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Kluzek S, Rubin KH, Sanchez-Santos M, O'Hanlon MS, Andersen M, Glintborg D, Abrahamsen B. Accelerated osteoarthritis in women with polycystic ovary syndrome: a prospective nationwide registry-based cohort study. Arthritis Res Ther 2021; 23:225. [PMID: 34461982 PMCID: PMC8406767 DOI: 10.1186/s13075-021-02604-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is the most common form of arthritis with multiple risk factors implicated including female sex and obesity. Metabolic dysregulation associated with obesity leading to metabolic syndrome is a proposed component of that association. Polycystic ovary syndrome (PCOS) commonly affects women of reproductive age and these women are at higher risk of developing metabolic syndrome and thus likely to represent a high-risk group for early OA development. There are no published studies exploring the epidemiology of knee, hip and hand OA in women diagnosed with PCOS. STUDY AIM To assess the prevalence and incidence of knee, hip and hand osteoarthritis (OA) in women with polycystic ovary syndrome (PCOS) when compared with age-matched controls. METHODS Prospective Danish national registry-based cohort study. The prevalence of OA in 2015 and incidence rates of OA over 11.1 years were calculated and compared in more than 75,000 Danish women with either a documented diagnosis of PCOS ± hirsutism (during the period of 1995 to 2012) or age-matched females without those diagnoses randomly drawn from the same population register. RESULTS In 2015, the prevalence of hospital treated knee, hip and hand OA was 5.2% in women with PCOS diagnosis. It was 73% higher than that seen in age-matched controls. Significantly higher incidence rates were observed in the PCOS cohort compared with the age-matched controls during the follow-up period (up to 20 years), with the following hazard ratios (HR): 1.9 (95% CI 1.7 to 2.1) for knee, 1.8 (95% CI 1.3-2.4) for hand and 1.3 (95% CI 1.1 to 1.6) for hip OA. After excluding women with obesity, similar associations were observed for knee and hand OA. However, risk of developing hip OA was no longer significant. CONCLUSIONS In this large prospective study, women with PCOS diagnosis had higher prevalence and accelerated onset of OA of both weight and non-weight bearing joints, when compared with age-matched controls. Further studies are needed to understand the relative effect of metabolic and hormonal changes linked with PCOS and their role in promoting development of OA.
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Affiliation(s)
- Stefan Kluzek
- Academic Department of Orthopaedics, Trauma and Sports Medicine, Versus Arthritis - Centre for Sport, Exercise and Osteoarthritis Research, Faculty of Medicine and Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK.
| | | | | | | | | | | | - Bo Abrahamsen
- Holbæk Hospital and University of Southern Denmark, Odense, Denmark
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Increased Gastrointestinal Surgical Hospital Burden After Laparoscopic Gastric Bypass for Obesity: A Nationwide 5-years Follow-up Study. Ann Surg 2019; 271:891-897. [PMID: 30896549 DOI: 10.1097/sla.0000000000003166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study long-term gastrointestinal surgical hospital burden (hospital readmissions and gastrointestinal surgical procedures) after laparoscopic gastric bypass. BACKGROUND Little is known about gastrointestinal surgical hospital burden after laparoscopic gastric bypass. METHODS Danish patients undergoing laparoscopic gastric bypass (BMI >35-50) from January 1, 2005 to December 31, 2013 were included (100% follow-up). The nonsurgical reference group were individuals with BMI of ≥ 30 drawn from The Danish National Health Surveys from 2005 to 2013. The primary outcome was gastrointestinal surgical hospital burden. Secondary outcome was mortality. Age, body mass index (BMI), gender, and calendar time (time of surgery and nonsurgical survey), diabetes status was adjusted for in a multivariate Poisson regression model. RESULTS 13,582 bariatric surgical patients and 45,948 reference individuals were included with a mean follow-up time of 4.7 years (SD 2.4). The incidence rate ratio (IRR) for hospital re-re-admission was 2.17 higher in the intervention group (95% CI 2.04-2.31). Sensitivity analysis showed that patients operated before 2010 had a higher incidence for re-re-admission than after. IRR for surgical gastrointestinal procedures was 6.56 (CI 6.15-6.99) and 3.04 (CI 3.51-4.17) after 1 and 5 years for the intervention group compared with the reference group. Surgery for internal hernia was the most common abdominal procedure. The mortality odds ratio was 0.84 (CI 0.65-0.96). CONCLUSIONS Gastrointestinal surgical hospital burden was significantly higher in the first 5 years after gastric bypass compared with a matched nonsurgical reference group of obese citizens.
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Merlin JS, Patel K, Thompson N, Kapo J, Keefe F, Liebschutz J, Paice J, Somers T, Starrels J, Childers J, Schenker Y, Ritchie CS. Managing Chronic Pain in Cancer Survivors Prescribed Long-Term Opioid Therapy: A National Survey of Ambulatory Palliative Care Providers. J Pain Symptom Manage 2019; 57:20-27. [PMID: 30342243 DOI: 10.1016/j.jpainsymman.2018.10.493] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT Chronic pain, or pain lasting more than three months, is common among cancer survivors, who are often prescribed long-term opioid therapy (LTOT). OBJECTIVE Our objective was to explore palliative care providers' experiences with managing chronic pain in cancer survivors prescribed LTOT, specifically in ambulatory palliative care settings, and their strategies for overcoming challenges. METHODS We recruited providers through leading national palliative care organizations who manage chronic pain in cancer survivors. Asked to consider only cancer survivors with chronic pain when responding, participants completed an online survey that included questions about use of opioid risk mitigation tools, confidence in addressing opioid misuse behaviors and discussing/recommending management approaches, and access to addiction treatment. RESULTS Of 157 participants, most were physicians (83%) or nurse practitioners (15%). Most reported using opioid risk mitigation tools such as urine drug testing (71%), opioid treatment agreements (85%), and practitioner database monitoring programs (94%). Participants were confident (7-8/10) managing the most commonly encountered opioid misuse behaviors (missing appointments, marijuana use, and using more opioids than prescribed) and in their ability to recommend nonpharmacologic and nonopioid pharmacologic treatments for chronic pain (10/10). They were least confident prescribing naloxone or managing addiction (5/10); only 27% reported having training or systems in place to address addiction. Only 13% had a waiver to prescribe buprenorphine. CONCLUSION Palliative care providers are comfortable with many aspects of managing chronic pain in cancer survivors on LTOT, although challenges persist, including the lack of systems-based approaches and training in addiction treatment.
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Affiliation(s)
- Jessica S Merlin
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - Kanan Patel
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Nicole Thompson
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Jennifer Kapo
- Palliative Medicine Program, Division of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Frank Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jane Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Judith Paice
- Division Hematology-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joanna Starrels
- Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Julie Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
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Barreto ML, Rodrigues LC. Linkage of Administrative Datasets: Enhancing Longitudinal Epidemiological Studies in the Era of “Big Data”. CURR EPIDEMIOL REP 2018. [DOI: 10.1007/s40471-018-0177-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Birke H, Ekholm O, Højsted J, Sjøgren P, Kurita GP. Chronic Pain, Opioid Therapy, Sexual Desire, and Satisfaction in Sexual Life: A Population-Based Survey. PAIN MEDICINE 2018; 20:1132-1140. [DOI: 10.1093/pm/pny122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jette Højsted
- Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Geana Paula Kurita
- Department of Oncology
- Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Birke H, Ekholm O, Sjøgren P, Kurita GP, Højsted J. Long-term opioid therapy in Denmark: A disappointing journey. Eur J Pain 2017; 21:1516-1527. [PMID: 28481052 DOI: 10.1002/ejp.1053] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Longitudinal population-based studies of long-term opioid therapy (L-TOT) in chronic non-cancer pain (CNCP) patients are sparse. Our study investigated incidence and predictors for initiating L-TOT and changes in self-rated health, pain interference and physical activities in long-term opioid users. METHODS Data were obtained from the national representative Danish Health and Morbidity Surveys and The Danish National Prescription Registry. Respondents with no dispensed opioids the year before the survey were followed from 2000 and from 2005 until the end of 2012 (n = 12,145). A nationally representative subsample of individuals (n = 2015) completed the self-administered questionnaire in both 2000 and 2013. Collected information included chronic pain (≥6 months), health behaviour, self-rated health, pain interference with work activities and physical activities. Long-term users were defined as those who were dispensed at least one opioid prescription in six separate months within a year. RESULTS The incidence of L-TOT was substantially higher in CNCP patients at baseline than in others (9/1000 vs. 2/1000 person-years). Smoking behaviour and dispensed benzodiazepines were significantly associated with initiation of L-TOT in individuals with CNCP at baseline. During follow-up, L-TOT in CNCP patients increased the likelihood of negative changes in pain interference with work (OR 9.2; 95% CI 1.9-43.6) and in moderate activities (OR 3.7; 95% CI 1.1-12.6). The analysis of all individuals indicated a dose-response relationship between longer treatment duration and the risk of experiencing negative changes. CONCLUSIONS Individuals on L-TOT seemed not to achieve the key goals of opioid therapy: pain relief, improved quality of life and functional capacity. SIGNIFICANCE Long-term opioid therapy does not seem to provide pain relief, improvement in HRQOL and physical capacity in CNCP patients in a general population.
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Affiliation(s)
- H Birke
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark
| | - O Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - P Sjøgren
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen, Denmark
| | - G P Kurita
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark.,Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Denmark
| | - J Højsted
- Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Denmark
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Bennett M, Paice JA, Wallace M. Pain and Opioids in Cancer Care: Benefits, Risks, and Alternatives. Am Soc Clin Oncol Educ Book 2017; 37:705-713. [PMID: 28561731 DOI: 10.1200/edbk_180469] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pain remains common in the setting of malignancy, occurring as a consequence of cancer and its treatment. Several high-quality studies confirm that more than 50% of all patients with cancer experience moderate to severe pain. The prevalence of pain in cancer survivors is estimated to be 40%, while close to two-thirds of those with advanced disease live with pain. Progress has occurred in the management of cancer pain, yet undertreatment persists. Additionally, new challenges are threatening these advances. These challenges are numerous and include educational deficits, time restraints, and limited access to all types of care. New challenges to access are occurring as a result of interventions designed to combat the prescription drug abuse epidemic, with fewer clinicians willing to prescribe opioids, pharmacies reluctant to stock the medications, and payers placing strict limits on reimbursement. A related challenge is our evolving understanding of the risks of long-term adverse effects associated with opioids. And reflective of the opioid abuse epidemic affecting the general population, the potential for misuse or abuse exists in those with cancer. Guidelines have been developed to support oncologists when prescribing the long-term use of opioids for cancer survivors. The challenges surrounding the use of opioids, and the need for safe and effective alternative analgesics, are leading to intense interest in the potential benefits of cannabis for cancer-related pain. Oncologists are faced with questions regarding the types of cannabis available, differences between routes of administration, data concerning safety and efficacy, and legal and regulatory dynamics.
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Affiliation(s)
- Mike Bennett
- From the Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom; Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, IL; Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Judith A Paice
- From the Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom; Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, IL; Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Mark Wallace
- From the Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom; Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, IL; Department of Anesthesiology, University of California, San Diego, San Diego, CA
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Ekholm O, Juel K, Bonde LO. Associations between daily musicking and health: Results from a nationwide survey in Denmark. Scand J Public Health 2016; 44:726-732. [DOI: 10.1177/1403494816664252] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: To examine the associations between singing/playing musical instruments daily and various outcomes such as health-related quality of life and health behaviour. Methods: Data originates from the Danish Health and Morbidity Survey 2013. The survey was based on a random sample of 25,000 adult Danes (response rate: 57%). Besides standard health-related questions the survey included eight specific music questions, based on a review of the sparse literature on music and health. On the same basis, ‘daily musicking’ was defined as normally singing/playing musical instruments at least 1 h/day. Results: Both musically active men and women were more likely to report good self-rated health than individuals that were not active musically. However, the results also indicated that musically active women were less likely to report poor physical and mental health than women who were not active musically, while this pattern was not found among men. Conclusions: Gender seems to play an important role in the association between musicking and health, but more research is needed to understand these differences and the underlying mechanisms. In addition, longitudinal studies are warranted to examine the causal effects of musicking.
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Affiliation(s)
- Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Ole Bonde
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
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Birke H, Kurita GP, Sjøgren P, Højsted J, Simonsen MK, Juel K, Ekholm O. Chronic non-cancer pain and the epidemic prescription of opioids in the Danish population: trends from 2000 to 2013. Acta Anaesthesiol Scand 2016; 60:623-33. [PMID: 26861026 DOI: 10.1111/aas.12700] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/20/2015] [Accepted: 12/18/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Chronic pain has serious consequences for individuals and society. In addition, opioid prescription for chronic non-cancer pain (CNCP) has become more frequent. This study aims to examine the trends regarding the prevalence of CNCP, dispensed opioids, and concurrent use of benzodiazepine (BZD)/BZD-related drugs in the Danish population. METHODS Data from the cross-sectional national representative Danish Health and Morbidity Surveys (2000, 2005, 2010, and 2013) were combined with The Danish National Prescription Registry at an individual level. The study populations varied between 5000 and 13,000 individuals ≥16 years (response rates: 51-63%). Respondents completed a self-administered questionnaire, which included the analyzed items on identification of chronic pain (≥6 months). RESULTS From 2000 to 2013, the prevalence of CNCP increased and subsequently the annual prevalence of opioid use from 4.1% to 5.7% among CNCP individuals. Higher CNCP prevalence was related to female gender, no cohabitation partner, short education, non-Western origin, and overweight/obesity. In addition, women with CNCP, especially >65 years, became more frequent users of opioids and used higher doses than men. Concurrent use of BZD/BZD-related drugs decreased (13%) from 2010 to 2013, still one-third of long-term opioid user were co-medicated with these drugs. CONCLUSIONS The use of opioids has increased in Denmark, especially among elderly women. The concurrent use of BZD/BZD-related drugs has decreased from 2010 to 2013, but still one-third of long-term opioid users were co-medicated.
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Affiliation(s)
- H. Birke
- Department of Oncology; Rigshospitalet; Copenhagen Denmark
| | - G. P. Kurita
- Department of Oncology; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - P. Sjøgren
- Department of Oncology; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - J. Højsted
- Multidisciplinary Pain Centre; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - M. K. Simonsen
- Finsencenter; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - K. Juel
- National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
| | - O. Ekholm
- National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
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Ekholm O, Juel K, Bonde L. Music and public health – An empirical study of the use of music in the daily life of adult Danes and the health implications of musical participation. Arts Health 2015. [DOI: 10.1080/17533015.2015.1048696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
BACKGROUND The number of patients surviving cancer disease has increased in last decades. Consequently, an emerging population with different needs due to long-term or late effects of cancer disease and/or treatment, e.g. chronic pain, is of major concern. EPIDEMIOLOGY Chronic pain is one of the main problems in this population and prevalence varies between 16% and 50%. Most information derives from breast cancer patients assessed by surveys from national or local institutional databases. A Danish population-based survey estimated that 41.5% of all cancer survivors reported chronic pain. PAIN ETIOLOGY: Neuropathic pain seems to be the major pain etiology in cancer survivors and therefore adjuvant analgesics should be the first choice of analgesic treatment. CONTEXT This article addresses the central aspects of pain epidemiology, mechanisms and the frequent pain syndromes met in cancer survivors. Pain management strategies are discussed according to the biopsychosocial model and with the rapidly growing number of cancer survivors the establishment of multidisciplinary clinics as a part of comprehensive cancer centers are proposed.
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Chronic pain, opioid prescriptions, and mortality in Denmark: A population-based cohort study. Pain 2014; 155:2486-2490. [DOI: 10.1016/j.pain.2014.07.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/30/2014] [Accepted: 07/03/2014] [Indexed: 11/23/2022]
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Bronnum-Hansen H, Jeune B. Gender-specific modifying effect on the educational disparities in the impact of smoking on health expectancy. Eur J Public Health 2014; 25:477-81. [DOI: 10.1093/eurpub/cku185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hansen E, Fonager K, Freund KS, Lous J. The impact of non-responders on health and lifestyle outcomes in an intervention study. BMC Res Notes 2014; 7:632. [PMID: 25213806 PMCID: PMC4175272 DOI: 10.1186/1756-0500-7-632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background A randomized intervention study, “Preventive consultations for 20- to 40-year-old young adults”, investigated whether preventive consultations with a general practitioner could help young adults with multiple psychosocial and lifestyle problems to change health behavior. To optimize the response rate of questionnaires at 1 year post-intervention, the non-responders were reminded by telephone. The aim of this study was to examine potential selection bias induced by non-response by comparing responder and non-responder populations at baseline, and to examine the impact on outcomes by comparing initial respondents to respondents after telephone reminding. Method Non-responders were compared with primary responders using logistic regression models that included socio-demographic factors, health-related factors, and variables related to the intervention study. In order to describe the impact of including responders after telephone reminding on the intervention’s effect on different health, resource, and lifestyle outcomes, we compared results in models including and excluding responders after telephone reminding. Results Telephone contact raised the response by 10% from 316 (64%) to 364 (74%) among young adults with multiple problems. Being male was the only factor that significantly predicted non-response in the model after adjustment for other variables. The responders after telephone reminding tended to improve health and lifestyle more than the primary responders, but not significantly so. Although the additional responses did not change the estimates of the 1-year effect on health and lifestyle changes, it contributed to increased precision of the results. Conclusion Even though the population of primary non-responders had to some degree a different composition than the primary responders, inclusion of responders after telephone reminding did not significantly change the estimates for effect at the 1-year follow-up; however, the additional responses increased the precision of the estimates. Trial registration ClinicalTrials.gov: NCT01231256
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Affiliation(s)
- Elsebeth Hansen
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, DK-9000 Aalborg, Denmark.
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Conaghan PG, Kloppenburg M, Schett G, Bijlsma JWJ. Osteoarthritis research priorities: a report from a EULAR ad hoc expert committee. Ann Rheum Dis 2014; 73:1442-5. [DOI: 10.1136/annrheumdis-2013-204660] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Hjsted J, Ekholm O, Kurita GP, Juel K, Sjgren P. Addictive behaviors related to opioid use for chronic pain: A population-based study. Pain 2013; 154:2677-2683. [DOI: 10.1016/j.pain.2013.07.046] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 02/09/2023]
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Helleberg M, Afzal S, Kronborg G, Larsen CS, Pedersen G, Pedersen C, Gerstoft J, Nordestgaard BG, Obel N. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis 2012; 56:727-34. [PMID: 23254417 DOI: 10.1093/cid/cis933] [Citation(s) in RCA: 326] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV). METHODS We estimated mortality rates (MRs), mortality rate ratios (MRRs), life expectancies, life-years lost, and population-attributable risk of death associated with smoking and with HIV among current and nonsmoking individuals from a population-based, nationwide HIV cohort and a cohort of matched HIV-negative individuals. RESULTS A total of 2921 HIV patients and 10 642 controls were followed for 14 281 and 45 122 person-years, respectively. All-cause and non-AIDS-related mortality was substantially increased among smoking compared to nonsmoking HIV patients (MRR, 4.4 [95% confidence interval {CI}, 3.0-6.7] and 5.3 [95% CI, 3.2-8.8], respectively). Excess MR per 1000 person-years among current vs nonsmokers was 17.6 (95% CI, 13.3-21.9) for HIV patients and 4.8 (95% CI, 3.2-6.4) for controls. A 35-year-old HIV patient had a median life expectancy of 62.6 years (95% CI, 59.9-64.6) for smokers and 78.4 years (95% CI, 70.8-84.0) for nonsmokers; the numbers of life-years lost in association with smoking and HIV were 12.3 (95% CI, 8.1-16.4) and 5.1 (95% CI, 1.6-8.5). The population-attributable risk of death associated with smoking was 61.5% among HIV patients and 34.2% among controls. CONCLUSIONS In a setting where HIV care is well organized and antiretroviral therapy is free of charge, HIV-infected smokers lose more life-years to smoking than to HIV. The excess mortality of smokers is tripled and the population-attributable risk of death associated with smoking is doubled among HIV patients compared to the background population.
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Affiliation(s)
- Marie Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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The burden of chronic pain: A cross-sectional survey focussing on diseases, immigration, and opioid use. Pain 2012; 153:2332-2338. [DOI: 10.1016/j.pain.2012.07.023] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 07/19/2012] [Accepted: 07/20/2012] [Indexed: 11/21/2022]
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Hartvigsen J, Davidsen M, Hestbaek L, Sogaard K, Roos E. Patterns of musculoskeletal pain in the population: A latent class analysis using a nationally representative interviewer-based survey of 4817 Danes. Eur J Pain 2012; 17:452-60. [DOI: 10.1002/j.1532-2149.2012.00225.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 11/12/2022]
Affiliation(s)
| | - M. Davidsen
- National Institute of Public Health; Copenhagen; Denmark
| | | | - K. Sogaard
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense; Denmark
| | - E.M. Roos
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense; Denmark
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A method to assess the potential effects of air pollution mitigation on healthcare costs. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:935825. [PMID: 22997524 PMCID: PMC3446725 DOI: 10.1155/2012/935825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/14/2012] [Indexed: 11/17/2022]
Abstract
Objective. The aim of this study was to develop a method to assess the potential effects of air pollution mitigation on healthcare costs and to apply this method to assess the potential savings related to a reduction in fine particle matter in Denmark. Methods. The effects of air pollution on health were used to identify “exposed” individuals (i.e., cases). Coronary heart disease, stroke, chronic obstructive pulmonary disease, and lung cancer were considered to be associated with air pollution. We used propensity score matching, two-part estimation, and Lin's method to estimate healthcare costs. Subsequently, we multiplied the number of saved cases due to mitigation with the healthcare costs to arrive to an expression for healthcare cost savings. Results. The potential cost saving in the healthcare system arising from a modelled reduction in air pollution was estimated at €0.1–2.6 million per 100,000 inhabitants for the four diseases. Conclusion. We have illustrated an application of a method to assess the potential changes in healthcare costs due to a reduction in air pollution. The method relies on a large volume of administrative data and combines a number of established methods for epidemiological analysis.
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Thvilum M, Brandt F, Brix TH, Hegedüs L. A review of the evidence for and against increased mortality in hypothyroidism. Nat Rev Endocrinol 2012; 8:417-24. [PMID: 22392154 DOI: 10.1038/nrendo.2012.29] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The lifetime risk of overt hypothyroidism is around 5%, and this disease is usually preceded by subclinical hypothyroidism, which has an even higher prevalence (estimated to be up to 9%). Hypothyroidism has been linked with cardiac dysfunction, atherosclerosis, hypertension and coagulopathy. Intuitively, this increased morbidity is expected to shorten patients' lifespan, but definitive data are lacking on whether either of these hypothyroid states (particularly overt hypothyroidism) increase mortality. Study findings are inconsistent and, overall, the pooled data do not demonstrate increased mortality in patients with either subclinical or overt hypothyroidism. However, none of the available studies was adequately designed to answer this question. This Review discusses major shortcomings in those studies, such as population dissimilarities, hypothyroid state classification and misclassification, the inclusion of nonthyroidal illness, drug interference from concurrent therapies, serious comorbidities (for example, cardiovascular disease), differences in duration of follow-up and the number of levothyroxine-treated individuals. Taken together, the data exhibit little evidence of systematic bias and no strong scientific proof of increased mortality related to either subclinical or overt hypothyroidism. Future studies, however, should take the above-mentioned shortcomings and potential genetic confounding into consideration.
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Affiliation(s)
- Marianne Thvilum
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
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