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Kirkegaard AM, Dalton SO, Boesen EH, Karlsen RV, Flyger H, Johansen C, von Heymann A. Effects on long-term survival of psychosocial group intervention in early-stage breast cancer: follow-up of a randomized controlled trial. Acta Oncol 2023; 62:422-428. [PMID: 37102368 DOI: 10.1080/0284186x.2023.2203329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND The promise of prolonged survival after psychosocial interventions has long been studied, but not convincingly demonstrated. This study aims to investigate whether a psychosocial group intervention improved long-term survival in women with early-stage breast cancer and investigate differences in baseline characteristics and survival between study participants and non-participants. METHODS A total of 201 patients were randomized to two six-hour psychoeducation sessions and eight weekly sessions of group psychotherapy or care as usual. Additionally, 151 eligible patients declined to participate. Eligible patients were diagnosed and treated at Herlev Hospital, Denmark, and followed for vital status up to 18 years after their primary surgical treatment. Cox's proportional hazard regressions were used to estimate hazard ratios (HRs) for survival. RESULTS The intervention did not significantly improve survival in the intervention group compared with the control group (HR, 0.68; 95% confidence interval (CI), 0.41-1.14). Participants and non-participants differed significantly in age, cancer stage, adjuvant chemotherapy, and crude survival. When adjusted, no significant survival difference between participants and non-participants remained (HR, 0.77; 95% CI, 0.53-1.11). CONCLUSIONS We could not show improved long-term survival after the psychosocial intervention. Participants survived longer than nonparticipants, but clinical and demographic characteristics, rather than study participation, seem accountable for this difference.
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Affiliation(s)
- Anne Marie Kirkegaard
- Cancer Survivorship and Treatment Late Effects - a Danish Cancer Society National Research Center, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | | | - Randi V Karlsen
- Psychosocial Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, University Hospital Herlev, Denmark Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects - a Danish Cancer Society National Research Center, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Psychosocial Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects - a Danish Cancer Society National Research Center, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Psychosocial Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
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Kirkegaard AM, Kloster S, Davidsen M, Christensen AI, Vestbo J, Nielsen NS, Ersbøll AK, Gunnarsen L. The Association between Perceived Annoyances in the Indoor Home Environment and Respiratory Infections: A Danish Cohort Study with up to 19 Years of Follow-Up. Int J Environ Res Public Health 2023; 20:1911. [PMID: 36767277 PMCID: PMC9915003 DOI: 10.3390/ijerph20031911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
The increasing prevalence of reported annoyances in the indoor environment threatens public health. This study aimed to investigate the association between perceived annoyances from the home environment and respiratory infections among individuals with and without asthma or chronic obstructive pulmonary disease (COPD). A total of 16,688 individuals from the Danish Health and Morbidity Survey initiated in 2000 were grouped according to their patterns of perceived annoyances. Information on respiratory infections (all causes, bacterial, viral, and those leading to hospital admissions) was obtained from Danish registers up to 19 years after the survey. Poisson regression of incidence rates (IRs) was applied to estimate incidence rate ratios (IRRs). Annoyances significantly increased the IR for respiratory infections of all causes and bacterial respiratory infections in individuals without asthma or COPD, adjusted IRR 1.16 (95% CI: 1.01, 1.34) and 1.15 (95% CI: 1.02, 1.31), respectively. However, no difference was observed for viral respiratory infections nor hospital admissions. Individuals with asthma or COPD and a high level of annoyances had a non-significantly increased IR in all four analyses of respiratory infections. These findings provide support for perceived annoyances as an important risk factor for respiratory infections.
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Affiliation(s)
- Anne Marie Kirkegaard
- Department of the Built Environment, Aalborg University, A.C. Meyers Vaenge 15, 2450 Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Stine Kloster
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Anne Illemann Christensen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9 PL, UK
| | - Niss Skov Nielsen
- Department of the Built Environment, Aalborg University, A.C. Meyers Vaenge 15, 2450 Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Lars Gunnarsen
- Department of the Built Environment, Aalborg University, A.C. Meyers Vaenge 15, 2450 Copenhagen, Denmark
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Kloster S, Kirkegaard AM, Davidsen M, Christensen AI, Nielsen NS, Gunnarsen L, Ersbøll AK. Patterns of Perceived Indoor Environment in Danish Homes. Int J Environ Res Public Health 2022; 19:11498. [PMID: 36141771 PMCID: PMC9517311 DOI: 10.3390/ijerph191811498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
The indoor environment is composed of several exposures existing simultaneously. Therefore, it might be useful to combine exposures into common combined measures when used to assess the association with health. The aim of our study was to identify patterns of the perceived indoor environment. Data from the Danish Health and Morbidity Survey in the year 2000 were used. The perceived indoor environment was assessed using a questionnaire (e.g., annoyances from noise, draught, and stuffy air; 13 items in total). Factor analysis was used to explore the structure of relationships between these 13 items. Furthermore, groups of individuals with similar perceived indoor environment were identified using latent class analysis. A total of 16,688 individuals ≥16 years participated. Their median age was 46 years. Four factors were extracted from the factor analysis. The factors were characterized by: (1) a mixture of items, (2) temperature, (3) traffic, and (4) neighbor noise. Moreover, three groups of individuals sharing the same perception of their indoor environment were identified. They were characterized by: a low (n = 14,829), moderate (n = 980), and large number of annoyances (n = 879). Observational studies need to take this correlation and clustering of perceived annoyances into account when studying associations between the indoor environment and health.
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Affiliation(s)
- Stine Kloster
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark
| | - Anne Marie Kirkegaard
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark
- Department of the Built Environment, Aalborg University, A.C. Meyers Vaenge 15, 2450 Copenhagen SV, Denmark
| | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark
| | - Anne Illemann Christensen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark
| | - Niss Skov Nielsen
- Department of the Built Environment, Aalborg University, A.C. Meyers Vaenge 15, 2450 Copenhagen SV, Denmark
| | - Lars Gunnarsen
- Department of the Built Environment, Aalborg University, A.C. Meyers Vaenge 15, 2450 Copenhagen SV, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark
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Kirkegaard AM, Breckling M, Nielsen DG, Tolstrup JS, Johnsen SP, Ersbøll AK, Kloster S. Length of hospital stay after delivery among Danish women with congenital heart disease: a register-based cohort study. BMC Pregnancy Childbirth 2021; 21:812. [PMID: 34876061 PMCID: PMC8650333 DOI: 10.1186/s12884-021-04286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background The literature about the impact of congenital heart disease (CHD) on the length of hospital stay after delivery is limited, and nonexisting in a country with free and equal access to healthcare. We aimed to examine the hypothesis that Danish women with CHD have a longer hospital stay after delivery compared to women without CHD. Secondarily, we aimed to examine the hypothesis that cesarean section modifies the association. Methods The study was a national cohort study using Danish nationwide registers in 1997–2014. Maternal CHD was categorized as simple, moderate, or complex CHD. The comparison group consisted of women without CHD. Outcome of interest was length of hospital stay after delivery registered in complete days. Mode of delivery was categorized as cesarean section or vaginal delivery. Data was analyzed using a generalized linear model with a Poisson distribution. Results We included 939,678 births among 551,119 women. Women without CHD were on average admitted to the hospital for 3.6 (SD 3.7) days, whereas women with simple, moderate, and complex CHD were admitted for 3.9 (SD 4.4), 4.0 (SD 3.8) and 5.1 (SD 6.7) days, respectively. The adjusted length of hospital stay after delivery was 12% (relative ratio (RR) = 1.12, 95% confidence interval (CI) 1.07–1.18), 14% (RR = 1.14, 95% CI: 1.07–1.21), and 45% (RR = 1.45, 95% CI: 1.24–1.70) longer among women with simple, moderate, and complex CHD, respectively, compared to women without CHD. The association between maternal CHD and length of hospital stay was not modified by mode of delivery (p-value of interaction = 0.62). Women who gave birth by cesarean section were on average admitted to the hospital for 2.7 days longer compared to women with vaginal delivery. Conclusion The hospital stay after delivery was significantly longer among women with CHD as compared to women without CHD. Further, higher complexity of CHD was associated with longer length of stay. Cesarean section did not modify the association. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04286-3.
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Affiliation(s)
- Anne Marie Kirkegaard
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Maria Breckling
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Dorte Guldbrand Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Stine Kloster
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.
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