 18 days (9-36, 25th-75th percentile) and 2 days (1-4, 25th-75th percentile) in the ICU. Thirty-days, 90-days and 1-year mortality were 37.8%, 44.5% and 51.2% respectively. Mortality within the ICU was 22.3% while the post-ICU in-hospital mortality was 19.4%. Higher age, comorbidity, delayed ICU admission, acute surgery, and gastrointestinal and orthopaedic surgery increased 30-days, 90-days and 1-year mortality. CONCLUSIONS Short- and long-term mortality in non-cardiac surgical patients admitted to the ICU is very high, especially among the elderly comorbid patients undergoing acute surgery. Future research should focus on targeting clinically modifiable risk factors and performing tailored treatment for these high-risk patients.
Collapse
Affiliation(s)
- Sarah Ekeloef
- Department of Surgery Zealand University Hospital Køge Denmark
| | - Lau C. Thygesen
- National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | - Ismail Gögenur
- Department of Surgery Zealand University Hospital Køge Denmark
| |
Collapse
|
37
|
Kjærulff TM, Ersbøll AK, Green A, Emneus M, Brasso K, Iversen P, Pukkala E, Bolin K, Thygesen LC. Finasteride Use and Risk of Male Breast Cancer: A Case-Control Study Using Individual-Level Registry Data from Denmark, Finland, and Sweden. Cancer Epidemiol Biomarkers Prev 2019; 28:980-986. [PMID: 30842126 DOI: 10.1158/1055-9965.epi-18-0904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/05/2018] [Accepted: 02/25/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In case reports, concerns have been raised as to whether finasteride use increases the risk of male breast cancer. Previous epidemiologic evidence on the potential link is conflicting. This study aimed to assess whether an association between finasteride use and male breast cancer exists after accounting for potential confounders. METHODS The source population consisted of all men (≥35 years) from Denmark (1995-2014), Finland (1997-2013), and Sweden (2005-2014). Cases with incident male breast cancer were identified in the cancer registries and matched with 50 density-sampled, age, and country-matched male population controls per case. Exposure information on finasteride use was derived from the prescription registries. Potential confounders were identified using the directed acyclic graph methodology and measured by use of information from nation-wide registries. RESULTS The study population comprised 1,005 male breast cancer cases and 43,058 controls. Confounder-adjusted odds of finasteride exposure were not statistically significantly increased [OR, 1.09; 95% confidence interval (CI), 0.77-1.54] in breast cancer cases relative to controls. There was no evidence of a dose-response relationship, as the group with greatest exposure to finasteride was associated with lowest OR of male breast cancer [OR, 0.72 (95% CI, 0.40-1.30)]. Sensitivity analyses did not reveal marked changes in results with different exposure definitions or for specific subgroups. CONCLUSIONS Results from this study provided no evidence that finasteride use was associated with male breast cancer. IMPACT This large confounder-adjusted study supports the view that exposure to finasteride is not associated materially with male breast cancer risk.
Collapse
Affiliation(s)
- Thora M Kjærulff
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Annette K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anders Green
- Odense University Hospital and University of Southern Denmark, Odense, Denmark.,Institute of Applied Economics and Health Research, Copenhagen, Denmark
| | - Martha Emneus
- Institute of Applied Economics and Health Research, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eero Pukkala
- Finnish Cancer Registry-Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Kristian Bolin
- Centre for Health Economics and Department of Economics with Statistics, University of Gothenburg, Gothenburg, Sweden
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
38
|
Grønset CN, Thygesen LC, Berg SK, Zangger G, Kristensen MS, Sibilitz KL, Pedersen SS, Oldridge NB, Zwisler AD. Measuring HRQoL following heart valve surgery: the HeartQoL questionnaire is a valid and reliable core heart disease instrument. Qual Life Res 2019; 28:1245-1253. [PMID: 30610503 DOI: 10.1007/s11136-018-02098-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Patient-reported health-related quality of life is a complementary healthcare outcome and important when assessing treatment efficacy. Using COSMIN methodological recommendations, this study evaluates the validity and reliability of a core heart disease-specific health-related quality of life questionnaire, the HeartQoL questionnaire (Danish version) in a sample of patients following heart valve surgery. DESIGN This project involved a cross-sectional validity study and a test-retest reliability study. METHODS Eligible patients completed the HeartQoL, the SF-36 health survey questionnaire, and the Hospital Anxiety and Depression Scale following heart valve surgery. Construct validity was tested using a priori hypotheses. Internal consistency reliability was assessed with Cronbach's alpha. An independent sample of patients participated in the test-retest study and reproducibility was determined with relative [intra-class correlation coefficient (ICC)] and absolute reliability [standard error of measurement (SEM) and smallest detectable change (SDC)]. RESULTS Internal consistency was high with Cronbach's alpha ≥ 0.87. ICC was 0.86-0.92. SEM ranged from 0.17 to 0.26 points and SDC ranged from 0.5 to 0.7 points. Construct validity was confirmed with 87% of all a priori hypotheses for predicted variables. CONCLUSIONS The HeartQoL questionnaire demonstrates acceptable construct validity, internal consistency, and test-retest reproducibility in patients following heart valve surgery. Future studies should focus on assessing the responsiveness of the HeartQoL questionnaire over time and following heart valve surgery.
Collapse
Affiliation(s)
- Charlotte N Grønset
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Graziella Zangger
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirstine L Sibilitz
- Department of Internal Medicine, Section of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Neil B Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| |
Collapse
|
39
|
Boesen MS, Blinkenberg M, Koch-Henriksen N, Thygesen LC, Uldall PV, Magyari M, Born AP. Implications of the International Paediatric Multiple Sclerosis Study Group consensus criteria for paediatric acute disseminated encephalomyelitis: a nationwide validation study. Dev Med Child Neurol 2018; 60:1123-1131. [PMID: 29744874 DOI: 10.1111/dmcn.13798] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Accepted: 03/16/2018] [Indexed: 12/01/2022]
Abstract
AIM The International Paediatric Multiple Sclerosis Study Group (IPMSSG) has proposed criteria for acute disseminated encephalomyelitis (ADEM) not evaluated in clinical practice. Our objective was to assess epidemiological implications of the IPMSSG criteria for ADEM in a cohort study using prospectively collected data. METHOD We identified all diagnosed cases of ADEM in Denmark between 2008 and 2015 from the Danish National Patient Register by International Classification of Diseases 10 codes assigned to acute demyelinating episodes, and we reviewed all medical records to validate ADEM. RESULTS We found 52 children up to the age of 18 years with a verified clinical diagnosis of ADEM (incidence rate 0.54/100 000 person-years; all had abnormal brain magnetic resonance imaging). Only 18 (35%) fulfilled the IPMSSG criteria regarding encephalopathy and polyfocal neurological deficits. Among all 52 children with ADEM, 33 per cent had clinical sequelae after a median follow-up of 4 years 6 months (range: 10mo-8y 3mo). Surprisingly, none progressed to multiphasic ADEM or multiple sclerosis, but median age at end of follow-up was only 10 years 9 months (range: 2y-24y 3mo). INTERPRETATION Among 52 children with ADEM, none converted to multiphasic ADEM or multiple sclerosis (median follow-up: 4y 6mo; range: 10mo-8y 3mo). Applying the IPMSSG criteria to all children with a diagnosis of ADEM leaves 65 per cent of the cases without a diagnosis and lowers the incidence rate of paediatric ADEM. WHAT THIS PAPER ADDS The incidence of paediatric acute disseminated encephalomyelitis (ADEM) was 0.54 per 100 000 person-years in children younger than 18 years. Only 35 per cent of children with ADEM fulfilled the International Paediatric Study Group consensus criteria. ADEM in clinical practice was primarily based on magnetic resonance imaging findings. Paediatric neurologists diagnosed ADEM in the absence of encephalopathy. None of the children with ADEM progressed to multiple sclerosis/multiphasic ADEM during follow-up.
Collapse
Affiliation(s)
- Magnus S Boesen
- Department of Paediatrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Blinkenberg
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nils Koch-Henriksen
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Epidemiology, University of Aarhus, Clinical Institute, Aarhus, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Peter V Uldall
- Department of Paediatrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alfred P Born
- Department of Paediatrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
40
|
Pinar I, Fransgaard T, Thygesen LC, Gögenur I. Long-Term Outcomes of Robot-Assisted Surgery in Patients with Colorectal Cancer. Ann Surg Oncol 2018; 25:3906-3912. [PMID: 30311167 DOI: 10.1245/s10434-018-6862-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Robotic technology has been proven to be a safe alternative to conventional laparoscopy with regards to the peri- and postoperative clinical outcomes. Oncological outcomes have been scarcely examined. The purpose of this study was to examine the disease-free survival in relation to the two surgical approaches: robot-assisted surgery and conventional laparoscopy. In addition, all-cause mortality and recurrence-free survival were investigated. METHODS Between January 2010 and December 2015, patients, undergoing either laparoscopic or robot-assisted elective, curative-intended surgery for colorectal cancer were included. RESULTS A total of 9184 patients underwent surgery in the study period: 5978 patients for colon cancer and 3206 patients for rectal cancer. Among patients with colon cancer, 331 patients (5.5%) underwent robot-assisted surgery, and 449 patients (14.0%) underwent robot-assisted surgery in the rectal cancer group. In the adjusted analyses, the hazard ratio (HR) for disease-free survival, for patients with colon cancer was 0.91 [95% confidence interval (CI) 0.71-1.18]. For patients with rectal cancer, the adjusted HR was 0.83 (95% CI 0.65-1.06). No difference in all-cause mortality and recurrence-free survival were observed. CONCLUSIONS The study demonstrated comparable rates of disease-free survival, all-cause mortality, and recurrence-free survival when comparing robot-assisted surgery with conventional laparoscopy in patients with colorectal cancer.
Collapse
Affiliation(s)
- Ismail Pinar
- Department of Surgery, Zealand University Hospital, Køge, Denmark.
| | - Tina Fransgaard
- Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, Køge, Denmark.,Institute for Clinical Medicine, Copenhagen University and Danish Colorectal Cancer Group, Copenhagen, Denmark
| |
Collapse
|
41
|
Andersen A, Bast LS, Due P, Thygesen LC. Evaluation of the smoking intervention X:IT after the second year: A randomized controlled trial. Scand J Public Health 2018; 47:885-889. [PMID: 30222087 DOI: 10.1177/1403494818799837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims:Review studies on the long-term effects of school-based smoking interventions show mixed results. X:IT was a three-year cluster randomized controlled trial to prevent uptake of smoking among Danish students from age 13 years until age 15 years which previously proved effective in preventing smoking after the first year of intervention. The aim of this paper was to conduct the pre-planned analyses of the effects of the X:IT intervention on smoking after the second year. Methods: We used self-reported questionnaire data from students at baseline, first, second, and third follow-up (n at second follow-up=3269, response rate=79.4%). Data from third follow-up were not suitable for analysis. Outcome measure: 'current smoking', dichotomised into smoke daily, weekly, monthly or more seldom versus do not smoke. We performed multilevel, logistic regression analyses of available cases and intention-to-treat (ITT) analyses, replacing missing outcome values by multiple imputation. Results: The prevalence of smoking increased from 5.8% at baseline to 17.0% at second follow-up among students at intervention schools, and from 7.6% to 18.7% among students at control schools. Analyses of available cases and ITT analyses did not support X:IT being effective in preventing smoking after the second year of intervention. Conclusions: Although X:IT was effective after the first year of intervention, we were not able to demonstrate any effects after the second year. Implementation of the intervention was lower in the second year compared to the first year which indicates that the missing effect of the intervention at second follow-up is due to lack of implementation.
Collapse
Affiliation(s)
- Anette Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lotus S Bast
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
42
|
Pommergaard HC, Rostved AA, Adam R, Thygesen LC, Salizzoni M, Gómez Bravo MA, Cherqui D, Filipponi F, Boudjema K, Mazzaferro V, Soubrane O, García-Valdecasas JC, Prous JF, Pinna AD, O'Grady J, Karam V, Duvoux C, Rasmussen A. Vascular invasion and survival after liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry. HPB (Oxford) 2018; 20:768-775. [PMID: 29622402 DOI: 10.1016/j.hpb.2018.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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] [Received: 11/16/2017] [Revised: 02/18/2018] [Accepted: 03/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies suggest that vascular invasion may be a superior prognostic marker compared with traditional selection criteria, e.g. Milan criteria. This study aimed to investigate the prognostic value of micro and macrovascular invasion in a large database material. METHODS Patients liver transplanted for HCC and cirrhosis registered in the European Liver Transplant Registry (ELTR) database were included. The association between the Milan criteria, Up-to-seven criteria and vascular invasion with overall survival and HCC specific survival was investigated with univariate and multivariate Cox regression analyses. RESULTS Of 23,124 patients transplanted for HCC, 9324 had cirrhosis and data on explant pathology. Patients without microvascular invasion, regardless of number and size of HCC nodules, had a five-year overall survival of 73.2%, which was comparable with patients inside both Milan and Up-to-seven criteria. Patients without macrovascular invasion had an only marginally reduced survival of 70.7% after five years. Patients outside both Milan and Up-to-seven criteria without micro or macrovascular invasion still had a five-year overall survival of 65.8%. CONCLUSION Vascular invasion as a prognostic indicator remains superior to criteria based on size and number of nodules. With continuously improving imaging studies, microvascular invasion may be used for selecting patients for transplantation in the future.
Collapse
Affiliation(s)
- Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Andreas A Rostved
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - René Adam
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, Univ Paris-Sud, Villejuif, France
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mauro Salizzoni
- Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Miguel A Gómez Bravo
- Department of Surgery - Liver Transplant Unit, Hospital Virgen Del Rocio, Sevilla, Spain
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, Univ Paris-Sud, Villejuif, France
| | - Franco Filipponi
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, 56124, Pisa, Italy
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Université de Rennes 1, Rennes, France
| | - Vincenzo Mazzaferro
- University of Milan and Division of Gastrointestinal Surgery and Liver Transplantataion, Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, University Denis Diderot, Paris, France
| | | | - Joan F Prous
- Unitat de Cirurgia Hepato-bilio-pancreàtica, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Antonio D Pinna
- General Surgery and Transplant Division, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Vincent Karam
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U 935, Univ Paris-Sud, Villejuif, France
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris Est University (UPEC), Créteil, France
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
43
|
Cromhout PF, Moons P, Thygesen LC, Nashef S, Damgaard S, Berg SK. Time to expand risk evaluation systems for cardiac surgery? Looking beyond physiological parameters. Eur J Cardiovasc Nurs 2018; 17:760-766. [DOI: 10.1177/1474515118783835] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Risk assessment in cardiac surgery traditionally consists of medical and physiological parameters. However, non-physiological factors have also been found to be predictive of poor outcomes following cardiac surgery. Therefore, the isolated focus on physiological parameters is questionable. This paper describes the emotional, behavioural, social and functional factors that have been established to play a role in outcomes following cardiac surgery. This forms a basis for future research, testing the value of these factors above and beyond the physiological parameters. By including such non-physiological factors, the accuracy of the existing risk scoring systems could potentially be improved.
Collapse
Affiliation(s)
- Pernille F Cromhout
- Department of Thoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Sune Damgaard
- Department of Cardio-thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Selina Kikkenborg Berg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| |
Collapse
|
44
|
Abstract
Aims: Appendicitis is a common disease. The nationwide Danish National Patient Register provides an important data source for epidemiological research. Data used in register-based epidemiological research needs to be validated. We aimed to validate the diagnosis of appendicitis in the Danish National Patient Register. Methods: From 1997 to 2015 nationwide data from the Danish National Patient Register, the Danish Pathology Register, and the Danish Civil Registration System were used to validate the diagnosis of appendicitis or the combination of the diagnosis for appendicitis and surgical removal of the appendix in the Danish National Patient Register. Sensitivity, specificity, and positive and negative predictive values were calculated using pathology reports as golden standard. Results: Diagnosis of appendicitis in the Danish National Patient Register had a sensitivity, specificity, positive predictive value, and negative predictive value of 0.928 (95% confidence interval (CI): 0.927; 0.930), 0.995 (95% CI: 0.995; 0.995), 0.769 (95% CI: 0.767; 0.771), and 0.999 (95% CI: 0.999; 0.999). A diagnosis of appendicitis and a procedure code for surgical removal of the appendix had a sensitivity, specificity, positive predictive value, and negative predictive value of 0.886 (95% CI: 0.885; 0.888), 0.998 (95% CI: 0.998; 0.998), 0.895 (95% CI: 0.894; 0.897), and 0.998 (95% CI: 0.998; 0.998). Conclusions: The diagnosis of appendicitis alone or in combination with the registered surgical removal of the appendix in the Danish National Patient Register showed acceptable validity. Whether to use the diagnosis for appendicitis only or in combination with procedure codes for the removal of the appendix depends on whether high sensitivity or high positive predictive values are warranted.
Collapse
Affiliation(s)
- Jakob Kleif
- Department of Surgery, North Zealand Hospital, Copenhagen University Hospital, Hillerød, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark
| |
Collapse
|
45
|
Zangger G, Zwisler AD, Kikkenborg Berg S, Kristensen MS, Grønset CN, Uddin J, Pedersen SS, Oldridge NB, Thygesen LC. Psychometric properties of HeartQoL, a core heart disease-specific health-related quality of life questionnaire, in Danish implantable cardioverter defibrillator recipients. Eur J Prev Cardiol 2017; 25:142-149. [DOI: 10.1177/2047487317733074] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 12/27/2022]
Abstract
Background Patient-reported health-related quality of life is increasingly used as an outcome measure in clinical trials and as a performance measure to evaluate quality of care. The objective of this study was to assess the psychometric properties of the Danish HeartQoL questionnaire, a core heart disease-specific health-related quality of life questionnaire, in implantable cardioverter defibrillator recipients. Design This study involved cross-sectional and test-retest study designs. Method Implantable cardioverter defibrillator recipients in the cross-sectional study completed the HeartQoL, the Short-Form 36 Health Survey, and the Hospital Anxiety and Depression Scale. The HeartQoL structure, construct-related validity (convergent and discriminative) and reliability (internal consistency) were assessed. HeartQoL reproducibility (test-retest) was assessed in an independent sample of implantable cardioverter defibrillator recipients. Results Mokken scale analysis supported the bi-dimensional structure of HeartQoL among 358 implantable cardioverter defibrillator recipients. Convergent ( r > 0.72) and discriminative validity were confirmed. The HeartQoL scales demonstrated satisfactory internal consistency (Cronbach’s alpha > 0.90). Test-retest reliability (two weeks interval) was assessed in 89 implantable cardioverter defibrillator recipients and found to be acceptable for each scale (intra-class correlation > 0.90). Conclusion The Danish HeartQoL questionnaire demonstrated satisfactory key psychometric attributes of validity and reliability in this implantable cardioverter defibrillator population. This study adds support for the HeartQoL as a core heart-specific health-related quality of life questionnaire in a broad group of patients with heart disease including implantable cardioverter defibrillator recipients.
Collapse
Affiliation(s)
- Graziella Zangger
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Denmark
- Department of Cardiology, Holbæk Hospital, Denmark
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Charlotte N Grønset
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jamal Uddin
- National Institute of Public Health, University of Southern Denmark, Denmark
- Department of Cardiac Surgery, Ibrahim Cardiac Hospital and Research Institute, Bangladesh
| | - Susanne S Pedersen
- Department of Cardiology, Holbæk Hospital, Denmark
- Department of Psychology, University of Southern Denmark, Denmark
| | - Neil B Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, USA
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| |
Collapse
|
46
|
Brixval CS, Axelsen SF, Thygesen LC, Due P, Koushede V. Antenatal education in small classes may increase childbirth self-efficacy: Results from a Danish randomised trial. Sexual & Reproductive Healthcare 2016; 10:32-34. [DOI: 10.1016/j.srhc.2016.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/22/2016] [Accepted: 03/14/2016] [Indexed: 11/27/2022]
|
47
|
Fransgaard T, Thygesen LC, Gogenur I. Metformin Decreases the Risk of Recurrence after Surgery for Colorectal Cancer. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
48
|
Jacobsen R, Thorsen SU, Cohen AS, Lundqvist M, Frederiksen P, Pipper CB, Pociot F, Thygesen LC, Ascherio A, Svensson J, Heitmann BL. Neonatal vitamin D status is not associated with later risk of type 1 diabetes: results from two large Danish population-based studies. Diabetologia 2016; 59:1871-81. [PMID: 27241183 DOI: 10.1007/s00125-016-4002-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 02/23/2016] [Accepted: 05/05/2016] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to assess whether neonatal levels of 25-hydroxyvitamin D (25(OH)D) are associated with risk of developing type 1 diabetes before the age of 18 years. METHODS Two large-scale studies with different designs-a case-cohort and a case-control-were conducted using Danish national register data and biobank material. Weighted Cox regression and conditional logistic regression were used to calculate HRs and ORs, respectively. The concentration of 25(OH)D was assessed from neonatal dried blood spots using highly sensitive liquid chromatography-tandem mass spectrometry. Quintiles of 25(OH)D3 were used in the main analyses. RESULTS The case-cohort study included 912 type 1 diabetes cases and 2866 individuals without type 1 diabetes born in Denmark between 1981 and 2002 and followed up until the end of 2012. The case-control study included 527 matched case-control pairs born between 1981 and 1999 and followed up until May 2004. Both studies found no association between 25(OH)D3 levels and later risk of developing type 1 diabetes. The neonatal total 25(OH)D levels in the studies were low: 46% (case-cohort study) and 51% (case-control study) of individuals had 25(OH)D levels <25 nmol/l. CONCLUSIONS/INTERPRETATION Our two large-scale national studies showed that 25(OH)D3 levels around the time of birth were not associated with later type 1 diabetes risk. Whether higher levels of 25(OH)D3 during pregnancy, acquired by higher doses of supplementation than are recommended today in most countries, could protect the offspring against type 1 diabetes cannot be ruled out by the present studies.
Collapse
Affiliation(s)
- Ramune Jacobsen
- Research Unit for Dietary Studies at The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, Hovedvejen, Entrance 5, Ground Floor, 2000, Frederiksberg, Denmark.
- The Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark.
| | - Steffen U Thorsen
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Paediatrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arieh S Cohen
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - Marika Lundqvist
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - Peder Frederiksen
- Research Unit for Dietary Studies at The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, Hovedvejen, Entrance 5, Ground Floor, 2000, Frederiksberg, Denmark
| | - Christian B Pipper
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Pociot
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Paediatrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Alberto Ascherio
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jannet Svensson
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Paediatrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Berit L Heitmann
- Research Unit for Dietary Studies at The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, Hovedvejen, Entrance 5, Ground Floor, 2000, Frederiksberg, Denmark
- The Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Boden Institute of Obesity, Nutrition Exercise and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
49
|
Moberg JY, Magyari M, Koch-Henriksen N, Thygesen LC, Laursen B, Soelberg Sørensen P. Educational achievements of children of parents with multiple sclerosis: A nationwide register-based cohort study. J Neurol 2016; 263:2229-2237. [PMID: 27541043 DOI: 10.1007/s00415-016-8255-4] [Citation(s) in RCA: 10] [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: 06/18/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
Abstract
Little is known about the impact of parental multiple sclerosis (MS) on offspring's educational attainment. The objective of the study was to examine educational achievements in offspring of parents with MS compared with matched children of parents without MS in a nationwide register-based cohort study. Children of all Danish-born residents with onset between 1950 and 1986 were identified by linking the Danish Multiple Sclerosis Registry with the Civil Registration System. Twins, children with MS, and emigrated persons were excluded. The reference cohort consisted of randomly drawn individuals from the Civil Registration System without parental MS matched 8:1 to the MS offspring by sex and year of birth. Information about education was linked to the cohorts from nationwide educational registries. We included 4177 children of MS parents and 33,416 reference persons. Children of MS parents achieved statistically significant higher average grades than the reference cohort in their final exam of basic school with a mean grade difference of 0.46 (95 % CI 0.22-0.69; p = 0.0002). We found no difference in achievement of educational level above basic school (OR 1.04; 95 % CI 0.98-1.10; p = 0.20). There was a trend toward more MS offspring attaining health-related educations (OR 1.10; 95 % CI 1.00-1.21; p = 0.06). In conclusion, children of MS parents showed a small advantage in grade point average in final examinations in basic school, and they more often tended toward health-related educations. This study revealed no negative consequences of parental MS on grades and highest educational level achieved.
Collapse
Affiliation(s)
- J Y Moberg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,University of Copenhagen, Norregade 10, 1165, Copenhagen, Denmark.
| | - M Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,The Danish Multiple Sclerosis Registry, Rigshospitalet, Tagensvej 22, 2200, Copenhagen, Denmark
| | - N Koch-Henriksen
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Tagensvej 22, 2200, Copenhagen, Denmark.,Department of Clinical Epidemiology, Clinical Institute, University of Aarhus, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark, Oster Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - B Laursen
- National Institute of Public Health, University of Southern Denmark, Oster Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - P Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,University of Copenhagen, Norregade 10, 1165, Copenhagen, Denmark
| |
Collapse
|
50
|
Sibilitz KL, Berg SK, Rasmussen TB, Risom SS, Thygesen LC, Tang L, Hansen TB, Johansen PP, Gluud C, Lindschou J, Schmid JP, Hassager C, Køber L, Taylor RS, Zwisler AD. Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial. Heart 2016; 102:1995-2003. [PMID: 27492941 DOI: 10.1136/heartjnl-2016-309414] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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] [Received: 02/04/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The evidence for cardiac rehabilitation after valve surgery remains sparse. Current recommendations are therefore based on patients with ischaemic heart disease. The aim of this randomised clinical trial was to assess the effects of cardiac rehabilitation versus usual care after heart valve surgery. METHODS The trial was an investigator-initiated, randomised superiority trial (The CopenHeartVR trial, VR; valve replacement or repair). We randomised 147 patients after heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting of physical exercise and monthly psycho-educational consultations (intervention) versus usual care without structured physical exercise or psycho-educational consultations (control). Primary outcome was physical capacity measured by VO2 peak and secondary outcome was self-reported mental health measured by Short Form-36. RESULTS 76% were men, mean age 62 years, with aortic (62%), mitral (36%) or tricuspid/pulmonary valve surgery (2%). Cardiac rehabilitation compared with control had a beneficial effect on VO2 peak at 4 months (24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40) or the exploratory physical and mental outcomes. Cardiac rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02). CONCLUSIONS Cardiac rehabilitation after heart valve surgery significantly improves VO2 peak at 4 months but has no effect on mental health and other measures of exercise capacity and self-reported outcomes. Further research is needed to justify cardiac rehabilitation in this patient group. TRIAL REGISTRATION NUMBER NCT01558765, Results.
Collapse
Affiliation(s)
- Kirstine L Sibilitz
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Selina K Berg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
| | - Trine B Rasmussen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
| | - Signe Stelling Risom
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Bachelor's Degree Programme in Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Tang
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Technology, Bachelor's Degree Programme in Physiotherapy, Department of Rehabilitation and Nutrition, Metropolitan University College, Copenhagen, Denmark.,CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tina B Hansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Zealand University Hospital, Department of Cardiology, Køgevej 7-13, 4000 Roskilde, Denmark
| | - Pernille Palm Johansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jean Paul Schmid
- Cardiology Clinic, Tiefenau Hospital and University of Bern, Bern, Switzerland
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Institute of Health Research, University of Exeter Medical School, Exeter, England
| | - Ann-Dorthe Zwisler
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Cardiology, Holbaek Sygehus, Holbaek, Denmark.,National Centre of Rehabilitation and Palliation, University of Southern Denmark, and University Hospital of Odense, Odense, Denmark
| |
Collapse
|