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Møllehave LT, Madsen AL, Kampmann FB, Bjerregaard AA, Dantoft TM, Leth-Møller KB, Thysen SM, Schovsbo SU, Jacobsen RK, Aadahl M, Osler M, Jørgensen T, Linneberg A, Kårhus LL. Cohort Profile Update: The Glostrup Population Studies 1964-2024. Int J Epidemiol 2024; 53:dyae051. [PMID: 38734963 DOI: 10.1093/ije/dyae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/22/2024] [Indexed: 05/13/2024] Open
Affiliation(s)
- Line Tang Møllehave
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anja Lykke Madsen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Freja Bach Kampmann
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anne Ahrendt Bjerregaard
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Katja Biering Leth-Møller
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Sanne Marie Thysen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Signe Ulfbeck Schovsbo
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rikke Kart Jacobsen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mette Aadahl
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Line Lund Kårhus
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Vo CQ, Samuelsen PJ, Sommerseth HL, Wisløff T, Wilsgaard T, Eggen AE. Comparing the sociodemographic characteristics of participants and non-participants in the population-based Tromsø Study. BMC Public Health 2023; 23:994. [PMID: 37248482 PMCID: PMC10226228 DOI: 10.1186/s12889-023-15928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Differences in the sociodemographic characteristics of participants and non-participants in population-based studies may introduce bias and reduce the generalizability of research findings. This study aimed to compare the sociodemographic characteristics of participants and non-participants of the seventh survey of the Tromsø Study (Tromsø7, 2015-16), a population-based health survey. METHODS A total of 32,591 individuals were invited to Tromsø7. We compared the sociodemographic characteristics of participants and non-participants by linking the Tromsø7 invitation file to Statistics Norway, and explored the association between these characteristics and participation using logistic regression. Furthermore, we created a geographical socioeconomic status (area SES) index (low-SES, medium-SES, and high-SES area) based on individual educational level, individual income, total household income, and residential ownership status. We then mapped the relationship between area SES and participation in Tromsø7. RESULTS Men, people aged 40-49 and 80-89 years, those who were unmarried, widowed, separated/divorced, born outside of Norway, had lower education, had lower income, were residential renters, and lived in a low-SES area had a lower probability of participation in Tromsø7. CONCLUSIONS Sociodemographic differences in participation must be considered to avoid biased estimates in research based on population-based studies, especially when the relationship between SES and health is being explored. Particular attention should be paid to the recruitment of groups with lower SES to population-based studies.
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Affiliation(s)
- Chi Quynh Vo
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway.
| | - Per-Jostein Samuelsen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), University Hospital of North Norway, Tromsø, Norway
| | - Hilde Leikny Sommerseth
- The Norwegian Historical Data Centre, Department of Archaeology, History, Religious Studies and Theology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
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3
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Inoue M, Li MH, Layman S, Tompkins CJ, Ihara ES. Characteristics of Nursing Facilities and Staff Willingness to Implement a Non-Pharmacological Intervention. Gerontol Geriatr Med 2022; 8:23337214221146410. [PMID: 36582661 PMCID: PMC9793045 DOI: 10.1177/23337214221146410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022] Open
Abstract
While non-pharmacological interventions could positively impact mood and behaviors of nursing-home residents who are living with dementia, some facilities are more willing to adopt such interventions than others. This study investigated the characteristics of Medicaid-funded nursing facilities that were associated with their willingness to implement a non-pharmacological intervention, personalized music. Using the publicly-available dataset (aka LTCfocus) from Brown University, this study examined characteristics of nursing homes in Virginia that have implemented or are in the process of implementing a personalized music intervention (n = 59) and that have decided not to implement it (n = 216). The findings indicate that nursing facilities with a higher proportion of long-term residents are more likely to implement the intervention. The findings can inform future research recruitment strategies. In addition, a greater understanding of the use of non-pharmacological interventions in relation to the characteristics of nursing facilities offers insight to policymakers and public health officials regarding resource allocations to facilities.
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Affiliation(s)
- Megumi Inoue
- George Mason University, Fairfax, VA,
USA,Megumi Inoue, Department of Social Work,
George Mason University, 4400 University Drive, MSN: 1F8, Fairfax, VA 22030,
USA.
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4
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Bender M, Willaing Tapager I, Brønnum-Hansen H, Andersen I, Glümer C, Vrangbæk K. Equity of referrals to type 2 diabetes rehabilitation in a universal welfare state. SSM Popul Health 2022; 20:101303. [DOI: 10.1016/j.ssmph.2022.101303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
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5
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Freyer-Adam J, Krolo F, Tiede A, Goeze C, Sadewasser K, Spielmann M, Krause K, John U. Proactive automatised lifestyle intervention (PAL) in general hospital patients: study protocol of a single-group trial. BMJ Open 2022; 12:e065136. [PMID: 36123081 PMCID: PMC9486346 DOI: 10.1136/bmjopen-2022-065136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The co-occurrence of health risk behaviours (HRBs, ie, tobacco smoking, at-risk alcohol use, insufficient physical activity and unhealthy diet) increases the risks of cancer, other chronic diseases and mortality more than additively; and applies to more than half of adult general populations. However, preventive measures that target all four HRBs and that reach the majority of the target populations, particularly those persons most in need and hard to reach are scarce. Electronic interventions may help to efficiently address multiple HRBs in healthcare patients. The aim is to investigate the acceptance of a proactive and brief electronic multiple behaviour change intervention among general hospital patients with regard to reach, retention, equity in reach and retention, satisfaction and changes in behaviour change motivation, HRBs and health. METHODS AND ANALYSIS A pre-post intervention study with four time points is conducted at a general hospital in Germany. All patients, aged 18-64 years, admitted to participating wards of five medical departments (internal medicine A and B, general surgery, trauma surgery, ear, nose and throat medicine) are systematically approached and invited to participate. Based on behaviour change theory and individual HRB profile, 175 participants receive individualised and motivation-enhancing computer-generated feedback at months 0, 1 and 3. Intervention reach and retention are determined by the proportion of participants among eligible patients and of participants who continue participation, respectively. Equity in reach and retention are measured with regard to school education and other sociodemographics. To investigate satisfaction with the intervention and subsequent changes, a 6-month follow-up is conducted. Descriptive statistics, multivariate regressions and latent growth modelling are applied. ETHICS AND DISSEMINATION The local ethics commission and data safety appointee approved the study procedures. Results will be disseminated via publication in international scientific journals and presentations on scientific conferences. TRIAL REGISTRATION NUMBER NCT05365269.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Filipa Krolo
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Anika Tiede
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Christian Goeze
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Kornelia Sadewasser
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Marie Spielmann
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Kristian Krause
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Ulrich John
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
- Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Staudt A, Freyer-Adam J, Meyer C, Bischof G, John U, Baumann S. The Moderating Effect of Educational Background on the Efficacy of a Computer-Based Brief Intervention Addressing the Full Spectrum of Alcohol Use: Randomized Controlled Trial. JMIR Public Health Surveill 2022; 8:e33345. [PMID: 35771621 PMCID: PMC9284353 DOI: 10.2196/33345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The alcohol-attributable burden of disease is high among socially disadvantaged individuals. Interventional efforts intending to have a public health impact should also address the reduction of social inequalities due to alcohol. Objective The aim was to test the moderating role of educational background on the efficacy of a computer-based brief intervention addressing the full spectrum of alcohol use. Methods We recruited 1646 adults from the general population aged 18 to 64 years (920 women, 55.9%; mean age 31 years; 574 with less than 12 years of school education, 34.9%) who reported alcohol use in the past year. The participants were randomly assigned a brief alcohol intervention or to assessment only (participation rate, 66.9%, 1646/2463 eligible persons). Recruitment took place in a municipal registry office in one German city. All participants filled out a self-administered, tablet-based survey during the recruitment process and were assessed 3, 6, and 12 months later by study assistants via computer-assisted telephone interviews. The intervention consisted of 3 computer-generated and individualized feedback letters that were sent via mail at baseline, month 3, and month 6. The intervention was based on the transtheoretical model of behavior change and expert system software that generated the feedback letters automatically according to previously defined decision rules. The outcome was self-reported change in number of alcoholic drinks per week over 12 months. The moderator was school education according to highest general educational degree (less than 12 years of education vs 12 years or more). Covariates were sex, age, employment, smoking, and alcohol-related risk level. Results Latent growth modeling revealed that the intervention effect after 12 months was moderated by educational background (incidence rate ratio 1.38, 95% CI 1.08-1.76). Individuals with less than 12 years of school education increased their weekly alcohol use to a lesser extent when they received the intervention compared to assessment only (incidence rate ratio 1.30, 95% CI 1.05-1.62; Bayes factor 3.82). No difference was found between groups (incidence rate ratio 0.95, 95% CI 0.84-1.07; Bayes factor 0.30) among those with 12 or more years of school education. Conclusions The efficacy of an individualized brief alcohol intervention was moderated by the participants’ educational background. Alcohol users with less than 12 years of school education benefited, whereas those with 12 or more years did not. People with lower levels of education might be more receptive to the behavior change mechanisms used by brief alcohol interventions. The intervention approach may support the reduction of health inequalities in the population at large if individuals with low or medium education can be reached. Trial Registration German Clinical Trials Register DRKS00014274; https://www.drks.de/DRKS00014274
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Affiliation(s)
- Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Christian Meyer
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany.,Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrich John
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany.,Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sophie Baumann
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Werba JP, Giroli MG, Simonelli N, Vigo L, Gorini A, Bonomi A, Veglia F, Tremoli E. Uptake and effectiveness of a primary cardiovascular prevention program in an underserved multiethnic urban community. Nutr Metab Cardiovasc Dis 2022; 32:1110-1120. [PMID: 35260313 DOI: 10.1016/j.numecd.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Cardiometabolic risk is increased among disadvantaged people and ethnic minorities. Paradoxically, their uptake of primary cardiovascular prevention is relatively low. New strategies are needed to tackle this public health problem. Aims of this study were to assess the uptake (as well as its determinants) and effectiveness of a primary cardiovascular prevention program for communities devised to facilitate access of disadvantaged and inclusion of ethnic minorities in addition to providing a state-of-the-art interdisciplinary personalized care. METHODS AND RESULTS Single center, hospital-based, open study. All the residents in an underserved multiethnic urban community aged 40-65 years (n = 1646, 43.6% immigrants) were proactively invited by post mail to participate in a cardiovascular prevention program and different approaches were adopted to promote accessibility and inclusiveness. Program uptake was 23% and individual features independently associated with program uptake were status of immigrant (OR [CI 95%]: 3.6 [2.6-5.1]), higher educational level (3.6 [2.8-4.7]), and female gender (1.6 [1.2-2.1]). Retention was 82% at 6 months and 69% at 12 months. A predefined outcome of global cardiovascular risk improvement at 12 months in subjects with glycaemia >126 mg/dl, LDL-C >115 mg/dl, systolic blood pressure ≥140 mmHg or BMI >28 at baseline was reached in 35%, 33%, 37% and 7% of the patients, respectively. 20% of smokers quitted and significant favorable changes were reported in diet quality, anxiety, depression and physical activity. CONCLUSION Access inequalities to effective prevention may be counteracted, but increasing global uptake requires further upstream sensitization and awareness actions. REGISTERED IN CLINICALTRIALS.GOV: NCT03129165.
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Affiliation(s)
- José P Werba
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.
| | - Monica G Giroli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Niccolò Simonelli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy; Struttura Complessa Cardiologia, Azienda Ospedaliera Ss. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Lorenzo Vigo
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Alessandra Gorini
- Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/a, 20122 Milan, Italy; Istituti Clinici Scientifici Maugeri di Milano, IRCCS, 20138 Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy; Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola Ravenna, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy; Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola Ravenna, Italy
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Shimoda A, Saito Y, Kondo N. Postal reminder with reduced burden of clinic information seeking for equitable participation in general health check-ups: A randomized controlled trial. Prev Med 2022; 157:107009. [PMID: 35248681 DOI: 10.1016/j.ypmed.2022.107009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/18/2022] [Accepted: 02/26/2022] [Indexed: 11/15/2022]
Abstract
High participation rate and low inequality in participation are key to the program success of general health check-ups in Japan. This study examined the effectiveness of a postal reminder including nearest clinic information, compared to the standard postal reminder including details of all local clinics, on participation rate and income-based participation rate in general health checks. This was a single-blind, two-arm, prospective, randomized controlled study conducted at the Fukuoka Branch of Japan Health Insurance Association. Dependents (family members) of insured persons aged 40-69 years were randomly assigned (1:1) to the intervention group that received a tailored postal reminder intervention (showing information on the nearest clinic from each participant's address) or to the control group that received an original template postal reminder (containing just the URL of the website listing all available clinics). Allocation was concealed from participants and service providers of general health check-up. The primary outcome was participation in general health check-ups within 1 month of intervention. Between February 1 and February 10, 2017, 21,017 were randomly assigned to the intervention (n = 10,474) or control (n = 10,543) group. The participation rate in the intervention group was higher than control group (3.2% vs. 2.1%; OR: 1.55, 95% CI: 1.31-1.85, P < 0.001). The intervention effect was estimated to decrease as the income category increased (P for interaction = 0.037). Tailored postal reminders with information on the nearest clinic were able to improve the overall participation rate and reduce income-based inequality in participation for general health check-ups in Japan. Trial registration: UMIN-CTR, UMIN000042509, Registered 26 November 2020 - Retrospectively registered.
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Affiliation(s)
- Akihiro Shimoda
- Department of Social Epidemiology and Global Health, Graduate School of Medicine and School of Public Health, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yoshiyuki Saito
- Department of Health Economics & Outcomes Research, Graduate School of Pharmaceutical Sciences, the University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Naoki Kondo
- Department of Social Epidemiology and Global Health, Graduate School of Medicine and School of Public Health, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
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Freyer-Adam J, Baumann S, Bischof G, Staudt A, Goeze C, Gaertner B, John U. Social Equity in the Efficacy of Computer-Based and In-Person Brief Alcohol Interventions Among General Hospital Patients With At-Risk Alcohol Use: A Randomized Controlled Trial. JMIR Ment Health 2022; 9:e31712. [PMID: 35089156 PMCID: PMC8838551 DOI: 10.2196/31712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Social equity in the efficacy of behavior change intervention is much needed. While the efficacy of brief alcohol interventions (BAIs), including digital interventions, is well established, particularly in health care, the social equity of interventions has been sparsely investigated. OBJECTIVE We aim to investigate whether the efficacy of computer-based versus in-person delivered BAIs is moderated by the participants' socioeconomic status (ie, to identify whether general hospital patients with low-level education and unemployed patients may benefit more or less from one or the other way of delivery compared to patients with higher levels of education and those that are employed). METHODS Patients with nondependent at-risk alcohol use were identified through systematic offline screening conducted on 13 general hospital wards. Patients were approached face-to-face and asked to respond to an app for self-assessment provided by a mobile device. In total, 961 (81% of eligible participants) were randomized and received their allocated intervention: computer-generated and individually tailored feedback letters (CO), in-person counseling by research staff trained in motivational interviewing (PE), or assessment only (AO). CO and PE were delivered on the ward and 1 and 3 months later, were based on the transtheoretical model of intentional behavior change and required the assessment of intervention data prior to each intervention. In CO, the generation of computer-based feedback was created automatically. The assessment of data and sending out feedback letters were assisted by the research staff. Of the CO and PE participants, 89% (345/387) and 83% (292/354) received at least two doses of intervention, and 72% (280/387) and 54% (191/354) received all three doses of intervention, respectively. The outcome was change in grams of pure alcohol per day after 6, 12, 18, and 24 months, with the latter being the primary time-point of interest. Follow-up interviewers were blinded. Study group interactions with education and employment status were tested as predictors of change in alcohol use using latent growth modeling. RESULTS The efficacy of CO and PE did not differ by level of education (P=.98). Employment status did not moderate CO efficacy (Ps≥.66). Up to month 12 and compared to employed participants, unemployed participants reported significantly greater drinking reductions following PE versus AO (incidence rate ratio 0.44, 95% CI 0.21-0.94; P=.03) and following PE versus CO (incidence rate ratio 0.48, 95% CI 0.24-0.96; P=.04). After 24 months, these differences were statistically nonsignificant (Ps≥.31). CONCLUSIONS Computer-based and in-person BAI worked equally well independent of the patient's level of education. Although findings indicate that in the short-term, unemployed persons may benefit more from BAI when delivered in-person rather than computer-based, the findings suggest that both BAIs have the potential to work well among participants with low socioeconomic status. TRIAL REGISTRATION ClinicalTrials.gov NCT01291693; https://clinicaltrials.gov/ct2/show/NCT01291693.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Sophie Baumann
- Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, Medical University of Lübeck, Luebeck, Germany
| | - Andreas Staudt
- Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christian Goeze
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
| | - Ulrich John
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany.,Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Knaup T, Esser A, Schettgen T, Kraus T, Kaifie A. Which factors influence the frequency of participation in longitudinal cohort studies? - An analysis of demographics, social factors, and medical preconditions in participants of the health effects in high level exposure to polychlorinated biphenyls (HELPcB) cohort. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2021; 84:973-985. [PMID: 34369284 DOI: 10.1080/15287394.2021.1962465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The continuous drop out of participants in longitudinal studies is a trend that may be observed in nearly all fields of medical research. A reduced participation rate might compromise the power of statistical analysis as well as lead to an attrition bias of the study. The aim of this analysis was to identify influencing factors on participation frequency in the monitoring program Health Effects in High Level Exposure to polychlorinated biphenyls (HELPcB) study, a cohort investigation of occupationally polychlorinated biphenyls (PCB) exposed individuals. The HELPcB study was initiated in 2010 and consisted of 7 study visits. At the last cross-section in 2019, less than one third of the included patients still actively participated. As possible influencing factors on study participation frequency, demographic, social, and medical characteristics of the participants were examined. In addition, a logistic regression model to predict study participation behavior was calculated. An overall higher frequency of participation was observed, if participants joined the program together with relatives or friends and had a higher age. For PCB plasma levels, an exceedance of the biological reference value (BAR) and further factors, such as (1) professional qualification, (2) later inclusion, (3) type of participant and (4) occupational-related disease notification, significant differences in the participation frequency were observed in the univariate analysis. Only age and joined study participation remained significant in the multivariate logistic regression. In conclusion, it was possible to identify several social and occupational-related factors that influence the frequency of participation of study attendees.
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Affiliation(s)
- Theresa Knaup
- Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andre Esser
- Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Thomas Schettgen
- Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Thomas Kraus
- Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andrea Kaifie
- Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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11
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Jalkanen K, Järvenpää R, Tilles-Tirkkonen T, Martikainen J, Aarnio E, Männikkö R, Rantala E, Karhunen L, Kolehmainen M, Harjumaa M, Poutanen K, Ermes M, Absetz P, Schwab U, Lakka T, Pihlajamäki J, Lindström J. Comparison of Communication Channels for Large-Scale Type 2 Diabetes Risk Screening and Intervention Recruitment: Empirical Study. JMIR Diabetes 2021; 6:e21356. [PMID: 34499036 PMCID: PMC8461532 DOI: 10.2196/21356] [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: 06/19/2020] [Revised: 11/26/2020] [Accepted: 07/13/2021] [Indexed: 01/19/2023] Open
Abstract
Background Clinical trials have shown that type 2 diabetes (T2D) is preventable through lifestyle interventions targeting high-risk people. Nevertheless, large-scale implementation of risk identification followed by preventive interventions has proven to be challenging. Specifically, recruitment of participants into preventive interventions is an important but often overlooked part of the intervention. Objective This study aims to compare the reach and yield of different communication channels to engage people at increased risk of T2D to fill in a digital screening questionnaire, with emphasis on reaching those at most risk. The participants expressing their willingness to participate is the final step in the risk screening test, and we aim to determine which channels had the most participants reach this step. Methods We established a stepwise web-based T2D risk screening tool with automated feedback according to the T2D risk level and, for those who were eligible, an invitation to participate in the StopDia prevention intervention study conducted in a primary health care setting. The risk estimate was based on the Finnish Diabetes Risk Score; history of repeatedly measured high blood glucose concentration; or, among women, previous gestational diabetes. We used several channels to invite people to the StopDia web-based screening tool, and respondents were classified into 11 categories based on the channel through which they reported having learned about StopDia. The demographics of respondents reached via different communication channels were compared using variance analysis. Logistic regression was used to study the respondents’ likelihood of progressing through risk screening steps. Results A total of 33,399 persons started filling the StopDia screening tool. Of these, 86.13% (28,768/33,399) completed the test and named at least one communication channel as the source of information about StopDia. Altogether, 26,167 persons filled in sufficient information to obtain risk estimates. Of them, 53.22% (13,925/26,167) were at increased risk, 30.06% (7866/26,167) were men, and 39.77% (10,136/25,485) had low or middle education levels. Most frequently mentioned channels were workplace (n=6817), social media or the internet (n=6712), and newspapers (n=4784). The proportion of individuals at increased risk was highest among those reached via community pharmacies (415/608, 68.3%) and health care (1631/2535, 64.33%). The communication channel reaching the largest percentage of interested and eligible men (1353/3979, 34%) was relatives or friends. Health care (578/1069, 54.07%) and radio or television (225/487, 46.2%) accounted for the largest proportion of people with lower education. Conclusions Communication channels reaching a large number of people, such as social media and newspapers, were the most effective channels for identifying at-risk people. Personalized approaches increased the engagement of men and less-educated people. Community pharmacies and health care services reached people with a particularly high T2D risk. Thus, communication and recruitment channels should be selected and modified based on the intended target group. International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-6574-y
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Affiliation(s)
- Kari Jalkanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Riia Järvenpää
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tanja Tilles-Tirkkonen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Janne Martikainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Emma Aarnio
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Reija Männikkö
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Eeva Rantala
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Leila Karhunen
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Marjukka Kolehmainen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Miikka Ermes
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Pilvikki Absetz
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ursula Schwab
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Timo Lakka
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - Jussi Pihlajamäki
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - Jaana Lindström
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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12
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Bjerregaard AL, Dalsgaard EM, Bruun NH, Norman K, Witte DR, Stovring H, Maindal HT, Sandbæk A. Effectiveness of the population-based 'check your health preventive programme' conducted in a primary care setting: a pragmatic randomised controlled trial. J Epidemiol Community Health 2021; 76:24-31. [PMID: 34145078 PMCID: PMC8666817 DOI: 10.1136/jech-2021-216581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/27/2021] [Indexed: 01/09/2023]
Abstract
Background Health checks have been suggested as an early detection approach aiming at lowering the risk of chronic disease development. This study aimed to evaluate the effectiveness of a health check programme offered to the general population, aged 30–49 years. Methods The entire population aged 30–49 years (N=26 216) living in the municipality of Randers, Denmark, was invited to a health check during 5 years. A pragmatic household cluster-randomised controlled trial was conducted in 10 505 citizens. The intervention group (IG, N=5250) included citizens randomised to the second year and reinvited in the 5th year. The comparison group (CG, N=5255) included citizens randomised to the 5th year. Outcomes were modelled cardiovascular disease (CVD) risk; self-reported physical activity (PA) and objectively measured cardio respiratory fitness (CRF); self-rated health (short-form 12 (SF-12)), self-rated mental health (SF-12_Mental Component Score (MCS)) and, registry information on sick-leave and employment. Due to low participation, we compared groups matched on propensity scores for participation when reinvited. Results Participation in the first health check was 51% (N=2698) in the IG and 40% (N=2120) in the CG. In the IG 26% (N=1340) participated in both the first and second health checks. No intervention effects were found comparing IG and CG. Mean differences were (95% CI): modelled CVD risk: −0.052 (95% CI −0.107 to 0.003)%, PA: −0.156 (−0.331 to 0.019) days/week with 30 min moderate PA, CRF: 0.133 (−0.560 to 0.826) mL O2/min/kg, SF-12: −0.003 (−0.032 to 0.026), SF-12_MCS: 0.355 (-0.423 to 1.132), sick leave periods ≥3 weeks: −0.004 (−0.025 to 0.017), employment: −0.004 (−0.032 to 0.024). Conclusions Preventive health checks offered to the general population, aged 30–49 years, had no effects on a wide range of indicators of chronic disease risk. Trial registration number NCT02028195.
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Affiliation(s)
- Anne-Louise Bjerregaard
- Public Health, Aarhus Universitet, Aarhus, Denmark .,Steno Diabetes Center Zealand, Holbaek, Denmark
| | | | | | | | - Daniel R Witte
- Public Health, Aarhus Universitet, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus Universitetshospital, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | | | - Helle Terkildsen Maindal
- Public Health, Aarhus Universitet, Aarhus, Denmark.,Health Promotion, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Annelli Sandbæk
- Public Health, Aarhus Universitet, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus Universitetshospital, Aarhus, Denmark
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13
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Kuneinen SM, Eriksson JG, Kautiainen H, Ekblad MO, Korhonen PE. The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century. Scand J Prim Health Care 2021; 39:157-165. [PMID: 34092186 PMCID: PMC8293959 DOI: 10.1080/02813432.2021.1913893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. DESIGN A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner's (GP) appointment for high-risk persons. Screening and interventions were performed during 2005-2006. SETTING A public health care centre in the town of Harjavalta, Finland. SUBJECTS All home-dwelling 45-70-year old inhabitants without manifested CVD or diabetes. MAIN OUTCOME MEASURES All-cause and CVD mortality. RESULTS Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants'. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. CONCLUSIONS Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis.Key PointsPreviously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality.With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community.Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons.Subjects not willing to participate in health surveys have the worst prognosis.
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Affiliation(s)
- Susanna M. Kuneinen
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
- Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Johan G. Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Mikael O. Ekblad
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
| | - Päivi E. Korhonen
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
- Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
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14
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Thilsing T, Larsen LB, Sonderlund AL, Andreassen SS, Christensen JR, Svensson NH, Dahl M, Sondergaard J. Effects of a Co-Design-Based Invitation Strategy on Participation in a Preventive Health Check Program: Randomized Controlled Trial. JMIR Public Health Surveill 2021; 7:e25617. [PMID: 33688836 PMCID: PMC7991992 DOI: 10.2196/25617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/22/2021] [Accepted: 02/15/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Preventive primary care programs that aim to reduce morbidity and mortality from lifestyle-related diseases are often affected by low-to-moderate participation rates. Improving participation rates is essential for clinical effectiveness and cost-effectiveness. In 2016-2017, we conducted a pilot study (TOF pilot1) for a preventive primary care intervention (TOF is the Danish abbreviation for "Early Detection and Prevention"). Among 8814 invited patients, 3545 (40.22%) consented to participate, with the highest participation rates among women and patients with higher income, education, and employment. OBJECTIVE The aim of this study was to evaluate the effects of a revised invitation strategy on invitation comprehensibility, the overall participation rate, and participant demography. The new strategy specifically targeted men and patients of low educational attainment. METHODS This study was embedded in the second TOF pilot study (TOF pilot2, initiated in October 2018) that tested an adjusted intervention. The revised invitation strategy comprised a prenotification postcard and a new invitation that specifically targeted men and patients of low educational attainment. The new invitation was developed in a co-design process that included communication professionals and target-group representatives. The study sample consisted of 4633 patients aged between 29 and 59 years, who resided in one of two municipalities in the Region of Southern Denmark. Eligible patients were randomly assigned to one of four invitation groups. The control group (Group 1) received the original invitation used in TOF pilot1. The intervention groups received the original invitation and the prenotification postcard (Group 2), the new revised invitation and the prenotification postcard (Group 3), or the new invitation but no prenotification postcard (Group 4). RESULTS Overall, 2171 (46.86%) patients consented to participate. Compared to the control group, participation rates increased significantly in all three intervention groups (all P<.001). Participation across the three intervention groups increased for women and men, as well as for patients with high and low educational attainment and high and low family income. The largest relative increase in participation rates occurred among men, patients with low educational attainment, and patients with low family income. No increase in participation was detected for unemployed patients or patients of non-Danish origin. Most participants found the original (813/987, 82.37%) and new (965/1133, 85.17%) invitations easy to understand with no significant difference (P=.08) in comprehensibility between invitations. CONCLUSIONS The results suggest that participation in preventive primary care interventions can be greatly increased by implementing a co-design-based invitation strategy that includes prenotification postcards and targeted invitations. Although firm conclusions cannot be made from this study, the observed increased participation rates for men and patients of low socioeconomic status may be relevant in programs that aim to reduce social inequality in health. TRIAL REGISTRATION ClinicalTrials.gov NCT03913585; https://clinicaltrials.gov/ct2/show/NCT03913585.
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Affiliation(s)
- Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Steno Diabetes Center Zealand, Holbaek, Denmark
| | - Anders Larrabee Sonderlund
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | | | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Research unit of User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Nanna Herning Svensson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Marie Dahl
- Vascular Research Unit, Department of Surgery, Regional Hospital Central Denmark, Viborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Sondergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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15
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Geyti C, Christensen KS, Dalsgaard EM, Bech BH, Gunn J, Maindal HT, Sandbaek A. Factors associated with non-initiation of mental healthcare after detection of poor mental health at a scheduled health check: a cohort study. BMJ Open 2020; 10:e037731. [PMID: 33067280 PMCID: PMC7569988 DOI: 10.1136/bmjopen-2020-037731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Poor mental health is an important public health concern, but mental health problems are often under-recognised. Providing feedback to general practitioners (GPs) on their patients' mental health status may improve the identification of cases in need of mental healthcare. OBJECTIVES To investigate the extent of initiation of mental healthcare after identification of poor mental health and to identify factors associated with non-initiation. DESIGN Prospective cohort study with 1-year follow-up. SETTING In a population-based health preventive programme, Check Your Health, we conducted a combined mental and physical health check in Randers Municipality, Denmark, in 2012-2015 in collaboration with local GPs. PARTICIPANTS Participants were 350 individuals aged 30-49 years old with screen-detected poor mental health who had not received mental healthcare within the past year. The cohort was derived from 14 167 randomly selected individuals of whom 52% (n=7348) participated. Mental health was assessed by the mental component summary score of the 12-item Short-Form Health Survey. OUTCOME The outcome was initiation of mental healthcare. Mental healthcare included psychometric testing by GP, talk therapy by GP, contact with a psychologist, contact with a psychiatrist and psychotropic medication. RESULTS Within 1 year, 22% (95% CI 18 to 27) of individuals with screen-detected poor mental health initiated mental healthcare. Among individuals who initiated mental healthcare within follow-up, one in six had visited their GP once or less in the preceding year. Male sex (OR: 0.49 (95% CI 0.28 to 0.86)) and less impaired mental health (OR: 0.93 (95% CI 0.89 to 0.98)) were associated with non-initiation of mental healthcare. We found no overall association between socioeconomic factors and initiating mental healthcare. CONCLUSION Systematic provision of mental health test results to GPs may improve the identification of cases in need of mental healthcare, but does not translate into initiation of mental healthcare. Further research should focus on methods to improve initiation of mental healthcare, especially among men. TRIAL REGISTRATION NUMBER NCT02028195.
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Affiliation(s)
- Christine Geyti
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kaj Sparle Christensen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Aarhus, Denmark
| | | | | | - Jane Gunn
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Annelli Sandbaek
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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16
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Freyer-Adam J, Noetzel F, Baumann S, Aghdassi AA, Siewert-Markus U, Gaertner B, John U. Behavioral health risk factor profiles in general hospital patients: identifying the need for screening and brief intervention. BMC Public Health 2019; 19:1594. [PMID: 31783832 PMCID: PMC6884835 DOI: 10.1186/s12889-019-7931-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background Little is known about the clustering of behavioral health risk factors (HRFs), namely the occurrence of 16 specific combinations of tobacco smoking, at-risk alcohol use, overweight and physical inactivity in general hospital patients. Furthermore, social inequalities in HRFs, health and life expectancy are a major concern in public health. In order to establish the need for screening and intervention in general hospital care, the study aimed to determine the co-occurrence of HRFs in patients in four medical departments, and to investigate differences by gender, age and socio-economic characteristics. Methods Over 17 months, a systematic multiple HRF screening was conducted at one general hospital in northeastern Germany. In total, 6251 18–64 year old patients (92% of eligibles) participated. Proportions and confidence intervals were calculated for all 16 HRF profiles stratified by department, gender, age group, school education, and employment status. Results In total, 92.2% of the participants (58.6% male) reported ≥1 HRF, and 65.7% ≥2 HRFs. Men (71.2%), patients aged 35–49 (67.9%) and 50–64 years (69.5%), lower educated (79.0%), and unemployed (77.8%) patients had larger proportions of ≥2 HRFs than their counterparts. In all departments, the most common HRF profiles included overweight. HRF profiles that included alcohol and/ or smoking were more common in ear-nose-throat and trauma surgery than in internal medicine and general surgery patients. Men had higher rates concerning almost all HRF profiles including ≥2 HRFs and alcohol; women concerning profiles that included ≤2 HRFs and inactivity. In older patients, profiles with ≥2 HRFs including overweight; and in younger patients, profiles with smoking and/or alcohol were more common. In lower educated patients, profiles with ≥2 HRFs including inactivity; and in higher educated patients profiles with ≤2 HRFs including alcohol were more common. Compared to others, unemployed patients had higher rates of profiles with ≥3 HRFs including smoking. Conclusions Two in three patients require interventions targeting two or more HRFs. The findings help to develop screening and brief intervention for patients with specific health risk profiles, that can reach most patients, including those most in need and those most hard to reach, with socio-economically disadvantaged people in particular. Registry clinicaltrials.gov: NCT01291693.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany. .,German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.
| | - Florian Noetzel
- Clinic and Policlinic of Urology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Sophie Baumann
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.,Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Ali Alexander Aghdassi
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.,German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Ulrich John
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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17
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Kamstrup-Larsen N, Dalton SO, Grønbæk M, Broholm-Jørgensen M, Thomsen JL, Larsen LB, Johansen C, Tolstrup J. The effectiveness of general practice-based health checks on health behaviour and incidence on non-communicable diseases in individuals with low socioeconomic position: a randomised controlled trial in Denmark. BMJ Open 2019; 9:e029180. [PMID: 31537563 PMCID: PMC6756442 DOI: 10.1136/bmjopen-2019-029180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The effectiveness of health checks aimed at the general population is disputable. However, it is not clear whether health checks aimed at certain groups at high risk may reduce adverse health behaviour and identify persons with metabolic risk factors and non-communicable diseases (NCDs). OBJECTIVES To assess the effect of general practice-based health checks on health behaviour and incidence on NCDs in individuals with low socioeconomic position. METHODS Individuals with no formal education beyond lower secondary school and aged 45-64 years were randomly assigned to the intervention group of a preventive health check or to control group of usual care in a 1:1 allocation. Randomisation was stratified by gender and 5-year age group. Due to the real-life setting, blinding of participants was only possible in the control group. Effects were analysed as intention to treat (ITT) and per protocol. The trial was undertaken in 32 general practice units in Copenhagen, Denmark. INTERVENTION Invitation to a prescheduled preventive health check from the general practitioner (GP) followed by a health consultation and an offer of follow-up with health risk behaviour change or preventive medical treatment, if necessary. PRIMARY OUTCOME MEASURES Smoking status at 12-month follow-up. Secondary outcomes included status in other health behaviours such as alcohol consumption, physical activity and body mass index (measured by self-administered questionnaire), as well as incidence of metabolic risk factors and NCDs such as hypertension, hypercholesterolaemia, chronic obstructive pulmonary disease, diabetes mellitus, hypothyroidism, hyperthyroidism and depression (drawn from national healthcare registries). RESULTS 1104 participants were included in the study. For the primary outcome, 710 participants were included in the per protocol analysis, excluding individuals who did not attend the health check, and 1104 participants were included in the ITT analysis. At 12-month follow-up, 37% were daily smokers in the intervention group and 37% in the control group (ORs=0.99, 95% CI: 0.76 to 1.30). No difference in health behaviour nor in the incidence of metabolic risk factors and NCDs between the intervention and control group were found. Side effects were comparable across the two groups. CONCLUSION The lack of effectiveness may be due to low intensity of intervention, a high prevalence of metabolic risk factors and NCDs among the participants at baseline as well as a high number of contacts with the GPs in general or to the fact that general practices are not an effective setting for prevention. TRIAL REGISTRATION NUMBER NCT01979107.
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Affiliation(s)
- Nina Kamstrup-Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship Research Unit, Danish Cancer Society, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Janus Laust Thomsen
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice in Odense, University of Southern Denmark, Odense, Denmark
| | - Christoffer Johansen
- Survivorship Research Unit, Danish Cancer Society, Copenhagen, Denmark
- Late Effect Research Unit CASTLE, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Janne Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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18
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Ørts LM, Løkke A, Bjerregaard AL, Maindal HT, Norman K, Bech BH, Sandbæk A. The effect on participation rates of including focused spirometry information in a health check invitation: a cluster-randomised trial in Denmark. BMC Public Health 2019; 19:1183. [PMID: 31462261 PMCID: PMC6714428 DOI: 10.1186/s12889-019-7531-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/21/2019] [Indexed: 11/15/2022] Open
Abstract
Background Early detection of lung disease may help reduce disease development. Detection through preventive health checks may be beneficial. Nevertheless, the knowledge is sparse on how to enhance the participation rate in health checks among citizens at risk of developing lung disease. This study investigates if focused information on spirometry can increase the participation rate in a general health check. Methods We conducted an open-label, household cluster-randomised trial with a two-group parallel design including 4407 citizens aged 30–49 years in Denmark and an average cluster size of 1.55 citizens per household. The control group (n = 2213) received a standard invitation describing the content of the general health check and containing practical information. The intervention group (n = 2194) received an extended invitation highlighting the benefits of early detection and prevention of lung disease. The primary outcome was difference in participation rate between the two groups. The secondary outcome was the proportion of participants at risk of lung disease in both groups. Risk profile was defined as current smoking or self-reported lung symptoms. The inclusion period was 25 November 2015–3 February 2017. Results No major difference in participation rate was seen between the intervention group (53.4%) and the control group (52.0%). Participants had statistically significantly higher education level compared to non-participants. A total of 24.2% of the participants were at risk of developing lung disease, but no difference was found between the intervention group and the control group. Conclusion This study revealed no effect on participation rate of including focused spirometry information in the health check invitation. Trial registration ClinicalTrials.gov: NCT02615769. Registered on 25 November 2015. The trial protocol has been published. Electronic supplementary material The online version of this article (10.1186/s12889-019-7531-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lene Maria Ørts
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark.
| | - Anders Løkke
- Department of Respiratory Diseases, Vejle Hospital, Vejle, Denmark
| | | | | | - Kasper Norman
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark
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19
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Larsen LB, Sondergaard J, Thomsen JL, Halling A, Sønderlund AL, Christensen JR, Thilsing T. Step-wise approach to prevention of chronic diseases in the Danish primary care sector with the use of a personal digital health profile and targeted follow-up - an assessment of attendance. BMC Public Health 2019; 19:1092. [PMID: 31409343 PMCID: PMC6693260 DOI: 10.1186/s12889-019-7419-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 07/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background Current evidence on chronic disease prevention suggests that interventions targeted at high-risk individuals represents the best way forward. We implemented a step-wise approach in the Danish primary care sector, designed for the systematic and targeted prevention of chronic disease. The intervention centered on a personal digital health profile for all participants, followed by targeted preventive programs for high-risk patients. The present paper examines individual characteristics and health-care usage of patients who took up the targeted preventive programs in response to their personal digital health profile. Methods A sample of patients born between 1957 and 1986 was randomly selected from the patient-list system of participating general practitioners in two Danish municipalities. The selected patients received a digital invitation to participate. Consenting patients received a second digital invitation for a personal digital health profile based on questionnaire and electronic patient record data. The personal digital health profile contained individualized information on risk profile and personalized recommendations on further actions. If at-risk or presenting with health-risk behaviour a patient would be advised to contact either their general practitioner or municipal health centre for targeted preventive programs. Attendance at the targeted preventive programs was examined using Poisson regression and chi-squared automatic interaction detection methods. Results A total of 9400 patients were invited. Of those who participated (30%), 22% were advised to get a health check at their general practitioner. Of these, 19% did so. Another 23% were advised to schedule an appointment for behaviour-change counselling at their municipal health centre. A total of 21% took the advice. Patients who had fair or poor self-rated health, a body mass index above 30, low self-efficacy, were female, non-smokers, or lead a sedentary lifestyle, were most likely to attend the targeted preventive programs. Conclusions A personal digital health profile shows some promise in a step-wise approach to prevention in the Danish primary care sector and seems to motivate people with low self-efficacy to attend targeted preventive programs. Trial registration Registered at Clinical Trial Gov (Unique Protocol ID: TOFpilot2016). Prospectively registered on the 29th of April 2016.
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Affiliation(s)
- Lars Bruun Larsen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark.
| | - Jens Sondergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Janus Laust Thomsen
- Department of Clinical Medicine, Research Unit for General Practice, Aalborg University, Aalborg, Denmark
| | - Anders Halling
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Anders Larrabee Sønderlund
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Trine Thilsing
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
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20
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Broholm-Jørgensen M, Kamstrup-Larsen N, Guassora AD, Reventlow S, Dalton SO, Tjørnhøj-Thomsen T. ‘It can’t do any harm’: A qualitative exploration of accounts of participation in preventive health checks. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1602251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Nina Kamstrup-Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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21
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Høgh MB, Kronborg C, Hansen JM, Schaffalitzky de Muckadell OB. The cost effectiveness of Helicobacter pylori population screening-economic evaluation alongside a randomised controlled trial with 13-year follow-up. Aliment Pharmacol Ther 2019; 49:1013-1025. [PMID: 30854700 DOI: 10.1111/apt.15193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/09/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Helicobacter pylori eradication improves dyspeptic symptoms in 8%-10%, prevents peptic ulcer and may reduce the risk of gastric cancer. Availability of a high quality diagnostic test and an effective treatment makes population screening and eradication of Helicobacter pylori an attractive option. AIM To evaluate the cost effectiveness of Helicobacter pylori population screening and eradication. METHODS Cost effectiveness analysis and cost utility analysis alongside randomised controlled trial with 13 years follow-up. The evaluation has a societal perspective. A random general population sample of 20 011 individuals aged 40-65 were randomised and invited in 1998-1999; 12 530 were enrolled and, of these, 8658 have been successfully followed up at 1, 5, and 13 years after intervention. Questionnaires included the quality of life instrument SF-36. From SF-36 responses an SF-6D score was derived and used for calculation of quality-adjusted life years. Register data on costs, use of health care resources and medication were obtained for all randomised individuals. The intervention was an invitation to Helicobacter pylori screening by in-office blood test; positive tests were validated by 13 C-urea breath test. Those who tested positive were offered eradication therapy. Main outcome measures were Incremental cost per quality-adjusted life year and life-years gained. RESULTS Helicobacter pylori population screening and eradication with 13 years follow-up was not effective in regards to quality of life and the cost per screened person was higher than not screening (mean difference 11 269 DKK [95% CI: 3175-19 362]). The probability of being cost-effective was 80% at a threshold of 400 000 DKK (approximately 53,800 Euros) of willingness-to-pay per life-year gained. CONCLUSIONS Helicobacter pylori population screening and eradication with 13 years follow-up was not effective in regards to quality of life and the cost of screening was higher than not screening.
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Affiliation(s)
- Maria Bomme Høgh
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Kronborg
- Department of Business and Economics, University of Southern Denmark, Odense, Denmark
| | - Jane Møller Hansen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ove B Schaffalitzky de Muckadell
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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22
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Guertler D, Moehring A, Krause K, Eck S, Batra A, Chenot JF, Freyer-Adam J, Ulbricht S, Rumpf HJ, Bischof G, John U, Meyer C. Proactive multipurpose health risk screening in health care settings: Methods, design, and reach. Int J Methods Psychiatr Res 2019; 28:e1760. [PMID: 30614134 PMCID: PMC6877248 DOI: 10.1002/mpr.1760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/08/2018] [Accepted: 11/23/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Real world implementation of proactive screening and brief intervention in health care is threatened by high cost. Using e-health interventions and screening for multiple health risk factors may provide more efficiency. We describe methodological details of a proactive multipurpose health risk screening in health care settings and report on participation rates, participants' characteristics, and participation factors. METHODS Patients between 18 and 64 years from ambulatory practices and hospitals were proactively approached by study assistants at three sites for a computerized screening on harmful alcohol and tobacco consumption, depressive symptoms, insufficient fruit/vegetable consumption, physical inactivity and overweight. On the basis of their health risk pattern, a computerized algorithm allocated patients to one of five studies each of them addressing a psychiatric research question. RESULTS Among all eligible patients, 13,763 (86.5%) were screened. Younger age and being female predicted screening participation. Of those with complete data (n = 12,828), 82.9% reported at least two health risks and 34.0% were eligible for a study. Study participation ranged between 35.2% and 50.8%, and was associated with socio-demographics and problem severity. CONCLUSIONS This study supports the use of systematic proactive screening for multiple health risks in health care settings as it is more resource-saving than single focused screening.
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Affiliation(s)
- Diana Guertler
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Anne Moehring
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Kristian Krause
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
| | - Sandra Eck
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - Jean-François Chenot
- Institute for Community Medicine, Section Family Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jennis Freyer-Adam
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Sabina Ulbricht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, Research Group S:TEP, University of Lübeck, Lübeck, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, Research Group S:TEP, University of Lübeck, Lübeck, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Christian Meyer
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
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23
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Pihlajamäki J, Männikkö R, Tilles-Tirkkonen T, Karhunen L, Kolehmainen M, Schwab U, Lintu N, Paananen J, Järvenpää R, Harjumaa M, Martikainen J, Kohl J, Poutanen K, Ermes M, Absetz P, Lindström J, Lakka TA. Digitally supported program for type 2 diabetes risk identification and risk reduction in real-world setting: protocol for the StopDia model and randomized controlled trial. BMC Public Health 2019; 19:255. [PMID: 30823909 PMCID: PMC6397451 DOI: 10.1186/s12889-019-6574-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/21/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The StopDia study is based on the convincing scientific evidence that type 2 diabetes (T2D) and its comorbidities can be prevented by a healthy lifestyle. The need for additional research is based on the fact that the attempts to translate scientific evidence into actions in the real-world health care have not led to permanent and cost-effective models to prevent T2D. The specific aims of the StopDia study following the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework are to 1) improve the Reach of individuals at increased risk, 2) evaluate the Effectiveness and cost-effectiveness of the digital lifestyle intervention and the digital and face-to-face group lifestyle intervention in comparison to routine care in a randomized controlled trial (RCT), and 3) evaluate the Adoption and Implementation of the StopDia model by the participants and the health care organizations at society level. Finally, we will address the Maintenance of the lifestyle changes at participant level and that of the program at organisatory level after the RCT. METHODS The StopDia study is carried out in the primary health care system as part of the routine actions of three provinces in Finland, including Northern Savo, Southern Carelia, and Päijät-Häme. We estimate that one fifth of adults aged 18-70 years living in these areas are at increased risk of T2D. We recruit the participants using the StopDia Digital Screening Tool, including questions from the Finnish Diabetes Risk Score (FINDRISC). About 3000 individuals at increased risk of T2D (FINDRISC ≥12 or a history of gestational diabetes, impaired fasting glucose, or impaired glucose tolerance) participate in the one-year randomized controlled trial. We monitor lifestyle factors using the StopDia Digital Questionnaire and metabolism using laboratory tests performed as part of routine actions in the health care system. DISCUSSION Sustainable and scalable models are needed to reach and identify individuals at increased risk of T2D and to deliver personalized and effective lifestyle interventions. With the StopDia study we aim to answer these challenges in a scientific project that is fully digitally integrated into the routine health care. TRIAL REGISTRATION ClinicalTials.gov . Identifier: NCT03156478 . Date of registration 17.5.2017.
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Affiliation(s)
- Jussi Pihlajamäki
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - Reija Männikkö
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Tanja Tilles-Tirkkonen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
| | - Leila Karhunen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
| | - Marjukka Kolehmainen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
| | - Ursula Schwab
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Niina Lintu
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi Paananen
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Riia Järvenpää
- Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | | | - Johanna Kohl
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Miikka Ermes
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Pilvikki Absetz
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Collaborative Care Systems Finland, Helsinki, Finland
| | - Jaana Lindström
- Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Timo A. Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
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24
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Comins JD, Freund KS, Christensen KB, Lous J, Brodersen J. Validation of a health screening questionnaire for primary care using Rasch models. J Patient Rep Outcomes 2019; 3:12. [PMID: 30771021 PMCID: PMC6377689 DOI: 10.1186/s41687-019-0104-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/07/2019] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Health inequality is on the rise due to various social and individual factors. While preventive health checks (PHC) aim to counteract health inequality, there is robust evidence against the use of PHC in general practice. It is unknown which factors can identify persons who will benefit from preventive interventions that are more beneficial than harmful. Hence, valid screening instruments are needed. METHODS The aim of this study was to assess the psychometric properties of a screening questionnaire (SQ-33), which targets vulnerable persons in primary care practice who can benefit from preventive consultations. Survey data were acquired from 20 primary care clinical practices in the Northern Region of Jutland, Denmark. Respondents were 2056 persons between 20 and 44 years old who, for any reason, consulted their family doctor. The psychometric properties of the SQ-33 were assessed using Rasch item response modelling. Follow-up analysis was performed on a subsample of 364 persons one year subsequent to initial inclusion, in order to assess responsiveness and predictive validity using a general health anchor item. RESULTS Twenty-three of the SQ-33 items in four subscales fit a Graphical loglinear Rasch model (GLLRM) at baseline and follow-up, thus confirming the scaling properties. The modified 23-item version (HSQ-23) revealed superior responsiveness and predictive validity compared with the SQ-33. CONCLUSIONS The Health Screening Questionnaire (HSQ-23) was shown to possess adequate psychometric properties and responsiveness and can thus be used as an outcome measure in preventive intervention studies. Future study should address whether the HSQ-23 successfully identifies patients who will benefit from PHC consultations.
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Affiliation(s)
- Jonathan David Comins
- Centre of Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark. .,Department of Rheumatology, Zealand University Hospital, Køge, Denmark. .,Department of Orthopedic Surgery and Sports Traumatology, Bispebjerg Hospital, Copenhagen, Denmark.
| | - Kirsten Schierup Freund
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karl Bang Christensen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Lous
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - John Brodersen
- Centre of Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark.,Zealand Region Primary Health Care Research Unit, Sorø, Denmark
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25
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Larsen LB, Sondergaard J, Thomsen JL, Halling A, Sønderlund AL, Christensen JR, Thilsing T. Digital Recruitment and Acceptance of a Stepwise Model to Prevent Chronic Disease in the Danish Primary Care Sector: Cross-Sectional Study. J Med Internet Res 2019; 21:e11658. [PMID: 30664466 PMCID: PMC6360391 DOI: 10.2196/11658] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 12/12/2022] Open
Abstract
Background During recent years, stepwise approaches to health checks have been advanced as an alternative to general health checks. In 2013, we set up the Early Detection and Prevention project (Tidlig Opsporing og Forebyggelse, TOF) to develop a stepwise approach aimed at patients at high or moderate risk of a chronic disease. A novel feature was the use of a personal digital mailbox for recruiting participants. A personal digital mailbox is a secure digital mailbox provided by the Danish public authorities. Apart from being both safe and secure, it is a low-cost, quick, and easy way to reach Danish residents. Objective In this study we analyze the association between the rates of acceptance of 2 digital invitations sent to a personal digital mailbox and the sociodemographic determinants, medical treatment, and health care usage in a stepwise primary care model for the prevention of chronic diseases. Methods We conducted a cross-sectional analysis of the rates of acceptance of 2 digital invitations sent to randomly selected residents born between 1957 and 1986 and residing in 2 Danish municipalities. The outcome was acceptance of the 2 digital invitations. Statistical associations were determined by Poisson regression. Data-driven chi-square automatic interaction detection method was used to generate a decision tree analysis, predicting acceptance of the digital invitations. Results A total of 8814 patients received an invitation in their digital mailbox from 47 general practitioners. A total of 40.22% (3545/8814) accepted the first digital invitation, and 30.19 % (2661/8814) accepted both digital invitations. The rates of acceptance of both digital invitations were higher among women, older patients, patients of higher socioeconomic status, and patients not diagnosed with or being treated for diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular disease. Conclusions To our knowledge, this is the first study to report on the rates of acceptance of digital invitations to participate in a stepwise model for prevention of chronic diseases. More studies of digital invitations are needed to determine if the acceptance rates seen in this study should be expected from future studies as well. Similarly, more research is needed to determine whether a multimodal recruitment approach, including digital invitations to personal digital mailboxes will reach hard-to-reach subpopulations more effectively than digital invitations only.
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Affiliation(s)
- Lars Bruun Larsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Sondergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Janus Laust Thomsen
- Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anders Halling
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Anders Larrabee Sønderlund
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Trine Thilsing
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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26
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Jørgensen ME, Ellervik C, Ekholm O, Johansen NB, Carstensen B. Estimates of prediabetes and undiagnosed type 2 diabetes in Denmark: The end of an epidemic or a diagnostic artefact? Scand J Public Health 2018; 48:106-112. [PMID: 30222048 DOI: 10.1177/1403494818799606] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Up-to-date information on undiagnosed type 2 diabetes and prediabetes based on current diagnostic criteria is lacking. The study aimed to model the total numbers of people with undiagnosed type 2 diabetes and prediabetes in Denmark based on existing population-based surveys. Methods: Two population-based Danish studies with information on HbA1c, date of examination, gender, age and known type 2 diabetes were identified: the Danish General Suburban Population Study, n = 21,205, and the Danish Health Examination Survey, n = 18,065. The prevalence of known, undiagnosed and pre-diabetes were estimated in the Danish General Suburban Population Study, and population-level age-specific prevalence of known type 2 diabetes was estimated from national registers. The Danish Health Examination Survey was included for sensitivity analysis. Combining estimates of the survey participation rate among known type 2 diabetes patients with known overall participation rates from the studies allowed for the correction of survey prevalence to plausible population-level estimates of age- and gender-specific prevalence. Results: The prevalence of known, undiagnosed and pre-diabetes was highest among men, increasing with age with a peak at age 70. Applying the survey-based prevalence to the entire Danish population, the estimated number (May 2011) with undiagnosed type 2 diabetes was 60,681, corresponding to 24% of all type 2 diabetes cases, and 292,715 had prediabetes, about 50% more than the total type 2 diabetes population. Conclusions: Estimates of undiagnosed type 2 diabetes and prediabetes are dramatically lower than reported in previous studies (60,681 vs 200,000 and 292,715 vs 750,000); however, whether this reflects a true decrease in incidence or the change to HbA1c-based diagnostic criteria is not clear.
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Affiliation(s)
- Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christina Ellervik
- Division of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Production, Research, and Innovation; Region Zealand, Sorø, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Nanna Borup Johansen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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27
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Haberecht K, Baumann S, Bischof G, Gaertner B, John U, Freyer-Adam J. Do brief alcohol interventions among unemployed at-risk drinkers increase re-employment after 15 month? Eur J Public Health 2018; 28:510-515. [PMID: 29036439 DOI: 10.1093/eurpub/ckx142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background At-risk alcohol use is associated bi-directionally to unemployment, and decreases chances of re-employment. Brief alcohol interventions (BAI) can reduce at-risk alcohol use. This study aimed to investigate 15-month effects of BAI on unemployment among persons with at-risk alcohol use. Methods As part of the randomized controlled 'Trial on proactive alcohol interventions among job-seekers, TOPAS', 1243 18- to 64-year-old job-seekers with at-risk alcohol use were systematically recruited at three job agencies in Germany (2008/09), and randomized to (i) a stage tailored intervention based on the trans-theoretical model of intentional behavior change (ST), (ii) a non-stage tailored intervention based on the theory of planned behavior (NST) and (iii) assessment only (AO). To test the effects of ST and NST on employment status 15 months after baseline, latent growth models were calculated among those initially unemployed (n = 586). Results In all three groups, unemployment significantly decreased over 15 months (ST: odds ratio, OR = 0.06; 95% confidence interval, CI: 0.01-0.27; NST: OR = 0.04; 95% CI: 0.01-0.18; AO: OR = 0.05; 95% CI: 0.01-0.21). No intervention effects were found on unemployment. Age (P = 0.002), school education (P = 0.001), self-rated health (P = 0.04), the Alcohol Use Disorder Identification Test-Consumption score (P = 0.02) and motivation to change (P = 0.04) significantly affected the development of unemployment over time. Conclusion After 15 months, no BAI effect on unemployment was found. The mediated effect of BAIs on unemployment could be a longsome process needing longer follow-ups to be detected.
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Affiliation(s)
- Katja Haberecht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (partner site Greifswald), Greifswald, Germany
| | - Sophie Baumann
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (partner site Greifswald), Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, Medical University of Luebeck, Luebeck, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (partner site Greifswald), Greifswald, Germany
| | - Jennis Freyer-Adam
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (partner site Greifswald), Greifswald, Germany.,Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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Haberecht K, Baumann S, Gaertner B, John U, Freyer-Adam J. Socioeconomic factors and heavy drinking over the course of the week among job seekers with at-risk alcohol use. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 73:154-161. [PMID: 28272999 DOI: 10.1080/19338244.2017.1300569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/24/2017] [Indexed: 06/06/2023]
Abstract
This article investigates the influence of socioeconomic factors on heavy drinking over the course of the week. As part of a randomized controlled trial, 1,282 job seekers with at-risk alcohol use were systematically recruited at 3 job agencies and reported number of drinks consumed on each day in the past week. Latent growth curve models were calculated to represent variations of alcohol use. School education and duration of lifetime unemployment were tested as predictors; sociodemographic variables were integrated as covariates. A weekly pattern was confirmed in the total sample: constant low alcohol use on working days, escalation on Friday, and a further increase on weekends. Significant associations between longer duration of lifetime unemployment and higher initial alcohol use on Sundays (p < .001) and less increase on Fridays (p = .001) disappeared after controlling for sociodemographic factors. Longer duration of lifetime unemployment does not appear to affect alcohol use trajectories over the course of the week.
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Affiliation(s)
- Katja Haberecht
- a Institute of Social Medicine and Prevention , University Medicine Greifswald , Greifswald , Germany
- b German Centre for Cardiovascular Research (partner site Greifswald) , Greifswald , Germany
| | - Sophie Baumann
- a Institute of Social Medicine and Prevention , University Medicine Greifswald , Greifswald , Germany
- b German Centre for Cardiovascular Research (partner site Greifswald) , Greifswald , Germany
| | - Beate Gaertner
- c Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
| | - Ulrich John
- a Institute of Social Medicine and Prevention , University Medicine Greifswald , Greifswald , Germany
- b German Centre for Cardiovascular Research (partner site Greifswald) , Greifswald , Germany
| | - Jennis Freyer-Adam
- a Institute of Social Medicine and Prevention , University Medicine Greifswald , Greifswald , Germany
- b German Centre for Cardiovascular Research (partner site Greifswald) , Greifswald , Germany
- d Institute for Medical Psychology , University Medicine Greifswald , Greifswald , Germany
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29
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Larsen LB, Sandbaek A, Thomsen JL, Bjerregaard AL. Uptake of health checks by residents from the Danish social housing sector - a register-based cross-sectional study of patient characteristics in the 'Your Life - Your Health' program. BMC Public Health 2018; 18:585. [PMID: 29720162 PMCID: PMC5932768 DOI: 10.1186/s12889-018-5506-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Poor uptake among socio-economically disadvantaged and susceptible populations is a well-known challenge of general health check interventions, and is widely cited as one of the reasons for the lack of population level effects seen in many studies. We report on patient characteristics among attendees and non-attendees of health checks made available to residents in the social housing sector of the municipality of Aarhus. We focus on this general population, as well as a particular sub-group living in an exceptionally deprived social housing area, and discuss the properties of intervention uptake that we need to be aware of to qualify and compare the effects of general versus targeted health checks in socially deprived areas. Methods Cross-sectionally in a sample of 6650 residents of the Aarhus social housing sector who were invited for a health check in the first year of the ‘Your Life – Your Health’ program. The analyses consisted of 1) descriptive analysis of the characteristics of attenders/non-attenders, 2) unadjusted and adjusted Poisson regression to examine associations of patient characteristics and uptake of health checks, and 3) decision tree analyses (CHAID) to examine interaction and homogeneity in patient characteristics among attenders. Results Of the overall population 30% attended. In a nested cohort of people residing in a particularly deprived social housing settlement, 25% attended. Further, in the overall population, we found an association between the likelihood of taking up a health check and age, sex, country of origin, educational attainment, cohabitation, occupational status, and past medical treatment. In the nested cohort the association between uptake and medical treatment was non-significant, while the association between uptake and occupation was limited to people who were employed. These results resonate with past evidence on health check attendance. Conclusions Attendance in the ‘Your Life – Your Health’ program is higher among people of a higher socio-economic status. This should be taken into consideration when analysing and interpreting the overall study effects. Moreover, the results suggest that a targeted approach in the social housing sector could be more effective than a mass screening approach. However, more information is required to make such assertion definitive. Electronic supplementary material The online version of this article (10.1186/s12889-018-5506-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars Bruun Larsen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
| | - Annelli Sandbaek
- Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark.,The Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Janus Laust Thomsen
- Department of Clinical Medicine, Research Unit for General Practice, Aalborg University, Aalborg, Denmark
| | - Anne-Louise Bjerregaard
- Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark
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30
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Blackburn R, Osborn D, Walters K, Nazareth I, Petersen I. Statin prescribing for prevention of cardiovascular disease amongst people with severe mental illness: Cohort study in UK primary care. Schizophr Res 2018; 192:219-225. [PMID: 28599749 DOI: 10.1016/j.schres.2017.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Severe mental illness (SMI) is associated with excess cardiovascular disease (CVD) morbidity, but little is known on provision of preventative interventions. We investigated statin initiation for primary CVD prevention in individuals with and without SMI. METHODS We used primary care data from The Health Improvement Network from 2006 to 2015 for UK patients aged 30-99years with no pre-existing CVD conditions and selected individuals with schizophrenia (n=13,252) or bipolar disorder (n=11,994). In addition, we identified samples of individuals without schizophrenia (n=66,060) and bipolar disorder (n=59,765), but with similar age and gender distribution. Missing data on CVD covariates were estimated using multiple imputation. Statin prescribing differences between individuals with and without SMI were investigated using multivariable Poisson regression models. RESULTS Initiation of statin prescribing was between 2 and 3 fold higher in people aged 30-59years with SMI than in those without after adjusting for CVD covariates. The rates in those aged 60-74years with SMI were similar or slightly higher relative to those without SMI. The incidence rate ratio (IRR) was 1.15 (95% CI 1.03-1.28) for bipolar disorder and 1.00 (0.91-1.11) for schizophrenia. The rate of statin prescribing was lower (IRR 0.81 (0.66-0.98)) amongst the oldest (aged 75+years) with schizophrenia relative to those without schizophrenia. CONCLUSIONS Despite higher rates of new statin prescriptions to younger individuals with SMI relative to individuals without SMI, there was evidence of lower rates of statin initiation for older individuals with schizophrenia, and this group may benefit from additional measures to prevent CVD.
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Affiliation(s)
- R Blackburn
- Division of Psychiatry, W1T 7NF and Institute for Health Informatics, UCL, NW1 2DA, UK.
| | - D Osborn
- Psychiatric Epidemiology, Division of Psychiatry, UCL, W1T 7NF and Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - K Walters
- Primary Care and Population Health, UCL, NW3 2PF, UK
| | - I Nazareth
- Primary Care and Population Health, UCL, NW3 2PF, UK; Primary Care and Population Science, Primary Care and Population Health, UCL, NW3 2PF, UK
| | - I Petersen
- Primary Care and Population Health, UCL, NW3 2PF, UK; Epidemiology and Statistics, Primary Care and Population Health, UCL, NW3 2PF, Department of Clinical Epidemiology, Aarhus University, 8200 Aarhus N, Denmark
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31
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Bomme M, Hansen JM, Wildner-Christensen M, Hallas J, Schaffalitzky de Muckadell OB. Effects of Community Screening for Helicobacter pylori: 13-Year Follow-Up Evaluation of a Randomized Controlled Trial. Clin Gastroenterol Hepatol 2017; 15:1715-1723.e7. [PMID: 28606845 DOI: 10.1016/j.cgh.2017.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Helicobacter pylori eradication improves the prognosis of peptic ulcer disease (PUD), dyspepsia, and possibly gastric cancer. H pylori screening tests are accurate and eradication therapy is effective. H pylori population screening seems attractive. The aim of this study was to evaluate the long-term effect of H pylori population screening and eradication on dyspepsia prevalence and the incidence of PUD, and as secondary outcomes to assess the effect on health care consumption and quality of life. METHODS At baseline in 1998 to 1999, 20,011 individuals aged 40 to 65 years were randomized to H pylori screening and eradication or a control group with no screening. Both groups received a questionnaire on dyspepsia and quality of life. Register data were obtained for all randomized individuals. RESULTS The baseline questionnaire response rate was 63%. Of the 5749 individuals screened, 1007 (17.5%) were H pylori positive. Complete symptom data were obtained for 8658 (69%) individuals after 13 years. Dyspepsia prevalence decreased in both groups during the follow-up period, but multivariate analysis showed no effect of H pylori screening and eradication (adjusted odds ratio, 0.93; 95% confidence interval, 0.82-1.04); compared with usual care. Intention-to-treat and per-protocol analyses of register data provided similar results. H pylori screening neither reduced PUD incidence significantly (adjusted odds ratio, 0.88; 95% confidence interval, 0.70-1.11) nor did it have a beneficial effect on health care consumption. H pylori screening had no long-term effect on quality of life. CONCLUSIONS This randomized clinical trial with 13 years of follow-up evaluation, designed to provide evidence on the effect of H pylori population screening, showed no significant long-term effect when compared with usual care in this low-prevalence area. ClinicalTrials.gov identifier: NCT02001727.
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Affiliation(s)
- Maria Bomme
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Jane Møller Hansen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Jesper Hallas
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ove B Schaffalitzky de Muckadell
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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32
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Rohde JF, Ängquist L, Larsen SC, Tolstrup JS, Husemoen LLN, Linneberg A, Toft U, Overvad K, Halkjær J, Tjønneland A, Hansen T, Pedersen O, Sørensen TIA, Heitmann BL. Alcohol consumption and its interaction with adiposity-associated genetic variants in relation to subsequent changes in waist circumference and body weight. Nutr J 2017; 16:51. [PMID: 28841830 PMCID: PMC5574083 DOI: 10.1186/s12937-017-0274-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/21/2017] [Indexed: 02/06/2023] Open
Abstract
Background Studies have suggested a link between alcohol intake and adiposity. However, results from longitudinal studies have been inconsistent, and a possible interaction with genetic predisposition to adiposity measures has often not been taken into account. Objective To examine the association between alcohol intake recorded at baseline and subsequent annual changes in body weight (∆BW), waist circumference (ΔWC) and WC adjusted for BMI (ΔWCBMI), and to test for interaction with genetic predisposition scores based on single nucleotide polymorphisms (SNPs) associated with various forms of adiposity. Method This study included a total of 7028 adult men and women from MONICA, the Diet, Cancer and Health cohort (DCH), and the Inter99 studies. We combined 50 adiposity-associated SNPs into four scores indicating genetic predisposition to BMI, WC, WHRBMI and all three traits combined. Linear regression was used to examine the association of alcohol intake (drinks of 12 g (g) alcohol/day) with ΔBW, ΔWC, and ΔWCBMI, and to examine possible interactions with SNP-scores. Results from the analyses of the individual cohorts were combined in meta-analyses. Results Each additional drink/day was associated with a ΔBW/year of −18.0 g (95% confidence interval (CI): −33.4, −2.6, P = 0.02) and a ΔWC of −0.3 mm/year (−0.5, −0.0, P = 0.03). In analyses of women only, alcohol intake was associated with a higher ΔWCBMI of 0.5 mm/year (0.2, 0.9, P = 0.002) per drink/day. Overall, we found no statistically significant interactions between the four SNP-scores and alcohol intake in relation to changes in adiposity measures. However in analyses of women separately, we found interaction between the complete score of all 50 SNPs and alcohol intake in relation to ΔBW (P for interaction = 0.03). No significant interaction was observed among the men. Conclusion Alcohol intake was associated with a decrease in BW and WC among men and women, and an increase in WCBMI among women only. We found no strong indication that these associations depend on a genetic predisposition to adiposity. Trial registration Registry: ClinicalTrials.gov Trial number: CT00289237, Registered: 19 September 2005 retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12937-017-0274-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeanett F Rohde
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Copenhagen, Nordre Fasanvej 57, entrance 5, ground floor, 2000, Frederiksberg, Denmark. .,Department of Clinical Epidemiology (Formerly 'Institute of Preventive Medicine'), Bispebjerg and Frederiksberg Hospital, the Capital Region, Nordre Fasanvej 57, Hovedvejen, entrance 5, first floor, 2000, Frederiksberg, Denmark.
| | - Lars Ängquist
- Department of Clinical Epidemiology (Formerly 'Institute of Preventive Medicine'), Bispebjerg and Frederiksberg Hospital, the Capital Region, Nordre Fasanvej 57, Hovedvejen, entrance 5, first floor, 2000, Frederiksberg, Denmark
| | - Sofus C Larsen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Copenhagen, Nordre Fasanvej 57, entrance 5, ground floor, 2000, Frederiksberg, Denmark.,Department of Clinical Epidemiology (Formerly 'Institute of Preventive Medicine'), Bispebjerg and Frederiksberg Hospital, the Capital Region, Nordre Fasanvej 57, Hovedvejen, entrance 5, first floor, 2000, Frederiksberg, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5 A, 1353, Copenhagen K, Denmark
| | - Lise Lotte N Husemoen
- Research Centre for Prevention and Health, Capital Region of Denmark, Nordre Ringvej 57, building 84-85, 2600, Glostrup, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, Capital Region of Denmark, Nordre Ringvej 57, building 84-85, 2600, Glostrup, Denmark.,Department of Clinical Experimental Research, Rigshospitalet, Nordre Ringvej 57, 2600, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, København N, Denmark
| | - Ulla Toft
- Research Centre for Prevention and Health, Capital Region of Denmark, Nordre Ringvej 57, building 84-85, 2600, Glostrup, Denmark
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Nordre Ringgade 1, 8000, Aarhus C, Denmark.,Department of Cardiology, Aalborg University Hospital, Fredrik Bajers Vej 7-D3, 9220, Aalborg, Denmark
| | - Jytte Halkjær
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research (Section of Metabolic Genetics), and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Alle 20, 2200, Copenhagen N, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research (Section of Metabolic Genetics), and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Alle 20, 2200, Copenhagen N, Denmark
| | - Thorkild I A Sørensen
- Department of Clinical Epidemiology (Formerly 'Institute of Preventive Medicine'), Bispebjerg and Frederiksberg Hospital, the Capital Region, Nordre Fasanvej 57, Hovedvejen, entrance 5, first floor, 2000, Frederiksberg, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research (Section of Metabolic Genetics), and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Alle 20, 2200, Copenhagen N, Denmark.,MRC Integrative Epidemiology Unit, Bristol University, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Berit L Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Copenhagen, Nordre Fasanvej 57, entrance 5, ground floor, 2000, Frederiksberg, Denmark.,Department of Clinical Epidemiology (Formerly 'Institute of Preventive Medicine'), Bispebjerg and Frederiksberg Hospital, the Capital Region, Nordre Fasanvej 57, Hovedvejen, entrance 5, first floor, 2000, Frederiksberg, Denmark.,National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5 A, 1353, Copenhagen K, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, NSW, 2006, Australia.,Section for General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, entrance Q, 1014, Copenhagen K, Denmark
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Woringer M, Cecil E, Watt H, Chang K, Hamid F, Khunti K, Dubois E, Evason J, Majeed A, Soljak M. Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study. BMC Health Serv Res 2017; 17:405. [PMID: 28615019 PMCID: PMC5471843 DOI: 10.1186/s12913-017-2346-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/31/2017] [Indexed: 11/14/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England’s National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups. Methods Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively. Results Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p < 0.05) than the general population. Screened populations in 29 of 38 LAs were significantly more deprived (p < 0.05). No statistically significant difference among ethnic minority groups was observed between LAs. Nonetheless some LAs – namely Leicester, Thurrock, Sutton, South Tyneside, Portsmouth and Gateshead were very successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p < 0.001) and mean proportion of 40–49 and 50–59 year olds was 9.98% and 3.58% higher (p < 0.0001 and p < 0.01 respectively) than the general population across 38 LAs. Conclusions Community-based outreach providers effectively reach under-served groups by delivering preventive CVD services to younger, more deprived populations, and a representative proportion of ethnic minority groups. If the programme is successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities therein.
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Affiliation(s)
- Maria Woringer
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
| | - Elizabeth Cecil
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Hillary Watt
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Kiara Chang
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Fozia Hamid
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester, LE5 4PW, UK
| | - Elizabeth Dubois
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Julie Evason
- Health Diagnostics Ltd., Suite C, The Quadrant,, Sealand Road,, Chester, CH1 4QR, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Michael Soljak
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
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Who benefits from computer-based brief alcohol intervention? Day-to-day drinking patterns as a moderator of intervention efficacy. Drug Alcohol Depend 2017; 175:119-126. [PMID: 28412302 DOI: 10.1016/j.drugalcdep.2017.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to test if people with different day-to-day drinking patterns benefitted differently from two brief alcohol interventions (BAIs). METHODS A total of 1243 job-seekers with at-risk alcohol use aged 18-64 years (64% men) were randomized to (a) intervention tailored to the motivational stage (ST), (b) non-stage tailored intervention (NST), or (c) assessment only (AO). ST and NST contained individualized computer-generated feedback letters. Follow-ups were conducted at months 3, 6, and 15. Using growth mixture models, day-to-day drinking patterns were identified based on the number of drinks consumed on each day in the week prior to baseline assessment. To test drinking pattern-specific intervention effects, zero-inflated growth models were used. Outcomes were (1) the 15-month change in the likelihood of any alcohol use and (2) the 15-month change in the total number of drinks per week when alcohol was consumed. RESULTS Four day-to-day drinking patterns were found: daily medium use (2-4 drinks/day; 47%), daily low use (1-2 drinks/day; 29%), weekend only use (18%), and no use (6%). Only persons with daily low use benefitted from intervention, with higher odds of being abstinent after 15 months in the ST group compared to AO (odds ratio, OR=1.67, p=0.001) and NST group (OR=1.43, p=0.035). ST worked better among persons with daily low use compared to daily medium use (OR=1.91, p=0.001). CONCLUSIONS Among at-risk drinking persons with regular low-quantity alcohol use, stage tailored BAIs may be superior over no BAI and non-stage tailored BAIs.
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Hansen L, Netterstrøm MK, Johansen NB, Rønn PF, Vistisen D, Husemoen LLN, Jørgensen ME, Rod NH, Færch K. Metabolically Healthy Obesity and Ischemic Heart Disease: A 10-Year Follow-Up of the Inter99 Study. J Clin Endocrinol Metab 2017; 102:1934-1942. [PMID: 28323999 DOI: 10.1210/jc.2016-3346] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/01/2017] [Indexed: 02/07/2023]
Abstract
CONTEXT Recent studies have suggested that a subgroup of obese individuals is not at increased risk of obesity-related complications. This subgroup has been referred to as metabolically healthy obese. OBJECTIVE To investigate whether obesity is a risk factor for development of ischemic heart disease (IHD) irrespective of metabolic health. DESIGN In all, 6238 men and women from the Danish prospective Inter99 study were followed during 10.6 (standard deviation = 1.7) years. SETTING General community. PARTICIPANTS Participants were classified according to body mass index and four metabolic risk factors (low high-density lipoprotein cholesterol, elevated blood pressure, triglycerides, and fasting plasma glucose). Metabolically healthy individuals were defined as having no metabolic risk factors, and metabolically unhealthy individuals were defined as having a minimum of one. MAIN OUTCOME MEASURES IHD. RESULTS During follow-up, 323 participants developed IHD. Metabolically healthy obese men had increased risk of IHD compared with metabolically healthy normal-weight men [hazard ratio (HR), 3.1; 95% confidence interval (CI), 1.1 to 8.2)]. The corresponding results for women were less pronounced (HR, 1.8; 95% CI, 0.7 to 4.8). Being metabolically healthy but overweight was not associated with higher risk of IHD in men (HR, 1.1; 95% CI, 0.5 to 2.4), and in women the risk was only slightly increased and insignificant (HR, 1.5; 95% CI, 0.8 to 3.0). A substantial proportion of metabolically healthy individuals became metabolically unhealthy after 5 years of follow-up. When these changes in exposure status were taken into account, slightly higher risk estimates were found. CONCLUSIONS Being obese is associated with higher incidence of IHD irrespective of metabolic status, and we question the feasibility of denoting a subgroup of obese individuals as metabolically healthy.
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Affiliation(s)
- Louise Hansen
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
| | | | - Nanna B Johansen
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
- Danish Diabetes Academy, 5000 Odense, Denmark
- Research Center for Prevention and Health, Center for Health, Capital Region of Denmark, 2600 Glostrup, Denmark
| | - Pernille F Rønn
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
- Department of Public Health, Center for Arctic Health, Aarhus University, 8000 Aarhus, Denmark
| | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
| | - Lise L N Husemoen
- Research Center for Prevention and Health, Center for Health, Capital Region of Denmark, 2600 Glostrup, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, 1353 Copenhagen, Denmark
| | - Naja H Rod
- Section of Social Medicine, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Kristine Færch
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
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Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries. Soc Sci Med 2017; 176:158-165. [DOI: 10.1016/j.socscimed.2017.01.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 07/18/2016] [Accepted: 01/22/2017] [Indexed: 12/17/2022]
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Bjerregaard AL, Maindal HT, Bruun NH, Sandbæk A. Patterns of attendance to health checks in a municipality setting: the Danish 'Check Your Health Preventive Program'. Prev Med Rep 2016; 5:175-182. [PMID: 28050340 PMCID: PMC5200886 DOI: 10.1016/j.pmedr.2016.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/22/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Anne-Louise Bjerregaard
- Section of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Corresponding author at: Section of General Practice, Department of Public Health, Bartholins Alle 2, DK-8000 Aarhus., Denmark.Section of General PracticeDepartment of Public HealthBartholins Alle 2AarhusDK-8000Denmark
| | - Helle T Maindal
- Steno Health Promotion Centre, Steno Diabetes Center A/S, Gentofte, Denmark
- Section of Health Promotion and Health Services, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Niels Henrik Bruun
- Section of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Annelli Sandbæk
- Section of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
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Waller M, Blomstrand A, Högberg T, Ariai N, Thorn J, Hange D, Björkelund C. A primary care lifestyle programme suitable for socioeconomically vulnerable groups - an observational study. Scand J Prim Health Care 2016; 34:352-359. [PMID: 27978782 PMCID: PMC5217284 DOI: 10.1080/02813432.2016.1248628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore whether a primary health care (PHC) health promotion programme reaches and engages socioeconomically vulnerable groups in a community to the same extent as higher socioeconomic groups. DESIGN Comparison of level of engagement and lifestyle improvements stratified by socioeconomic vulnerability level. SETTING Hisingen PHC catchment area (130,000 inhabitants) Gothenburg, Sweden. PARTICIPANTS Men and women aged 18-79, visiting any of the eight public PHC centres during an eight-month period 2007-2008, were presented with a short intervention health questionnaire and offered a health dialogue with a nurse, including a health profile, p-glucose and blood pressure check. Participants were classified according to four socioeconomic vulnerability factors: education, employment, ethnicity and living situation. RESULTS Out of 3691 participants, 27% had low education (Hisingen community level 23%), 18% were unemployed (community level 22%), and 16% were born outside Scandinavia (community level 22%). At the one-year follow-up, 2121 (57%) attended. At baseline, 3% of the individuals in the sample had three out of four socioeconomic vulnerability factors, 17% had two vulnerability factors, 43% had one vulnerability factor, and 37% had no vulnerability factors. Improved biological markers were seen in all vulnerability groups (1-3) and odds ratios for improvement were significantly higher in the most socioeconomically vulnerable group for smoking and stress compared to the group with no vulnerability factors. CONCLUSION Socioeconomically vulnerable groups were reached and lifestyle changes were accomplished to the same extent as in the higher socioeconomic groups in a PHC lifestyle intervention programme. KEY POINTS Primary care plays a major part in prevention of chronic diseases. However, non-pharmacological primary and secondary prevention is often less successful, especially concerning socioeconomically vulnerable groups. The health promoting intervention programme "Pro-Health" reached and engaged socioeconomically vulnerable groups. Participants from the socioeconomically vulnerable groups had comparable odds for lifestyle improvements after one year, compared to participants without vulnerability factors.
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Affiliation(s)
- Maria Waller
- CONTACT Maria Waller Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 454, 40530 Gothenburg, Sweden
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Olsen NJ, Ängquist L, Larsen SC, Linneberg A, Skaaby T, Husemoen LLN, Toft U, Tjønneland A, Halkjær J, Hansen T, Pedersen O, Overvad K, Ahluwalia TS, Sørensen TI, Heitmann BL. Interactions between genetic variants associated with adiposity traits and soft drinks in relation to longitudinal changes in body weight and waist circumference. Am J Clin Nutr 2016; 104:816-26. [PMID: 27465380 DOI: 10.3945/ajcn.115.122820] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 06/20/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Intake of sugar-sweetened beverages is associated with obesity, and this association may be modified by a genetic predisposition to obesity. OBJECTIVE We examined the interactions between a molecular genetic predisposition to various aspects of obesity and the consumption of soft drinks, which are a major part of sugar-sweetened beverages, in relation to changes in adiposity measures. DESIGN A total of 4765 individuals were included in the study. On the basis of 50 obesity-associated single nucleotide polymorphisms that are associated with body mass index (BMI), waist circumference (WC), or the waist-to-hip ratio adjusted for BMI (WHRBMI), the following 4 genetic predisposition scores (GRSs) were constructed: a complete genetic predisposition score including all 50 single nucleotide polymorphisms (GRSComplete), a genetic predisposition score including BMI-associated single nucleotide polymorphisms (GRSBMI), a genetic predisposition score including waist circumference-associated single nucleotide polymorphisms (GRSWC), and a genetic predisposition score including the waist-to-hip ratio adjusted for BMI-associated single nucleotide polymorphisms (GRSWHR). Associations between soft drink intake and the annual change (Δ) in body weight (BW), WC, or waist circumference adjusted for BMI (WCBMI) and possible interactions with the GRSs were examined with the use of linear regression analyses and meta-analyses. RESULTS For each soft drink serving per day, soft drink consumption was significantly associated with a higher ΔBW of 0.07 kg/y (95% CI: 0.01, 0.13 kg/y; P = 0.020) but not with the ΔWC or ΔWCBMI In analyses of the ΔBW, we showed an interaction only with the GRSWC (per risk allele for each soft drink serving per day: -0.06 kg/y; 95% CI: -0.10, -0.02 kg/y; P = 0.006). In analyses of the ΔWC, we showed interactions only with the GRSBMI and GRSComplete [per risk allele for each soft drink serving per day: 0.05 cm/y (95% CI: 0.02, 0.09 cm/y; P = 0.001) and 0.05 cm/y (95% CI: 0.02, 0.07 cm/y; P = 0.001), respectively]. Nearly identical results were observed in analyses of the ΔWCBMI CONCLUSIONS: A genetic predisposition to a high WC may attenuate the association between soft drink intake and BW gain. A genetic predisposition to high BMI as well as a genetic predisposition to high BMI, WC, and WHRBMI combined may strengthen the association between soft drink intake and WC gain. However, the public health impact may be limited.
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Affiliation(s)
- Nanna J Olsen
- Research Unit for Dietary Studies at the Parker Institute and Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark;
| | - Lars Ängquist
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Sofus C Larsen
- Research Unit for Dietary Studies at the Parker Institute and Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, Copenhagen, Denmark; Department of Clinical Experimental Research, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences
| | - Tea Skaaby
- Research Centre for Prevention and Health, Copenhagen, Denmark
| | | | - Ulla Toft
- Research Centre for Prevention and Health, Copenhagen, Denmark
| | | | - Jytte Halkjær
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, and
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, and
| | - Kim Overvad
- Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Tarunveer S Ahluwalia
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, and Steno Diabetes Center, Gentofte, Denmark
| | - Thorkild Ia Sørensen
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, and Medical Research Council Integrative Epidemiology Unit, Bristol University, Bristol, United Kingdom
| | - Berit L Heitmann
- Research Unit for Dietary Studies at the Parker Institute and Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; and The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
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Guertler D, Meyer C, Dörr M, Braatz J, Weymar F, John U, Freyer-Adam J, Ulbricht S. Reach of Individuals at Risk for Cardiovascular Disease by Proactive Recruitment Strategies in General Practices, Job Centers, and Health Insurance. Int J Behav Med 2016; 24:153-160. [DOI: 10.1007/s12529-016-9584-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Larsen SC, Ängquist L, Moldovan M, Huikari V, Sebert S, Cavadino A, Singh Ahluwalia T, Skaaby T, Linneberg A, Husemoen LLN, Toft U, Pedersen O, Hansen T, Herzig KH, Jarvelin MR, Power C, Hyppönen E, Heitmann BL, Sørensen TIA. Serum 25-Hydroxyvitamin D Status and Longitudinal Changes in Weight and Waist Circumference: Influence of Genetic Predisposition to Adiposity. PLoS One 2016; 11:e0153611. [PMID: 27077659 PMCID: PMC4831693 DOI: 10.1371/journal.pone.0153611] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 03/31/2016] [Indexed: 01/10/2023] Open
Abstract
Studies of the relationship between serum 25-hydroxyvitamin D (25(OH)D) and changes in measures of adiposity have shown inconsistent results, and interaction with genetic predisposition to obesity has rarely been examined. We examined whether 25(OH)D was associated with subsequent annual changes in body weight (ΔBW) or waist circumference (ΔWC), and whether the associations were modified by genetic predisposition to a high BMI, WC or waist-hip ratio adjusted for BMI (WHRBMI). The study was based on 10,898 individuals from the Danish Inter99, the 1958 British Birth Cohort and the Northern Finland Birth Cohort 1966. We combined 42 adiposity-associated Single Nucleotide Polymorphisms (SNPs) into four scores indicating genetic predisposition to BMI, WC and WHRBMI, or all three traits combined. Linear regression was used to examine the association between serum 25(OH)D and ΔBW or ΔWC, SNP-score × 25(OH)D interactions were examined, and results from the individual cohorts were meta-analyzed. In the meta-analyses, we found no evidence of an association between 25(OH)D and ΔBW (-9.4 gram/y per 10 nmol/L higher 25(OH)D [95% CI: -23.0, +4.3; P = 0.18]) or ΔWC (-0.06 mm/y per 10 nmol/L higher 25(OH)D [95% CI: -0.17, +0.06; P = 0.33]). Furthermore, we found no statistically significant interactions between the four SNP-scores and 25(OH)D in relation to ΔBW or ΔWC. Thus, in view of the narrow CIs, our results suggest that an association between 25(OH)D and changes in measures of adiposity is absent or marginal. Similarly, the study provided evidence that there is either no or very limited dependence on genetic predisposition to adiposity.
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Affiliation(s)
- Sofus C. Larsen
- Research unit for Dietary Studies, the Parker Institute, Frederiksberg and Bispebjerg Hospitals, The Capital Region, Frederiksberg, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, the Capital Region, Copenhagen, Denmark
- * E-mail:
| | - Lars Ängquist
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, the Capital Region, Copenhagen, Denmark
| | - Max Moldovan
- Centre for Population Health Research, School of Health Sciences and Sansom Institute, University of South Australia, Adelaide, Australia
| | - Ville Huikari
- Center for Life-Course Health Research, Faculty of Medicine, P.O.Box 5000, FI-90014 University of Oulu, Oulu, Finland
| | - Sylvain Sebert
- Center for Life-Course Health Research, Faculty of Medicine, P.O.Box 5000, FI-90014 University of Oulu, Oulu, Finland
| | - Alana Cavadino
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Population, Policy and Practice, UCL Institute of Child Health, University College London, London, United Kingdom
| | - Tarunveer Singh Ahluwalia
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center, Gentofte, Denmark
| | - Tea Skaaby
- Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lise Lotte N. Husemoen
- Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
| | - Ulla Toft
- Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karl-Heinz Herzig
- Institute of Biomedicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu and Oulu University Hospital, Oulu, Finland
- Biocenter Oulu, P.O.Box 5000, Aapistie 5A, FI-90014 University of Oulu, Oulu, Finland
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
| | - Marjo-Riitta Jarvelin
- Center for Life-Course Health Research, Faculty of Medicine, P.O.Box 5000, FI-90014 University of Oulu, Oulu, Finland
- Biocenter Oulu, P.O.Box 5000, Aapistie 5A, FI-90014 University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
- Unit of Primary Care, Oulu University Hospital, Kajaanintie 50, P.O.Box 20, FI-90220 Oulu, 90029 OYS, Finland
| | - Chris Power
- Population, Policy and Practice, UCL Institute of Child Health, University College London, London, United Kingdom
| | - Elina Hyppönen
- Centre for Population Health Research, School of Health Sciences and Sansom Institute, University of South Australia, Adelaide, Australia
- Population, Policy and Practice, UCL Institute of Child Health, University College London, London, United Kingdom
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Berit L. Heitmann
- Research unit for Dietary Studies, the Parker Institute, Frederiksberg and Bispebjerg Hospitals, The Capital Region, Frederiksberg, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, the Capital Region, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
| | - Thorkild I. A. Sørensen
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, the Capital Region, Copenhagen, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
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Emborg HD, Teunis P, Simonsen J, Krogfelt KA, Jørgensen CS, Takkinen J, Mølbak K. Was the increase in culture-confirmed Campylobacter infections in Denmark during the 1990s a surveillance artefact? ACTA ACUST UNITED AC 2016; 20:30041. [PMID: 26538161 DOI: 10.2807/1560-7917.es.2015.20.41.30041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 09/21/2015] [Indexed: 11/20/2022]
Abstract
In 1991, 1999 and 2006, randomly selected individuals from the Danish Central Personal Register provided a serum sample. From individuals aged 30 years and above, 500 samples from each year were analysed for Campylobacter IgG, IgA and IgM antibodies using a direct ELISA method. We applied a seroincidence calculator available from the European Centre for Disease Prevention and Control to perform a mathematical back-calculation to estimate the annual Campylobacter seroincidence in the Danish population. The estimated Campylobacter seroincidence did not differ significantly between the 1991, 1999 and 2006 studies although the reported number of culture-confirmed cases of Campylobacter infection increased 2.5 fold from 1993 to 1999 among individuals aged 30 years and above. This suggests that Campylobacter was widely present in the Danish population before the increase in poultry-associated clinical Campylobacter infections observed from 1993 to 2001 among individuals of this age groups.
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Affiliation(s)
- Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
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Freyer-Adam J, Baumann S, Haberecht K, Tobschall S, Schnuerer I, Bruss K, Bandelin E, John U, Gaertner B. In-person and computer-based alcohol interventions at general hospitals: reach and retention. Eur J Public Health 2016; 26:844-849. [PMID: 26748101 DOI: 10.1093/eurpub/ckv238] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High reach of target populations is relevant for public health impact of interventions. Concerning intervention programs requiring multiple contacts, little is known about how many persons may be kept in the intervention program over multiple time points. The aim of this study was to investigate (i) the reach of general hospital inpatients with at-risk alcohol use through screening and brief intervention and (ii) whether their continued intervention participation after hospital discharge differs by in-person vs. computer-based intervention (CO) delivery. METHODS As part of a randomized controlled trial, general hospital inpatients aged 18-64 years were screened for at-risk alcohol use on 13 wards. Participants were allocated to in-person intervention (PE), CO and assessment only. Both interventions were provided on site, and 1 and 3 months after baseline. RESULTS Ninety-two percent of all eligible inpatients ( N: = 6251) completed the screening. Eighty-one percent ( N: = 961) of the screening-positives participated in the trial and received their allocated intervention. At months 1 and 3, interventions were delivered to 83 and 79% of the CO participants and to 74 and 64% of the PE participants. The delivery of CO and PE required an average of 5.2 and 7.7 contact attempts per delivered intervention, respectively. CONCLUSION General hospital inpatients with at-risk alcohol use were well reached through proactive interventions. COs may result in higher retention rates over 1 and 3 months and may require less contact attempts than PEs. Public health efforts that aim to achieve high intervention retention should consider proactive COs.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany .,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Sophie Baumann
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Katja Haberecht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Stefanie Tobschall
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
| | - Inga Schnuerer
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany.,Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Kornelia Bruss
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
| | - Elke Bandelin
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Bender AM, Jørgensen T, Pisinger C. Is self-selection the main driver of positive interpretations of general health checks? The Inter99 randomized trial. Prev Med 2015; 81:42-8. [PMID: 26190370 DOI: 10.1016/j.ypmed.2015.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/01/2015] [Accepted: 07/10/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate if the lower mortality among participants of a health check followed by lifestyle intervention of high risk persons is explained by self-selection. METHODS All persons residing in the study area (Copenhagen; Denmark) were randomized to intervention (n=11,629) or control group (n=47,987). Persons in the intervention group were invited for a health check and individual lifestyle counselling. At baseline, 52.5% participated. Differences between participants and control group in 10-year all-cause and disease specific mortality was assessed. In survival analyses we controlled for socio-demography and mental and physical health. RESULTS Mortality rates were highest among non-participants and lowest among participants in the intervention group, whereas mortality rates of controls were approximately the average of those of participants and non-participants. In adjusted analyses the difference in both all-cause mortality (HR 0.73, 95% CI 0.62-0.85) and disease specific mortality was diminished between participants and controls, and turning insignificant as regard cancer mortality. In total, 39% of the lower mortality among participants in the intervention group was explained by self-selection according to socio-demography and health. CONCLUSION A substantial part of the lower mortality among participants in a preventive health check can be explained by confounding. The remaining lower mortality is most probably due to residual confounding, as the lower mortality was seen both for lifestyle related and non-lifestyle related diseases.
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Affiliation(s)
- Anne Mette Bender
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark.
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark; Faculty of Health Science, University of Copenhagen, Denmark; Faculty of Medicine, University of Aalborg, Denmark
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark
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Christensen AV, Koch MB, Davidsen M, Jensen GB, Andersen LV, Juel K. Educational inequality in cardiovascular disease depends on diagnosis: A nationwide register based study from Denmark. Eur J Prev Cardiol 2015; 23:826-33. [DOI: 10.1177/2047487315613665] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Anne V Christensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mette B Koch
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Gorm B Jensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Danish Heart Association, Copenhagen, Denmark
- Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Baumann S, Toft U, Aadahl M, Jørgensen T, Pisinger C. The long-term effect of a population-based life-style intervention on smoking and alcohol consumption. The Inter99 Study--a randomized controlled trial. Addiction 2015; 110:1853-60. [PMID: 26173928 DOI: 10.1111/add.13052] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/02/2015] [Accepted: 07/03/2015] [Indexed: 11/30/2022]
Abstract
AIMS To examine whether improvements in smoking and alcohol consumption throughout the 5-year course of a population-based multi-factorial life-style intervention were sustained 5 years after its discontinuation. DESIGN Population-based randomized controlled trial. SETTING Suburbs of Copenhagen, Denmark. PARTICIPANTS A total of 9415 people aged 30-60 years were randomized to an intervention group (n = 6091) and an assessment-only control group (n = 3324). INTERVENTION All participants in the intervention group received screening, risk assessment and individual life-style counselling; participants at high risk of ischaemic heart disease-according to pre-specified criteria-were also offered group-based counselling. MEASUREMENTS Self-reported point abstinence from smoking as well as changes in the average alcohol consumption per week and binge drinking in the past week from baseline to 10-year follow-up were investigated using random-effects modelling. FINDINGS At 10-year follow up, people in the intervention group reported a higher smoking abstinence rate [odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.02-3.33, P = 0.043] and a greater reduction in binge drinking (net change = -0.08 days with binge drinking in the last week, 95% CI = -0.16 to -0.01, P = 0.028) than in the control group. There were no detectable long-term intervention effects on the average alcohol consumption per week. CONCLUSIONS A population-based multi-factorial life-style intervention of 5 years' duration in Denmark had sustained beneficial effects on smoking abstinence and binge drinking 5 years after its discontinuation.
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Affiliation(s)
- Sophie Baumann
- University Medicine Greifswald, Institute of Social Medicine and Prevention, Greifswald, Germany.,Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark
| | - Ulla Toft
- Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark
| | - Mette Aadahl
- Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Baumann S, Godtfredsen NS, Lange P, Pisinger C. The impact of birth weight on the level of lung function and lung function decline in the general adult population. The Inter99 study. Respir Med 2015; 109:1293-9. [DOI: 10.1016/j.rmed.2015.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/13/2015] [Accepted: 08/15/2015] [Indexed: 12/14/2022]
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Baumann S, Gaertner B, Schnuerer I, Haberecht K, John U, Freyer-Adam J. Belief incongruence and the intention-behavior gap in persons with at-risk alcohol use. Addict Behav 2015; 48:5-11. [PMID: 25930010 DOI: 10.1016/j.addbeh.2015.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/02/2015] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION When intentions are expressed, e.g., when filling in a health questionnaire, people may have unrealistic beliefs towards behavior change resulting in strong intentions to change. These may fail to correspond to reality when the behavior actually should be performed. Belief incongruence was tested as a possible source of the intention-behavior gap. METHODS The study sample consisted of 433 job agency clients with at-risk alcohol use (64% men, mean age=30.6 (SD=11.6) years). Behavioral, normative, and control beliefs, intention, and alcohol use were assessed at baseline and three months later. The influence of belief incongruence on the intention-behavior gap was examined using latent interaction models. RESULTS The gap between stated intentions and at-risk alcohol use three months later was larger when the according normative beliefs were incongruent (total effect: b=-0.44, p<0.05 for persons with congruent beliefs vs. b=-0.06, p>0.10 for persons with incongruent beliefs). When controlling for the mediating effect of changes in intentions, the association between belief incongruence and intention-behavior gap was attenuated (direct effect: b=-0.56, p<0.01 for persons with congruent beliefs vs. b=-0.28, p<0.05 for persons with incongruent beliefs). Neither behavioral belief incongruence nor control belief incongruence was significantly associated with the intention-behavior gap. CONCLUSIONS Normative belief incongruence may contribute to the gap between intentions to adhere to recommended drinking limits and subsequent at-risk alcohol use. Focusing on the reduction of misperceptions about drinking norms could help to increase the proportion of persons who succeed in translating their intentions into behavior.
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Affiliation(s)
- Sophie Baumann
- University Medicine Greifswald, Institute of Social Medicine and Prevention, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, 17489 Greifswald, Germany.
| | - Beate Gaertner
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62-66, 12101 Berlin, Germany
| | - Inga Schnuerer
- University Medicine Greifswald, Institute of Social Medicine and Prevention, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, 17489 Greifswald, Germany
| | - Katja Haberecht
- University Medicine Greifswald, Institute of Social Medicine and Prevention, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, 17489 Greifswald, Germany
| | - Ulrich John
- University Medicine Greifswald, Institute of Social Medicine and Prevention, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, 17489 Greifswald, Germany
| | - Jennis Freyer-Adam
- University Medicine Greifswald, Institute of Social Medicine and Prevention, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, 17489 Greifswald, Germany
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Bender AM, Kawachi I, Jørgensen T, Pisinger C. Neighborhood social capital is associated with participation in health checks of a general population: a multilevel analysis of a population-based lifestyle intervention- the Inter99 study. BMC Public Health 2015. [PMID: 26197982 PMCID: PMC4511436 DOI: 10.1186/s12889-015-2042-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Participation in population-based preventive health check has declined over the past decades. More research is needed to determine factors enhancing participation. The objective of this study was to examine the association between two measures of neighborhood level social capital on participation in the health check phase of a population-based lifestyle intervention. Methods The study population comprised 12,568 residents of 73 Danish neighborhoods in the intervention group of a large population-based lifestyle intervention study - the Inter99. Two measures of social capital were applied; informal socializing and voting turnout. Results In a multilevel analysis only adjusting for age and sex, a higher level of neighborhood social capital was associated with higher probability of participating in the health check. Inclusion of both individual socioeconomic position and neighborhood deprivation in the model attenuated the coefficients for informal socializing, while voting turnout became non-significant. Conclusion Higher level of neighborhood social capital was associated with higher probability of participating in the health check phase of a population-based lifestyle intervention. Most of the association between neighborhood social capital and participation in preventive health checks can be explained by differences in individual socioeconomic position and level of neighborhood deprivation. Nonetheless, there seems to be some residual association between social capital and health check participation, suggesting that activating social relations in the community may be an avenue for boosting participation rates in population-based health checks. Trial registration ClinicalTrials.gov (registration no. NCT00289237). Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2042-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Mette Bender
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600, Glostrup, Denmark. .,Harvard School of Public Health. Department of Social and Behavioral Sciences, 677 Huntington Ave., 7th floor, Boston, MA, 02115, USA.
| | - Ichiro Kawachi
- Harvard School of Public Health. Department of Social and Behavioral Sciences, 677 Huntington Ave., 7th floor, Boston, MA, 02115, USA.
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600, Glostrup, Denmark. .,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark. .,Faculty of Medicine, University of Aalborg, Aalborg, Denmark.
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600, Glostrup, Denmark. .,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.
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Neighborhood deprivation is strongly associated with participation in a population-based health check. PLoS One 2015; 10:e0129819. [PMID: 26039635 PMCID: PMC4454539 DOI: 10.1371/journal.pone.0129819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/13/2015] [Indexed: 11/19/2022] Open
Abstract
Background We sought to examine whether neighborhood deprivation is associated with participation in a large population-based health check. Such analyses will help answer the question whether health checks, which are designed to meet the needs of residents in deprived neighborhoods, may increase participation and prove to be more effective in preventing disease. In Europe, no study has previously looked at the association between neighborhood deprivation and participation in a population-based health check. Methods The study population comprised 12,768 persons invited for a health check including screening for ischemic heart disease and lifestyle counseling. The study population was randomly drawn from a population of 179,097 persons living in 73 neighborhoods in Denmark. Data on neighborhood deprivation (percentage with basic education, with low income and not in work) and individual socioeconomic position were retrieved from national administrative registers. Multilevel regression analyses with log links and binary distributions were conducted to obtain relative risks, intraclass correlation coefficients and proportional change in variance. Results Large differences between neighborhoods existed in both deprivation levels and neighborhood health check participation rate (mean 53%; range 35-84%). In multilevel analyses adjusted for age and sex, higher levels of all three indicators of neighborhood deprivation and a deprivation score were associated with lower participation in a dose-response fashion. Persons living in the most deprived neighborhoods had up to 37% decreased probability of participating compared to those living in the least deprived neighborhoods. Inclusion of individual socioeconomic position in the model attenuated the neighborhood deprivation coefficients, but all except for income deprivation remained statistically significant. Conclusion Neighborhood deprivation was associated with participation in a population-based health check in a dose-response manner, in which increasing neighborhood deprivation was associated with decreasing participation. This suggests the need to develop preventive health checks tailored to deprived neighborhoods.
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