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Mogensen H, Erdmann F, Mader L, Vrelits Sørensen G, Talbäck M, Tjørnelund Nielsen T, Hasle H, Heyman M, Winther JF, Feychting M, Tettamanti G, Kenborg L. Early mortality in children with cancer in Denmark and Sweden: The role of social background in a setting with universal healthcare. Int J Cancer 2024; 154:1719-1730. [PMID: 38259167 DOI: 10.1002/ijc.34851] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Abstract
Socioeconomic differences in overall survival from childhood cancer have been shown previously, but the underlying mechanisms remain unclear. We aimed to investigate if social inequalities were seen already for early mortality in settings with universal healthcare. From national registers, all children diagnosed with cancer at ages 0-19 years, during 1991-2014, in Sweden and Denmark, were identified, and information on parental social characteristics was collected. We estimated odds ratios (OR) and 95% confidence intervals (CI) of early mortality (death within 90 days after cancer diagnosis) by parental education, income, employment, cohabitation, and country of birth using logistic regression. For children with acute lymphoblastic leukaemia (ALL), clinical characteristics were obtained. Among 13,926 included children, 355 (2.5%) died within 90 days after diagnosis. Indications of higher early mortality were seen among the disadvantaged groups, with the most pronounced associations observed for maternal education (ORadj_Low_vs_High 1.65 [95% CI 1.22-2.23]) and income (ORadj_Q1(lowest)_vs_Q4(highest) 1.77 [1.25-2.49]). We found attenuated or null associations between social characteristics and later mortality (deaths occurring 1-5 years after cancer diagnosis). In children with ALL, the associations between social factors and early mortality remained unchanged when adjusting for potential mediation by clinical characteristics. In conclusion, this population-based cohort study indicated differences in early mortality after childhood cancer by social background, also in countries with universal healthcare. Social differences occurring this early in the disease course requires further investigation, also regarding the timing of diagnosis.
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Affiliation(s)
- Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Cancer Registry Bern-Solothurn, University of Bern, Bern, Switzerland
| | - Gitte Vrelits Sørensen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
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Lomholt FK, Emborg HD, Nørgaard SK, Nielsen J, Munkstrup C, Møller KL, Krog JS, Trebbien R, Vestergaard LS. Resurgence of Respiratory Syncytial Virus in the Summer of 2021 in Denmark-a Large out-of-season Epidemic Affecting Older Children. Open Forum Infect Dis 2024; 11:ofae069. [PMID: 38495773 PMCID: PMC10941316 DOI: 10.1093/ofid/ofae069] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/02/2024] [Indexed: 03/19/2024] Open
Abstract
Background When coronavirus disease 2019 (COVID-19) restrictions were lifted in Denmark in the spring of 2021, a surge in respiratory syncytial virus (RSV) cases followed, causing a large out-of-season epidemic. This study aims to investigate the summer epidemic compared with 3 typical pre-COVID-19 RSV winter seasons using Danish registers to identify RSV cases, RSV-related admissions, and use of intensive care treatment. Methods Incidence rates (IR) per 1000 person-years for RSV cases, RSV-related admissions, and intensive care treatment were calculated with 95% confidence interval (CI) for each season, stratified by age groups and incidence rate ratios (IRR) with 95% CI were calculated to compare the summer epidemic with the winter season for 2019-2020. Results In the summer epidemic, the IR of RSV cases and admissions exceeded previous winter seasons for all age groups. The highest increases in IRs were seen among children aged 2 to 3 years and 4 to 5 years. The IRR of cases were 4.6 (95% CI, 4.1-5.2) and 3.3 (2.6-4.2) and the IRR of admissions were 3.3 (2.7-4.2) and 3.8 (2.3-6.5) in the 2 age groups, respectively, when compared with the winter season 2019-2020. Conclusions Likely because of immunity debt following COVID-19 restrictions, the summer epidemic was significantly larger than previous winter seasons, most markedly among children aged 2 to 3 and 4 to 5 years but had a similar disease severity spectrum.
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Affiliation(s)
| | - Hanne-Dorthe Emborg
- Department of Infections Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Sarah Kristine Nørgaard
- Department of Infections Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Nielsen
- Department of Infections Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Charlotte Munkstrup
- Department of Infections Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | | | - Jesper Schak Krog
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Ramona Trebbien
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Lasse Skafte Vestergaard
- Department of Infections Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
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Dreier JW, Trabjerg BB, Plana-Ripoll O, Skipper N, Agerbo E, Cotsapas C, Berg AT, Christensen J. Epilepsy in childhood and school performance: a nation-wide cohort study. Brain 2024; 147:532-541. [PMID: 38102964 DOI: 10.1093/brain/awad382] [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: 08/15/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023] Open
Abstract
Childhood epilepsy has been linked to poor academic performance, but large-scale studies are lacking. In this nation-wide study of school-aged children, we examined the association between childhood epilepsy and school performance in standardized tests according to phenotypic and treatment-related characteristics. We performed a matched register-based cohort study of children born in Denmark (1997-2009) who participated in the Danish National School Test Programme between 2010 and 2019. We used population and health registers to identify children with epilepsy and a randomly sampled sex- and age-matched reference cohort without epilepsy (ratio 1:10). Norm-based test scores from language and mathematics reflecting performance as a percentile of the nation-wide distribution of scores (scale 1-100) were used to assess academic performance. Adjusted differences in mean standardized scores between children with and without epilepsy were estimated using linear regression models. Among 582 840 children participating in the School Test Programme, we identified 4659 (0.8%) children with epilepsy (52.8% males) and 46 590 matched reference children. Median age at epilepsy onset was 7.5 years (interquartile range: 4.0-10.6). Childhood epilepsy was associated with poorer school performance overall (mean score = 48.2 versus references = 56.7; adjusted difference = -6.7, 95% CI: -7.4 to -6.0), and worse performance was found in all epilepsy subgroups, including in 3534 children with uncomplicated epilepsy (i.e. no other pre-existing neurologic or intellectual disabilities and no identified possible cause for epilepsy; adjusted difference = -6.0, 95% CI: -6.8 to -5.2). No major variation by sex, age or subject was observed, but larger score differences were seen in children using antiseizure medication at time of testing (e.g. valproate monotherapy, adjusted difference = -9.3, 95% CI: -11.5 to -7.0 and lamotrigine monotherapy, adjusted difference = -13.1, 95% CI: -15.0 to -11.3) and in children with psychiatric comorbidity, especially epilepsy with comorbid intellectual disability (adjusted difference = -27.0, 95% CI: -30.0 to -23.9) and epilepsy with comorbid attention deficit/hyperactivity disorder (adjusted difference = -15.7, 95% CI: -19.0 to -12.4). Children with epilepsy scored significantly lower than their unaffected siblings (adjusted difference = -6.2, 95% CI: -7.1 to -5.4). In conclusion, childhood epilepsy was associated with impaired academic performance throughout schooling, which suggest that there is a widespread need for educational support of children with epilepsy, even when the child has no other comorbidities and when the epilepsy appears well-managed.
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Affiliation(s)
- Julie W Dreier
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Betina B Trabjerg
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Niels Skipper
- Department of Economics and Business Economics, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Chris Cotsapas
- Department of Neurology, Yale, New Haven, CT 06510, USA
- Department of Genetics, Yale, New Haven, CT 06510, USA
| | - Anne T Berg
- Department of Neurology, Northwestern University - Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jakob Christensen
- Department of Neurology, Affiliated Member of the European Reference Network EpiCARE, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
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Upreti RP, Mmbaga E, Haugnes HS, Kiserud CE, Del Risco Kollerud R. Most common health problems in general practice among adolescents, and young adults' survivors of lymphoma: a register-based cohort study in Norway. Acta Oncol 2023; 62:1607-1615. [PMID: 37897712 DOI: 10.1080/0284186x.2023.2273894] [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: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The aim was to investigate the distribution of health problems in general practice (GP) among adolescent and young adult (AYA) survivors of lymphoma and to compare problem rates with the general population. METHODS All GP consultations between 2006 and 2020 were identified from the national GP claims register. Diseases and complaints presented 3-10 years after the cancer diagnosis were identified using the International Classification of Primary Care codes (ICPC-2) and compared by applying logistic regression models, presented with odds ratio (OR) and 95%CI. RESULTS A total of 2,500,557 AYAs, of whom 1105 were diagnosed with lymphoma, and over 50 million GP consultations were included. The most common causes of consultation among AYA survivors of lymphoma were related to Hodgkin's disease (13%), pregnancy (11%), respiratory diseases (9%), psychological problems (8%), musculoskeletal system (6%) and fatigue (4%). Almost all these problems were significantly higher among AYA lymphoma survivors compared to the general population (OR ranging from 1.1 to 1.5). CONCLUSION Compared to the general population, young lymphoma survivors have increased contact with the GP for a considerable number of health problems for up to 10 years post-diagnosis. This emphasizes the importance of robust follow-up and a good flow of information between hospital and primary care.
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Affiliation(s)
- Ram Prasad Upreti
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Elia Mmbaga
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, UIT- The Arctic University, Tromsø, Norway
| | | | - Ruby Del Risco Kollerud
- Department of rehabilitation, National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
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Clausen AR, Stokholm L, Frederiksen KH, Möller S, Blaabjerg M, Pedersen FN, Grauslund J. Retinal vein occlusion as an age-dependent marker of incident dementia in a long-term Danish national cohort. Acta Ophthalmol 2023. [PMID: 37874264 DOI: 10.1111/aos.15797] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The aim of this study was to investigate retinal vein occlusion (RVO) as an independent marker of incident dementia. METHODS In a prospective nationwide cohort study, we identified 2 225 568 individuals through the Danish national health registers. Individuals older than 65 years, without unspecified retinal vascular occlusion or dementia were included from 1998 to 2020 and followed until 2022. We calculated the incidence rate (IR) and performed a Cox regression analysis with a hazard ratio (HR) and 95% confidence interval (CI) for RVO (exposure) as a marker of all-cause dementia adjusted for systemic comorbidity. RESULTS We identified 19 669 individuals with RVO who had a higher prevalence of systemic comorbidity at inclusion compared to those without RVO (n = 2 185 483). We performed a Cox regression analysis for age-dependent exposure due to non-proportional hazards in the pre-planned analysis. Exposed individuals younger than 75 years had an increased risk of all-cause dementia (adjusted HR 1.09, 95% CI 1.01-1.18), whereas individuals older than 75 years had a decreased risk of all-cause dementia (adjusted HR 0.92, 95% CI 0.86-0.98). CONCLUSION Individuals with RVO had an age-dependent risk of dementia, with a 9% increased risk in individuals with RVO younger than 75 years and an 8% decreased risk in individuals older than 75 years at the time of exposure.
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Affiliation(s)
- Anna Rebien Clausen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN-Open Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | | | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN-Open Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Morten Blaabjerg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Frederik Nørregaard Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Honoré ET, Jakobsen SH, Osler M, Jørgensen TSH. The impact of AUD on death for men with different IQ-scores: a register-based cohort study of 645 955 men. Alcohol Alcohol 2023; 58:442-450. [PMID: 36966540 DOI: 10.1093/alcalc/agad020] [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: 12/17/2022] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 07/20/2023] Open
Abstract
AIM To investigate whether the effect of alcohol use disorder (AUD) on death by natural and unnatural causes, respectively, differs according to intelligence quotient (IQ) scores. METHODS We followed 654 955 Danish men, including 75 267 brothers, born between 1939 and 1959 from their 25th birthday, 1 January 1970, or date of conscription (whichever came last) until 31 December 2018. The exposure of AUD was defined by first registered treatment (diagnosis since 1969, prescription medicine since 1994, or other treatment since 2006), and the outcomes of death by natural and unnatural causes, respectively, were obtained from nationwide registers since 1970. Information on IQ score was retrieved at conscription from the Danish Conscription Database. RESULTS AND CONCLUSION In total, 86 106 men were defined with an AUD. AUD combined with the highest, middle, and lowest IQ score tertiles, respectively, were associated with a 5.90 (95% confidence interval [CI] 5.75; 6.01), 6.88 (95% CI: 6.73; 7.04), and 7.53 (95% CI: 7.38; 7.68) times higher hazard of death by natural causes compared with no AUD and the highest IQ score tertile. The risk of death by unnatural causes was comparable for men with AUD regardless of IQ score tertile. A within-brother analysis showed that the impact of AUD on death by natural and unnatural causes, respectively, did not vary between men with different IQ score tertiles, but were hampered by statistical uncertainty. Our study indicates a need of special focus on men with lower levels of IQ score and AUD for prevention of death by natural causes.
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Affiliation(s)
- Emilie Theisen Honoré
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Gothersgade 160, 1123 Copenhagen, Denmark
| | - Søren Helmer Jakobsen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Gothersgade 160, 1123 Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Bartholinsgade 6, 1356 Copenhagen, Denmark
| | - Terese Sara Høj Jørgensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Gothersgade 160, 1123 Copenhagen, Denmark
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Søegaard SH, Rostgaard K, Kamper-Jørgensen M, Schmiegelow K, Hjalgrim H. Childcare attendance and risk of childhood acute lymphoblastic leukaemia: A register study based on the Danish childcare database. Int J Cancer 2023; 152:1817-1826. [PMID: 36545888 DOI: 10.1002/ijc.34413] [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: 07/29/2022] [Revised: 11/17/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Childhood acute lymphoblastic leukaemia (ALL) is suggested to result from a dysregulated immune response to infections in children with a preleukaemic state. Childcare in early life supposedly may protect against childhood ALL by facilitating sufficient exposure to infections to stimulate and ensure normal maturation of the immune system. We assessed the association between childcare attendance before age 2 years and risk of childhood ALL in a register-based cohort study, including all children aged 2 to 14 years born in Denmark during 1991 to 2014 with available childcare information recorded in the Danish Childcare Database (n = 1 116 185). Cox regression was used to estimate hazard ratios (HRs) comparing children enrolled in childcare and children not enrolled before age 2 years. Further, we assessed the association according to age at enrolment, type of childcare facility and specific ALL subtypes. During 10 460 811 person-years of follow-up, 460 children developed ALL at ages 2 to 14 years. Of these, 57 (12.4%) never attended childcare before age 2 years compared with 10.6% in the total cohort. Compared with homecare, childcare attendance before age 2 years was associated with a statistically non-significantly, marginally decreased risk of childhood ALL with adjusted HR = 0.87 (95% confidence interval [CI]: 0.65-1.16). Risk estimates did neither vary statistically significantly by age at enrolment nor by type of childcare facility and also not between childhood ALL subtypes, including frequently prenatally initiated ALL subtypes. Results from this large, nationwide register-based study provided no evidence that childcare attendance in the first years of life protects against childhood ALL.
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Affiliation(s)
- Signe Holst Søegaard
- Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Klaus Rostgaard
- Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Haematology, University Hospital Rigshospitalet, Copenhagen, Denmark
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8
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Mamasoula C, Bigirumurame T, Chadwick T, Addor MC, Cavero-Carbonell C, Dias CM, Echevarría-González-de-Garibay LJ, Gatt M, Khoshnood B, Klungsoyr K, Randall K, Stoianova S, Haeusler M, Nelen V, Neville AJ, Perthus I, Pierini A, Bertaut-Nativel B, Rissmann A, Rouget F, Schaub B, Tucker D, Wellesley D, Zymak-Zakutnia N, Barisic I, de Walle HEK, Lanzoni M, Sayers G, Mullaney C, Pennington L, Rankin J. Maternal age and the prevalence of congenital heart defects in Europe, 1995-2015: A register-based study. Birth Defects Res 2023; 115:583-594. [PMID: 36734416 DOI: 10.1002/bdr2.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence on the direction and strength of association between maternal age and the prevalence of congenital heart defects (CHD) in different age group categories is conflicting. Some studies have illustrated different trends with an increase in prevalence in younger and older age groups while other studies have reported a linear relationship. Given the increase in maternal age over recent years, it is important to study the CHD prevalence by maternal age. OBJECTIVES To examine the association between maternal age and the prevalence of CHD in Europe between 1995 and 2015 using population-based data from 24 registries belonging to the European Surveillance of Congenital Anomalies (EUROCAT) network. METHODS Associations over time of all nonsyndromic CHD according to maternal age category and for three CHD severity groupings (severity group I: very severe; severity group II: severe; severity group III: less severe) were examined using Bayesian multilevel Poisson regression modeling. Further subgroup analyses were undertaken within four maternal age-bands: ≤24, 25-29, 30-34 and 35-44 years. Descriptive summaries are also presented. RESULTS There were 51,608 nonsyndromic CHD cases in Europe over the 20-year study period. Total prevalence for all CHD combined was increased for younger mothers (≤24 years) and for mothers 35-44 years of age when compared with mothers aged 25-29 years (reference group) (IRR: 1.05, 95% CI: 1.02, 1.07). The total prevalence was increased for severity group I (very severe) only for younger mothers compared to those aged 25-29 years (IRR: 1.14, 95% CI: 1.04, 1.23). We found an increased prevalence of the following CHD subtypes: double outlet right ventricle (IRR:1.33, 95% CI: 1.09, 1.60), hypoplastic left heart syndrome (IRR: 1.18, 95% CI: 1.05, 1.32), hypoplastic right heart syndrome (IRR: 1.41, 95% CI: 1.05, 1.84), atrioventricular septal defect (IRR: 1.15, 95% CI: 1.01, 1.32), coarctation of aorta (IRR: 1.15, 95% CI: 1.03, 1.28) and atrial septal defect (IRR: 1.08, 95% CI: 1.02, 1.13). For older mothers (35-44 years) compared to the reference category, we observed an increased risk in the prevalence for severity group II (IRR: 1.09, 95% CI: 1.03, 1.14), severity group III (IRR: 1.05, 95% CI: 1.01, 1.08) and an increased prevalence of the CHD subtypes: Pulmonary valve stenosis (IRR: 1.22, 95% CI: 1.09, 1.34), ASD (IRR: 1.07, 95% CI: 1.02, 1.13), CoA (IRR: 1.18, 95% CI: 1.06, 1.32) and Tetralogy of Fallot (IRR: 1.14, 95% CI: 1.01, 1.28). Finally, for all age categories compared to the reference category, different associations of ASD and an increased prevalence of CoA was also observed. CONCLUSIONS Based on data for cases of CHD from 24 European population-based registries, evidence of a positive association between maternal age and the total prevalence of CHD for younger (≤24 years old) and older (35-44 years old) mothers was observed. The results suggest that young maternal age (≤24 years old) is a factor associated with severe CHD phenotypes while a positive association between advanced maternal age (35-44 years old) and mild CHD phenotypes was observed.
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Affiliation(s)
| | | | - Thomas Chadwick
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Medical Center CHUV, Lausanne, Switzerland
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Carlos M Dias
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
- Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Luis-Javier Echevarría-González-de-Garibay
- Ministry of Health of the Basque Government. Directorate for Healthcare Planning, Organisation and Evaluation, Registries and Health Information Unit, Vitoria-Gasteiz, Spain
| | - Miriam Gatt
- Malta Congenital Anomalies Register, Directorate for Health Information and Research, Pietà, Malta
| | - Babak Khoshnood
- Université de Paris, INSERM U1153, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Kari Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Kay Randall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sylvia Stoianova
- South West Congenital Anomaly Register, Bristol Medical School, University of Bristol, Bristol, UK
| | - Martin Haeusler
- Styrian Malformation Registry, Med. University of Graz, Graz, Austria
| | - Vera Nelen
- Provinciaal Instituut voor Hygiene (PIH), Antwerp, Belgium
| | - Amanda J Neville
- Registro IMER - IMER Registry (Emilia Romagna Registry of Birth Defects), Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy
| | - Isabelle Perthus
- Auvergne registry of congenital anomalies (CEMC-Auvergne), Department of clinical genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Pierini
- Tuscany Registry of Congenital Defects (RTDC), Institute of Clinical Physiology - National Research Council/ Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Anomalies, CHU Rennes, University Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Bruno Schaub
- French West Indies Registry, Registre des Malformations des Antilles (REMALAN), Maison de la Femme de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, France
| | - David Tucker
- CARIS, Public Health Wales, Singleton Hospital, Swansea, UK
| | - Diana Wellesley
- Wessex Clinical Genetics Department, Princess Anne Hospital, Southampton, UK
| | - Natalya Zymak-Zakutnia
- OMNI-Net Ukraine Birth Defects Program and Khmelnytsky City Children's Hospital, Khmelnytsky, Ukraine
| | - Ingeborg Barisic
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Zagreb, Croatia
| | - Hermien E K de Walle
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, Netherlands
| | - Monica Lanzoni
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Gerardine Sayers
- Health Service Executive, Dr Steeven's Hospital, Dublin, Ireland
| | - Carmel Mullaney
- Department of Public Health, Service Executive (HSE) South East Area, Limerick, Ireland
| | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Liu X, Henriksen TB, Pedersen LH. Quetiapine treatment in the third trimester and neonatal morbidities. Am J Obstet Gynecol MFM 2023; 5:100942. [PMID: 36965696 DOI: 10.1016/j.ajogmf.2023.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Xiaoqin Liu
- The National Centre for Register-based Research, Aarhus University, Denmark.
| | - Tine Brink Henriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Henning Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark; Department of Biomedicine, Aarhus University, Denmark
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Russo A, Blettner M, Merzenich H, Wollschlaeger D, Erdmann F, Gianicolo E. Incidence of childhood leukemia before and after shut down of nuclear power plants in Germany in 2011: A population-based register study during 2004 to 2019. Int J Cancer 2023; 152:913-920. [PMID: 36155927 DOI: 10.1002/ijc.34303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 01/06/2023]
Abstract
The association between leukemia and proximity to nuclear-power-plants (NPPs) has been assessed in several countries with inconsistent results. A case-control study from Germany had shown an increased risk for childhood leukemia (diagnoses 1980-2003) near NPPs. Germany began shutting down nuclear reactors in 2011, following the Fukushima disaster. We tested whether the previously observed association between leukemia and proximity to NPP persisted despite the shutdown. We used an ecological study design to investigate the incidence of leukemia during 2004 to 2019 in children aged 0 to 14 years living near NPPs where at least one reactor was shut down in 2011. We defined study and control areas as municipalities whose surface area was at least 75% within 10 km or between 10 and 50 km of NPPs, respectively. We calculated age-standardized rates and incidence rate ratios (IRR) using control-areas as the reference. We also computed standardized incidence ratios (SIR) separately for each NPP using incidence rates of the German population as a reference. IRR decreased from 1.20 (95% confidence interval: 0.81-1.77) in 2004 to 2011 to 1.12 (0.75-1.68) in 2012 to 2019. Analyses of single plants showed an excess of childhood leukemia during 2004 to 2019 for the Unterweser-NPP, based only on three cases, and the Krümmel-NPP (n = 14; SIR: 1.98, 1.17-3.35). We found slightly decreasing of leukemia incidence rate ratios after the shutdown of nuclear reactors in 2011. Due to the small number of cases, risk estimates have large uncertainty. Further research including a longer follow-up is warranted. The consistent excess of incidence cases around Krümmel may require analytical epidemiological analysis.
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Affiliation(s)
- Antonello Russo
- Master of epidemiology student, University of Turin, Turin, Italy
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Hiltrud Merzenich
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Daniel Wollschlaeger
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Friederike Erdmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Emilio Gianicolo
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Institute of Clinical Physiology, National Research Council, Lecce
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11
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Golovina K, Elovainio M, Hakulinen C. Association between depression and the likelihood of having children: a nationwide register study in Finland. Am J Obstet Gynecol 2023; 228:211.e1-211.e11. [PMID: 36283480 DOI: 10.1016/j.ajog.2022.10.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Depression may be associated with a lower likelihood of having children, but the findings are inconsistent. Previous population-based studies on this topic are limited. OBJECTIVE We examined associations between depression and the likelihood of having children, the number of children, and the parental age at first birth. We also evaluated whether these associations differ for people with low, middle, and high educational levels. STUDY DESIGN We conducted a nationwide register cohort study including all individuals born in Finland from 1960 to 1980 (n=1,408,951). Depression diagnoses were identified from the Care Register for Health Care (containing records of inpatient hospital episodes for the period 1969 to 2017 and of specialist outpatient visits for the period 1996 to 2017). The main outcomes-having biological children, the number of biological children, and the parental age at first birth-were identified from the Population Register of Statistics Finland and were defined either in the last year of the follow-up in 2017 or the last year alive or living in Finland. The association between depression and the likelihood of having children was examined using a logistic regression analysis; the association between depression and the number of children was evaluated using Poisson regression analyses, and the association between depression and the age at first birth was evaluated using a linear regression analysis. All analyses were conducted separately for men and women. RESULTS For both men and women, secondary care-treated depression was associated with a lower likelihood of having children (odds ratio, 0.66; 95% confidence interval, 0.64-0.67 for men; odds ratio, 0.84; 95% confidence interval, 0.82-0.85 for women) and with having fewer children (incidence rate ratio, 0.86; 95% confidence interval, 0.86-0.87 for men; incidence rate ratio, 0.96; 95% confidence interval, 0.96-0.96 for women). Depression was associated with a slightly lower parental age at first birth (33.1 vs 34.0; P<.001 for men; 31.3 vs 32.1; P<.001 for women). Dose-response associations between the severity of depression and a decreased likelihood of having children, as well as having fewer children, were observed. Earlier onset of depression was related to a lower likelihood of having children and to having fewer children. Among men and women in middle- and high-level educational groups, depression was associated with a lower likelihood of having children and with having fewer children. Among men with a low level of education, no associations were observed. Among women with a low level of education, depression was associated with a higher likelihood of having children and with having more children. CONCLUSION Both men and women with secondary care-treated depression have a lower likelihood of having children and have fewer children. Our findings suggest that depression may be one of the factors that contribute to the likelihood of having children, which should be addressed by policy makers.
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Affiliation(s)
- Kateryna Golovina
- Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland.
| | - Marko Elovainio
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Christian Hakulinen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
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12
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Elo J, Tolppanen AM, Koponen M, Tiihonen M, Hartikainen S. Recent Hospitalization and Initiation of Antiepileptics Among Persons With Alzheimer's Disease. J Am Med Dir Assoc 2023; 24:213-219.e6. [PMID: 36403662 DOI: 10.1016/j.jamda.2022.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/22/2022] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Antiepileptic drugs (AEDs) are frequently prescribed for persons with Alzheimer's disease (AD), but little is known on factors associated with AED initiation in this population. We investigated whether recent hospitalization is associated with AED initiation in persons with AD. DESIGN Nested case-control study in the nationwide register-based Medication use and Alzheimer's disease (MEDALZ) cohort. PARTICIPANTS AND SETTINGS The MEDALZ cohort includes 70,718 persons diagnosed with AD during 2005-2011 in Finland. Altogether 6814 AED initiators and 6814 age-, sex-, and time since AD diagnosis-matched noninitiators were included in this study. Matching date was the date of AED initiation. METHODS AED purchases were identified from the Prescription Register and hospitalizations from the Care Register for Health Care. Recent hospitalization was defined as hospitalization ending within 2 weeks before the matching date. Association between recent hospitalization and AED initiation was assessed with conditional logistic regression. RESULTS The most frequently initiated AEDs were pregabalin (42.9%) and valproic acid (32.2%). A bigger proportion of AED initiators (36.9%) than noninitiators (5.3%) were recently hospitalized [odds ratio (OR) 10.5, 95% CI 9.22-11.9]. Dementia was the most frequent discharge diagnosis among AED initiators (29.1%) and noninitiators (27.9%). Among AED initiators, the next most frequent diagnosis was epilepsy (20.6%). Musculoskeletal diagnoses and use of analgesics including opioids was more common among gabapentinoid initiators compared with other AED initiators. CONCLUSIONS AND IMPLICATIONS Recent hospitalization was significantly related to AED initiation. Initiations of AED might have been related to common symptoms in persons with AD like neuropathic pain, epilepsy, and neuropsychiatric symptoms.
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Affiliation(s)
- Jenna Elo
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; Center for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Miia Tiihonen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
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13
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Pajula S, Gissler M, Jyränki J, Tukiainen E, Koljonen V. Actualized lower body contouring surgery after bariatric surgery - a nationwide register-based study. J Plast Surg Hand Surg 2022; 56:335-341. [PMID: 32776860 DOI: 10.1080/2000656x.2020.1800481] [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] [Indexed: 12/30/2022]
Abstract
Massive weight loss might lead to excess skin folds causing functional, physical, and psychosocial discomfort. Following bariatric procedures, an increasing number of patients are seeking lower body contouring surgery (LBCS). The proportion of bariatric patients who undergo LBCS is largely unknown. The aim of this current study was to analyse the incidence and realization of LBCS in bariatric patients in Finland.National retrospective register linkage study including all adult patients who received bariatric surgery in Finland during 1998-2016. The data were obtained from the Finnish national health registers maintained by the Finnish Institute for Health and Welfare. Altogether 1089 (14.1%) of 7703 bariatric patients underwent LBCS during the study period. The majority of the LBCS procedures were abdominoplasty (89%). Median latency between bariatric surgery and LBCS was 31 months. The patients with LBCS were younger (p < 0.001) and received sleeve gastrectomy (p < 0.001). We revealed an annual correlation between LBCS and bariatric procedures (r = 0.683). With a two-year latency between the bariatric and post-bariatric operations, the correlation co-efficiency was strong (r = 0.927). LBCS operations ranged from 5 to 215 per hospital district. Most LBCSs (97.3%) were performed in public hospitals, and some (41%) were performed in university hospitals. This study shows that only 14.1% of bariatric patients undergo LBCS. There is a correlation between bariatric procedures and succeeding plastic surgical reconstructive procedures.
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Affiliation(s)
- Susanna Pajula
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.,Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland and Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Janne Jyränki
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Virve Koljonen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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14
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Backer V, Porsborg A, Hansen V, Skjold T, Schmid JM, Kehlet M, Torp-Pedersen C, Aasbjerg K. A register-based study: cough - a frequent phenomenon in the adult population. BMC Pulm Med 2022; 22:426. [PMCID: PMC9675275 DOI: 10.1186/s12890-022-02228-z] [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: 12/05/2021] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Chronic cough, more than 8 weeks, can either be without co-morbidity called unexplained chronic cough (UCC) or with co-morbidity called refractory chronic cough (RCC). Using datasets from the Danish National Prescription Registry (Prescription Registry) and Danish National Patient Registry (Patient Registry) we wanted to investigate the prevalence and factors of importance of cough in a Nationwide registry. Material and methods Inclusion criteria were patients 18–90 years with at least one final cough diagnosis (ICD-10 DR05/DR059) in Patient registry or patients who have redeemed ≥2 prescriptions for relevant cough-medication within a 90-day harvest in the Prescription registry from 2008 to 2017. To validate this study’s chosen proxy on chronic cough an analysis of the Patient registry sub-population with a contact of ≥8 weeks and then final diagnosis code DR05/DR059 was also performed. The population was divided into UCC and RCC. Results Of the 104,216 patients from the Prescription registry, 52,727 were classified as having UCC and 51,489 were classified with RCC. From the Patient registry 34,260 were included, of whom 12,278 had UCC and 21,982 had RCC. Cough were frequently found among females (p < 0.0001). Both genders were around 2 years older in RCC than UCC (p < 0.0001) Spirometry was performed in 69 and 57%, X-ray in 73 and 58% and asthma challenge test performed in 13 and 5% (UCC and RCC, respectively, p < 0.0001). The frequency of co-morbidities such as heart failure, rheumatologic disease, pulmonary embolism, and diabetes was < 10%. Conclusion Many patients suffer from chronic cough or cough requiring medications, with or without co-morbidity; frequently found among menopausal women. Most patients had a substantial work-up performed. The high frequency and the resources consuming work-up program call for systematic coding of disease, systematic patient evaluation and more specific treatment options. The study was approved (ID: no. P-2019-191).
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Affiliation(s)
- Vibeke Backer
- grid.5254.60000 0001 0674 042XDepartment of otorhinolaryngology Head & Neck surgery, Rigshospitalet, Copenhagen University, Blegdamsvej 9, DK-2100 Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XCenter of physical activity Research (CFAS), Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Andreas Porsborg
- grid.7048.b0000 0001 1956 2722Department of Respiratory Medicine and Allergy, Aarhus University hospital, Aarhus University, Aarhus, Denmark
| | - Victor Hansen
- grid.7048.b0000 0001 1956 2722Department of Respiratory Medicine and Allergy, Aarhus University hospital, Aarhus University, Aarhus, Denmark
| | - Tina Skjold
- grid.7048.b0000 0001 1956 2722Department of Respiratory Medicine and Allergy, Aarhus University hospital, Aarhus University, Aarhus, Denmark
| | - Johannes Martin Schmid
- grid.7048.b0000 0001 1956 2722Department of Respiratory Medicine and Allergy, Aarhus University hospital, Aarhus University, Aarhus, Denmark
| | - Mette Kehlet
- MSD Denmark, Havneholmen 25, V, 1561 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- grid.414092.a0000 0004 0626 2116Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark ,grid.27530.330000 0004 0646 7349Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Aasbjerg
- grid.5254.60000 0001 0674 042XDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark
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15
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Müller V, Gerdtham U, Alriksson‐Schmidt A, Jarl J. Parental decisions to divorce and have additional children among families with children with cerebral palsy: Evidence from Swedish longitudinal and administrative data. Health Econ 2022; 31:2170-2186. [PMID: 35778857 PMCID: PMC9543549 DOI: 10.1002/hec.4567] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/03/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
This study analyzes the relationship of having a child with the early-onset disability cerebral palsy (CP) and the parental decision to divorce and to have additional children. We use longitudinal matched case-control data from multiple linked Swedish National Population Registers between 2001 and 2015 and perform Cox proportional hazards regressions with interval-censoring. Although we do not find a general excess parental divorce risk on CP relative to the comparison group without CP, we find that having a child with CP increases the risk of divorce for parents with low education. We also find that having a child with CP reduces the likelihood of having additional children, especially for mothers in the older age range (maternal age at delivery >33 years) and parents with low education. The severity level of the disability, as indicated by gross motor function, is not related to the results. These findings should be understood in the Swedish context, which provides extensive welfare support (e.g., personal assistance). If future studies would find adverse results in countries with less social care and benefits, our results may indicate that it is possible to mitigate negative consequences for the family of a child with disability.
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Affiliation(s)
- Vibeke Müller
- Department of Clinical Sciences, MalmöHealth Economics UnitLund UniversityLundSweden
| | - Ulf Gerdtham
- Department of Clinical Sciences, MalmöHealth Economics UnitLund UniversityLundSweden
- Department of EconomicsLund UniversityLundSweden
| | | | - Johan Jarl
- Department of Clinical Sciences, MalmöHealth Economics UnitLund UniversityLundSweden
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16
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Matsuda S, Ikawa F, Hidaka T, Yamaguchi S, Inagawa T, Horie N, Kurisu K, Akiyama Y, Goto Y, Nakayama T, Fukuda H, Ueba T, Sasaki M, Ishikawa T, Shimamura N, Ohkuma H. Recent Declining Trend of Incidence Rate of Subarachnoid Hemorrhage in Shimane, Japan: The Japan Incidence of Subarachnoid Hemorrhage (JIS) Study. Neurol Med Chir (Tokyo) 2022; 62:458-464. [PMID: 36130903 PMCID: PMC9637398 DOI: 10.2176/jns-nmc.2022-0067] [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] [Indexed: 11/30/2022] Open
Abstract
The “Izumo Study” revealed the incidence rate of subarachnoid hemorrhage (SAH) in Izumo City, Shimane Prefecture, Japan, from 1980 to 1998. However, no study has been published regarding the incidence of SAH in Shimane Prefecture after 1998. Most studies reporting the incidence of SAH in Japan have been conducted before 2000, although a few have been reported after 2000. This study aimed to assess the estimated age-adjusted incidence rate (AAIR) of SAH in Shimane Prefecture after 1998, following the Izumo Study. A retrospective study was conducted to identify the estimated AAIR of SAH in Shimane Prefecture, using the age-adjusted SAH mortality rate for this population from 1999 to 2017 and assuming that the case-fatality rate of SAH decreased by 0.7% annually from 45% in 1999 to 32.4% in 2017. We used linear regression analysis for trend to the estimated AAIR of SAH. Sensitivity analyses were also conducted by various case-fatality rates of SAH using assuming case-fatality rate based on previous reports. The estimated AAIR of SAH in Shimane Prefecture declined from 33.6 (95% confidence interval [CI]: 29.7-37.9) per 100,000 person-years in 1999, by 26.5%, to 24.7 (95% CI: 21.4-28.5) in 2017 (p < 0.01, r = 0.58). Declining trend of incidence rate of SAH in Shimane Prefecture from 1999 to 2017 was confirmed in this study.
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Affiliation(s)
- Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | | | | | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Department of Neurosurgery, Chugoku Rosai Hospital
| | - Yasuhiko Akiyama
- Department of Neurosurgery, Shimane University Faculty of Medicine
| | - Yoshihito Goto
- Department of Clinical Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School, Kochi University
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University
| | - Masahiro Sasaki
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center
| | - Tatsuya Ishikawa
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center
| | | | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University Graduate School
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Conway PM, Erlangsen A, Grynderup MB, Clausen T, Rugulies R, Bjorner JB, Burr H, Francioli L, Garde AH, Hansen ÅM, Hanson LM, Kirchheiner-Rasmussen J, Kristensen TS, Mikkelsen EG, Stenager E, Thorsen SV, Villadsen E, Høgh A. Workplace bullying and risk of suicide and suicide attempts: A register-based prospective cohort study of 98 330 participants in Denmark. Scand J Work Environ Health 2022; 48:425-434. [PMID: 35648097 PMCID: PMC9888442 DOI: 10.5271/sjweh.4034] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure. METHODS Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004-2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Register. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity. RESULTS The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06-2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09-2.50) and 2.08 (0.82-5.27), respectively. Analyses stratified by sex showed a statistically significant association between workplace bullying and suicidal behavior among men but not women. CONCLUSIONS The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.
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Affiliation(s)
- Paul Maurice Conway
- Department of Psychology, University of Copenhagen, Denmark,
Correspondence to: Paul Maurice Conway, Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark. [E-mail: ]
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark,Copenhagen Research Centre for Mental Health, Capital Region of Denmark, Copenhagen, Denmark,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | | | - Thomas Clausen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Reiner Rugulies
- Department of Psychology, University of Copenhagen, Denmark,National Research Centre for the Working Environment, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- National Research Centre for the Working Environment, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark,Optum Patient Insights, Lincoln, RI, USA
| | - Hermann Burr
- Department of Work and Health, Federal Institute for Occupational Safety and Health BAuA, Berlin, Germany
| | | | - Anne Helene Garde
- National Research Centre for the Working Environment, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- National Research Centre for the Working Environment, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Elsebeth Stenager
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ebbe Villadsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Annie Høgh
- Department of Psychology, University of Copenhagen, Denmark
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Klemetti R, Perry B, Henningsen AKA, Spangmose AL, Pinborg A, Opdahl S, Romundstad LB, Bergh C, Wennerholm UB, Tiitinen A, Gissler M. Puberty disorders among ART-conceived singletons: a Nordic register study from the CoNARTaS group. Hum Reprod 2022; 37:2402-2411. [PMID: 36029044 PMCID: PMC9527471 DOI: 10.1093/humrep/deac192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/22/2022] [Revised: 08/10/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Do ART-conceived children have an increased risk for puberty disorders? SUMMARY ANSWER Both ART-conceived boys and girls had a higher risk of puberty disorders; early puberty was more common among girls and late puberty among boys. WHAT IS KNOWN ALREADY Some physiological differences in growth and metabolism have been reported for ART-conceived children compared to non-ART-conceived children. Knowledge on pubertal development and disorders in ART-conceived children is limited. STUDY DESIGN, SIZE, DURATION A register-based cohort study was carried out including data from 1985 to 2015. The Committee of Nordic Assisted Reproductive Technology and Safety (CoNARTaS) study population consists of all live and stillborn children, as well as their mothers, registered in the Medical Birth Registers during the study period in Denmark, Sweden, Finland and Norway. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 122 321 ART-conceived singletons and 6 576 410 non-ART singletons born in Denmark (1994–2014), Finland (1990–2014), Norway (2002–2015) and Sweden (1985–2015) were included. Puberty disorders were defined using International Classification of Diseases and Related Health Problems (ICD)-9/ICD-10 codes and classified in the following groups: late puberty (6268/E30.0), early puberty (2591 and 2958/E30.1 and E30.8) and unspecified disorders (V212 and V579/E30.9 and Z00.3 as well as Z51.80 for Finland). The results in Cox regression were adjusted for maternal age, parity, smoking, gestational diabetes, chronic hypertension, hypertensive disorders during pregnancy and country, and further for either gestational age, birthweight, small for gestational age or large for gestational age. MAIN RESULTS AND THE ROLE OF CHANCE There were 37 869 children with diagnoses related to puberty disorders, and 603 of them were born after ART. ART-conceived children had higher risks for early (adjusted hazard ratio (aHR) 1.45, 95% CI: 1.29–1.64) and late puberty (aHR 1.47, 95% CI: 1.21–1.77). Girls had more diagnoses related to early puberty (aHR 1.46, 95% CI: 1.29–1.66) and boys with late puberty (aHR 1.55, 95% CI: 1.24–1.95). LIMITATIONS, REASONS FOR CAUTION Using reported puberty disorders with ICD codes in health care registers might vary, which may affect the numbers of cases found in the registers. Register data may give an underestimation both among ART and non-ART-conceived children, especially among non-ART children, who may not be as carefully followed as ART-conceived children. Adjustment for causes and duration of infertility, mothers’ own puberty characteristics and BMI, as well as children’s BMI, was not possible because data were not available or data were missing for the early years. It was also not possible to compare ART to non-ART siblings or to study the pubertal disorders by cause of subfertility owing to a small number of discordant sibling pairs and a large proportion of missing data on cause of subfertility. WIDER IMPLICATIONS OF THE FINDINGS This large, register-based study suggests that ART-conceived children have a higher risk for puberty disorders. However, the mechanisms of infertility and pubertal onset are complex, and ART is a rapidly advancing field with various treatment options. Studying the pubertal disorders of ART-conceived offspring is a continuing challenge. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Nordic Trial Alliance: a pilot project jointly funded by the Nordic Council of Ministers and NordForsk (71450), the Central Norway Regional Health Authorities (46045000), the Nordic Federation of Obstetrics and Gynaecology (NF13041, NF15058, NF16026 and NF17043), the Interreg Öresund-Kattegat-Skagerrak European Regional Development Fund (ReproUnion project), the Research Council of Norway’s Centre of Excellence funding scheme (262700), the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-70940) and FLUX Consortium ‘Family Formation in Flux—Causes, Consequences and Possible Futures’, funded by the Strategic Research Council, Academy of Finland (DEMOGRAPHY 345130). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- R Klemetti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - B Perry
- University of Tampere, Tampere, Finland
| | - A K Aaris Henningsen
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lærke Spangmose
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Pinborg
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - S Opdahl
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - L Bente Romundstad
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - C Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Women's Health, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - U B Wennerholm
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Women's Health, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Tiitinen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M Gissler
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,INVEST Joint Research Flagship Centre, University of Turku, Turku, Finland.,Department of Knowledge Brokers, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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Rissanen E, Kuvaja-Köllner V, Elonheimo H, Sillanmäki L, Sourander A, Kankaanpää E. The long-term cost of childhood conduct problems: Finnish Nationwide 1981 Birth Cohort Study. J Child Psychol Psychiatry 2022; 63:683-692. [PMID: 34402045 DOI: 10.1111/jcpp.13506] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Commonly recognized childhood conduct problems often lead to costly problems in adulthood. This study aimed to evaluate the long-term cumulative cost of childhood conduct problems until the age of 30. The costs included inpatient care, nervous system medicine purchases, and criminal offences. METHODS The study used population-based nationwide 1981 birth cohort data. Families and teachers assessed the conduct problems of the eight-year-olds based on Rutter questionnaires. We grouped 5,011 children into low-level of conduct problems (52%), intermediate-level of conduct problems (37%), and high-level of conduct problems (11%) groups, based on combined conduct symptoms scores. The analysis included the cohort data with the Care Register for Health Care, the Drug Prescription Register, and the Finnish Police Register. The cost valuation of service use applied national unit costs in 2016 prices. We used Wilcoxon rank-sum test to test the differences between groups and gender. RESULTS During 1989-2011, average cumulative costs of the high-level (€44,348, p < .001) and the intermediate-level (€19,405, p < .001) of conduct problems groups were higher than the low-level of conduct problems group's (€10,547) costs. In all three groups, the boys' costs were higher than girls' costs. CONCLUSIONS The costs associated with conduct problems in childhood are substantial, showing a clear need for cost-effective interventions. Implementation decisions of interventions benefit from long-term cost-effectiveness modelling studies. Costing studies, like this, provide cost and cost offset information for modelling studies.
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Affiliation(s)
- Elisa Rissanen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Virpi Kuvaja-Köllner
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | | | - Lauri Sillanmäki
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - André Sourander
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Eila Kankaanpää
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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20
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Roustaei Z, Räisänen S, Gissler M, Heinonen S. Socioeconomic differences in the association between maternal age and maternal obesity: a register-based study of 707,728 women in Finland. Scand J Public Health 2022:14034948221088003. [PMID: 35593408 DOI: 10.1177/14034948221088003] [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: 11/15/2022]
Abstract
AIMS To examine the association between maternal age and maternal obesity across socioeconomic groups and to determine whether socioeconomic status modifies the association between maternal age and maternal obesity with a view to informing public health policies. METHODS Data for this register-based study were sourced from the Finnish Medical Birth Register and Statistics Finland, using the information of 707,728 women who gave birth in Finland from 2004 to 2015. We used multivariable regression models to assess the association between maternal age and maternal obesity across socioeconomic groups. We further assessed interactions on both multiplicative and additive scales. RESULTS Across all socioeconomic groups, the adjusted odds ratio for the association between maternal age and maternal obesity increased, peaking for women 35 years or older. Using women below 20 years of age in the category of upper-level employees as a single reference group, in the category of upper-level employees, the adjusted odds ratio and 95% confidence intervals among women 35 years or older was 1.92 (1.39-2.64) for maternal obesity. Equally, the adjusted odds ratio and 95% confidence intervals in the category of long-term unemployed was 4.35 (3.16-5.98). Synergistic interactions on both multiplicative and additive scales were found across age and socioeconomic groups. CONCLUSIONS The association between maternal age and maternal obesity was strongest among women 35 years or older with lower socioeconomic status. Population-level interventions that address maternal risk factors from teenage years are needed alongside individual-level interventions that target high-risk mothers in areas of low socioeconomic status and maternal obesity.
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Affiliation(s)
- Zahra Roustaei
- Department of Health Sciences, University of Helsinki, Helsinki, Finland
| | - Sari Räisänen
- School of Health Care and Social Services, Tampere University of Applied Sciences, Tampere, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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21
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Madsen IE, Sørensen JK, Bruun JE, Framke E, Burr H, Melchior M, Sivertsen B, Stansfeld S, Kivimäki M, Rugulies R. Emotional demands at work and risk of hospital-treated depressive disorder in up to 1.6 million Danish employees: a prospective nationwide register-based cohort study. Scand J Work Environ Health 2022; 48:302-311. [PMID: 35262742 PMCID: PMC9524161 DOI: 10.5271/sjweh.4020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Previous studies on effects of emotional demands on depression have relied on self-reported exposure data and lacked control for potential confounding by pre-employment risk factors for depression. This study used a register-based design to examine the risk of hospital-treated depressive disorder in relation to occupational levels of emotional demands at work, furthermore addressing the role of risk factors for depression before workforce entry. METHODS We analyzed data from two Danish register-based cohorts - Job Exposure Matrix Analyses of Psychosocial Factors and Healthy Ageing in Denmark (JEMPAD, N= 1 665 798) (17) and Danish Work Life Course Cohort (DaWCo, N=939 411), which link assessments of emotional demands by job exposure matrices to records of hospital-treated depressive disorder among employees aged 15-59 years at baseline (average follow up: 9.7 years in JEMPAD, 7.3 years in DaWCo). Potential confounders comprised sociodemographics, job control, work-related violence and physical demands at work. In DaWCo, we followed individuals from their entry into the workforce, and also included data on risk factors for depression before workforce entry (eg, parental income, education, and psychiatric diagnoses). RESULTS Employees in occupations with high emotional demands had an increased risk of hospital-treated depressive disorder with confounder-adjusted hazard ratios of 1.32 [95% confidence interval (CI) 1.24‒1.41] and 1.19 (95% CI 1.09‒1.30) in JEMPAD and DaWCO, respectively. This association remained after controlling for risk factors before workforce entry. CONCLUSIONS This study suggests that employees in occupations with high emotional demands are at increased risk of hospital-treated depressive disorder. This increased risk was neither attributable to reporting bias nor explained by the included risk factors for depression recorded before workforce entry.
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Affiliation(s)
- Ida Eh Madsen
- National Research Centre for the Working Environment, Lerso Parkalle 105, DK- 2100 Copenhagen, Denmark.
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22
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Holst C, Tolstrup JS, Becker U. Risk of somatic disease and mortality in individuals of parents with alcohol use disorder: a register-based cohort study. Addiction 2022; 117:905-912. [PMID: 34697856 DOI: 10.1111/add.15722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022]
Abstract
AIMS To estimate the risks of 12 types of somatic disease-alcohol-related, blood, cancer, circulatory, digestive, endocrine and metabolic, genitourinary, infectious, musculoskeletal, nervous, respiratory and skin-in individuals with parental alcohol use disorder (AUD) versus a reference population, and to estimate the risks of all-cause mortality and of death from an alcohol-related cause. DESIGN Matched cohort study followed-up through nation-wide health registries. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). SETTING Denmark. PARTICIPANTS A total of 14 008 individuals born 1962-2003 of parents with AUD and 139 087 reference offspring randomly selected from the Danish Civil Registration System were followed from their 15th birthday and onward during 1970-2018. Follow-up time ranged between 2 423 955 and 3 208 366 person-years for somatic diseases and was 3 214 411 person-years for all-cause and alcohol-related mortality. MEASUREMENTS Information on somatic disease was obtained from the Danish National Patient Registry. Causes of death were obtained from the Danish Cause of Death Registry. FINDINGS Individuals of parents with AUD had a higher risk of alcohol-related diseases (HR = 2.70, 95% CI = 2.24-3.24) compared with the reference individuals. Higher HRs among individuals with parental AUD compared with reference individuals were also observed in all other somatic diseases except for cancer. All-cause mortality (HR = 1.80, 95% CI = 1.63-2.00) and alcohol-related mortality (HR = 3.28, 95% CI = 2.11-5.08) were higher among individuals of parents with AUD compared with the reference individuals. No significant differences were found in relation to the gender of either parents or offspring. CONCLUSIONS In Denmark, parental alcohol use disorder appears to predict alcohol-related and non-alcohol-related somatic morbidity and mortality in offspring.
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Affiliation(s)
- Charlotte Holst
- 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
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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23
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Spanggaard M, Bøgelund M, Dirksen C, Jørgensen NB, Madsbad S, Panton UH, Pedersen MH, Reitzel SB, Johansen P. The substantial costs to society associated with obesity - a Danish register-based study based on 2002-2018 data. Expert Rev Pharmacoecon Outcomes Res 2022; 22:823-833. [PMID: 35297718 DOI: 10.1080/14737167.2022.2053676] [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: 11/04/2022]
Abstract
INTRODUCTION The Danish national health registers were used to investigate the economic burden of obesity, associated costs of comorbidities and a breakdown into direct and indirect costs. METHODS The study population comprised all Danish adult citizens registered with a hospital diagnosis of obesity in the Danish National Patient Register between 2002 and 2018. Cases were matched with five controls via the Danish Civil Registration System. We estimated the difference in total healthcare costs and indirect costs between cases and controls and the difference in healthcare resource utilization. In a sub-analysis, we estimated total healthcare costs for persons who had been registered with one or more of 11 predefined comorbidities. RESULTS People with obesity experienced a statistically significant twofold increase in average direct healthcare costs per year (EUR 5,934), compared with controls (EUR 2,788) and had statistically significantly higher indirect costs compared to controls. Total healthcare costs for people with obesity and one or more of the 11 comorbidities were 91.7%-342.8% higher than total healthcare costs of the population with obesity but none of the 11 comorbidities. CONCLUSION Obesity was associated with an increase in both direct and indirect costs. The presence of comorbidities was associated with additional healthcare costs. KEY POINTS Obesity is associated with an increase in direct and indirect costs in Denmark.Comorbidities are associated with additional healthcare costs.
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Affiliation(s)
| | | | - Carsten Dirksen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Steen Madsbad
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | - Ulrik Haagen Panton
- Novo Nordisk North West Europe Pharmaceuticals A/S, Crowne Plaza Copenhagen Towers, Copenhagen, Denmark
| | | | | | - Pierre Johansen
- Novo Nordisk North West Europe Pharmaceuticals A/S, Crowne Plaza Copenhagen Towers, Copenhagen, Denmark
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24
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Latvala A, Kuja-Halkola R, D'Onofrio BM, Jayaram-Lindström N, Larsson H, Lichtenstein P. Association of parental substance misuse with offspring substance misuse and criminality: a genetically informed register-based study. Psychol Med 2022; 52:496-505. [PMID: 32597745 DOI: 10.1017/s0033291720002135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Genetically informed studies have provided mixed findings as to what extent parental substance misuse is associated with offspring substance misuse and antisocial behavior due to shared environmental and genetic factors. METHODS We linked data from nationwide registries for a cohort of 2 476 198 offspring born in Sweden 1958-1995 and their parents. Substance misuse was defined as International Classification of Diseases diagnoses of alcohol/drug use disorders or alcohol/drug-related criminal convictions. Quantitative genetic offspring-of-siblings analyses in offspring of monozygotic and dizygotic twin, full-sibling, and half-sibling parents were conducted. RESULTS Both maternal and paternal substance misuse were robustly associated with offspring substance misuse [maternal adjusted hazard ratio (aHR) = 1.83 (95% confidence interval (CI) 1.80-1.87); paternal aHR = 1.96 (1.94-1.98)] and criminal convictions [maternal aHR = 1.56 (1.54-1.58); paternal aHR = 1.66 (1.64-1.67)]. Additive genetic effects explained 42% (95% CI 25-56%) and 46% (36-55%) of the variance in maternal and paternal substance misuse, respectively, and between 36 and 44% of the variance in substance misuse and criminality in offspring. The associations between parental substance misuse and offspring outcomes were mostly due to additive genetic effects, which explained 54-85% of the parent-offspring covariance. However, both nuclear and extended family environmental factors also contributed to the associations, especially with offspring substance misuse. CONCLUSIONS Our findings from a large offspring-of-siblings study indicate that shared genetic influences mostly explain the associations between parental substance misuse and both offspring substance misuse and criminality, but we also found evidence for the contribution of environmental factors shared by members of nuclear and extended families.
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Affiliation(s)
- Antti Latvala
- Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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25
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Kiadaliri A, Englund M. Osteoarthritis and risk of hospitalization for ambulatory care-sensitive conditions: a general population-based cohort study. Rheumatology (Oxford) 2021; 60:4340-4347. [PMID: 33590848 PMCID: PMC8410004 DOI: 10.1093/rheumatology/keab161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/10/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine the association between OA and risk of hospitalization for ambulatory care-sensitive conditions (HACSCs). METHODS We included all individuals aged 40-85 years who resided in Skåne, Sweden on 31 December 2005 with at least one healthcare consultation during 1998-2005 (n = 515 256). We identified those with a main diagnosis of OA between 1 January 1998 and 31 December 2016. People were followed from 1 January 2006 until an HACSC, death, relocation outside Skåne, or 31 December 2016 (whichever occurred first). OA status was treated as a time-varying covariate (those diagnosed before 1 January 2006 considered as exposed for whole study period). We assessed relative [hazard ratios (HRs) using Cox proportional hazard model] and absolute (hazard difference using additive hazard model) effects of OA on HACSCs adjusted for potential confounders. RESULTS Crude incidence rates of HACSCs were 239 (95% CI: 235, 242) and 151 (150, 152) per 10 000 person-years among OA and non-OA persons, respectively. The OA persons had an increased risk of HACSCs [HR (95% CI) 1.11 (1.09, 1.13)] and its subcategories of medical conditions except chronic obstructive pulmonary disease [HR (95% CI) 0.86 (0.81, 0.90)]. There were 20 (95% CI: 16, 24) more HACSCs per 10 000 person-years in OA compared with non-OA persons. While HRs for knee and hip OA were generally comparable, only knee OA was associated with increased risk of hospitalization for diabetes. CONCLUSION OA is associated with an increased risk of HACSCs, highlighting the urgent need to improve outpatient care for OA patients.
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Affiliation(s)
- Ali Kiadaliri
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopaedics.,Centre for Economic Demography, Lund University, Lund, Sweden
| | - Martin Englund
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopaedics
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Vaajanen A, Purola P, Ojamo M, Gissler M, Uusitalo H. Changes in incidence and severity of visual impairment due to glaucoma during 40 years - a register-based study in Finland. Acta Ophthalmol 2021; 100:534-540. [PMID: 34595821 DOI: 10.1111/aos.15030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/05/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To report the incidence and severity of reported visual impairment (VI) due to glaucoma and the changes in them during the past 40 years in Finland. METHODS A register-based study, in which the data were collected from the Finnish Register of Visual Impairment between 1980 and 2019. These data included 5819 visually impaired glaucoma patients, of which 61% were female. Visual impairment (VI) was classified according to the Finnish national definitions. The number of treated glaucoma patients in Finland was calculated using glaucoma medication reimbursement data available between 1986 and 2019 from the Social Insurance Institution of Finland registers. RESULTS The incidence of reported VI due to glaucoma per 100 000 persons had increased from 2.3 in the 1980s to 3.4 in the 2010s. During the same time period, the incidence of reported VI per 10 000 treated glaucoma patients had decreased from 32 in the 1980s to 21 in the 2010s. Primary open-angle glaucoma (45%) was the main subtype for reported VI due to glaucoma. During the 40 years, the proportion of mild VI and the age at the onset of reported VI had increased. CONCLUSION The incidence of reported VI due to glaucoma has increased during the 40 years, but the risk of treated glaucoma patients becoming visually impaired has decreased. Visual impairment (VI) also occurs at an older age. This is likely due to the earlier diagnoses and improved therapy. To prevent the unfavourable development of VI due to glaucoma among the ageing population in the future, all attempts need to be made to improve glaucoma care.
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Affiliation(s)
- Anu Vaajanen
- Department of Ophthalmology University of Helsinki and Helsinki University Hospital Helsinki Finland
- SILK Department of Ophthalmology Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Petri Purola
- SILK Department of Ophthalmology Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Finnish Register of Visual Impairment Finnish Federation of the Visually Impaired Helsinki Finland
| | - Matti Ojamo
- Finnish Register of Visual Impairment Finnish Federation of the Visually Impaired Helsinki Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare Information Services Department Helsinki Finland
- Academic Primary Health Care Centre Stockholm Sweden
- Department of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden
| | - Hannu Uusitalo
- SILK Department of Ophthalmology Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Finnish Register of Visual Impairment Finnish Federation of the Visually Impaired Helsinki Finland
- Tays Eye Centre Tampere University Hospital Tampere Finland
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27
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Kläppe U, Longinetti E, Larsson H, Ingre C, Fang F. Mortality among family members of patients with amyotrophic lateral sclerosis - a Swedish register-based study. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:226-235. [PMID: 34296642 DOI: 10.1080/21678421.2021.1953075] [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: 10/20/2022]
Abstract
Objective: To test two hypotheses: (1) partners of ALS patients have higher mortality due to outcomes related to psychological distress, and (2) parents and siblings of ALS patients have higher mortality due to diseases that co-occur with ALS.Methods: We performed a nationwide, register-based cohort study in Sweden. We included ALS-free partners, biological parents and full siblings (N = 11,704) of ALS patients, as well as ALS-free partners, biological parents and full siblings (N = 14,460,150) of ALS-free individuals, and followed them during 1961-2013. Hazard ratios (HRs) and 95% confidence intervals (CIs) of overall and cause-specific mortality were derived from Cox regression.Results: Partners of ALS patients, compared to partners of ALS-free individuals, displayed higher mortality due to external causes (HR 2.14; 95% CI 1.35-3.41), including suicide (HR 2.44; 95% CI 1.09-5.44) and accidents (HR 2.09; 95% CI 1.12-3.90), after diagnosis of the ALS patients. Parents of ALS patients had a slightly higher overall mortality (HR 1.03; 95% CI 1.00-1.07), compared with parents of ALS-free individuals. This was driven by mortality due to dementias and cardiovascular, respiratory, and skin diseases. Parents of ALS patients had, however, lower mortality than parents of ALS-free individuals due to neoplasms. Siblings of ALS patients had higher mortality due to dementias, and digestive and skin diseases.Conclusions: Increased mortality due to suicide and accidents among partners of ALS patients is likely attributable to severe psychological distress following the ALS diagnosis. Increased mortality due to dementias among parents and full siblings of ALS patients suggests shared mechanisms between neurodegenerative diseases.
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Affiliation(s)
- Ulf Kläppe
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Elisa Longinetti
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Orebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, and
| | - Caroline Ingre
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Rossi HR, Uimari O, Arffman R, Vaaramo E, Kujanpää L, Ala-Mursula L, Piltonen TT. The association of endometriosis with work ability and work life participation in late forties and lifelong disability retirement up till age 52: A Northern Finland Birth Cohort 1966 study. Acta Obstet Gynecol Scand 2021; 100:1822-1829. [PMID: 34235718 DOI: 10.1111/aogs.14210] [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: 02/22/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Endometriosis may cause a deterioration of daily functioning due to related symptoms such as pain, fatigue and psychological distress. Accordingly, endometriosis may jeopardize work ability, as suggested in mainly survey-based case-control studies, including clinically established cases at fertile age. This is the first general population-level study to evaluate how endometriosis is associated with (1) self-rated work ability and sick leave dates at age 46 years, (2) registered disability and unemployment days between age 46 and 48 and (3) lifelong emergence of registered disability retirement up to age 52. MATERIAL AND METHODS Endometriosis case identification was based on the Care Register for Health Care and self-reported diagnosis from a population-based birth cohort, which covers 96% of children born in Northern Finland in 1966. A total of 348 women with endometriosis and 3487 women without endometriosis were identified. Questionnaire data on Work Ability Index Score was collected at age 46. Unemployment and disability days were determined from the Social Insurance Institution of Finland and the Finnish Center for Pensions registers. Finally, each individual's first-ever granted pension decision and diagnoses were collected until age 52 years. The associations between endometriosis and work ability were assessed using logistic regression models. RESULTS Endometriosis was associated with poor work ability at age 46 (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.06-2.47). Furthermore, the association between endometriosis and over 10 days of absenteeism was increased (OR 1.53; 95% CI 1.05-2.23). Between ages 46 and 48, women with endometriosis had 10 days more disability days (55.5 vs 45.5, p = 0.030) in comparison to women without endometriosis, but 20 days less unemployment days (40.6 vs 59.2 days, p = 0.013). There were no differences in early retirement between the study groups until age 52. CONCLUSIONS Our study showed that endometriosis associates with poor work ability at age 46. Women with endometriosis have more disability days. However, their employment rate and risk of early retirement are comparable to those of women without endometriosis at late fertile age.
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Affiliation(s)
- Henna-Riikka Rossi
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Outi Uimari
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Riikka Arffman
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
| | - Eeva Vaaramo
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Linda Kujanpää
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
| | - Leena Ala-Mursula
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
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de Wind A, Tamminga SJ, Bony CAG, Diether M, Ludwig M, Velthuis MJ, Duijts SFA, de Boer AGEM. Loss of Paid Employment up to 4 Years after Colorectal Cancer Diagnosis-A Nationwide Register-Based Study with a Population-Based Reference Group. Cancers (Basel) 2021; 13:cancers13122868. [PMID: 34201371 PMCID: PMC8229293 DOI: 10.3390/cancers13122868] [Citation(s) in RCA: 9] [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: 05/20/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Previous research indicated that cancer survivors have a higher risk of loss of paid employment. This is unfortunate as work is important for cancer survivors because it contributes to financial independency and quality of life. Not much work has been done on patients diagnosed with colorectal cancer while it is one of the most common cancers in the working population. We compared a group of 12,007 colorectal cancer survivors up to four years after diagnosis with the general population. We found that colorectal cancer survivors had a 56% higher risk of loss of paid employment, mainly due to work disability. Within the group of colorectal cancer survivors, those being younger, having a higher cancer stage and receiving radiotherapy, had a higher risk of loss of paid employment. Colorectal cancer survivors at high risk of loss of paid employment may benefit from work support interventions as part of cancer survivorship care. Abstract Cancer survivors consider work as a key aspect of cancer survivorship while previous research indicated that cancer survivors have a higher risk of unemployment. The objectives were to assess: (1) whether colorectal cancer survivors less often have paid employment at diagnosis compared to a population-based reference group, (2) whether colorectal cancer survivors with paid work have a higher risk of loss of employment up to 4 years after diagnosis compared to a population-based reference group and (3) which colorectal cancer survivors are at highest risk of loss of paid employment. In a nationwide register-based study, persons diagnosed with colorectal cancer (N = 12,007) as registered in the Netherlands Cancer Registry, were compared on loss of paid employment with a sex and age-matched population-based reference group (N = 48,028) from Statistics Netherlands. Cox regression analyses were conducted. Colorectal cancer survivors had a higher risk of loss of paid employment (HR 1.56 [1.42, 1.71]). Within the group of colorectal cancer survivors, risk of loss of paid employment was lower for older survivors (>60 vs. 45–55) (HR 0.64 [0.51, 0.81]) and higher for those with a more advanced cancer stage (IV vs. I) (HR 1.89 [1.33, 2.70]) and those receiving radiotherapy (HR 1.37 [1.15, 1.63]). Colorectal cancer survivors at high risk of loss of paid employment may benefit from work support interventions as part of cancer survivorship.
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Affiliation(s)
- Astrid de Wind
- Amsterdam UMC, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.J.T.); (C.A.G.B.); (M.D.); (A.G.E.M.d.B.)
- Correspondence: ; Tel.: +31-020-5663279
| | - Sietske J. Tamminga
- Amsterdam UMC, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.J.T.); (C.A.G.B.); (M.D.); (A.G.E.M.d.B.)
| | - Claudia A. G. Bony
- Amsterdam UMC, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.J.T.); (C.A.G.B.); (M.D.); (A.G.E.M.d.B.)
- Deloitte Consulting Netherlands, Analytics & Cognitive, 1081 LA Amsterdam, The Netherlands;
| | - Maren Diether
- Amsterdam UMC, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.J.T.); (C.A.G.B.); (M.D.); (A.G.E.M.d.B.)
- Deloitte Consulting Netherlands, Analytics & Cognitive, 1081 LA Amsterdam, The Netherlands;
| | - Martijn Ludwig
- Deloitte Consulting Netherlands, Analytics & Cognitive, 1081 LA Amsterdam, The Netherlands;
| | - Miranda J. Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands;
| | - Saskia F. A. Duijts
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - Angela G. E. M. de Boer
- Amsterdam UMC, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.J.T.); (C.A.G.B.); (M.D.); (A.G.E.M.d.B.)
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Hakala A, Tolppanen AM, Koponen M, Taipale H, Tanskanen A, Hartikainen S, Tiihonen M. Does Recent Hospitalization Increase Antipsychotic Initiation Among Community Dwellers With Alzheimer's Disease? J Am Med Dir Assoc 2021; 22:1543-1547.e3. [PMID: 33460619 DOI: 10.1016/j.jamda.2020.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Antipsychotics are often prescribed to persons with cognitive impairment in the hospital, but it is not known whether recent hospital care increases the risk of antipsychotic initiation in community dwellers with Alzheimer's disease (AD). We studied whether hospital care during the previous 2 weeks is associated with antipsychotic initiation in persons with AD. DESIGN Register-based study. PARTICIPANTS AND SETTING The nationwide Medication use and Alzheimer's disease (MEDALZ) cohort containing Finnish community dwellers with AD between 2005 and 2011 (N = 70,718) was used. METHODS Incident antipsychotic use was identified with a 1-year washout period. Each new initiator was matched with noninitiator according to age, sex, and time since AD diagnosis (n = 22,281 matched pairs). The use of antipsychotics was identified from the Prescription Register. Information on hospital discharge within the past 2 weeks of antipsychotic initiation was extracted from the Hospital Discharge Register. RESULTS Antipsychotic initiators were 5 times more likely to have recently been discharged from the hospital compared with the matched noninitiators (29.8% and 5.3%, respectively). In adjusted regression analyses, a hospital stay longer than a week and especially more than 2 months [odds ratio (OR) 4.40, 95% confidence interval (CI) 3.51-5.53], use of benzodiazepines and related drugs (OR 1.66, 95% CI 1.44-1.92), and memantine (OR 1.30, 95% CI 1.12-1.52) were associated with antipsychotic initiation. Older age (OR 0.77, 95% CI 0.62-0.95), asthma or chronic obstructive pulmonary disease (OR 0.73, 95% CI 0.60-0.89), diabetes (OR 0.82, 95% CI 0.69-0.97), and cardiovascular disease (OR 0.82, 95% CI 0.72-0.94) were associated with a lower risk of initiation. CONCLUSIONS AND IMPLICATIONS Recent hospital care seems to be a risk factor for antipsychotic initiation in community-dwelling persons with AD. The need of antipsychotic treatment must be carefully assessed at the time of discharge. Well planned hospital discharge and home care might reduce antipsychotic initiation.
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Norup A, Kruse M, Soendergaard PL, Rasmussen KW, Biering-Sørensen F. Socioeconomic Consequences of Traumatic Brain Injury: A Danish Nationwide Register-Based Study. J Neurotrauma 2020; 37:2694-2702. [PMID: 32808586 DOI: 10.1089/neu.2020.7064] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 11/13/2022] Open
Abstract
This study examined if acquiring a traumatic brain injury (TBI) increases utilization of health care costs, increases risk of job loss for the patient and the closest relatives, and increases the risk of divorce 1 to 5 years following the injury. The study was conducted as a Danish national population-based register study with follow-up. Participants included a cohort of patients with TBI (n = 18,328) admitted to a hospital or treated in an emergency room (ER) and a matching control group (n = 89,155). For both the TBI group and the matching controls, relatives were identified, using national registers (TBI relatives: n = 25,708 and control relatives: n = 135,325). The outcome measures were utilization of health care costs (including hospital services, use of general practitioner and practicing specialists, and prescribed medication), risk of job loss, and risk of divorce among the TBI group and the control group and their relatives. Patients with TBI had significantly increased health care costs at baseline (i.e., the year before the injury) and during the following 4 years. Further, TBI relatives had a significantly higher utilization of health care costs the first and the third year after injury. The TBI group had a significant increased risk of job loss (odds ratio [OR] = 2.88; confidence interval [CI]: 2.70-3.07) and divorce (OR = 1.44; CI: 1.27-1.64) during the first 3 years following injury. In conclusion, the TBI group had significantly higher utilization of health care costs, both pre-morbidly and post-injury. Further, increased risk of job loss and divorce were found, emphasizing that the socioeconomic consequences of TBI last for years post-injury.
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Affiliation(s)
- Anne Norup
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Marie Kruse
- DaCHE - Danish Center for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Pernille Langer Soendergaard
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Katrine Winther Rasmussen
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Erdmann F, Hvidtfeldt UA, Feychting M, Sørensen M, Raaschou-Nielsen O. Is the risk of childhood leukaemia associated with socioeconomic measures in Denmark? A nationwide register-based case-control study. Int J Cancer 2020; 148:2227-2240. [PMID: 33210292 DOI: 10.1002/ijc.33402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 01/11/2023]
Abstract
The aetiology of childhood leukaemia is poorly understood. Knowledge about differences in risk by socioeconomic status (SES) may enhance etiologic insights. We conducted a nationwide register-based case-control study to evaluate socioeconomic differences in the risk of childhood leukaemia in Denmark and to access whether associations varied by different measures of SES, time point of assessment, leukaemia type and age at diagnosis. We identified all cases of leukaemia in children aged 0 to 19 years, born and diagnosed between 1980 and 2013 from the Danish Cancer Registry (N = 1336) and sampled four individually matched controls per case (N = 5330). We used conditional logistic regression models for analysis. Medium and high level of parental education was associated with a higher risk of acute myeloid leukaemia (AML) in the offspring, mainly driven by children diagnosed at ages 0 to 4 years [odds ratio (OR) for high maternal education = 3.07; 95% confidence interval (CI): 1.44-6.55]. We also observed a modestly increased risk for lymphoid leukaemia (LL) in association with higher level of parental education, but only in children diagnosed at ages 5 to 19 years. Higher parental income was associated with an increased risk of LL but not AML among children aged 5 to 19 years at diagnosis (OR for high maternal income = 2.78; 95% CI: 1.32-5.89). Results for neighbourhood SES measures indicated null associations. Bias or under-ascertainment of cases among families with low income or basic education are unlikely to explain the observed socioeconomic differences. Future research addressing explicitly the underlying mechanisms of our results may help to enhance etiologic insights of the disease.
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Affiliation(s)
- Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mette Sørensen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Roskilde, Denmark
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Hvidtfeldt UA, Erdmann F, Urhoj SK, Brandt J, Geels C, Ketzel M, Frohn LM, Christensen JH, Sørensen M, Raaschou-Nielsen O. Residential Exposure to PM 2.5 Components and Risk of Childhood Non-Hodgkin Lymphoma in Denmark: A Nationwide Register-Based Case-Control Study. Int J Environ Res Public Health 2020; 17:E8949. [PMID: 33271946 DOI: 10.3390/ijerph17238949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/13/2022]
Abstract
In a recent study, we observed an increased risk of childhood non-Hodgkin lymphoma (NHL) associated with exposure to fine atmospheric particulate matter (PM2.5) and black carbon (BC). In this nationwide register-based case-control study, we focus on specific components of PM2.5 in relation to childhood NHL in Denmark (1981–2013) by identifying all incidents of childhood NHL cases in the Danish Cancer Registry (n = 170) and four (cancer-free) randomly selected controls matched by date of birth and sex. We applied PM2.5 concentrations and the following sub-components: secondary organic aerosols (SOA), secondary inorganic aerosols (SIA; i.e., NO3−, NH4+ and SO42−), BC, organic carbon (OC) and sea salt. We calculated a time-weighted exposure average from birth to index-date at all addresses. Odds ratios (ORs) were adjusted for register-based socio-demographic variables. We observed adjusted ORs and 95% confidence intervals (95% CI) of 2.05 (1.10, 3.83) per interquartile range (IQR, 4.83 µg/m3) PM2.5 and 1.73 (0.68, 4.41) per IQR (3.71 µg/m3) SIA, 0.95 (0.71, 1.29) per IQR (0.05 µg/m3) SOA, 1.22 (1.02, 1.46) per IQR (0.39 µg/m3) BC, 1.02 (0.83, 1.26) per IQR (0.56 µg/m3) OC and 1.01 (0.79, 1.30) per IQR (0.87 µg/m3) sea salt, respectively. The estimates were attenuated after adjustment for PM2.5, whereas the OR for PM2.5 remained increased regardless of adjustment for specific components. The findings indicate that the previously observed relation between PM2.5 and childhood NHL may be related to BC (as reported in our previous study) but also partly to SIA, but the role of specific chemical components of PM2.5 remains ambiguous.
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Aanesen A, Katzmarzyk PT, Ernstsen L. Breakfast skipping and overweight/obesity in first grade primary school children: A nationwide register-based study in Iceland. Clin Obes 2020; 10:e12384. [PMID: 32613747 DOI: 10.1111/cob.12384] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022]
Abstract
Although several studies have revealed an association between skipping breakfast and overweight (OW) or obesity (OB) in older children and adolescents, less is known about that association in younger children. The purpose of our study was to assess the association between skipping breakfast and OW/OB in children in the first grade. The sample included 4360 children (51.5% boys) aged 5.6 to 7.4 years who participated in the annual health examination in Iceland during 2016 and 2017, completed by 91% of all first graders in Iceland. Binary logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs) was used to assess the association between skipping breakfast and OW/OB. Skipping breakfast was assessed as not eating breakfast on the day of the assessment, whereas OW or OB was based on measured height and weight relative to the International Obesity Task Force reference. The final analyses were adjusted for bedtime, well-being in school, commuting to school and physical activity. 7.2% of the boys (n = 162) and 7.5% of the girls (n = 158) had not eaten breakfast. After multivariable adjustment, a statistically significant association emerged between skipping breakfast and OW/OB in girls (OR 1.66, 95% CI 1.17-2.36) but not in boys (OR 1.02, 95% CI 0.63-1.63). Because the study's results suggest an association between skipping breakfast and OW/OB only in first-grade girls in Iceland, sex-based differences should be further investigated to inform future strategies for preventing OW and OB in young children.
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Affiliation(s)
- Anita Aanesen
- Health Care Institution of North Iceland, Iceland
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Linda Ernstsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Beau AB, Napolitano GM, Ewertz M, Vejborg I, Schwartz W, Andersen PK, Lynge E. Impact of chronic diseases on effect of breast cancer screening. Cancer Med 2020; 9:3995-4003. [PMID: 32253821 PMCID: PMC7286470 DOI: 10.1002/cam4.3036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/12/2020] [Accepted: 03/12/2020] [Indexed: 12/27/2022] Open
Abstract
Background Although breast cancer screening reduces breast cancer mortality at the population level, subgroups of women may benefit differently. We investigated the impact of health status on the effect of breast cancer screening. Methods The study included 181 299 women invited in two population‐based screening programs in Denmark and 1 526 446 control subjects, followed from April 1981 to December 2014. Poisson regressions were used to compare the observed breast cancer mortality rate in women invited to screening with the expected rate in the absence of screening among women with and without chronic diseases. Chronic diseases were defined as any diagnosis in the Charlson Comorbidity Index during 4 years before the first invitation to screening. Results Almost 10% of women had chronic diseases before first invitation to screening. Whereas we observed a reduction in breast cancer mortality following invitation to screening of 28% (95% CI, 20% to 35%) among women without chronic diseases, only a 7% (95% CI, −39% to 37%) reduction was seen for women with chronic diseases (P‐value for interaction = .22). For participants, the reduction, corrected for selection bias, was 35% (95% CI 16% to 49%) for women without, and 4% (95% CI −146% to 62%) for women with chronic diseases (P‐value for interaction = .43). Conclusion Our data indicate a marginal effect of mammography screening on breast cancer mortality in women with chronic diseases. If our results are confirmed in other populations, the presence of chronic diseases will be an important factor to take into consideration in personalized screening.
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Affiliation(s)
- Anna-Belle Beau
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - George M Napolitano
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Ewertz
- Department of Oncology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ilse Vejborg
- Department of Radiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Walter Schwartz
- Mammography Centre, Odense University Hospital, Odense, Denmark
| | - Per K Andersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elsebeth Lynge
- Centre for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
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Volk J, Heck JE, Schmiegelow K, Hansen J. Parental occupational exposure to diesel engine exhaust in relation to childhood leukaemia and central nervous system cancers: a register-based nested case-control study in Denmark 1968-2016. Occup Environ Med 2020; 76:809-817. [PMID: 31611302 DOI: 10.1136/oemed-2019-105847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/28/2019] [Revised: 07/31/2019] [Accepted: 08/25/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Using nationwide register data, we investigated the association between maternal and paternal perinatal employment in industries with exposure to diesel engine exhaust and risk of leukaemia and central nervous system (CNS) cancers, including certain subtypes. METHODS Children aged≤19 years and diagnosed with childhood cancer from 1968 to 2016 were identified in the Danish Cancer Registry and 25 randomly selected cancer-free controls per case were matched by age and sex. Parents were identified in the Danish Civil Registration System and employment histories were retrieved from a nationwide mandatory pension fund. The probability of exposure to diesel engine exhaust was assessed using a validated job exposure matrix. Conditional logistic regression was used for estimation of ORs, including their 95% CIs. RESULTS Maternal employment in industries with diesel engine exhaust exposure was associated with an increased risk of CNS cancers (OR 1.31, 95% CI 0.99 to 1.74) and of astrocytoma (OR 1.49, 95% CI 1.04 to 2.14) in offspring. The highest OR for these cancers were seen for mothers with highest probability of exposure to diesel engine exhaust. For fathers, ORs for cancers under study were close to one. No increased risks of leukaemias were found for either mothers or fathers employed in diesel industries. CONCLUSIONS Risks were increased for CNS and astrocytoma for maternal employment in industries with diesel engine exhaust.
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Affiliation(s)
- Julie Volk
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Julia E Heck
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Johnni Hansen
- Institute of Cancer Epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
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Kc S, Gissler M, Klemetti R. The duration of gestation at previous induced abortion and its impacts on subsequent births: A nationwide registry-based study. Acta Obstet Gynecol Scand 2020; 99:651-659. [PMID: 32128786 DOI: 10.1111/aogs.13788] [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] [Received: 02/08/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous induced abortions have been associated with adverse birth outcomes. However, only a few studies have considered the possible influence of gestational age at induced abortion. Therefore, this study aimed to identify the impacts of gestational age during prior induced abortion(s) on subsequent births among first-time mothers in Finland. MATERIAL AND METHODS First-time mothers (n = 418 690) with singleton births between 1996 and 2013 were identified from the Finnish Medical Birth Register and linked to the Abortion Register. Logistic regression analysis was used to estimate the risk (odds ratio [OR] and 95% confidence interval [CI]) of birth outcomes such as prematurity, low birthweight, perinatal death and small for gestational age (SGA). RESULTS Higher risk was determined for extremely preterm birth (OR 2.28; 95% CI 1.53-3.39) and very low birthweight (OR 1.62; 95% CI 1.22-2.16) in women having had late-induced abortion(s) (≥12 gestational weeks) compared with women having had early-induced abortion(s) (<12 gestational weeks); after adjusting for women's background characteristics, abortion method and interval between the pregnancies. When the analysis was limited to a single abortion, an increased risk was found for extremely preterm birth (OR 1.71; 95% CI 1.02-2.81). Higher risks were found for extremely preterm (OR 4.09; 95% CI 2.05-8.18) and very low birthweight (OR 2.65; 95% CI 1.61-4.35) among women with two or more late-induced abortions compared with those with two or more early-induced abortions. Worse outcomes were seen after a late-induced abortion compared to an early-induced abortion for both medically and surgically induced abortion. CONCLUSIONS The risk of subsequent adverse birth outcomes is very small if any, but the risk is higher with increasing gestational age at the time of induced abortion. Our study supports reduction of unintended pregnancy and offering abortion services without delay and as early in gestation as possible.
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Affiliation(s)
- Situ Kc
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mika Gissler
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Reija Klemetti
- Department of Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Karjalainen K, Haukka J, Kuussaari K, Hautala S, Hakkarainen P. Mortality and causes of death among people suspected of driving under the influence and testing positive for multiple substances. Scand J Public Health 2019; 48:809-816. [PMID: 31856686 DOI: 10.1177/1403494819894166] [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: 11/16/2022]
Abstract
Aims: Understanding the mortality of drug users using multiple substances is helpful in preventing the harmful effects of polydrug use. We examined overall and cause-specific mortality and differences in mortality based on social background among people suspected of driving under the influence and testing positive for multiple substances (DUIMS) compared with the general Finnish population. Methods: Register data from 785 DUIMS during 2003-2006 were studied, with a reference population (n = 25,381) drawn from the general Finnish population. The effect of DUIMS on all-cause and cause-specific mortality was estimated using a Poisson regression model. Results: DUIMS had an increased risk of death compared with the general population (MRR 5.3, 95% CI 4.2-6.6). The most common causes of death in DUIMS were poisonings (37.9%) and suicides (13.6%), whereas in the reference population these were cardiovascular diseases (30.8%) and cancer (26.6%). The cause-specific risk of death among DUIMS was higher in all observed causes of death, except for cancer. The effect of DUIMS on mortality was modified by age, employment status and marital status; DUIMS was associated with an elevated risk of death especially in younger age groups and in singles. Conclusions: DUIMS indicates higher mortality, and DUIMS' profiles in causes of death differ from the general population. Elevated risk for, for instance, suicidal, accidental and violent death among those using multiple substances highlights the need to also pay attention to causes of death other than poisoning/overdose.
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Affiliation(s)
- Karoliina Karjalainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Finland
| | - Jari Haukka
- Department of Public Health, Clinicum, University of Helsinki, Finland
| | - Kristiina Kuussaari
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Finland
| | - Sanna Hautala
- Faculty of Social Sciences, University of Lapland, Finland
| | - Pekka Hakkarainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Finland
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Filatova S, Upadhyaya S, Kronström K, Suominen A, Chudal R, Luntamo T, Sourander A, Gyllenberg D. Time trends in the incidence of diagnosed depression among people aged 5-25 years living in Finland 1995-2012. Nord J Psychiatry 2019; 73:475-481. [PMID: 31443615 DOI: 10.1080/08039488.2019.1652342] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Knowledge of time trends for depression is important for disease prevention and healthcare planning. Only a few studies have addressed these questions regarding the incidence and cumulative incidence of diagnosed depression from childhood to early adulthood and findings have been inconclusive. Aim: The aim of this national register-based Finnish study was to report the time trends of the age-specific and gender-specific incidence and cumulative incidence of diagnosed depression. Methods: The study sample included all 1,245,502 singletons born in Finland between 1 January 1987 and 31 December 2007 and still living in Finland at the end of 2012. The participants were divided into three cohorts by birth year: 1987-1993, 1994-2000 and 2001-2007. Depression diagnoses (ICD-9: 2961; ICD-10: F32, F33) given in 1995-2012 were available and identified from the Care Register for Health Care. Results: Ten percent of the females and five percent of the males were diagnosed with depression in specialized services by age 25 years. The cumulative incidence of depression by age 15 years rose from 1.8% (95% CI 1.8-1.9) to 2.9% (95% CI 2.8-3.0) in females and from 1.0% (95% CI 1.1-1.2) to 1.6% (95% CI 1.6-1.7) in males when the cohorts born 1987-1993 and 1994-2000 were compared. Conclusions: A larger proportion of young people in Finland are diagnosed with depression in specialized services than before. This can be due to better identification, more positive attitudes to mental health problems and increased availability of the services.
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Affiliation(s)
- Svetlana Filatova
- Research Centre for Child Psychiatry, University of Turku , Turku , Finland
| | - Subina Upadhyaya
- Research Centre for Child Psychiatry, University of Turku , Turku , Finland
| | - Kim Kronström
- Research Centre for Child Psychiatry, University of Turku , Turku , Finland.,Department of Adolescent Psychiatry, Turku University Hospital , Turku , Finland
| | - Auli Suominen
- Research Centre for Child Psychiatry, University of Turku , Turku , Finland.,Turku University Hospital , Turku , Finland
| | - Roshan Chudal
- Research Centre for Child Psychiatry, University of Turku , Turku , Finland
| | - Terhi Luntamo
- Research Centre for Child Psychiatry, University of Turku , Turku , Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku , Turku , Finland.,Turku University Hospital , Turku , Finland.,INVEST Research Flagship, University of Turku , Turku , Finland
| | - David Gyllenberg
- Research Centre for Child Psychiatry, University of Turku , Turku , Finland.,National Institute of Health and Welfare , Helsinki , Finland.,Department of Adolescent Psychiatry, Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland
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Bak‐Nielsen S, Ramlau‐Hansen CH, Ivarsen A, Plana‐Ripoll O, Hjortdal J. A nationwide population-based study of social demographic factors, associated diseases and mortality of keratoconus patients in Denmark from 1977 to 2015. Acta Ophthalmol 2019; 97:497-504. [PMID: 30426693 DOI: 10.1111/aos.13961] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 07/24/2018] [Accepted: 09/28/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE To study sociodemographic factors, associated diseases and survival of Danish keratoconus patients. METHODS All patients diagnosed with keratoconus 1977-2015 (n = 2679) were matched to 10 persons who had not been diagnosed with keratoconus (n = 26 790). Conditional logistic regression assessed whether sociodemographic factors and specific systemic diseases were associated with the odds of keratoconus. Mortality was assessed with time-to-event analysis. RESULTS After adjustment, non-Europeans had more than threefold higher odds of keratoconus compared to Europeans (OR, 3.34; 96% CI 2.94-3.80). Single persons had 27% higher odds (OR, 1.27; 95% CI 1.13-1.43), and divorced persons had 18% lower odds (OR 0.82; 95% CI 0.68-0.97) of keratoconus compared with persons in a relationship. Persons living in cities with <500 and 500-4999 inhabitants had 40% (OR, 0.60; 95% CI 0.51-0.71) and 30% (OR, 0.70; 95% CI 0.61-0.81) lower odds of keratoconus, respectively, compared with those living in the capital (>1 000 000 inhabitants). Persons receiving government substitution had 68% higher odds of keratoconus (OR, 1.68; 95% CI 1.30-2.17) compared to self-employed. Keratoconus patients had more than twofold higher odds of asthma (OR, 2.21; 95% CI 1.91-2.55), more than threefold higher odds of allergic rhinitis (OR, 3.44; 95% CI 2.75-4.30), more than sevenfold higher odds of atopic dermatitis (OR, 7.97; 95% CI, 6.21-10.21) and 69% higher odds of depression (OR, 1.69; 95% CI 1.18-2.43). Mortality rates were similar among keratoconus patients and controls (HR, 1.02; 95% CI 0.90-1.16). CONCLUSION Danish keratoconus patients differ from controls on several sociodemographic factors and have higher risk of allergic rhinitis, asthma, atopic dermatitis and depression. They do not have excess mortality compared to controls.
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Affiliation(s)
| | | | - Anders Ivarsen
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
| | | | - Jesper Hjortdal
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
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Hyttinen V, Jyrkkä J, Saastamoinen LK, Vartiainen AK, Valtonen H. Patient- and health care-related factors associated with initiation of potentially inappropriate medication in community-dwelling older persons. Basic Clin Pharmacol Toxicol 2018; 124:74-83. [PMID: 30003664 DOI: 10.1111/bcpt.13096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/20/2018] [Accepted: 07/08/2018] [Indexed: 11/28/2022]
Abstract
Potentially inappropriate medications (PIMs) in older persons are defined as medications of which the potential harms outweigh their benefits. The purpose of this study was to determine how initiation of PIMs accumulate in community-dwelling persons aged 65-74 and ≥75 years, and which patient- and health care-related factors are associated with PIM initiation over time. Data of this study were gathered from population-based registers by a 10% random sample of persons (n = 28 497) aged ≥65 years with no prior PIMs within a 2-year period preceding the index date (1 January 2002), and the study individuals were followed until 2013. The Finnish Prescription Register was linked using a personal identity code to register on inpatient care and causes of deaths and socio-economic data. In this study, 10 698 (37.5%) persons initiated PIMs during the study period. Female gender was associated with PIM initiation in 65-74-year-olds, but not in ≥75-year-olds. In 65-74-year-olds, the risk of PIM initiation increased with the higher income, whereas in ≥75-year-olds, the association between PIM initiation and the high income was not significant. The prescribing physician explained 9%-16% of the variation in the probability of PIM initiation. In conclusion, there were age-related differences in the factors associated with PIM initiation in relation to gender and socio-economic status. Overall, patient-related factors explained a large proportion of variation of PIM initiation, but there were also differences in PIM prescribing among physicians. However, physician-related variance of PIM initiations decreased during the 12-year follow-up.
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Affiliation(s)
- Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Johanna Jyrkkä
- Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland
| | | | - Anna-Kaisa Vartiainen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Hannu Valtonen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Padyab M, Armelius BÅ, Armelius K, Nyström S, Blom B, Grönlund AS, Lundgren L. Is Clinical Assessment of Addiction Severity of Individuals with Substance Use Disorder, Using the Addiction Severity Index, A Predictor of Future Inpatient Mental Health Hospitalization? A Nine-Year Registry Study. J Dual Diagn 2018; 14:187-191. [PMID: 29683791 DOI: 10.1080/15504263.2018.1466086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE In Sweden, the Addiction Severity Index (ASI) is the Swedish National Board of Health and Welfare's recommended substance use disorder assessment tool and used routinely for patient intakes. Our study of 213 individuals assessed for substance use disorder with the ASI used nine years of the National Patient Register and examined whether clinical social workers' assessments of addiction severity at baseline were associated with later hospitalizations for mental health disorder (MHD). METHODS ASI composite scores and interviewer severity rating were used to measure clients' problems in seven areas (mental health, family and social relationships, employment, alcohol, drug use, health, and legal) at baseline. A stepwise regression method was used to assess the relative importance of ASI composite scores, MHD hospitalization two years prior to baseline, age, and gender for MHD hospitalization seven years post-baseline. RESULTS Almost two-thirds of the individuals (63%) were hospitalized at least once for MHD in the seven years post-baseline. At the multivariable level, MHD hospitalization prior to baseline was the strongest predictor of future MHD hospitalization, followed by ASI composite scores for drug use, employment, mental health and, last, male gender. CONCLUSIONS A key finding is that higher ASI composite scores for drug use and mental health are predictors of future need for MHD treatment. Future studies will replicate this effort with a national population of individuals with substance use disorder.
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Affiliation(s)
- Mojgan Padyab
- a Department of Social Work , Centre for Demography and Ageing Research, Umeå University , Umeå , Sweden
| | | | | | - Siv Nyström
- c Department for Knowledge-Based Policy of Social Services , National Board of Health and Welfare , Stockholm , Sweden
| | - Björn Blom
- d Department of Social Work , Umeå University , Umeå , Sweden
| | | | - Lena Lundgren
- d Department of Social Work , Umeå University , Umeå , Sweden.,e The Graduate School of Social Work , University of Denver , Denver , Colorado , USA
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Abstract
We investigated the epidemiology of Lyme borreliosis (LB) in Finland for the period 1995–2014 by using data from 3 different healthcare registers. We reviewed data on disseminated LB cases from the National Infectious Diseases Register (21,051 cases) and the National Hospital Discharge Register (10,402 cases) and data on primary LB (erythema migrans) cases from the Register for Primary Health Care Visits (11,793 cases). Incidence of microbiologically confirmed disseminated LB cases increased from 7/100,000 population in 1995 to 31/100,000 in 2014. Incidence of primary LB cases increased from 44/100,000 in 2011 to 61/100,000 in 2014. Overall, cases occurred predominantly in women, and we observed a bimodal age distribution in all 3 registers. Our results clearly demonstrate that the geographic distribution of LB has expanded in Finland and underscore the importance of LB as an increasing public health concern in Finland and in northern Europe in general.
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Ji J, Sundquist J, Sundquist K. Increased incidence of inguinal hernia in offspring of female survivors of childhood central nervous system tumors. Int J Cancer 2018; 143:591-596. [PMID: 29476543 DOI: 10.1002/ijc.31340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/01/2018] [Accepted: 02/12/2018] [Indexed: 12/24/2022]
Abstract
Female survivors of childhood central nervous system (CNS) tumors experience an increased risk of infertility and various pregnancy complications. We aimed to explore whether the incidence of inguinal hernia could be higher in offspring of female CNS tumor survivors as compared to the general population. Girls who were younger than 15 years of age and diagnosed with CNS tumors between 1958 and 2013 were identified from the Swedish Cancer Registry. By linking with the Swedish Medical Birth Registry, we identified 580 children who were born to mothers of CNS tumor survivors. After 9,662 person-years of follow-up, 23 of them were diagnosed with inguinal hernia, giving an incidence rate (IR) of 2.4 per 1,000 person-years, whereas the IR was 1.2 for the matched controls. Cox regression analysis was used to calculate the hazard ratio (HR) of inguinal hernia. After adjusting for some confounding factors, the incidence of inguinal hernia was significantly increased with an HR of 1.92 (95%CI 1.08-3.41). The association was predominant in offspring whose mothers were diagnosed with CNS tumors at the age of 10 and older, and with CNS tumors located in the brain.
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Affiliation(s)
- Jianguang Ji
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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Haukka J, Kriikku P, Mariottini C, Partonen T, Ojanperä I. Non-medical use of psychoactive prescription drugs is associated with fatal poisoning. Addiction 2018; 113:464-472. [PMID: 28841781 DOI: 10.1111/add.14014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 01/18/2017] [Revised: 05/18/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022]
Abstract
AIMS The aims of this study were to estimate the prevalence and predictors of non-medical substance use, and to assess the association between non-medical substance use and fatal poisoning or history of drug abuse in Finland. DESIGN AND SETTING Retrospective cohort study of all medico-legally investigated death cases in Finland. The postmortem toxicology database was linked together with the register on reimbursed prescription medicines. PARTICIPANTS AND CASES All postmortem cases between 2011 and 2013 positive for one or more of the following drugs: oxycodone, fentanyl, tramadol, clonazepam, gabapentin, pregabalin, tizanidine, olanzapine, quetiapine, risperidone, alprazolam, zolpidem, mirtazapine and bupropion, n = 2974. MEASUREMENTS Non-medical use of substance was the outcome variable. Predictors were the following: gender, residence at the time of death, place of death, blood alcohol concentration, age, drug abuse, number of prescriptions of any psychoactive drugs in last year and proportion of prescriptions issued by psychiatrist in last year. FINDINGS In 50.4% of the studied cases, at least one drug was detected without a prescription. Clonazepam, alprazolam and tramadol were the most prevalent non-medical findings in these cases (6.6, 6.1 and 5.6%, respectively). The risk of non-medical use of prescription drugs was especially high in cases with history of drug abuse (88.5%) and in fatal poisonings (71.0%). The proportion of non-medical use of the studied substances varied between 5.9% [95% confidence interval (CI) = 3.1-10.1%)] for risperidone and 55.7% for fentanyl (95% CI = 44.1-66.9%). Valid prescription for one or more of any psychoactive drug was associated with lower odds for non-medical use of the studied substances. Additionally, the higher the proportion of psychoactive drugs prescribed by a psychiatrist, the lower the probability of non-medical use. CONCLUSIONS Non-prescribed psychoactive drugs are found commonly at postmortem in drug poisoning deaths in Finland, with history of drug abuse being a major contributing factor.
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Affiliation(s)
- Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pirkko Kriikku
- Forensic Toxicology Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Claudia Mariottini
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Ilkka Ojanperä
- Forensic Toxicology Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
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Riihimäki O, Paavonen J, Luukkaala T, Gissler M, Metsäranta M, Andersson S, Nuutila M, Pukkala E, Melin J, Tikkanen M. Mortality and causes of death among women with a history of placental abruption. Acta Obstet Gynecol Scand 2017; 96:1315-1321. [PMID: 28832915 DOI: 10.1111/aogs.13212] [Citation(s) in RCA: 5] [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: 03/14/2017] [Revised: 07/11/2017] [Accepted: 08/09/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Women with a history of placental abruption have an increased later morbidity, but not much is known of the later mortality. MATERIAL AND METHODS Data on women with placental abruption (index cohort) between 1969 and 2005 (n = 7805) were collected from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. A matched reference cohort consisted of women without placental abruption (n = 23 523). The causes of death were retrieved from the Cause-of-Death Register. Cause-specific mortality was compared by hazard ratios (HR). Standardized mortality ratios were calculated to compare both cohorts with the general female population. The main outcome measure was subsequent mortality. RESULTS By the end of 2013 there were 395 deaths in the index cohort and 863 deaths in the reference cohort. The overall mortality was increased in the index cohort compared with the reference cohort [HR 1.39, 95% confidence interval (CI) 1.24-1.57]. The index cohort had an increased risk of death from respiratory tract malignancies (HR 1.72, 95% CI 1.05-2.82), alcohol-related causes (HR 1.84, 95% CI 1.25-2.72), and external causes (HR 1.63, 95% CI 1.19-2.22), especially suicide (HR 1.71, 95% CI 1.07-2.74). The mortality from cardiovascular diseases did not differ. The standardized mortality ratio was increased in the index cohort compared with the general Finnish female population (HR 1.13, 95% CI 1.02-1.24), especially for respiratory tract malignancies (HR 1.79, 95% CI 1.16-2.64). The index cohort women tended to die younger than referent women (p < 0.001). CONCLUSIONS Overall mortality among women with a history of placental abruption is increased. These women tend to die younger than referent women do.
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Affiliation(s)
- Outi Riihimäki
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Luukkaala
- Science Center, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland
| | - Marjo Metsäranta
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sture Andersson
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Nuutila
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Pukkala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Johanna Melin
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Holst C, Tolstrup JS, Sørensen HJ, Becker U. Alcohol dependence and risk of somatic diseases and mortality: a cohort study in 19 002 men and women attending alcohol treatment. Addiction 2017; 112:1358-1366. [PMID: 28225200 DOI: 10.1111/add.13799] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 07/18/2016] [Revised: 10/03/2016] [Accepted: 02/10/2017] [Indexed: 12/25/2022]
Abstract
AIMS To (1) estimate sex-specific risks of a comprehensive spectrum of somatic diseases in alcohol-dependent individuals versus a control population, and in the same population to (2) estimate sex-specific risks of dying from the examined somatic diseases. DESIGN Register-based matched cohort study. Alcohol-dependent individuals were identified from the Copenhagen Alcohol Cohort. Controls were selected randomly from the Danish Civil Registration System. Information on somatic diseases was obtained from the Danish National Patient Registry and causes of death obtained from the Cause of Death Registry. Cox proportional hazards model was applied to estimate hazard ratios (HRs). SETTING Denmark. PARTICIPANTS A total of 19 002 alcohol-dependent individuals and 186 767 controls. MEASUREMENTS Outcome variables included 11 disease groups and 29 subgroups, defined according to the International Classification of Diseases (ICD). The main predictor variable was diagnosis of alcohol dependence according to ICD. FINDINGS Alcohol-dependent men and women compared with controls had statistically significantly higher risks of all disease groups and the majority of subgroups when analysed as disease events. HRs were elevated for well-established alcohol-related diseases but also for diseases such as dementia [men, HR = 2.0, 95% confidence interval (CI) = 1.6-2.3; women, HR = 2.4, 95% CI = 1.8-3.2], psoriasis (men, HR = 4.3, 95% CI = 3.5-5.2; women, HR = 5.4, 95% CI = 3.7-7.8) and breast cancer in men (HR = 3.3, 95% CI = 1.6-7.0). Similar results were found when disease groups and subgroups were analysed as causes of death. CONCLUSIONS Alcohol-dependent men and women have significantly higher risks of a comprehensive spectrum of somatic diseases, both as disease events and as causes of death, relative to individuals from the general population.
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Affiliation(s)
- Charlotte Holst
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Holger Jelling Sørensen
- Mental Health Centre Copenhagen, the Capital Region, Bispebjerg Hospital, Copenhagen, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Osooli M, Steen Carlsson K, Astermark J, Berntorp E. Surgery and survival in birth cohorts with severe haemophilia and differences in access to replacement therapy: The Malmö experience. Haemophilia 2017; 23:e403-e408. [PMID: 28758324 DOI: 10.1111/hae.13302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Persons with severe haemophilia require lifelong replacement therapy, prophylaxis, to prevent bleeding. Data describing long-term outcomes of prophylactic treatment are scarce. The aim of this study was to investigate joint surgery and survival among persons with severe haemophilia with special attention to access to prophylaxis in the early years of life. METHODS Eligible participants had severe haemophilia A or B and were treated at the Malmö centre from the 1960s onward. Time from birth until joint surgery was analysed for participants negative for factor inhibitor and alive in 2000. We compared survival among the entire cohort with severe haemophilia treated at the Malmö centre with the general male population of Sweden and a sample of persons with severe haemophilia from the United Kingdom (UK). RESULTS Overall, 167 participants were included, 106 (63.5%) of whom had complete data on joint surgery. Among those born before 1970, 1970-1979 and ≥1980 approximately 37%, 21% and 0% had their first joint surgery by age 30, respectively. There were no second joint surgeries reported in cohorts born ≥1970. Persons with severe haemophilia and negative for HIV treated in Malmö have attained approximately similar survival to that of the general male population in Sweden and live slightly longer than persons with severe haemophilia from the UK. DISCUSSION AND CONCLUSION Prophylaxis in Sweden, although costly, has markedly improved survival and joint outcomes for persons with severe haemophilia. This study highlights the importance of early start of replacement therapy to prevent or postpone serious joint damage.
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Affiliation(s)
- M Osooli
- Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - K Steen Carlsson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.,Swedish Institute for Health Economics, Lund, Sweden
| | - J Astermark
- Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - E Berntorp
- Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
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Abstract
Caesarean section has been shown to affect the health of the child. Only a few studies have investigated whether the mode of delivery is associated with dental caries, and they present conflicting results. Our study investigated whether dental caries was associated with delivery method in Swedish preschool children. This retrospective register-based cohort study included all children born from 2000 to 2003 who were residing in Stockholm County, Sweden, at 3 y of age (n = 83,147). The study followed the cohort until individuals were 7 y of age. Children examined at 3 and 7 y constituted the final study cohort (n = 65,259). We dichotomized the key exposure “delivery starts by caesarean section” and analyzed it in univariate analyses as well as in multivariate analyses. The multivariate analyses used 3 outcomes: caries experience at age 3 (deft >0 [decayed, extracted, and filled teeth]), caries increment between 3 and 7 y of age (Δdeft > 0), and caries experience at age 7 (deft > 0). Of the final cohort, 15% (n = 9,587) were delivered by caesarean section. At 3 y of age, the results showed no statistically significant association between caesarean section and caries experience (odds ratio = 0.92, 95% confidence interval [CI] = 0.82 to 1.04). Between 3 and 7 y of age, the association of caesarean section on caries increment was 0.88 (95% CI = 0.83 to 0.94) and at 7 y of age, 0.88 (caries experience; 95% CI = 0.82 to 0.94). Higher mean values for caries experience and caries increment were observed in vaginally delivered children. We found that preschool children who were delivered by caesarean section do not represent a group with an excess risk of developing dental caries. Furthermore, the statistically significant associations with caries increment and caries experience at age 7 were negative. Knowledge Transfer Statement: Children born by caesarean section are at greater risk of developing asthma and obesity. The proportion of elective caesarean sections without a medical indication has increased over the years; therefore, it is important to know how this mode of delivery affects oral health of the child. The results show that children who are delivered by caesarean section are not at greater risk of developing dental caries, and clinicians can use these findings in their risk assessment.
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Affiliation(s)
- E Brandquist
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Pediatric Dental Clinic in Gothenburg, Public Dental Service in Västra Götaland, Sweden
| | - G Dahllöf
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity Studies, Stockholm, Sweden
| | - A Julihn
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Pediatric Dental Clinic in Gothenburg, Public Dental Service in Västra Götaland, Sweden
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Hyttinen V, Taipale H, Tolppanen AM, Tanskanen A, Tiihonen J, Hartikainen S, Valtonen H. Incident Use of a Potentially Inappropriate Medication and Hip Fracture in Community-Dwelling Older Persons With Alzheimer's Disease. Ann Pharmacother 2017; 51:725-734. [PMID: 28486815 DOI: 10.1177/1060028017708394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Potentially inappropriate medications (PIMs) increase the risk of adverse drug reactions and events and have been associated with greater health care service use, such as an increased risk of hospitalization. OBJECTIVE The aim of this study is to evaluate the association between PIM use and hip fractures in a nationwide cohort of community-dwelling persons ≥65 years old with Alzheimer's disease (AD). METHODS The study, which is based on the Finnish nationwide MEDALZ cohort, included all persons diagnosed with AD between 2005 and 2011 (n = 70 718). After a 1-year washout period for PIM use and exclusion of persons with previous hip fracture before AD diagnosis or those who had been hospitalized, we included 47 850 persons ≥65 years old with AD. PIM use was identified using Finnish criteria. Associations between PIM use and hip fracture were analyzed with Cox proportional hazards regression. RESULTS Of the study population, 12.3% (n = 5895) initiated PIMs during the follow-up (maximum follow-up 2921 days and total number of person-years 139 538.7). Of those, 103 (1.7%) persons had hip fractures during the PIM use period. The results suggest that PIM use was only associated with an increased risk of hip fracture with incident PIM use (adjusted hazard ratio = 1.31; 95% CI = 1.06-1.63; P = 0.014). CONCLUSIONS PIM use is associated with increased risk of hip fracture when a person uses PIMs for the first time. However, the association between PIM use and hip fracture should be investigated more comprehensively in future studies.
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Affiliation(s)
| | - Heidi Taipale
- 1 University of Eastern Finland, Kuopio, Finland
- 2 Karolinska Institutet, Stockholm, Sweden
| | | | - Antti Tanskanen
- 1 University of Eastern Finland, Kuopio, Finland
- 2 Karolinska Institutet, Stockholm, Sweden
- 3 National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- 1 University of Eastern Finland, Kuopio, Finland
- 2 Karolinska Institutet, Stockholm, Sweden
| | - Sirpa Hartikainen
- 1 University of Eastern Finland, Kuopio, Finland
- 4 Kuopio University Hospital, Kuopio, Finland
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