Published in 2020

Elimination af hepatitis C-virus i Danmark

Døssing, A., Røge, B. T., Madsen, L. G., Laursen, A. L., Hansen, J. B., Bukh, J. & Weis, N., 24 feb. 2020, I: Ugeskrift for Laeger. 182, 9

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In Denmark, about 50% of patients with chronic hepatitis C virus (HCV) infection are undiagnosed. Since 2014, therapy containing direct-acting antivirals (DAA) has proven efficient and is available to all patients, who have a chronic HCV infection and a Danish personal identification number. The World Health Organization has a goal of elimination of viral hepatitis in 2030. Elimination of HCV in Denmark should focus on reducing HCV transmission, incidence and prevalence, combined with treatment with DAA of all infected patients. Micro-elimination strategies may play a major role, but a national strategy is lacking.
Bidragets oversatte titel Elimination of hepatitis C virus in Denmark
Originalsprog Dansk
Tidsskrift Ugeskrift for Laeger
Vol/bind 182
Udgave nummer 9
ISSN 0041-5782
Status Udgivet - 24 feb. 2020

Estimating physical activity and sedentary behaviour in a free-living environment: A comparative study between Fitbit Charge 2 and Actigraph GT3X

Mikkelsen, M-L. K., Berg-Beckhoff, G., Frederiksen, P., Horgan, G., O'Driscoll, R., Palmeira, A. L., Scott, S. E., Stubbs, J., Heitmann, B. L. & Larsen, S. C., jun. 2020, I: PLoS One. 15, 6 June, s. e0234426 e0234426.

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BACKGROUND: Activity trackers such as the Fitbit Charge 2 enable users and researchers to monitor physical activity in daily life, which could be beneficial for changing behaviour. However, the accuracy of the Fitbit Charge 2 in a free-living environment is largely unknown.

OBJECTIVE: To investigate the agreement between Fitbit Charge 2 and ActiGraph GT3X for the estimation of steps, energy expenditure, time in sedentary behaviour, and light and moderate-to-vigorous physical activity under free-living conditions, and further examine to what extent placing the ActiGraph on the wrist as opposed to the hip would affect the findings.

METHODS: 41 adults (n = 10 males, n = 31 females) were asked to wear a Fitbit Charge 2 device and two ActiGraph GT3X devices (one on the hip and one on the wrist) for seven consecutive days and fill out a log of wear times. Agreement was assessed through Bland-Altman plots combined with multilevel analysis.

RESULTS: The Fitbit measured 1,492 steps/day more than the hip-worn ActiGraph (limits of agreement [LoA] = -2,250; 5,234), while for sedentary time, it measured 25 min/day less (LoA = -137; 87). Both Bland-Altman plots showed fixed bias. For time in light physical activity, the Fitbit measured 59 min/day more (LoA = -52;169). For time in moderate-to-vigorous physical activity, the Fitbit measured 31 min/day less (LoA = -132; 71) and for activity energy expenditure it measured 408 kcal/day more than the hip-worn ActiGraph (LoA = -385; 1,200). For the two latter outputs, the plots indicated proportional bias. Similar or more pronounced discrepancies, mostly in opposite direction, appeared when comparing to the wrist-worn ActiGraph.

CONCLUSION: Moderate to substantial differences between devices were found for most outputs, which could be due to differences in algorithms. Caution should be taken if replacing one device with another and when comparing results.

Originalsprog Engelsk
Artikelnummer e0234426
Tidsskrift PLoS One
Vol/bind 15
Udgave nummer 6 June
Sider (fra-til) e0234426
ISSN 1932-6203
DOI
Status Udgivet - jun. 2020

European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020

Husby, S., Koletzko, S., Korponay-Szabó, I., Kurppa, K., Mearin, M. L., Ribes-Koninckx, C., Shamir, R., Troncone, R., Auricchio, R., Castillejo, G., Christensen, R., Dolinsek, J., Gillett, P., Hróbjartsson, A., Koltai, T., Maki, M., Nielsen, S. M., Popp, A., Størdal, K., Werkstetter, K. & Wessels, M., jan. 2020, I: Journal of Pediatric Gastroenterology and Nutrition. 70, 1, s. 141-156 16 s.

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OBJECTIVES: The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.

METHODS: Literature databases and other sources of information were searched for studies that could inform on 10 formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations.

RESULTS: Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable, an IgG-based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10× ULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10× ULN at least 4 biopsies from the distal duodenum and at least 1 from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely.

CONCLUSIONS: CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.

Originalsprog Engelsk
Tidsskrift Journal of Pediatric Gastroenterology and Nutrition
Vol/bind 70
Udgave nummer 1
Sider (fra-til) 141-156
Antal sider 16
ISSN 0277-2116
DOI
Status Udgivet - jan. 2020

Evaluation of serum ARGS neoepitope as an osteoarthritis biomarker using a standardized model for exercise-induced cartilage extra cellular matrix turnover

Bjerre-Bastos, J. J., Nielsen, H. B., Andersen, J. R., He, Y., Karsdal, M., Bay-Nielsen, A-C., Boesen, M., Mackey, A. L. & Bihlet, A. R., apr. 2020, I: Osteoarthritis and Cartilage Open.

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Originalsprog Engelsk
Tidsskrift Osteoarthritis and Cartilage Open
Status Udgivet - apr. 2020

Everyday activities when living at home with advanced cancer: A cross-sectional study

Waehrens, E. E., Brandt, Å., Peoples, H. & la Cour, K., sep. 2020, I: European Journal of Cancer Care. 29, 5, s. e13258 e13258.

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OBJECTIVE: This study aimed at exploring everyday activities of people with advanced cancer living at home: which everyday activities they perform; perceived and observed quality of performance of self-care and household activities; which activities they would like to be able to perform; and determine any gender differences.

METHODS: Outpatients (n = 164) with advanced cancer were recruited from Danish oncology units. Data were based on medical hospital records, standardised questionnaires, a 1-day diary, standardised interviews and standardised observations. All data were subject to descriptive and statistical analyses.

RESULTS: More than 95% of the study sample was classified in ECOG performance status 1 and 2. Compared to population-based norms, the participants reported lower levels of global health and quality of life, as well as lower physical and role functioning. Across gender, participants spent the majority of the day involved in self-care and leisure activities. They reported to perform self-care independently without risk, although 60% reported problems with mobility. While heavy household activities were reported as most problematic, participants prioritised support to engage in more active leisure and social activities.

CONCLUSION: People with advanced cancer experience problems related to performance of and engagement in everyday activities indicating a need for palliative rehabilitation services.

Originalsprog Engelsk
Artikelnummer e13258
Tidsskrift European Journal of Cancer Care
Vol/bind 29
Udgave nummer 5
Sider (fra-til) e13258
ISSN 0961-5423
DOI
Status Udgivet - sep. 2020

Bibliografisk note

© 2020 John Wiley & Sons Ltd.

Familial associations in hair cortisol concentration: A cross-sectional analysis based on the Healthy Start study

Dauegaard, S., Olsen, N. J., Heitmann, B. L. & Larsen, S. C., nov. 2020, I: Psychoneuroendocrinology. 121, s. 104836 104836.

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A few studies have shown a direct association between maternal and child hair cortisol concentrations (HCC), but the potential correlations within paternal-child and maternal-paternal dyads are not clear from the current evidence. Thus, we aimed to thoroughly examine associations between family members HCC. We conducted a cross-sectional study based on 159 children and their parents (159 mothers and 159 fathers) participating in the Danish Healthy Start Study. Information was available on HCC from both children, mothers and fathers, as well as on several sociodemographic factors. First, Pearson's correlation coefficients were applied to assess crude correlations between family members' HCC. Secondly, analysis of covariance, adjusted for covariates, was applied to estimate child mean HCC in quartiles of maternal and paternal HCC, and mean paternal HCC in quartiles of maternal HCC. Our results showed direct associations between HCC of all family members. We found statistically robust correlations between maternal and child HCC (r = 0.33; P < 0.001), paternal and child HCC (r = 0.37; P < 0.001) and between maternal and paternal HCC (r = 0.31; P < 0.001). Similar results were found when adjusting for covariates in analyses of covariance. Our data provides evidence of associations between family members' HCC. However, we were unable to determine the extent to which these associations were due to shared genetics, assortative mating or environmental factors.

Originalsprog Engelsk
Artikelnummer 104836
Tidsskrift Psychoneuroendocrinology
Vol/bind 121
Sider (fra-til) 104836
ISSN 0306-4530
DOI
Status Udgivet - nov. 2020

Bibliografisk note

Copyright © 2020 Elsevier Ltd. All rights reserved.

Fetal exposure to paternal smoking and semen quality in the adult son

Haervig, K. K., Høyer, B. B., Giwercman, A., Hougaard, K. S., Ramlau-Hansen, C. H., Specht, I. O., Toft, G., Bonde, J. P. & Søgaard Tøttenborg, S., sep. 2020, I: Andrology. 8, 5, s. 1117-1125 9 s.

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BACKGROUND: The negative impact of maternal smoking during pregnancy on offspring semen quality is well established. Less is known about the impact of paternal smoking.

METHODS: We estimated differences in semen parameters and testicle size according to paternal smoking in 772 adult sons of women enrolled in the Danish National Birth Cohort when pregnant. Parents' smoking was reported around gestational week 16, and analyses were adjusted for parents' ages at conception, maternal pre-pregnancy body mass index, maternal alcohol and caffeine intake, family occupational status, ejaculatory abstinence time, clinic of semen analysis, and season.

RESULTS: Sons of smoking fathers and non-smoking mothers had a 10% (95% confidence interval: -24%, 7%) lower semen concentration and 11% (95% confidence interval: -27%, 8%) lower sperm count than sons of non-smoking parents. Having two smoking parents was associated with 19% reduction in sperm count (95% confidence interval: -37%, 3%). Paternal smoking was not associated with volume, motility, or morphology. Adjusting for maternal smoking, paternal smoking was associated with a 26% increased risk of small testicular volume (95% confidence interval: 0.89, 1.78).

DISCUSSION: Exclusion of sons with a history of testicular cancer, chemotherapy, orchiectomy, and with only one or no testicles may have caused us to underestimate associations if these men's reproductive health including semen quality are in fact more sensitive to paternal smoking.

CONCLUSION: The study provides limited support for slightly lower sperm concentration and total sperm concentration in sons of smoking fathers, but findings are also compatible with no association.

Originalsprog Engelsk
Tidsskrift Andrology
Vol/bind 8
Udgave nummer 5
Sider (fra-til) 1117-1125
Antal sider 9
ISSN 2047-2919
DOI
Status Udgivet - sep. 2020

Bibliografisk note

© 2020 American Society of Andrology and European Academy of Andrology.

Fetal Programming of Semen Quality (FEPOS) Cohort - A DNBC Male-Offspring Cohort

Keglberg Hærvig, K., Bonde, J. P., Ramlau-Hansen, C. H., Toft, G., Hougaard, K. S., Specht, I. O., Giwercman, A., Nybo Andersen, A-M., Olsen, J., Lindh, C., Bjerre Høyer, B. & Tøttenborg, S. S., 2020, I: Clinical Epidemiology. 12, s. 757-770 14 s.

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Background: Prenatal exposures may contribute to male infertility in adult life, but large-scale epidemiological evidence is still lacking. The Fetal Programming of Semen quality (FEPOS) cohort was founded to provide means to examine if fetal exposures can interfere with fetal reproductive development and ultimately lead to reduced semen quality and reproductive hormone imbalances in young adult men.

Methods: Young adult men at least 18 years and 9 months of age born to women in the Danish National Birth Cohort living in relative proximity to Copenhagen or Aarhus and for whom a maternal blood sample and two maternal interviews during pregnancy were available were invited to FEPOS. Recruitment began in March 2017 and ended in December 2019. The participants answered a comprehensive questionnaire and underwent a physical examination where they delivered a semen, urine, and hair sample, measured their own testicular volume, and had blood drawn.

Results: In total 21,623 sons fulfilled eligibility criteria of whom 5697 were invited and 1058 participated making the response rate 19%. Semen characteristics did not differ between sons from the Copenhagen and Aarhus clinics. When comparing the FEPOS semen parameters to similar cohorts, the median across all semen characteristics was slightly lower for FEPOS participants, although with smaller variation.

Conclusion: With its 1058 young adult men, the FEPOS cohort is the largest population-based male-offspring cohort worldwide specifically designed to investigate prenatal determinants of semen quality. Wide-ranging information on maternal health, lifestyle, socioeconomic status, occupation, and serum concentrations of potential reproductive toxicants during pregnancy combined with biological markers of fertility in their sons collected after puberty allow for in-depth investigations of the 'fetal origins of adult disease hypothesis'.

Originalsprog Engelsk
Tidsskrift Clinical Epidemiology
Vol/bind 12
Sider (fra-til) 757-770
Antal sider 14
ISSN 1179-1349
DOI
Status Udgivet - 2020

Bibliografisk note

© 2020 Keglberg Hærvig et al.

Fysioterapeutisk træning til patienter med knæartrose

Henriksen, M. & Skou, S. T., 12 okt. 2020, I: Ugeskrift for Laeger. 182, 42

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Therapeutic exercise for knee osteoarthritis is recommended globally, based on more than 100 randomised, controlled trials documenting beneficial effects on pain and function. There are adverse effects of exercise and symptom exacerbations may occur in the first 4-6 weeks of an exercise programme, but will most often decline with time. If pain and function do not improve after a structured exercise program, other treatments must be considered. The effects of exercise decline over time, if regular exercise is not implemented in the daily life of the patient.

Bidragets oversatte titel Exercise for knee osteoarthritis
Originalsprog Dansk
Tidsskrift Ugeskrift for Laeger
Vol/bind 182
Udgave nummer 42
ISSN 0041-5782
Status Udgivet - 12 okt. 2020

Glucocorticoid-trials in rheumatoid arthritis mostly study representative real-world patients: A systematic review and meta-analysis

Palmowski, A., Nielsen, S. M., Buttgereit, T., Palmowski, Y., Boers, M., Christensen, R. & Buttgereit, F., dec. 2020, I: Seminars in Arthritis and Rheumatism. 50, 6, s. 1400-1405 6 s.

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OBJECTIVE: Randomized controlled trials (RCTs) are considered the gold standard in clinical research due to credible causality. Their results, however, may not be generalizable to real-world populations. While glucocorticoids (GCs) remain a mainstay of rheumatoid arthritis (RA) treatment, it is unclear whether the results of GC-RCTs are generalizable to current real-world RA patients.

METHODS: MEDLINE was searched for RCTs and, as comparators, cohort studies (CSs) in RA evaluating systemic GCs. Random-effects meta-analyses were performed for descriptive baseline characteristics (including general demographics, comorbidities, and disease activity) that have been shown to be able to modify the benefit-risk-ratio of various RA therapeutics. These meta-analyses were stratified by study type (RCT and CS). Stratified estimates were subsequently compared. Further sensitivity analyses were performed stratifying by disease duration.

RESULTS: 56 RCTs (7053 participants) and 10 CSs (14,688 participants) were included. 12 characteristics were reported frequently enough to allow for comparative analysis. In 10/12 characteristics (83%), RCT estimates did not appear to differ from CS estimates. However, RCT participants were younger (-4.7 years [95% CI -7.2 to -2.1]; p < 0.001) and had higher erythrocyte sedimentation rates (11.8 mm/h [5.7 to 17.8]; p < 0.001) than CS participants. Comorbidities could not be assessed due to insufficient reporting.

CONCLUSION: Our findings suggest that evidence from GC trials in RA is of acceptable generalizability to current real-world patients - especially compared to findings from biologic agents in RA. However, RCT participants were younger than real-world patients, potentially limiting the generalizability of trial results to elderly patients.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42019134675).

Originalsprog Engelsk
Tidsskrift Seminars in Arthritis and Rheumatism
Vol/bind 50
Udgave nummer 6
Sider (fra-til) 1400-1405
Antal sider 6
ISSN 0049-0172
DOI
Status Udgivet - dec. 2020

Bibliografisk note

Copyright © 2020 Elsevier Inc. All rights reserved.

BACKGROUND: Myocardial injury after non-cardiac surgery occurs in a high number of patients, resulting in increased mortality in the post-operative period. The use of high inspiratory oxygen concentrations may cause hyperoxia, which is associated with impairment of coronary blood flow. Furthermore, the surgical stress response increases reactive oxygen species, which is involved in several perioperative complications including myocardial injury and death. Avoidance of hyperoxia and substitution of reactive oxygen species scavengers may be beneficial. Our primary objective is to examine the effect of oxygen and added antioxidants for prevention of myocardial injury assessed by area under the curve for troponin measurements during the first three post-operative days.

METHODS: The VIXIE trial (VitamIn and oXygen Interventions and cardiovascular Events) is an investigator-initiated, blinded, 2 × 2 factorial multicentre clinical trial. We include 600 patients with cardiovascular risk factors undergoing major non-cardiac surgery. Participants are randomised to an inspiratory oxygen fraction of 0.80 or 0.30 during and for 2 hours after surgery and either an intravenous bolus of vitamin C and an infusion of N-acetylcysteine or matching placebo of both. The primary outcome is the area under the curve for high-sensitive cardiac troponin release during the first three post-operative days as a marker of the extent of myocardial injury. Secondary outcomes are mortality, non-fatal myocardial infarction and non-fatal serious adverse events within 30 days.

PERSPECTIVE: The current trial will provide further evidence for clinicians on optimal administration of perioperative oxygen in surgical patients with cardiovascular risks and the clinical effects of two common antioxidants.

Originalsprog Engelsk
Tidsskrift Acta Anaesthesiologica Scandinavica
Vol/bind 64
Udgave nummer 3
Sider (fra-til) 400-409
Antal sider 10
ISSN 0001-5172
DOI
Status Udgivet - 1 mar. 2020

Bibliografisk note

© 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

OBJECTIVES: The main study aim was to examine the applicability of a novel method to assess the criterion of values and preferences within the Grading of Recommendation, Assessment, Development and Evaluation evidence to decision framework. The group concept mapping (GCM) approach was applied to identify, organise and prioritise values and preferences in the example of health professionals' choice of analgesia for patients with acute trauma pain.

SETTING: Prehospital and emergency care centres in the Nordic countries of Denmark, Norway, Sweden, Finland and Iceland.

PARTICIPANTS: Acute care health professionals with qualifications to administer analgesic agents to patients in emergency and prehospital settings, including advanced ambulance assistants, rescue officers, paramedics, emergency physicians and emergency nurses, participated in an online survey in which statements were generated (n=40) and structured (n=11) and finally analysed and interpreted in a validation meeting (n=4).

RESULTS: Using GCM, ideas were generated and structured through online participation. Results were interpreted at a validation meeting. In total, 111 unique ideas were identified and organised into seven clusters: drug profile, administration, context, health professionals' preferences and logistics, safety profile, patient's medical history and acute clinical situation.

CONCLUSIONS: Based on GCM, a conceptual model was developed, and values and preferences around choice of analgesia in emergency care were revealed. Health professionals within acute care can apply the conceptual model to support their decision-making when choosing the best available treatment for pain for their patients in emergency care.

Originalsprog Engelsk
Artikelnummer e031863
Tidsskrift BMJ Open
Vol/bind 10
Udgave nummer 3
Sider (fra-til) e031863
ISSN 2044-6055
DOI
Status Udgivet - 10 mar. 2020

Bibliografisk note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Background: Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic diseases that affect patients' quality of life. The purpose of the present study was to develop a pilot outcome-based, patient-centric management model for PsO and PsA.

Methods: The non-interventional IMPROVE (Incentives for healthcare management based on patient-related outcomes and value) study being conducted in Denmark consists of 5 phases: 1) collecting real-world evidence to estimate treatment patterns and disease burden to the healthcare sector and patients; 2) identifying disease aspects which matter most to patients by use of concept mapping; 3) conducting interviews with healthcare professionals and patient organization involved in a typical PsO or PsA patient journey in order to determine relevant measures to quantify patient-identified outcomes; 4) developing a value-based remuneration model based on outcomes from phases 1-3; and 5) testing the outcome-based model in pre-selected hospitals in Denmark.

Results: Both PsO and PsA are associated with multiple co-morbidities, increased healthcare costs, and loss of earnings. Seven important 'clusters' of disease aspects were identified for both PsO and PsA, including uncertainty about disease progression and treatments, as well as inter-personal relations with healthcare providers. Hospital-based treatment was associated with high treatment costs. Although the outcome-based model could result in strategic behavior by doctors, those involved in defining the best outcome goals consider it unlikely.

Conclusion: The new patient-centric outcome-based management model is expected to support optimal treatment and secure best possible outcomes for patients suffering from PsO or PsA. The practical implication of the present study are that the models developed are expected to increase focus on patient-centered healthcare, and help eliminate some of the inappropriate incentives that exist in activity-based remuneration systems.

Trial registration: Not applicable; data collected from patient registries in Denmark.

Originalsprog Engelsk
Artikelnummer 95
Tidsskrift Archives of public health = Archives belges de sante publique
Vol/bind 78
Udgave nummer 1
Sider (fra-til) 95
ISSN 0778-7367
DOI
Status Udgivet - 12 okt. 2020

Bibliografisk note

© The Author(s) 2020.

Interhospital Transport of Sick Newborns In Denmark

Heiring, C., Zachariassen, G., Christensen, P. S., Kjærgaard, S., Nielsen, H. V., Hansen, T. G., Mortensen, S., Hertel, S. A. & Breindahl, M., 30 mar. 2020, I: Ugeskrift for Laeger. 182, 14A

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Interhospital transport of sick newborn infants is dangerous, but the risk of adverse events can be reduced, when transport is being performed by trained neonatal retrieval teams. In this review, we describe the current organisation of neonatal retrieval service in Denmark. The services are based at the neonatal intensive care units of the four university hospitals. Improved cooperation and harmonisation of operations between the teams is needed, as this is a prerequisite for the development of a national clinical consensus guideline and national quality metrics enabling benchmarking both within Denmark and abroad.

Bidragets oversatte titel Interhospital transport of sick newborns in Denmark
Originalsprog Dansk
Tidsskrift Ugeskrift for Laeger
Vol/bind 182
Udgave nummer 14A
ISSN 0041-5782
Status Udgivet - 30 mar. 2020

Irritable bowel syndrome symptoms in axial spondyloarthritis more common than among healthy controls: is it an overlooked comorbidity?

Wallman, J. K., Mogard, E., Marsal, J., Andréasson, K., Jöud, A., Geijer, M., Kristensen, L. E., Lindqvist, E. & Olofsson, T., 1 jan. 2020, I: Annals of the Rheumatic Diseases. 79, 1, s. 159-161 3 s.

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Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 79
Udgave nummer 1
Sider (fra-til) 159-161
Antal sider 3
ISSN 0003-4967
DOI
Status Udgivet - 1 jan. 2020

Less Severe Preoperative Synovitis is Associated With Higher Self-reported Pain Intensity 12 Months After Total Knee Arthroplasty-An Exploratory Prospective Observational Study

Petersen, K. K., Arendt-Nielsen, L., Vela, J., Skou, S. T., Eld, M., Al-Mashkur, N. M., Boesen, M., Riis, R. G. C. & Simonsen, O., jan. 2020, I: The Clinical journal of pain. 36, 1, s. 34-40 7 s.

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OBJECTIVES: Synovitis is one of the possible pain generators in osteoarthritis (OA) and is associated with upregulation of proinflammatory cytokines, which can lead to worsening of the postoperative pain. This exploratory study aimed to investigate the association between perioperative synovitis and self-reported pain 12 months after total knee arthroplasty (TKA) in patients with OA.

MATERIALS AND METHODS: Twenty-six knee OA patients were included in this analysis. The perioperative volume of synovitis in predefined locations was assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Perioperative synovitis was assessed histologically from biopsies of the synovium. Highest pain intensity within the last 24 hours (Visual Analog Scale, VAS, 0 to 100) was assessed before and 12 months after TKA. Patients were divided into a low-pain intensity (VAS≤30) and a high-pain intensity (VAS>30) group on the basis of 12 months postoperative VAS.

RESULTS: The high-pain intensity group had significantly lower perioperative contrast-enhanced-synovitis (P=0.025), DCE-synovitis (P<0.04), and a trend toward lower histologically assessed synovitis (P=0.077) compared with the low-pain intensity group. Perioperative synovitis scores were inversely correlated with pain intensity 12 months after TKA (P<0.05), indicating that more severe perioperative synovitis is associated with less severe pain intensity at 12 months.

DISCUSSION: Higher degrees of perioperative synovitis scores are found to be associated with less postoperative pain 12 months after TKA. Further, correlation analysis revealed that less severe perioperative CE-MRI and DCE-MRI synovitis was associated with higher pain intensity 12 months after TKA, suggesting that CE-MRI and DCE-MRI synovitis grades could be used as imaging markers for prediction of chronic postoperative pain after TKA.

Originalsprog Engelsk
Tidsskrift The Clinical journal of pain
Vol/bind 36
Udgave nummer 1
Sider (fra-til) 34-40
Antal sider 7
ISSN 0749-8047
DOI
Status Udgivet - jan. 2020

Lessons learned about occupation-focused and occupation-based interventions: A synthesis using group concept mapping methodology

Nielsen, K. T., la Cour, K., Christensen, J. R., Pilegaard, M. S., von Bülow, C., Brandt, Å., Peoples, H., Jonsson, H. & Wæhrens, E. E., okt. 2020, I: Scandinavian Journal of Occupational Therapy. 27, 7, s. 481-492 12 s.

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Introduction: Occupational therapy (OT) is based on the core assumption that humans are active beings through engagement in occupations. Within OT, occupation is typically used as primary means and/or ends i.e. occupation-focused and/or occupation-based interventions are employed. Studies evaluating such interventions are limited.Objectives: To synthesize experiences about occupation-focused and/or occupation-based interventions. Hence, to identify, organize and prioritize experiences with employing occupation as a core element in OT intervention studies.Methods: Participants were OT PhD students and researchers involved in studies concerning occupation-focused and/or occupation-based interventions. Group Concept Mapping was applied.Results: Based on 133 ideas, a conceptual model emerged encompassing two overall dimensions concerning 'developing interventions' and 'planning intervention studies', respectively. Moreover, ten themes related to one or both dimensions were defined and 94 ideas across clusters had high importance ratings.Conclusion: Synthesis of participants' experiences indicates that 'doing' as agent of change is a core element of OT interventions. Moreover, a multi-level perspective is needed to reach sustainable changes in doing. Group- and peer-support can work as amplifier for change, and flexibility is important during intervention. Such complex interventions need special design and mixed methods in the development, and evaluation of outcome needs to address occupation.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Occupational Therapy
Vol/bind 27
Udgave nummer 7
Sider (fra-til) 481-492
Antal sider 12
ISSN 1103-8128
DOI
Status Udgivet - okt. 2020

Levels and changes in body mass index decomposed into fat and fat-free mass index: relation to long-term all-cause mortality in the general population

Sørensen, T. I. A., Frederiksen, P. & Heitmann, B. L., okt. 2020, I: International journal of obesity (2005). 44, 10, s. 2092-2100 9 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: In the general population, body mass index (BMI = weight (kg)/(height (m))2) shows a U-shaped relation to mortality, which is attributable to a combination of an inverse association with fat-free mass index (FFMI) and a direct association with fat mass index (FMI). However, preceding changes in body composition related to diseases, health behaviors, or social conditions that are also influencing later mortality may confound these associations.

OBJECTIVE: To examine associations of FFMI and FMI, adjusted for preceding changes in FFMI and FMI over a 6 years period, with all-cause mortality in a healthy general population.

METHODS: The study population was a random subset of adult Danes, participating in the Danish MONICA project; 989 men and 962 women, born 1922, 1932, 1942, and 1952, and examined in 1987-88 and 1993-94. They had no known major co-morbidities until start of follow-up in 1993-94, and were followed up for 18 years. Measures included height, weight, and bio-impedance, from which BMI, FFMI, and FMI were calculated, and information on educational level, smoking, alcohol drinking, leisure-time physical activity, which were obtained by questionnaires. We analyzed the relation between body composition and all-cause mortality by Cox proportional hazards model with splines, stratified by birth cohorts, and with adjustment for preceding changes in body composition and for the covariates including gender. We estimated hazard ratios (HR) with 95% confidence intervals (CI) relative to HR = 1.00 at the median values of BMI, FMI, and FFMI.

RESULTS: During 18 years of follow-up, 286 men and 200 women died. BMI showed the well-known U-shaped association with mortality, and FMI was directly and FFMI inversely associated with mortality. Associations were not significantly modified by gender. Preceding changes in BMI, FMI, and FFMI were only weakly and not significantly associated with mortality. Associations for FMI and FFMI were monotonic, but curve-linear with a higher mortality above and below the respective median values of FMI and FFMI: at the 5th percentiles of FMI and FFMI, HRs were 0.80 (CI 0.57-1.13) and 2.01 (1.24-3.27), and at the 95th percentiles, HRs were 2.16 (1.38-3.38) and 0.81 (0.52-1.27), respectively.

CONCLUSIONS: In an apparently healthy general population, a large fat mass and a small fat-free mass are associated with greater risk of early mortality, also after adjusting for preceding changes in body composition, health behaviors, and educational level.

Originalsprog Engelsk
Tidsskrift International journal of obesity (2005)
Vol/bind 44
Udgave nummer 10
Sider (fra-til) 2092-2100
Antal sider 9
ISSN 0307-0565
DOI
Status Udgivet - okt. 2020

Long-term exposure to air pollution and incidence of myocardial infacrtion: a Danish Nurse Cohort study

Cramer, J., Jørgensen, J. T., Hoffmann, B., Loft, S., Bräuner, E., Prescott, E., Ketzel, M., Hertel, O., Brandt, J., Jensen, S., Backalarz, C., Simonsen, M. K. & Andersen, Z. J., 2020, I : Environmental Health Perspectives. DOI 10.1289/EHP5818.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Originalsprog Engelsk
Artikelnummer DOI 10.1289/EHP5818
Tidsskrift Environmental Health Perspectives
ISSN 0091-6765
DOI
Status Udgivet - 2020

Long-Term Exposure to Air Pollution and Incidence of Myocardial Infarction: A Danish Nurse Cohort Study

Cramer, J., Jørgensen, J. T., Hoffmann, B., Loft, S., Bräuner, E. V., Prescott, E., Ketzel, M., Hertel, O., Brandt, J., Jensen, S. S., Backalarz, C., Simonsen, M. K. & Andersen, Z. J., maj 2020, I: Environmental Health Perspectives. 128, 5, s. 57003

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Air pollution exposure has been linked to coronary heart disease, although evidence on

PM

2.5

and myocardial infarction (MI) incidence is mixed.

OBJECTIVES: This prospective cohort study aimed to investigate associations between long-term exposure to air pollution and MI incidence, adjusting for road traffic noise.

METHODS: We used data from the nationwide Danish Nurse Cohort on 22,882 female nurses (

>
44
 years

of age) who, at recruitment in 1993 or 1999, reported information on cardiovascular disease risk factors. Data on MI incidence was collected from the Danish National Patient Register until the end of 2014. Annual mean concentrations of particulate matter (PM) with a diameter

<
2.5

μg
/

m

3

(

PM

2.5

),

PM

10

, nitrogen dioxide (

NO

2

), and nitrogen oxides (

NO

x

) at the nurses' residences since 1990 (

PM

10

and

PM

2.5

) or 1970 (

NO

2

and

NO

x

) were estimated using the Danish Eulerian Hemispheric Model/Urban Background Model/AirGIS (DEHM/UBM/AirGIS) dispersion model. We used time-varying Cox regression models to examine the association between 1- and 3-y running means of these pollutants, as well as 23-y running means of

NO

2

and

NO

x

, with both overall and fatal incident MI. Associations were explored in three progressively adjusted models: Model 1, adjusted for age and baseline year; Model 2, with further adjustment for potential confounding by lifestyle and cardiovascular disease risk factors; and Model 3, with further adjustment for road traffic noise, modeled as the annual mean of a weighted 24-h average (

L

den

).

RESULTS: Of the 22,882 women, 641 developed MI during a mean follow-up of 18.6 y, 121 (18.9%) of which were fatal. Reported hazard ratios (HRs) were based on interquartile range increases of 5.3, 5.5, 8.1, and

11.5

μ
g
/

m

3

for

PM

2.5

,

PM

10

,

NO

2

, and

NO

x

, respectively. In Model 1, we observed a positive association between a 3-y running mean of

PM

2.5

and an overall incident MI with an

HR
=

 1.20 (95% CI: 1.07, 1.35), which attenuated to

HR
=

 1.06 (95% CI: 0.92, 1.23) in Model 2. In Model 1 for incident fatal MI, we observed a strong association with a 3-y running mean of

PM

2.5

, with an

HR
=

 1.69 (95% CI: 1.33, 2.13), which attenuated to

HR
=

 1.35 (95% CI: 1.01, 1.81) in Model 2. Similar associations were seen for

PM

10

, with 3-y, Model 2 estimates for overall and fatal incident MI of

HR
=

 1.06 (95% CI: 0.91, 1.23) and

HR
=

 1.35 (95% CI: 1.01, 1.81), respectively. No evidence of an association was observed for

NO

2

or

NO

x

. For all pollutants, associations in Model 2 were robust to further adjustment for road traffic noise in Model 3 and were similar for a 1-y running mean exposure.

CONCLUSIONS: We found no association between long-term exposure to

PM

2.5

,

PM

10

,

NO

2

, or

NO

x

and overall MI incidence, but we observed positive associations for

PM

2.5

and

PM

10

with fatal MI. We present novel findings that the association between PM and MI incidence is robust to adjustment for road traffic noise. https://doi.org/10.1289/EHP5818.

Originalsprog Engelsk
Tidsskrift Environmental Health Perspectives
Vol/bind 128
Udgave nummer 5
Sider (fra-til) 57003
ISSN 0091-6765
DOI
Status Udgivet - maj 2020

Pages