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Tønnesen H, Raffing R, Lauridsen SV, Lauritzen JB, Elholm AMH, Jensen HS, Espinosa P, Jansson KÅ, Berman AH, Fernández-Valencia J, Muñoz-Mahamud E, Santiñà M, Combalia A. Two novel prehabilitation apps to help patients stop smoking and risky drinking prior to hip and knee arthroplasty. Int Orthop 2023; 47:2645-2653. [PMID: 37550591 PMCID: PMC10602983 DOI: 10.1007/s00264-023-05890-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/02/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Daily smoking or risky drinking increases the risk of complications after surgery by ~50%. Intensive prehabilitation aimed at complete cessation reduces the complication rate but is time-consuming. The purpose of this study was to carry out preoperative pilot tests (randomized design) of the feasibility (1A) and validation (1B) of two novel prehabilitation apps, habeat® (Ha-app) or rehaviour® (Re-app). METHODS Patients scheduled for hip or knee arthroplasty with daily smoking, risky drinking, or both were randomised to one of the two apps. In part 1A, eight patients and their staff measured feasibility on a visual analog scale (VAS) and were interviewed about what worked well and the challenges requiring improvement. In part 1B, seven patients and their staff tested the improved apps for up to two weeks before validating the understanding, usability, coverage, and empowerment on a VAS and being interviewed. RESULTS In 1A, all patients and staff returned scores of ≥5 for understanding the apps and mostly suggested technical improvements. In 1B, the scores varied widely for both apps, with no consensus achieved. Two of four patients (Ha-app) and one-third of the patients (Re-app) found the apps helpful for reducing smoking, but without successful quitting. The staff experienced low app competencies among patients and high time consumption. Specifically, patients most often needed help for the Ha-app, and the staff most often for Re-app; however, the staff reported the Re-app dashboard was more user-friendly. Support and follow-up from an addiction specialist staff member were suggested to complement the apps, thereby increasing the time consumption for staff. CONCLUSIONS This pilot study to test prototype apps generated helpful feedback for the app developers. Based on the patient and staff comments, multiple improvements in functionality seem required before scaling up the evaluation for effect on prehabilitation and postoperative complications.
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Affiliation(s)
- Hanne Tønnesen
- WHO CC (DK-62), Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Rie Raffing
- WHO CC (DK-62), Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Vahr Lauridsen
- WHO CC (DK-62), Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jes Bruun Lauritzen
- Department of Orthopedic Surgery, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Marie Halmø Elholm
- Department of Orthopedic Surgery, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helle Sæderup Jensen
- Department of Orthopedic Surgery, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Espinosa
- Department of Molecular Medicine and Surgery, Karolinska Institute at Reconstructive Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Karl Åke Jansson
- Department of Molecular Medicine and Surgery, Karolinska Institute at Reconstructive Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anne H Berman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm & Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Jenaro Fernández-Valencia
- Department of Orthopedic Surgery, Hospital Clinic Barcelona and Faculty of Medicine & Health Sciences, University of Barcelona, Barcelona, Spain
| | - Ernesto Muñoz-Mahamud
- Department of Orthopedic Surgery, Hospital Clinic Barcelona and Faculty of Medicine & Health Sciences, University of Barcelona, Barcelona, Spain
| | - Manuel Santiñà
- Department of Orthopedic Surgery, Hospital Clinic Barcelona and Faculty of Medicine & Health Sciences, University of Barcelona, Barcelona, Spain
| | - Andrés Combalia
- Department of Orthopedic Surgery, Hospital Clinic Barcelona and Faculty of Medicine & Health Sciences, University of Barcelona, Barcelona, Spain
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Baldus C, Elgán TH, Soyez V, Tønnesen H, Arnaud N, Csemy L, Thomasius R. Risky Sexual Behaviour and Sexual Victimization among Young People with Risky Substance Use in Europe-Perspectives from Belgium, Sweden, the Czech Republic, and Germany. Int J Environ Res Public Health 2023; 20:7002. [PMID: 37947560 PMCID: PMC10648046 DOI: 10.3390/ijerph20217002] [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] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Research indicates that among the risks associated with young people's alcohol and illicit drug use are sexual risks. However, insights into co-occurrence of substance use and sexual risks in adolescent samples and possible differences across countries are limited. METHODS A sample of 1449 adolescents from Belgium, Sweden, the Czech Republic, and Germany screened positive for risky alcohol/illicit drug use in a web-based intervention against alcohol and illicit drug use. They also reported incidents of sex while being drunk and/or high on drugs, condomless sex on these occasions, and sexualized touching and sexual victimization while being drunk or high on drugs. RESULTS In the sample, 21.5% of the participants reported sexualized touching, 9.9% being victim to sexual assault, and 49.8% having had sex while being drunk and/or high on drugs; of the latter, 48.3% had condomless sex. Reports on having had sex while being drunk and/or high on drugs were associated with higher levels of past 30-day binge drinking. Being a victim of sexual assault was associated with past 30-day binge drinking only in young men. CONCLUSION When devising preventive interventions against risky substance use in adolescents, an additional focus should be set on integrating steps against sexual risks.
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Affiliation(s)
- Christiane Baldus
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Tobias H. Elgán
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 11364 Stockholm, Sweden;
| | - Veerle Soyez
- Department of Psychology, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, Lund University, 22185 Lund, Sweden
| | - Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ladislav Csemy
- Public Mental Health Research Program, National Institute of Mental Health, 25067 Klecany, Czech Republic
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Lauridsen SV, Jensen BT, Tønnesen H, Dalton SO, Rasmussen M. The gold standard program (GSP) for smoking cessation: a cohort study of its effectiveness among smokers with and without cancer. Acta Oncol 2023; 62:774-781. [PMID: 37405937 DOI: 10.1080/0284186x.2023.2228445] [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: 10/22/2022] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Smoking cessation treatment is an important prognostic factor for survival after a cancer diagnosis, especially for tobacco-related cancers. After being diagnosed with lung cancer, approximately 50% of patients continue smoking or frequently relapse after a quit attempt. Given the importance of smoking cessation treatment for cancer survivors, the objective was to compare the effectiveness of a 6-week intensive smoking cessation intervention, the Gold Standard Program (GSP), among cancer survivors compared with smokers without cancer. Second, we compared successful quitting among socioeconomically disadvantaged cancer survivors with that among nondisadvantaged cancer survivors. MATERIALS AND METHODS This was a cohort study based on 38,345 smokers from the Danish Smoking Cessation Database (2006-2016). Linkage to the National Patient Register was used to identify cancer survivors undergoing the GSP after being diagnosed with cancer (except nonmelanoma skin cancer). Linkage to the Danish Civil Registration System was used to identify participants who died, went missing, or emigrated before the follow-up. Logistic regression models were applied to evaluate effectiveness. RESULTS AND CONCLUSION Six percent (2438) of the included smokers were cancer survivors at the time they undertook the GSP. Their 6-month successful quitting showed no difference compared to that of smokers without cancer, neither before nor after adjustment; 35% versus 37% in crude rates and an aOR of 1.13 (95% CI: 0.97-1.32). Likewise, the results for disadvantaged compared to nondisadvantaged cancer survivors were not significantly different (32% versus 33% and an adjusted aOR of 0.87 (95% CI 0.69-1.11)). Overall, an intensive smoking cessation program seems effective in helping both people without cancer and cancer survivors become successful quitters.
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Affiliation(s)
- S V Lauridsen
- Clinical Health Promotion Centre (WHO-CC), the Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Denmark
- Department of Urology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - B T Jensen
- Department of Urology, Aarhus University Hospital & Aarhus University, Department of Public Health, Aarhus, Denmark
| | - H Tønnesen
- Clinical Health Promotion Centre (WHO-CC), the Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Denmark
- Clinical Health Promotion Centre (WHO-CC), Department of Health Sciences, Lund University and Region Skåne SE, Sweden
| | - S O Dalton
- Survival and Inequality in Cancer, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - M Rasmussen
- Clinical Health Promotion Centre (WHO-CC), the Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Denmark
- Clinical Health Promotion Centre (WHO-CC), Department of Health Sciences, Lund University and Region Skåne SE, Sweden
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Raffing R, Larsen S, Konge L, Tønnesen H. From Targeted Needs Assessment to Course Ready for Implementation-A Model for Curriculum Development and the Course Results. Int J Environ Res Public Health 2023; 20:2529. [PMID: 36767895 PMCID: PMC9915190 DOI: 10.3390/ijerph20032529] [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: 12/14/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
This article contributes guidance on how to approach the development of a course curriculum in general and presents a specific example from medical research education. The purpose of this study is to discuss a model for translating needs assessments of targeted learners into a course curriculum. The model employs established methods for data collection, such as different interview approaches and surveys. The authors argue that there is value in going from exploratory in-depth qualitative data collection methods to more conclusive rigorous quantitative methods when developing a course curriculum. In this way, the model is especially sensitive to the needs of targeted learners in the initial phase and at the same time offers a systematic and practical approach to curriculum development. The model is presented step-by-step with the aid of an empirical example of how to assess the needs of medical doctors in the publication process and develop an introductory course in writing an initial manuscript for publication. The article concludes that the proposed model gives curriculum developers a unique opportunity to explore the needs of targeted learners in depth, while systematically aiming towards conclusive decisions on curriculum content ready for implementation.
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Affiliation(s)
- Rie Raffing
- WHO Collaborating Centre, Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Sanne Larsen
- Centre for Internationalisation and Parallel Language Use, Faculty of Humanities, University of Copenhagen, DK-2300 Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR and Education, The Capital Region of Denmark, DK-2100 Copenhagen, Denmark
| | - Hanne Tønnesen
- WHO Collaborating Centre, Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, DK-2400 Copenhagen, Denmark
- WHO Collaborating Centre, Clinical Health Promotion Centre, Health Sciences, Lund University, SE-20502 Malmo, Sweden
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Hedin G, Garmy P, Norell-Clarke A, Tønnesen H, Hagell P, Westergren A. Measurement properties of the minimal insomnia symptom scale (MISS) in adolescents. Sleep Science Practice 2022. [DOI: 10.1186/s41606-022-00075-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The Minimal Insomnia Symptom Scale (MISS) is a three-item screening instrument that has been found to be psychometrically sound and capable of screening for insomnia among adults and older people. This study aimed to test the measurement properties of the MISS together with an additional item focusing on daytime functioning among adolescents using the Rasch measurement model.
Methods
A cross-sectional design was used, and data from adolescents (age 13–17 years, n = 3022) were analyzed using the Rasch measurement model.
Results
The MISS had good measurement properties. When adding the item “daytime disturbance”, the measurement properties deteriorated. When replacing the original MISS item “not rested by sleep” with the item “daytime disturbance”, the measurement properties slightly improved. We label this new scale the MISS-Revised (MISS-R). The reliability was better for the MISS-R (0.55) compared to the MISS (0.50). The optimal cut-off was found to be > 6 points, both for the MISS and the MISS-R.
Conclusions
This study provides general support that both the MISS as well as the MISS-R have good fit to the Rasch model. At this stage, neither the MISS nor the MISS-R can be advocated over the other for use among adolescents, although the MISS-R had slightly better reliability than the MISS. Additional studies are needed to determine the clinically optimal cut-score for identification of insomnia.
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Hedin G, Garmy P, Norell-Clarke A, Tønnesen H, Hagell P, Westergren A. Measuring insomnia among adolescents – analysis of the Minimal Insomnia Symptom Scale (MISS) with the Rasch measurement model. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hedin G, Norell-Clarke A, Tønnesen H, Westergren A, Garmy P. Predictors of insomnia among adolescents A longitudinal study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hedin G, Garmy P, Norell-Clarke A, Tønnesen H, Hagell P, Westergren A. Correction: Measurement properties of the minimal insomnia symptom scale (MISS) in adolescents. Sleep Science Practice 2022. [DOI: 10.1186/s41606-022-00077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lauridsen SV, Thomsen T, Jensen JB, Kallemose T, Schmidt Behrend M, Steffensen K, Poulsen AM, Jacobsen A, Walther L, Isaksson A, Thind P, Tønnesen H. Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy-the STOP-OP Study: A Randomised Clinical Trial. Eur Urol Focus 2022; 8:1650-1658. [PMID: 35241394 DOI: 10.1016/j.euf.2022.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Evidence concerning the reduction of postoperative complications due to smoking and alcohol drinking in patients undergoing radical cystectomy is incomplete. OBJECTIVE To evaluate the efficacy of a 6-wk smoking and/or alcohol cessation intervention, initiated shortly before surgery and continued until 4 wk after, in reducing complications. DESIGN, SETTING, AND PARTICIPANTS Between 2014 and 2018, we enrolled 104 patients with high-risk bladder cancer who were daily smokers or consuming at least 3 units of alcohol daily in a multicentre randomised clinical trial. INTERVENTION Patients were randomised to a 6-wk intensive smoking and/or alcohol cessation intervention or treatment as usual. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the number of patients developing any postoperative complication, or death, within 30 d after surgery. The secondary endpoints were successful quitters, health-related quality of life, length of stay, time back to habitual activity, and mortality. An intention-to-treat analysis was applied to evaluate treatment effect. RESULTS AND LIMITATIONS There were some differences in baseline demographic and lifestyle characteristics. Postoperatively, 64% in the intervention group versus 70% in the control group (risk ratio [RR] 0.91, confidence interval [CI] 0.68-1.21, p = 0.51) developed complications. Significantly fewer patients developed three or more complications after 30 d (RR 0.39; CI 0.18-0.84, p = 0.01). The rates of successful quitting were 51% in the intervention group and 27% in the control group (RR 2, CI 1.14-3.51, p = 0.01). The external validity of this trial may be limited because 53% of eligible patients refused participation. CONCLUSIONS Despite a significant effect on the quit rate at completion of the intervention, this multimodal prehabilitation did not show a significant difference regarding our primary outcome postoperative complications. PATIENT SUMMARY A 6-wk smoking and alcohol cessation intervention in relation to bladder cancer surgery did not reduce postoperative complications, but it was effective in supporting people to quit in the short term.
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Affiliation(s)
- Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; WHO-CC, Clinical Health Promotion Centre, Parker Institute, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark.
| | - Thordis Thomsen
- Department of Anaesthesiology, Herlev and Gentofte Hospital, Copenhagen University Hospitals, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | | | | | - Alicia Martin Poulsen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - André Jacobsen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Urology, Herlev Hospital, Herlev, Denmark
| | - Lisa Walther
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, University Hospital, Lund University, Lund, Sweden
| | - Anders Isaksson
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, University Hospital, Lund University, Lund, Sweden
| | - Peter Thind
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Tønnesen
- WHO-CC, Clinical Health Promotion Centre, Parker Institute, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark; Clinical Health Promotion Centre, Health Sciences, Lund University, Lund, Skåne, Sweden
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Rasmussen M, Lauridsen SV, Pedersen B, Backer V, Tønnesen H. Intensive versus short face-to-face smoking cessation interventions: a meta-analysis. Eur Respir Rev 2022; 31:31/165/220063. [PMID: 36002170 DOI: 10.1183/16000617.0063-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of intensive smoking cessation interventions (ISCIs) directly compared with shorter interventions (SIs), measured as successful quitting. METHOD Medline, Embase, the Cochrane Library and CINAHL were searched on 15 October 2021. Peer-reviewed randomised controlled trials (RCTs) of adult, daily smokers undergoing an ISCI were included. No setting, time or language restrictions were imposed. Risk of bias and quality of evidence was assessed using the Cochrane tool and Grading of Recommendations, Assessment, Development and Evaluation, respectively. Meta-analyses were conducted using a random-effects model. RESULTS 17 550 unique articles were identified and 17 RCTs evaluating 9812 smokers were included. 14 studies were conducted in Europe or the USA. The quality of the evidence was assessed as low or moderate. Continuous abstinence was significantly higher in ISCIs in the long term (risk ratio 2.60, 95% CI 1.71-3.97). Direction and magnitude were similar in the short term; however, they were not statistically significant (risk ratio 2.49, 95% CI: 0.94-6.56). When measured as point prevalence, successful quitting was still statistically significant in favour of ISCIs, but lower (long term: 1.64, 1.08-2.47; short term: 1.68, 1.10-2.56). Sensitivity analysis confirmed the robustness of the results. CONCLUSION ISCIs are highly effective compared to SIs. This important knowledge should be used to avoid additional morbidity and mortality caused by smoking.
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Affiliation(s)
- Mette Rasmussen
- Clinical Health Promotion Centre (WHO-CC), the Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Frederiksberg, Denmark .,Clinical Health Promotion Centre (WHO-CC), Department of Health Sciences, Lund University, Lund, Sweden
| | - Susanne Vahr Lauridsen
- Clinical Health Promotion Centre (WHO-CC), the Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Frederiksberg, Denmark.,Department of Urology, Rigshospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bolette Pedersen
- Clinical Health Promotion Centre (WHO-CC), the Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Frederiksberg, Denmark
| | - Vibeke Backer
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Tønnesen
- Clinical Health Promotion Centre (WHO-CC), the Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Frederiksberg, Denmark.,Clinical Health Promotion Centre (WHO-CC), Department of Health Sciences, Lund University, Lund, Sweden
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11
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Hedin G, Norell-Clarke A, Tønnesen H, Westergren A, Garmy P. Contributory Factors for Teen Insomnia Symptoms: A Prospective Cohort Study in Sweden. Front Neurosci 2022; 16:904974. [PMID: 35837125 PMCID: PMC9275817 DOI: 10.3389/fnins.2022.904974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Insufficient sleep is a public health problem that impacts the mental and physical health of children and adolescents. Complaints of insomnia are particularly pervasive among adolescents. This longitudinal study investigates factors that contribute to teen insomnia symptoms. Design Five-year prospective follow-up study. Setting School-based. Participants A total of 522 children (49.8% girls) aged 9.4 ± 1.3 years at baseline; 14.4 ± 0.7 years at follow-up. Measurements The dependent variable of insomnia symptoms at follow-up was assessed with the Minimal Insomnia Symptom Scale-Revised. The independent variables at baseline were the perceived family financial situation, tiredness at school, problems waking up, short sleep duration, sleeping difficulties, having a bedroom Television (TV), and time spent with a TV/computer. Multivariate binary logistic regression analyses were used to examine whether the independent variables at baseline predicted insomnia symptoms at follow-up. Results Perceived quite bad/very bad family financial situation (OR 3.1; CI 1.4–6.7) and short sleep duration (<10 h) (OR 2.3; CI 1.0–5.3) among girls at baseline were associated with insomnia symptoms at follow-up. Having problems waking up among boys at baseline was associated with insomnia symptoms at follow-up (OR 4.9; CI 1.6–14.4). Conclusion Short sleep duration, problems waking up, and perceived bad family financial situation during childhood were linked with adolescent insomnia symptoms. The sex-based differences in these associations warrant further investigation to effectively mitigate adolescent insomnia.
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Affiliation(s)
- Gita Hedin
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- Clinical Health Promotion Centre, WHO-Collaborating Centre, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- *Correspondence: Gita Hedin,
| | - Annika Norell-Clarke
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO-Collaborating Centre, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Albert Westergren
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Pernilla Garmy
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- Clinical Health Promotion Centre, WHO-Collaborating Centre, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Laugesen M, Rasmussen M, Christensen R, Tønnesen H, Bliddal H. Smoking Cessation Rates among Patients with Rheumatoid Arthritis and Osteoarthritis Following the 'Gold Standard Programme' (GSP): A Prospective Analysis from the Danish Smoking Cessation Database. Int J Environ Res Public Health 2022; 19:5815. [PMID: 35627350 PMCID: PMC9141404 DOI: 10.3390/ijerph19105815] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: Smoking cessation may be very difficult, even if smoking aggravates the prognosis of a disease, which has been shown to be the case for persons with rheumatoid arthritis (RA). In contrast, an association in patients with osteoarthritis (OA) is still disputed. The primary objective was to compare smokers diagnosed with RA and OA to controls, regarding smoking cessation rates after following the intensive 'Gold Standard programme' (GSP). Secondary objectives included the identification of significant prognostic factors for successful quitting. (2) Methods: In total, 24,652 patients were included in this prospective cohort study, after attending the national GSP for smoking cessation intervention 2006-2016, as registered in the Danish Smoking Cessation Database. Data were linked to the National Patient Register. Hereof, 227 patients (1%) were diagnosed with seropositive RA and 2899 (12%) with OA. Primary outcome was continuous abstinence six months after the planned quitting date. (3) Results: In total, 16,969 (69%) of the patients participated in the follow-up interviews. The adjusted odds ratios for successful quitting were similar to the control group for both RA (1.28, 95% CI: 0.90-1.80) and OA patients (0.92, 0.82-1.03). The outermost, strongest positive factor for successful quitting was compliance, defined as attending ≥75% of the meetings. To a lesser degree, attending an individual intervention was a positive predictor, while being heavy smokers, disadvantaged smokers, women, living with a smoker, and if GSP was recommended by health professionals were negative predictors. (4) Conclusions: The odds ratios for quitting were similar to controls for both RA and OR patients. Additional research is needed to determine effective actions towards increased attendance at the programmes.
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Affiliation(s)
- Monika Laugesen
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Copenhagen, Denmark; (M.L.); (M.R.); (H.T.)
| | - Mette Rasmussen
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Copenhagen, Denmark; (M.L.); (M.R.); (H.T.)
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, 20502 Malmö, Sweden
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen, Denmark;
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, 5000 Odense, Denmark
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Copenhagen, Denmark; (M.L.); (M.R.); (H.T.)
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, 20502 Malmö, Sweden
| | - Henning Bliddal
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Copenhagen, Denmark; (M.L.); (M.R.); (H.T.)
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Tønnesen H, Lydom LN, Joensen UN, Egerod I, Pappot H, Lauridsen SV. STRONG for Surgery & Strong for Life - against all odds: intensive prehabilitation including smoking, nutrition, alcohol and physical activity for risk reduction in cancer surgery - a protocol for an RCT with nested interview study (STRONG-Cancer). Trials 2022; 23:333. [PMID: 35449008 PMCID: PMC9027477 DOI: 10.1186/s13063-022-06272-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background There is a large unused potential for risk reduction in the preoperative period via effective lifestyle intervention targeting co-existing risky lifestyles: Smoking, malNutrition, obesity, risky Alcohol intake and insufficient Physical activity (SNAP). This trial compares the efficacy of the integrated STRONG programme with standard care on preoperative risk reduction and secondly on SNAP factor improvement and frailty, postoperative complications and quality of life. A nested interview study explores the patient preferences and the multi-perspective view of patients, relatives and health professionals. Methods In total, 42 surgical patients with ≥1 SNAP factor are allocated to individually tailored STRONG programme or usual care during adjuvant chemotherapy prior to radical bladder cancer surgery. The STRONG programme has ≥6 weekly sessions with patient education, motivational and pharmaceutical support. It is based on intensive smoking and alcohol cessation interventions reporting perioperative quit rates > 50%. Surgical risk reduction is measured as ≥1 step for 1 or more risky lifestyles on the ASA-score, secondly as having no risky SNAP factors, and as any SNAP improvement. The outcomes are validated by measurements and biomarkers. Postoperative complications are categorised according to the Clavien-Dindo classification. Health-related quality of life is measured by EQ-5D. The patients are followed up after 6 weeks at surgery and 6 weeks and 6 months postoperatively. A representative sample of the participants, their relatives and the clinical staff are interviewed until data saturation. Transcription, triangulated analyses and data management are conducted using NVivo computer software. Discussion The surgical agenda is characterised by fixed dates for surgery focusing on clear risk reduction within a short time. This requires a clinical useful lifestyle intervention programme with a high effect and coverage as well as containing all SNAP factors and tailored to individual needs. The STRONG programme seems to meet these requirements. After development in multi-professional collaboration, STRONG is delivered by a specially trained nurse as part of the surgical patient journey. Overall, this study will bring important new knowledge about risk reduction in a frail patient group undergoing major cancer surgery. Trial registration Registration at www.clintrials.gov (NCT04088968) The manuscript form from https://trialsjournal.biomedcentral.com/bmc/journal and the SPIRIT guidelines are followed.
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Affiliation(s)
- Hanne Tønnesen
- Clinical Health Promotion Centre, The Parker Institute, Bispebjerg-Frederiksberg Hospital, Part of Copenhagen University Hospitals, 2000, Frederiksberg, Denmark.
| | - Line Noes Lydom
- Clinical Health Promotion Centre, The Parker Institute, Bispebjerg-Frederiksberg Hospital, Part of Copenhagen University Hospitals, 2000, Frederiksberg, Denmark
| | - Ulla Nordström Joensen
- Department of Urology 2112, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Susanne Vahr Lauridsen
- Clinical Health Promotion Centre, The Parker Institute, Bispebjerg-Frederiksberg Hospital, Part of Copenhagen University Hospitals, 2000, Frederiksberg, Denmark.,Department of Urology 2112, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
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Rasmussen M, Larsson M, Gilljam H, Adami J, Wärjerstam S, Post A, Björk-Eriksson T, Helgason AR, Tønnesen H. Effectiveness of tobacco cessation interventions for different groups of tobacco users in Sweden: a study protocol for a national prospective cohort study. BMJ Open 2022; 12:e053090. [PMID: 35078840 PMCID: PMC8796232 DOI: 10.1136/bmjopen-2021-053090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Tobacco is still one of the single most important risk factors among the lifestyle habits that cause morbidity and mortality in humans. Furthermore, tobacco has a heavy social gradient, as the consequences are even worse among disadvantaged and vulnerable groups. To reduce tobacco-related inequity in health, those most in need should be offered the most effective tobacco cessation intervention. The aim of this study is to facilitate and improve the evaluation of already implemented national tobacco cessation efforts, focusing on 10 disadvantaged and vulnerable groups of tobacco users. METHODS AND ANALYSIS This is a prospective cohort study. Data will be collected by established tobacco cessation counsellors in Sweden. The study includes adult tobacco or e-cigarette users, including disadvantaged and vulnerable patients, receiving in-person interventions for tobacco or e-cigarette cessation (smoking, snus and/or e-cigarettes). Patient inclusion was initiated in April 2020. For data analyses patients will be sorted into vulnerable groups based on risk factors and compared with tobacco users without the risk factor in question.The primary outcome is continuous successful quitting after 6 months, measured by self-reporting. Secondary outcomes include abstinence at the end of the treatment programme, which could be from minutes over days to weeks, 14-day point prevalence after 6 months, and patient satisfaction with the intervention. Effectiveness of successful quitting will be examined by comparing vulnerable with non-vulnerable patients using a mixed-effect logistic regression model adjusting for potential prognostic factors and known confounders. ETHICS AND DISSEMINATION The project will follow the guidelines from the Swedish Data Protection Authority and have been approved by the Swedish Ethical Review Authority before patient inclusion (Dnr: 2019-02221). Only patients providing written informed consent will be included. Both positive and negative results will be published in scientific peer-reviewed journals and presented at national and international conferences. Information will be provided through media available to the public, politicians, healthcare providers and planners as these are all important stakeholders. TRIAL REGISTRATION NUMBER NCT04819152.
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Affiliation(s)
- Mette Rasmussen
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Matz Larsson
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
- The Cardiology-Lung Clinic, Örebro University Hospital, Örebro, Sweden
| | - Hans Gilljam
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sanne Wärjerstam
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
| | - Ann Post
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden
- Department of Oncology, University of Gothenburg, Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
| | | | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Frederiksberg University Hospital, Frederiksberg, Denmark
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Rasmussen M, Hovhannisyan K, Adami J, Tønnesen H. Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions. Eur Addict Res 2021; 27:123-130. [PMID: 33080594 PMCID: PMC8006577 DOI: 10.1159/000510608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/07/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Patients addicted to alcohol or drug often have additional unhealthy lifestyles, adding to the high mortality and morbidity in this patient group. Therefore, it is important to consider lifestyle interventions as part of the usual addiction treatment. OBJECTIVE The aim was to identify predictors of successful changes in lifestyle risk factors among patients in treatment for alcohol or drug addiction. METHODS We conducted a secondary analysis of a trial using a 6-week intensive integrated lifestyle intervention: The very integrated program (VIP). Patients were recruited in Addiction Centres Malmö and Psychiatry Skåne, Sweden. The primary outcome was successful changes in lifestyle, measured as quitting tobacco, exercising 30 min per day, and not being over- or underweight after 6 weeks and 12 months. RESULTS A total of 212 patients were included in the RCT, and 128 were included in this secondary analysis: 108 at 6 weeks and 89 at 12 months of follow-up. A total of 69 patients were respondents at both follow-ups. The follow-up rates were 51 and 42%, respectively. More education, having at least 2 lifestyle risk factors and having a high quality of life were predictors of a successful change in lifestyle after 6 weeks. After 12 months, the predictors for a successful outcome were having 3 or more risk factors, while an education level up to 3 years was a negative predictor. CONCLUSIONS Having several unhealthy lifestyles in addition to alcohol and drug addiction was a significant predictor of successful lifestyle changes in the short- and long term after the VIP for lifestyle interventions. Likewise, education was significant. The results should be considered in future development and research among this vulnerable group of patients.
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Affiliation(s)
- Mette Rasmussen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark,*Mette Rasmussen, Department of Health Sciences, Clinical Health Promotion Unit, WHO-CC, Lund University, Södra Förstadsgatan 35, SE–20502 Malmö (Sweden),
| | - Karen Hovhannisyan
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Hanne Tønnesen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
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Hedin G, Norell-Clarke A, Hagell P, Tønnesen H, Westergren A, Garmy P. Insomnia in Relation to Academic Performance, Self-Reported Health, Physical Activity, and Substance Use Among Adolescents. Int J Environ Res Public Health 2020; 17:ijerph17176433. [PMID: 32899407 PMCID: PMC7504459 DOI: 10.3390/ijerph17176433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
Purpose: Insomnia affects up to one in four adolescents and has been shown to have a negative impact on their mental and physical health. This study aimed to investigate the association between insomnia, academic performance, self-reported health, physical activity, school start time, and substance use among adolescents. Methods: A survey with a cross-sectional design was completed by adolescents (15–17 years old; n = 1504) in southern Sweden. The Minimal Insomnia Symptoms Scale (MISS) was used to operationalize insomnia. A multiple logistic regression analysis was used to analyze the relationship between insomnia and self-reported health, failed school courses, substance use, school start time, family financial situation, screen time, and gender. Results: Insomnia (MISS ≥ 6) was associated with poor self-reported health (OR: 4.35), failed school courses (OR: 1.47), and use of alcohol and/or cigarettes (OR: 1.43). When the combined effect of self-reported health and physical activity were investigated, a combination of low physical activity (≤1 time/week) and poor self-reported health was strongly associated with insomnia (OR: 18.87). Conclusions: Insomnia was associated with other problems that in themselves are risk factors for poor health. This highlights the need for a holistic health-promoting approach to prevent insomnia, such as efforts to promote physical activity, school success, and the reduction of alcohol/cigarette use.
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Affiliation(s)
- Gita Hedin
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 85 Lund, Sweden;
- Correspondence: ; Tel.: +46-44-250-38-45
| | - Annika Norell-Clarke
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
- Department of Social and Psychological Studies, Karlstad University, SE-651 88 Karlstad, Sweden
| | - Peter Hagell
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 85 Lund, Sweden;
| | - Albert Westergren
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
- Health-Promoting Complex Interventions, Department of Health Sciences, Lund University, SE-221 85 Lund, Sweden
| | - Pernilla Garmy
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 85 Lund, Sweden;
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Hovhannisyan K, Rasmussen M, Adami J, Wikström M, Tønnesen H. Evaluation of Very Integrated Program: Health Promotion for Patients With Alcohol and Drug Addiction-A Randomized Trial. Alcohol Clin Exp Res 2020; 44:1456-1467. [PMID: 32424821 DOI: 10.1111/acer.14364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compared to the general population, patients with alcohol and drug addiction have an increased risk of additional hazardous lifestyles and suffer from more chronic diseases, adding to their already significantly higher morbidity and mortality. The objective of this study was to test the efficacy of the Very Integrated Program (VIP) on treatment and health outcomes for patients diagnosed with alcohol and drug addiction. METHODS Parallel randomized clinical trial with intervention as add-on to addiction care as usual. A total of 322 patients aged 18 years or older were identified, and the study requirements were fulfilled by 219 patients, 7 of whom participated in a pilot. The intervention was a 6-week intensive, tailored, educational program that included motivational interviewing, a smoking cessation program, dietary and physical activity counseling, and patient education. The main outcome measures were substance-free days, time to relapse, and treatment adherence assessed after 6 weeks and 12 months. Secondary outcomes were lifestyle factors, symptoms of comorbidity, and quality of life. Missing data were imputed conservatively by using data closest to the follow-up date and baseline values in patients with no follow-up. RESULTS The 212 patients (intervention, n = 113; control, n = 99) were randomized, and 202 had complete data for primary outcomes. After 6 weeks, there were no significant differences between the groups regarding primary or secondary outcomes. At the 12-month follow-up, the patients in the control group had significantly more total substance-free days (139 days; ranging 0 to 365 vs. 265; 0 to 366, p = 0.021)-specifically among the patients with drug addiction-and higher physical and mental quality of life (45 vs. 58, p = 0.049 and 54 vs. 66, p = 0.037), but not in the per-protocol analysis (60 vs. 46, p = 0.52 and 70 vs. 66, p = 0.74). The sensitivity analyses did not support significant differences between the groups. CONCLUSION Overall, adding VIP intervention did not improve outcome of the alcohol or drug addiction care or the lifestyle compared to the addiction care alone. This patient group is still in need of effective programs, and new intervention research is required to develop that.
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Affiliation(s)
- Karen Hovhannisyan
- From the, Department of Health Science, (KH, MR, MW, HT), Clinical Health Promotion Centre, WHO-CC, Region Skåne, Lund University, Lund, Sweden
| | - Mette Rasmussen
- From the, Department of Health Science, (KH, MR, MW, HT), Clinical Health Promotion Centre, WHO-CC, Region Skåne, Lund University, Lund, Sweden.,Clinical Health Promotion Centre, (MR, HT), WHO-CC, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Maria Wikström
- From the, Department of Health Science, (KH, MR, MW, HT), Clinical Health Promotion Centre, WHO-CC, Region Skåne, Lund University, Lund, Sweden
| | - Hanne Tønnesen
- From the, Department of Health Science, (KH, MR, MW, HT), Clinical Health Promotion Centre, WHO-CC, Region Skåne, Lund University, Lund, Sweden.,Clinical Health Promotion Centre, (MR, HT), WHO-CC, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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18
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Hedin G, Norell-Clarke A, Hagell P, Tønnesen H, Westergren A, Garmy P. Facilitators and Barriers for a Good Night's Sleep Among Adolescents. Front Neurosci 2020; 14:92. [PMID: 32116531 PMCID: PMC7019014 DOI: 10.3389/fnins.2020.00092] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background Sleep deprivation among adolescents is a major public health issue. Although previous studies have described their sleep habits and the consequences thereof, the voices of adolescents themselves are rarely heard. The aim of this study was to investigate adolescents’ experiences regarding what they perceived as facilitators and barriers for a good night’s sleep. Methods A qualitative focus group study with Swedish adolescents (n = 45) aged 16–18 years was performed with seven focus groups and analyzed using qualitative content analysis. Results Three categories were identified in the analysis regarding facilitators and barriers for achieving a good night’s sleep: (1) Striving for a sense of well-being, (2) Tiring yourself out, and (3) Regulating electronic media availability. The adolescents thought that sleep was important in order to be able to cope with everyday life and to allow physical recovery. Overall, the adolescents were knowledgeable regarding commonly recommended strategies for improving sleep, but they had trouble finding a balance between sleep and other activities. Electronic media was used to obtain a sense of belonging and to communicate with others, which in itself was described as important for the adolescents’ well-being. However, communicating with friends and family during the night conflicted with achieving a good night’s sleep. Parental behaviors (late work habits, internet rules) were also perceived as important for adolescents’ sleep habits. Conclusions An understanding of the dilemma of finding a balance between sleep and other activities may aid future sleep-promoting interventions for adolescents, incorporating the impact from social factors’ on the adolescents’ sleep.
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Affiliation(s)
- Gita Hedin
- Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
| | - Annika Norell-Clarke
- Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.,Faculty of Health and Science, Kristianstad University, Kristianstad, Sweden
| | - Peter Hagell
- Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden
| | | | - Albert Westergren
- Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
| | - Pernilla Garmy
- Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
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Wong J, An D, Urman RD, Warner DO, Tønnesen H, Raveendran R, Abdullah HR, Pfeifer K, Maa J, Finegan B, Li E, Webb A, Edwards AF, Preston P, Bentov N, Richman DC, Chung F. Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement on Perioperative Smoking Cessation. Anesth Analg 2019; 131:955-968. [DOI: 10.1213/ane.0000000000004508] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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Hovhannisyan K, Günther M, Raffing R, Wikström M, Adami J, Tønnesen H. Compliance with the Very Integrated Program (VIP) for Smoking Cessation, Nutrition, Physical Activity and Comorbidity Education Among Patients in Treatment for Alcohol and Drug Addiction. Int J Environ Res Public Health 2019; 16:E2285. [PMID: 31261620 PMCID: PMC6650928 DOI: 10.3390/ijerph16132285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 12/20/2022]
Abstract
Meeting adherence is an important element of compliance in treatment programmes. It is influenced by several factors one being self-efficacy. We aimed to investigate the association between self-efficacy and meeting adherence and other factors of importance for adherence among patients with alcohol and drug addiction who were undergoing an intensive lifestyle intervention. The intervention consisted of a 6-week Very Integrated Programme. High meeting adherence was defined as >75% participation. The association between self-efficacy and meeting adherence were analysed. The qualitative analyses identified themes important for the patients and were performed as text condensation. High self-efficacy was associated with high meeting adherence (ρ = 0.24, p = 0.03). In the multivariate analyses two variables were significant: avoid complications (OR: 0.51, 95% CI: 0.29-0.90) and self-efficacy (OR: 1.28, 95% CI: 1.00-1.63). Reflections on lifestyle change resulted in the themes of Health and Wellbeing, Personal Economy, Acceptance of Change, and Emotions Related to Lifestyle Change. A higher level of self-efficacy was positively associated with meeting adherence. Patients score high on avoiding complications but then adherence to the intervention drops. There was no difference in the reflections on lifestyle change between the group with high adherence and the group with low adherence.
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Affiliation(s)
- Karen Hovhannisyan
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden.
| | - Michelle Günther
- Skånevård Kryh, Medicon Village, Region Skåne, 223 81 Lund, Sweden
| | - Rie Raffing
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden.
- Clinical Health Promotion Centre, WHO Collaborating Centre for Evidence-based Health promotion in Hospitals and Health Services, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57-59, Entr. 5, 2000 Frederiksberg, Denmark.
| | - Maria Wikström
- Student Health, Malmö University, Neptuniplan 7, 21118 Malmö, Sweden
| | - Johanna Adami
- President Office, Sophiahemmet University, Box 5605, 114 86 Stockholm, Sweden
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden
- Clinical Health Promotion Centre, WHO Collaborating Centre for Evidence-based Health promotion in Hospitals and Health Services, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57-59, Entr. 5, 2000 Frederiksberg, Denmark
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21
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Svane JK, Chiou ST, Groene O, Kalvachova M, Brkić MZ, Fukuba I, Härm T, Farkas J, Ang Y, Andersen MØ, Tønnesen H. A WHO-HPH operational program versus usual routines for implementing clinical health promotion: an RCT in health promoting hospitals (HPH). Implement Sci 2018; 13:153. [PMID: 30577871 PMCID: PMC6304000 DOI: 10.1186/s13012-018-0848-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 12/06/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Implementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. CHP focuses on potentially modifiable lifestyle risks such as smoking, alcohol, diet, and physical inactivity. An operational program was created to improve implementation. It included patients, staff, and the organization, and it combined existing standards, indicators, documentation models, a performance recognition process, and a fast-track implementation model. The aim of this study was to evaluate if the operational program improved implementation of CHP in clinical hospital departments, as measured by health status of patients and staff, frequency of CHP service delivery, and standards compliance. METHODS Forty-eight hospital departments were recruited via open call and stratified by country. Departments were assigned to the operational program (intervention) or usual routine (control group). Data for analyses included 36 of these departments and their 5285 patients (median 147 per department; range 29-201), 2529 staff members (70; 10-393), 1750 medical records (50; 50-50), and standards compliance assessments. Follow-up was measured after 1 year. The outcomes were health status, service delivery, and standards compliance. RESULTS No health differences between groups were found, but the intervention group had higher identification of lifestyle risk (81% versus 60%, p < 0.01), related information/short intervention and intensive intervention (54% versus 39%, p < 0.01 and 43% versus 25%, p < 0.01, respectively), and standards compliance (95% versus 80%, p = 0.02). CONCLUSIONS The operational program improved implementation by way of lifestyle risk identification, CHP service delivery, and standards compliance. The unknown health effects, the bias, and the limitations should be considered in implementation efforts and further studies. TRIAL REGISTRATION ClinicalTrials.gov : NCT01563575. Registered 27 March 2012. https://clinicaltrials.gov/ct2/show/NCT01563575.
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Affiliation(s)
- Jeff Kirk Svane
- Clinical Health Promotion Centre, WHO-CC, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospitals, Nordre Fasanvej 57, Build. 14, Entr. 5, 2nd fl, 2000 Frederiksberg, Denmark
| | - Shu-Ti Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Cheng Hsin General Hospital, Taipei, Taiwan
| | - Oliver Groene
- OptiMedis AG, Hamburg, Germany
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Milena Kalvachova
- Health Services Quality Department, Ministry of Health, Prague, Czech Republic
| | - Mirna Zagrajski Brkić
- General hospital “Dr. Tomislav Bardek”, Koprivnica, Županija Koprivničko-križevačka Croatia
| | - Isao Fukuba
- Saitama Cooperative Hospital, Kawaguchi, Saitama Japan
| | - Tiiu Härm
- National Institute for Health Development;, Tallin, Estonia
| | - Jerneja Farkas
- National Institute of Public Health, Ljubljana, Slovenia
| | - Yen Ang
- Penang Adventist Hospital, Penang, Malaysia
| | | | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO-CC, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospitals, Nordre Fasanvej 57, Build. 14, Entr. 5, 2nd fl, 2000 Frederiksberg, Denmark
- Clinical Health Promotion Centre, WHO-CC, Health Sciences, Lund University, Lund, Sweden
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Abstract
BACKGROUND Risky consumption of alcohol is a global problem. More than 3.3 million deaths annually are associated with risky use of alcohol, and global alcohol consumption continues to increase. People who have high alcohol consumption often require planned and emergency surgical procedures.Risky drinking is associated with increased postoperative complications such as infections, cardiopulmonary complications, and bleeding episodes. Alcohol causes disorders of the liver, pancreas, and nervous system. Stopping consumption of alcohol can normalize these organ systems to some degree and may reduce the occurrence of complications after surgery.This review was first published in 2012 and was updated in 2018. OBJECTIVES To assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. SEARCH METHODS We searched the following databases up until 21 September 2018: Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; CINAHL via EBSCOhost; and two trials registers. We scanned the reference lists and citations of included trials and any identified relevant systematic reviews for further references to additional trials. When necessary, we contacted trial authors to ask for additional information. SELECTION CRITERIA We included all randomized controlled trials (RCTs) that evaluated the effects of perioperative alcohol cessation interventions on postoperative complications and alcohol consumption. We included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered a perioperative alcohol cessation intervention or no intervention.We defined 'risky drinking' as alcohol consumption equivalent to more than 3 alcoholic units (AU)/d or 21 AU/week (with 1 AU containing 12 grams of ethanol) with or without symptoms of alcohol abuse or dependency. This corresponds to the amount of alcohol associated with increased postoperative complication rates in most clinical studies. DATA COLLECTION AND ANALYSIS We used guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. We presented main outcomes as dichotomous variables in a meta-analysis. When data were available, we conducted subgroup and sensitivity analyses to explore the risk of bias. Primary outcome measures were postoperative complications and in-hospital and 30-day mortality. Secondary outcomes were successful quitting at the end of the programme, postoperative alcohol use, and length of hospital stay. We assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included in this updated review one new study (70 participants), resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.Overall, 53 of the 122 participants from three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.In-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.Investigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.All three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the standard deviation (SD). We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term. AUTHORS' CONCLUSIONS This systematic review assessed the efficacy of perioperative alcohol cessation interventions for postoperative complications and alcohol consumption. All three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.Included studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomized controlled trials is needed. Once published and assessed, the one 'ongoing' study identified may alter the conclusions of this review.
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Affiliation(s)
- Julie WM Egholm
- Hospital of Southern Jutland, University of Southern DenmarkOrthopaedic DepartmentAabenraaDenmark6200
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
| | - Bolette Pedersen
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
- Lund UniversityDepartment of Health SciencesLundSweden
| | - Ann Merete Møller
- Herlev and Gentofte Hospital, University of CopenhagenCochrane Anaesthesia, Critical and Emergency Care GroupHerlev RingvejHerlevDenmark2730
| | - Johanna Adami
- Sophiahemmet UniversityLindstedtsvägen 8StockholmSweden
| | - Carsten B Juhl
- University of Southern DenmarkSEARCH (Research group for synthesis of evidence and research), Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical BiomechanicsCampusvej 55Odense MDenmark5230
| | - Hanne Tønnesen
- Hospital of Southern Jutland, University of Southern DenmarkOrthopaedic DepartmentAabenraaDenmark6200
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
- Lund UniversityDepartment of Health SciencesLundSweden
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Pedersen B, Askgaard G, Jørgensen C, Oppedal K, Tønnesen H. Disulfiram for alcohol use disorder. Hippokratia 2018. [DOI: 10.1002/14651858.cd010487.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Bolette Pedersen
- Bispebjerg and Frederiksberg Hospitals, University of Copenhagen; WHO-CC, Clinical Health Promotion Centre; Nordre Fasanvej 57 Copenhagen Denmark 2000
| | - Gro Askgaard
- Rigshospitalet; Department of Hepatology; Blegdamsvej 9 København Ø Denmark 2100
| | - Charlotte Jørgensen
- Bispebjerg and Frederiksberg University Hospital; WHO-CC, Clinical Health Promotion Centre; Copenhagen Denmark
| | - Kristian Oppedal
- Stavanger University Hospital; Alcohol and Drug Research Western Norway (KoRFor); Postboks 8100 Stavanger Norway 4068
| | - Hanne Tønnesen
- Bispebjerg and Frederiksberg Hospitals, University of Copenhagen; WHO-CC, Clinical Health Promotion Centre; Nordre Fasanvej 57 Copenhagen Denmark 2000
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Svane JK, Egerod I, Tønnesen H. Staff experiences with strategic implementation of clinical health promotion: A nested qualitative study in the WHO-HPH Recognition Process RCT. SAGE Open Med 2018; 6:2050312118792394. [PMID: 30140439 PMCID: PMC6094165 DOI: 10.1177/2050312118792394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/09/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Health promotion is on the global agenda. The risks targeted include smoking, hazardous alcohol consumption, nutrition and insufficient physical activity. Implementation of clinical health promotion, however, remains a major challenge. While several processes, models and frameworks for strategic implementation exist, very few have been tested in randomized designs. Testing a strategic implementation process for clinical health promotion was only recently attempted via a randomized clinical trial on the World Health Organization Health Promotion Hospitals Recognition Process. The randomized clinical trial showed that the process improved central parts of implementation. To complement these findings, this nested qualitative study aimed to explore experiences and perceptions of staff and managers, who had completed the process, and generate hypotheses for improvements. METHODS We interviewed a purposeful sample of 45 key informants from four countries, who worked at clinical departments and had undertaken the World Health Organization Health Promotion Hospitals implementation process. The informants included 14 managers, 14 medical doctors, 13 nurses and 4 other clinical staff. Interview transcripts were analyzed using qualitative content analysis and an inductive approach to coding and categorization supported by QSR NVivo. RESULTS The informants' experiences and perceptions centered around four global themes concerning (1) awareness, cultural re-orientation and integration; (2) learnings; (3) normalization and legitimacy and (4) a more evidence-based, structured and systematic approach to clinical health promotion. Informants were positive toward the implementation process, although it was sometimes challenging. The suggested improvements to increase acceptability related to the patient survey, time consumption, translation, tailoring to local circumstances and in-advance training. CONCLUSIONS Managers and staff were positive toward the World Health Organization Health Promotion Hospitals process, which was perceived to bring about positive changes and learnings. The findings also suggest that the implementation process may be improved by minor adjustments to process elements and design. It is our recommendation to use the process in clinical departments to further implementation of clinical health promotion.
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Affiliation(s)
- Jeff Kirk Svane
- WHO Collaborating Center
(WHO-CC)/Clinical Health Promotion Center, Bispebjerg and Frederiksberg Hospital,
Copenhagen University Hospital, Frederiksberg, Denmark
| | - Ingrid Egerod
- Intensive Care Unit, University of
Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Tønnesen
- WHO Collaborating Center
(WHO-CC)/Clinical Health Promotion Center, Bispebjerg and Frederiksberg Hospital,
Copenhagen University Hospital, Frederiksberg, Denmark
- Clinical Health Promotion Centre,
Department of Health Sciences, Lund University, Lund, Sweden
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25
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Rasmussen M, Klinge M, Krogh J, Nordentoft M, Tønnesen H. Effectiveness of the Gold Standard Programme (GSP) for smoking cessation on smokers with and without a severe mental disorder: a Danish cohort study. BMJ Open 2018; 8:e021114. [PMID: 29895653 PMCID: PMC6009564 DOI: 10.1136/bmjopen-2017-021114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We compared the effectiveness of an intensive smoking cessation intervention among smokers with and without a severe mental disorder (SMD) and identified factors associated with successful quitting. The main hypothesis was that smokers with an SMD would be less likely to stay continuously smoke-free for 6 months. DESIGN A prospective cohort study. SETTING In all, 302 smoking cessation clinics in Denmark from municipal clinics, pharmacies, hospitals, midwives, primary care facilities and other private providers who reported data to the national Danish Smoking Cessation Database from 2006 to 2016 participated in this study. PARTICIPANTS A total of 38 293 patients from the Danish Smoking Cessation Database. Patients with an SMD were identified by linking data to the Danish National Patient Register. Diagnoses of organic mental disorders (F0 chapter) or intellectual disabilities (F7 chapter) were not included. Smokers ≥18 years old who were attending a Gold Standard Programme (GSP) with planned follow-up were included. Smokers not wanting contact after 6 months were excluded. INTERVENTIONS A comprehensive manual-based smoking cessation intervention comprising five meetings over a 6-week period (the GSP). MAIN OUTCOME MEASURES Self-reported continuous abstinence at the 6-month follow-up. RESULTS In all, 69% of the participants participated in the follow-up after 6 months. The overall rate of successful quitting was high but significantly lower in SMD smokers (29% vs 38%; OR 0.74; 95% CI 0.68 to 0.80). Variables associated with successful quitting were compliance (defined as attending ≥75% of the planned meetings), older age and male gender as well as not being disadvantaged, heavy smoking or recommendation of intervention by health professionals. CONCLUSIONS Only 29% of smokers with an SMD successfully quit smoking which was significantly lower than the 38% of smokers without an SMD. Compliance was the most important predictor for successful quitting.
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Affiliation(s)
- Mette Rasmussen
- Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Mads Klinge
- Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jesper Krogh
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Health Science, University of Southern Denmark, Odense, Denmark
- Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Lund, Sweden
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Roelsgaard IK, Thomsen T, Østergaard M, Christensen R, Hetland ML, Jacobsen S, Andersen L, Tønnesen H, Rollefstad S, Semb AG, Esbensen BA. The effect of an intensive smoking cessation intervention on disease activity in patients with rheumatoid arthritis: study protocol for a randomised controlled trial. Trials 2017; 18:570. [PMID: 29183347 PMCID: PMC5706378 DOI: 10.1186/s13063-017-2309-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/02/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, inflammatory rheumatic disease with the potential to induce significant disability. Patients with RA are at increased risk of cardiovascular diseases (CVD). Smokers with RA tend to experience more pain and fatigue, higher disease activity, more erosive joint destruction and a lower health-related quality of life (HR-QoL) than non-smokers. It remains to be determined whether these effects can be reduced by smoking cessation. This randomised controlled trial (RCT) in patients with RA aims to examine the effect of intensive smoking cessation intervention (motivational counselling combined with tailored nicotine replacement therapy) versus standard care on smoking cessation, and consequently on disease activity. Secondary objectives are to explore the effect on flare, risk factors for CVD, lung function, physical function, HR-QoL, pain and fatigue in patients with RA. METHODS This will be a multicentre, open label, two arm, parallel group, RCT, including 150 daily smokers with RA, being in remission or having low-moderate disease activity (DAS28 ≤ 5.1). The intervention group (n = 75) will receive five counselling sessions with a trained smoking cessation counsellor based on the principles of motivational counselling. Furthermore, intervention patients will be offered nicotine replacement therapy tailored to individual needs. Participants randomised to the control group will receive standard care. The co-primary outcome is a hierarchical endpoint, which will be evaluated at 3 months follow-up and will include (1) self-reported smoking cessation biochemically validated by exhaled carbon monoxide and (2) achievement of EULAR clinical response (an improvement in DAS28 of > 0.6). Follow-up visits will be performed at 3, 6 and 12 months post-intervention. DISCUSSION This trial will reveal whether intensive smoking cessation counselling helps smokers with RA to achieve continuous smoking cessation and whether, as a concomitant benefit, it will reduce their RA disease activity. The trial aims to generate high quality evidence for the feasibility of a health promotion intervention for smokers with RA. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02901886 . Registered on 10 September 2016. Recruitment status updated on 10th October 2016.
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Affiliation(s)
- Ida Kristiane Roelsgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.
| | - Thordis Thomsen
- Abdominal Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,DANBIO Registry, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Søren Jacobsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Lena Andersen
- The Danish Rheumatism Association, Gentofte, Denmark
| | - Hanne Tønnesen
- WHO-CC, Bispebjerg-Frederiksberg Hospital, Copenhagen University, Copenhagen, Denmark.,Clinical Health Promotion Centre, Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Health, Faculty of Medicine, University of Southern Denmark, Odense, Denmark
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Lauridsen SV, Thomsen T, Kaldan G, Lydom LN, Tønnesen H. Smoking and alcohol cessation intervention in relation to radical cystectomy: a qualitative study of cancer patients' experiences. BMC Cancer 2017; 17:793. [PMID: 29178899 PMCID: PMC5702236 DOI: 10.1186/s12885-017-3792-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/16/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Despite smoking and risky alcohol drinking being modifiable risk factors for cancer as well as postoperative complications, perioperative cessation counselling is often ignored. Little is known about how cancer patients experience smoking and alcohol interventions in relation to surgery. Therefore the aim of this study was to explore how bladder cancer patients experience a perioperative smoking and alcohol cessation intervention in relation to radical cystectomy. METHODS A qualitative study was conducted in two urology out-patient clinics. We conducted semi-structured in-depth interviews with 11 purposively sampled persons who had received the smoking and alcohol cessation intervention. The analysis followed the steps contained in the thematic network analysis. RESULTS Two global themes emerged: "smoking and alcohol cessation was experienced as an integral part of bladder cancer surgery" and "returning to everyday life was a barrier for continued smoking cessation/alcohol reduction". Participants described that during hospitalization their focus shifted to the operation and they did not experience craving to smoke or drink alcohol. Concurrent with improved well-being or experiencing stressful situations, the risk of relapse increased when returning to everyday life. CONCLUSIONS The smoking and alcohol cessation intervention was well received by the participants. Cancer surgery served as a kind of refuge and was a useful cue for motivating patients to quit smoking and to reconsider the consequences of risky drinking. These results adds to the sparse evidence of what supports smoking and alcohol cessation in relation to bladder cancer patients undergoing major surgery and point to the need to educate healthcare professionals in offering smoking and alcohol cessation interventions in hospitals. The study also provides knowledge about the intervention in the STOP-OP study and will help guide the design of future smoking and alcohol cessation studies aimed at cancer patients undergoing surgery.
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Affiliation(s)
- Susanne Vahr Lauridsen
- Department of Urology 2112, Inge Lehmanns Vej 7, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Thordis Thomsen
- Abdominal Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Health & Medical Sciences, Copenhagen, Denmark
| | - Gudrun Kaldan
- Abdominal Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Line Noes Lydom
- Department of Urology 2112, Inge Lehmanns Vej 7, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark
- Clinical Health Promotion Centre, Health Sciences, Lund University, Lund, Sweden
- Health Science, University of Southern Denmark, Odense, Denmark
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Raffing R, Jensen TB, Tønnesen H. Self-reported needs for improving the supervision competence of PhD supervisors from the medical sciences in Denmark. BMC Med Educ 2017; 17:188. [PMID: 29058586 PMCID: PMC5651628 DOI: 10.1186/s12909-017-1023-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/05/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Quality of supervision is a major predictor for successful PhD projects. A survey showed that almost all PhD students in the Health Sciences in Denmark indicated that good supervision was important for the completion of their PhD study. Interestingly, approximately half of the students who withdrew from their program had experienced insufficient supervision. This led the Research Education Committee at the University of Copenhagen to recommend that supervisors further develop their supervision competence. The aim of this study was to explore PhD supervisors' self-reported needs and wishes regarding the content of a new program in supervision, with a special focus on the supervision of PhD students in medical fields. METHODS A semi-structured interview guide was developed, and 20 PhD supervisors from the Graduate School of Health and Medical Sciences at the Faculty of Health and Medical Sciences at the University of Copenhagen were interviewed. Empirical data were analysed using qualitative methods of analysis. RESULTS Overall, the results indicated a general interest in improved competence and development of a new supervision programme. Those who were not interested argued that, due to their extensive experience with supervision, they had no need to participate in such a programme. The analysis revealed seven overall themes to be included in the course. The clinical context offers PhD supervisors additional challenges that include the following sub-themes: patient recruitment, writing the first article, agreements and scheduled appointments and two main groups of students, in addition to the main themes. CONCLUSIONS The PhD supervisors reported the clear need and desire for a competence enhancement programme targeting the supervision of PhD students at the Faculty of Health and Medical Sciences. Supervision in the clinical context appeared to require additional competence. TRIAL REGISTRATION The Scientific Ethical Committee for the Capital Region of Denmark. Number: H-3-2010-101, date: 2010.09.29.
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Affiliation(s)
- Rie Raffing
- WHO Collaborating Centre, Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2nd floor, 2000 Frederiksberg, Denmark
- WHO Collaborating Centre, Clinical Health Promotion Centre, Faculty of Medicine, Department of Health Sciences, Lund University, Skåne University Hospital, Södra Förstadsgatan 101, 214 28 Malmö, Sweden
| | - Thor Bern Jensen
- WHO Collaborating Centre, Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2nd floor, 2000 Frederiksberg, Denmark
| | - Hanne Tønnesen
- WHO Collaborating Centre, Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2nd floor, 2000 Frederiksberg, Denmark
- WHO Collaborating Centre, Clinical Health Promotion Centre, Faculty of Medicine, Department of Health Sciences, Lund University, Skåne University Hospital, Södra Förstadsgatan 101, 214 28 Malmö, Sweden
- Hospital of Southern Jutland, Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark
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Lauridsen SV, Tønnesen H, Jensen BT, Neuner B, Thind P, Thomsen T. Complications and health-related quality of life after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis of four RCTs. Syst Rev 2017; 6:150. [PMID: 28768530 PMCID: PMC5541663 DOI: 10.1186/s13643-017-0547-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/20/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radical cystectomy is associated with high rates of perioperative morbidity. Robotic-assisted radical cystectomy (RARC) is widely used today despite limited evidence for clinical superiority. The aim of this review was to evaluate the effect of RARC compared to open radical cystectomy (ORC) on complications and secondary on length of stay, time back to work and health-related quality of life (HRQoL). METHODS The databases PubMed, The Cochrane Library, Embase and CINAHL were searched. A systematic review according to the PRISMA guidelines and cumulative analysis was conducted. Randomized controlled trials (RCTs) that examined RARC compared to ORC were included in this review. We assessed the quality of evidence using the Cochrane Collaboration's 'Risk of bias' tool and Grading of Recommendations Assessment, Development and Evaluation approach. Data were extracted and analysed. RESULTS The search retrieved 273 articles. Four RCTs were included involving overall 239 patients. The quality of the evidence was of low to moderate quality. There was no significant difference between RARC and ORC in the number of patients developing complications within 30 or 90 days postoperatively or in overall grade 3-5 complications within 30 or 90 days postoperatively. Types of complications differed between the RARC and the ORC group. Likewise, length of stay and HRQoL at 3 and 6 months did not differ. CONCLUSION Our review presents evidence for RARC not being superior to ORC regarding complications, LOS and HRQoL. High-quality studies with consistent registration of complications and patient-related outcomes are warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016038232.
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Affiliation(s)
- Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, 2112, Rigshospitalet, 2100, Copenhagen, Denmark.
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark.,Clinical Health Promotion Centre, Health Sciences, Lund University, Lund, Sweden.,Health Science, University of Southern Denmark, Odense, Denmark
| | - Bente Thoft Jensen
- Department of Urology, Aarhus University Hospital and Centre of Research in Rehabilitation, Aarhus University, Aarhus, Denmark
| | - Bruno Neuner
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Thind
- Department of Urology, Copenhagen University Hospital, 2112, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Thordis Thomsen
- Abdominal Centre, University Hospital of Copenhagen, Health and Medical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Lauridsen SV, Thomsen T, Thind P, Tønnesen H. STOP smoking and alcohol drinking before OPeration for bladder cancer (the STOP-OP study), perioperative smoking and alcohol cessation intervention in relation to radical cystectomy: study protocol for a randomised controlled trial. Trials 2017; 18:329. [PMID: 28716147 PMCID: PMC5513198 DOI: 10.1186/s13063-017-2065-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/26/2017] [Indexed: 01/16/2023] Open
Abstract
Background To evaluate the effect of a smoking-, alcohol- or combined-cessation intervention starting shortly before surgery and lasting 6 weeks on overall complications after radical cystectomy. Secondary objectives are to examine the effect on types and grades of complications, smoking cessation and alcohol cessation, length of hospital stay, health-related quality of life and return to work or habitual level of activity up to 12 months postoperatively. Methods/design The study is a multi-institutional randomised clinical trial involving 110 patients with a risky alcohol intake and daily smoking who are scheduled for radical cystectomy. Patients will be randomised to the 6-week Gold Standard Programme (GSP) or treatment as usual (control). The GSP combines patient education and pharmacologic strategies. Smoking and alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly meetings and at follow-up. Discussion Herein, we report the design of the STOP-OP study, objectives and accrual up-date. This study will provide new knowledge about how to prevent smoking and alcohol-related postoperative complications at the time of bladder cancer surgery. Till now 77 patients have been enrolled. Patient accrual is expected to be finalised before the end of 2017 and data will be published in 2018. Trial registration ClinicalTrials.gov, ID: NCT02188446. Registered on 28 May 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2065-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, 2112, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Thordis Thomsen
- Abdominal Centre, Copenhagen University Hospital, Rigshospitalet and University of Copenhagen, Health and Medical Sciences, Copenhagen, Denmark
| | - Peter Thind
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, 2112, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark.,Clinical Health Promotion Centre, Health Sciences, Lund University, Lund, Sweden.,Health Science, University of Southern Denmark, Odense, Denmark
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Abstract
OBJECTIVES We compared the effectiveness of the Gold Standard Programme (a comprehensive smoking cessation intervention commonly used in Denmark) with other face-to-face smoking cessation programmes in Denmark after implementation in real life, and we identified factors associated with successful quitting. DESIGN Prospective cohort study. SETTING A total of 423 smoking cessation clinics from different settings reported data from 2001 to 2013. PARTICIPANTS In total, 82 515 patients were registered. Smokers ≥15 years old and attending a programme with planned follow-up were included. Smokers who did not want further contact, who intentionally were not followed up or who lacked information about the intervention they received were excluded. A total of 46 287 smokers were included. INTERVENTIONS Various real-life smoking cessation interventions were identified and compared: The Gold Standard Programme, Come & Quit, crash courses, health promotion counselling (brief intervention) and other interventions. MAIN OUTCOME Self-reported continuous abstinence for 6 months. RESULTS Overall, 33% (11 184) were continuously abstinent after 6 months; this value was 24% when non-respondents were considered smokers. The follow-up rate was 74%. Women were less likely to remain abstinent, OR 0.83 (CI 0.79 to 0.87). Short interventions were more effective among men. After adjusting for confounders, the Gold Standard Programme was the only intervention with significant results across sex, increasing the odds of abstinence by 69% for men and 31% for women. In particular, compliance, and to a lesser degree, mild smoking, older age and not being disadvantaged were associated with positive outcomes for both sexes. Compliance increased the odds of abstinence more than 3.5-fold. CONCLUSIONS Over time, Danish smoking cessation interventions have been effective in real life. Compliance is the main predictor of successful quitting. Interestingly, short programmes seem to have relatively strong effects among men, but the absolute numbers are very small. Only the comprehensive Gold Standard Programme works across sexes.
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Affiliation(s)
- Mette Rasmussen
- WHO-CC Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Frederiksberg, Denmark
| | - Esteve Fernández
- Tobacco Control Unit, Institut Català d'Oncologia (ICO-IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Hanne Tønnesen
- Health Science, University of Southern Denmark, Odense, Denmark
- WHO-CC Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Arnaud N, Baldus C, Elgán TH, De Paepe N, Tønnesen H, Csémy L, Thomasius R. Effectiveness of a Web-Based Screening and Fully Automated Brief Motivational Intervention for Adolescent Substance Use: A Randomized Controlled Trial. J Med Internet Res 2016; 18:e103. [PMID: 27220276 PMCID: PMC4897296 DOI: 10.2196/jmir.4643] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 09/17/2015] [Accepted: 02/20/2016] [Indexed: 11/29/2022] Open
Abstract
Background Mid-to-late adolescence is a critical period for initiation of alcohol and drug problems, which can be reduced by targeted brief motivational interventions. Web-based brief interventions have advantages in terms of acceptability and accessibility and have shown significant reductions of substance use among college students. However, the evidence is sparse among adolescents with at-risk use of alcohol and other drugs. Objective This study evaluated the effectiveness of a targeted and fully automated Web-based brief motivational intervention with no face-to-face components on substance use among adolescents screened for at-risk substance use in four European countries. Methods In an open-access, purely Web-based randomized controlled trial, a convenience sample of adolescents aged 16-18 years from Sweden, Germany, Belgium, and the Czech Republic was recruited using online and offline methods and screened online for at-risk substance use using the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening instrument. Participants were randomized to a single session brief motivational intervention group or an assessment-only control group but not blinded. Primary outcome was differences in past month drinking measured by a self-reported AUDIT-C-based index score for drinking frequency, quantity, and frequency of binge drinking with measures collected online at baseline and after 3 months. Secondary outcomes were the AUDIT-C-based separate drinking indicators, illegal drug use, and polydrug use. All outcome analyses were conducted with and without Expectation Maximization (EM) imputation of missing follow-up data. Results In total, 2673 adolescents were screened and 1449 (54.2%) participants were randomized to the intervention or control group. After 3 months, 211 adolescents (14.5%) provided follow-up data. Compared to the control group, results from linear mixed models revealed significant reductions in self-reported past-month drinking in favor of the intervention group in both the non-imputed (P=.010) and the EM-imputed sample (P=.022). Secondary analyses revealed a significant effect on drinking frequency (P=.037) and frequency of binge drinking (P=.044) in the non-imputation-based analyses and drinking quantity (P=.021) when missing data were imputed. Analyses for illegal drug use and polydrug use revealed no significant differences between the study groups (Ps>.05). Conclusions Although the study is limited by a large drop-out, significant between-group effects for alcohol use indicate that targeted brief motivational intervention in a fully automated Web-based format can be effective to reduce drinking and lessen existing substance use service barriers for at-risk drinking European adolescents. Trial Registration International Standard Randomized Controlled Trial Registry: ISRCTN95538913; http://www.isrctn.com/ISRCTN95538913 (Archived by WebCite at http://www.webcitation.org/6XkuUEwBx)
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Affiliation(s)
- Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ), Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Mikkelsen LMS, Tønnesen H, Nielsen PR. [Multidisciplinary and cross-sectorial treatment of patients with complex regional pain syndrome]. Ugeskr Laeger 2016; 178:V09150702. [PMID: 27045795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Complex regional pain syndrome (CRPS) is a complex, painful, debilitating disease which occurs after trauma or surgery mainly in the wrists with a variation of 5.5-26.2 at 100,000 inhabitants in international studies. In Denmark the prevalence is unknown, and it is perceived that many patients with CRPS are diagnosed late in their illness. There is international consensus on diagnostic criteria and early identification. Evidence for treatment is weak, but there are good experiences with highly specialized multidisciplinary treatment. A national clinical guideline is required.
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Kehlet M, Heeseman S, Tønnesen H, Schroeder TV. Perioperative smoking cessation in vascular surgery: challenges with a randomized controlled trial. Trials 2015; 16:441. [PMID: 26438129 PMCID: PMC4595121 DOI: 10.1186/s13063-015-0965-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background The effect of intensive smoking cessation programs on postoperative complications has never before been assessed in soft tissue surgery when smoking cessation is initiated on the day of surgery. Methods A single-blinded randomized clinical trial conducted at two vascular surgery departments in Denmark. The intervention group was offered the Gold Standard Program (GSP) for smoking cessation intervention. The control group was offered the departments’ standard care. Inclusion criteria were patients with planned open peripheral vascular surgery and who were daily smokers. According to the power calculation a total of 144 patients were needed in the trial. Results Due to slow patient inclusion, the trial was terminated prior to fulfilling the power calculation. Thirty-two patients were included in the trial from March 2011 to September 2012. Of these, 11 were randomized to the GSP intervention and 21 as controls. There was no difference in 30-day complication rates or 6-week abstinence rates between the two groups. Conclusions A trial assessing the effect of smoking cessation on postoperative complications on the day of soft tissue surgery is still needed. If another trial is to be planned it must be more pragmatic with less extended inclusion criteria and conducted nationally or internationally to ensure enough patients for the trial. Trial registration ClinicalTrials.gov (NCT01469091). Registration date: 27 October 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0965-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mette Kehlet
- Vascular Clinic, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Centre for Clinical Education, University of Copenhagen and Capital Region of Denmark, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| | - Sabine Heeseman
- Vascular Clinic, Lillebaelt Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark.
| | - Hanne Tønnesen
- WHO-CC Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark. .,Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Skåne University Hospital, Södra Förstadsgatan 101, 214 28, Malmö, Sweden.
| | - Torben V Schroeder
- Vascular Clinic, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Centre for Clinical Education, University of Copenhagen and Capital Region of Denmark, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
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Tønnesen H, Egholm JW, Oppedal K, Lauritzen JB, Madsen BL, Pedersen B. Patient education for alcohol cessation intervention at the time of acute fracture surgery: study protocol for a randomised clinical multi-centre trial on a gold standard programme (Scand-Ankle). BMC Surg 2015; 15:52. [PMID: 25925742 PMCID: PMC4422327 DOI: 10.1186/s12893-015-0035-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background Patients with hazardous alcohol intake are overrepresented in emergency departments and surgical wards. These patients have an increased risk of postoperative complications with prolonged hospital stays and admissions to intensive care unit after surgery. In elective surgery, preoperative alcohol cessation interventions can reduce postoperative complications, but no studies have investigated the effect of alcohol cessation intervention at the time of acute fracture surgery. This protocol describes a randomised clinical trial that aims to evaluate the effect of a new gold standard programme for alcohol cessation intervention in the perioperative period regarding postoperative complications, alcohol intake and cost-effectiveness. Methods/Design Patients with hazardous alcohol intake undergoing ankle fracture surgery will be recruited into the trial from multiple orthopaedic wards at university hospitals in Denmark, Sweden and Norway. Included patients will be randomly allocated to either standard care or the gold standard programme aimed at complete alcohol abstinence before, during and 6 weeks after surgery. It includes a structured patient education programme and weekly interventions meetings at the orthopaedic outpatient clinic. Furthermore, patients are provided with thiamine and B-vitamins, alcohol withdrawal prophylaxis and treatment, and disulfiram to support abstinence. Alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly intervention meetings and follow-up visits. Follow-up assessments will be conducted 6 weeks and 3, 6, 9 and 12 months after surgery for all patients. The effect of the gold standard programme will be assessed comparing the outcome measures between the intervention and control group at each follow-up point. Discussion The study will provide new knowledge about how to prevent alcohol-related postoperative complications at the time of acute fracture surgery. If effective, the results will be a benefit for the clinical course, patients and society alike. Trial registration The protocol is registered in ClinicalTrials.gov (Id: NCT00986791).
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Affiliation(s)
- Hanne Tønnesen
- WHO-CC, Clinical Health Promotion Centre, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark. .,Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Julie Weber Egholm
- WHO-CC, Clinical Health Promotion Centre, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Orthopedic Department, Hospital of Southern Jutland, University of Southern Denmark, Aabenraa, Denmark
| | - Kristian Oppedal
- Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Jes Bruun Lauritzen
- Department of Orthopaedic Surgery, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn Lindegård Madsen
- Department of Orthopaedic Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Pedersen
- WHO-CC, Clinical Health Promotion Centre, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Kehlet M, Schroeder TV, Tønnesen H. The Gold Standard Program for smoking cessation is effective for participants over 60 years of age. Int J Environ Res Public Health 2015; 12:2574-87. [PMID: 25734789 PMCID: PMC4377919 DOI: 10.3390/ijerph120302574] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/28/2015] [Accepted: 02/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tobacco smoking is more prevalent among the elderly than among the young, and the elderly also have the most frequent contact with the health care system. The aim of this study was to evaluate the effectiveness of the Gold Standard Program, which is an intensive six-week smoking cessation program, on continuous self-reported abstinence rates after six months, on participants over the age of 60 years in a real life setting. METHODS This was a retrospective cohort study from the national Danish smoking cessation database. RESULTS The database registered 7369 participants over the age of 60 years (range 60-82) and 24,294 below 60 years (range 15-59). Continuous abstinence rate after six months was 37% for the elderly compared to 35% for the younger (p<0.05). The significant variables for continuous abstinence were: living with another adult (OR 1.10), prior professional recommendation for smoking cessation (OR 1.12), being compliant with program (OR 1.35) and being abstinent at end of course (OR 13.3). CONCLUSIONS Participants over the age of 60 years had significantly higher continuous abstinence rates after six months than the participants less than 60 years. It is never too late for health professionals to recommend and educate patients about smoking cessation programs even if they are over 60 years of age.
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Affiliation(s)
- Mette Kehlet
- Vascular Clinic, RK, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Torben V Schroeder
- Vascular Clinic, RK, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
- Centre for Clinical Education, Region Hovedstaden, 2100 Copenhagen, Denmark.
| | - Hanne Tønnesen
- WHO Collaborating Centres, Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Denmark.
- Clinical Health Promotion Centre, Lund University, Skåne University Hospital, Malmö SE 205 02, Sweden.
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Wåhlin S, Tønnesen H. [Time for "alcohol-free operations". Two standard drinks a day doubles the risk of postoperative complications]. Lakartidningen 2014; 111:1966-1969. [PMID: 25349999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Increasing evidence points out that alcohol intake is a significant risk factor for patient safety at surgery. This review updates the evidence, mechanisms and recommendations. The threshold is relatively low; about two standard drinks per day or more for two weeks prior to surgery double the complication rate. The mechanisms include reduced immune capacity, sub-clinical cardiomyopathy, haemostatic imbalance, delayed wound healing and increased stress response to surgery. These organ dysfunctions are significantly improved or even normalised during total abstinence from alcohol for 1 to 9 weeks. Only two RCTs has been performed to evaluate the effect of intensive alcohol intervention prior to elective surgery. A 70 % reduction of postoperative complications was shown in a meta-analysis. The intervention targeted complete alcohol cessation, with a high success rate. Research on acute surgery is missing. We recommend that patients are given information on alcohol and increased surgical risk, that alcohol history taking is standardised and that evidence-based intervention programs for risk reduction are included in the surgical guidelines in order to improve the patient safety.
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Affiliation(s)
- Sven Wåhlin
- Beroendecentrum Stockholm - Riddargatan 1 Stockholm, Sweden - Stockholm, Sweden
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Rubinsky AD, Bishop MJ, Maynard C, Henderson WG, Hawn MT, Harris AHS, Beste LA, Tønnesen H, Bradley KA. Postoperative risks associated with alcohol screening depend on documented drinking at the time of surgery. Drug Alcohol Depend 2013; 132:521-7. [PMID: 23683792 DOI: 10.1016/j.drugalcdep.2013.03.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/27/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Both AUDIT-C alcohol screening scores up to a year before surgery and clinical documentation of drinking over 2 drinks per day immediately prior to surgery ("documented drinking >2d/d") are associated with increased postoperative complications and health care utilization. The purpose of this study was to evaluate whether documented drinking >2d/d contributed additional information about postoperative risk beyond past-year AUDIT-C screening results. METHOD Male Veterans Affairs (VA) patients who had a non-emergent, non-cardiac, major surgery assessed by the VA's Surgical Quality Improvement Program 10/2003-9/2006 and completed the AUDIT-C by mailed survey in the prior year were eligible for this study. Linear or logistic regression models compared 30-day postoperative complication(s), return to operating room (OR), hospital length of stay (LOS), and intensive care unit (ICU) days across eight groups defined by past-year AUDIT-C score and clinically documented drinking >2d/d, with AUDIT-C scores 1-4 and no documented drinking >2d/d as the referent, after adjusting for important covariates. RESULTS Overall 8811 patients met inclusion criteria. Among patients with documented drinking >2d/d immediately prior to surgery, postoperative risk varied widely depending on past-year AUDIT-C score; scores ≥5 were associated with increased risk of complication(s), and scores ≥9 with increased hospital LOS and ICU days. Among patients without documentation of drinking >2d/d, increasing AUDIT-C scores were not associated with these outcomes. CONCLUSIONS Clinical documentation of drinking >2d/d immediately prior to surgery contributed additional information about postoperative risk beyond past-year AUDIT-C score. However, among patients with documented drinking >2d/d, postoperative risk varied widely depending on the AUDIT-C score.
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Affiliation(s)
- Anna D Rubinsky
- Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; Department of Health Services, University of Washington, Seattle, WA, United States.
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Abstract
BACKGROUND Hazardous drinking has been associated with an increased postoperative complication rate after surgery. Common complications include postoperative infections, cardiopulmonary complications, and bleeding episodes. Preoperative abstinence may to some degree reverse alcohol-induced pathophysiological processes and thus prevent postoperative complications. OBJECTIVES To assess the effect of preoperative alcohol cessation interventions on the rate of postoperative complications including mortality in hazardous drinkers. To assess the effect of preoperative alcohol cessation interventions for hazardous drinkers on alcohol use in the postoperative period and in the long term. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 9); Ovid MEDLINE (1966 to September 2011); Ovid EMBASE (1966 to September 2011); CINAHL via EBSCOhost (1982 to September 2011). We combined the MEDLINE search strategy with the Cochrane highly sensitive search strategy, as contained in the Cochrane Handbook for Systematic Reviews of Interventions, to identify randomized controlled trials (RCTs). SELECTION CRITERIA We included all randomized controlled trials (RCTs) that evaluated the effects of a preoperative alcohol cessation intervention on postoperative complications or postoperative alcohol consumption, or both, in the short and long term in hazardous drinkers . We excluded intraoperative and postoperative alcohol interventions. DATA COLLECTION AND ANALYSIS Three authors independently assessed studies to determine eligibility and extracted data using a tool based on guidance in the Cochrane Handbook for Systematic Reviews of Interventions. Where required, we obtained additional information through collaboration with the original author. We presented the main outcomes as dichotomous variables. Where data were available, we planned to conduct subgroup analyses as well as a sensitivity analysis to explore risk of bias. MAIN RESULTS We included two studies which involved 69 patients. Both studies were RCTs evaluating the effect of intensive alcohol cessation interventions including pharmacological strategies for alcohol withdrawal and relapse prophylaxis.Our primary outcome measure was postoperative complications and in-hospital and 30-day mortality. Meta-analysis showed an effect on the overall complication rates (odds ratio (OR) 0.22; 95% confidence interval (CI) 0.08 to 0.61; P = 0.004). There was no significant reduction of in-hospital and 30-day mortality (OR 0.39; 95% CI 0.06 to 2.83; P = 0.35).Secondary outcomes included length of stay and postoperative alcohol use. No significant reduction was found. AUTHORS' CONCLUSIONS Based on the finding of two studies, it appears that intensive preoperative alcohol cessation interventions, including pharmacological strategies for relapse prophylaxis and withdrawal symptoms, may significantly reduce postoperative complication rates. No effect was found on mortality rates and length of stay.The effect of preoperative alcohol cessation intervention should be further explored in an effort to reduce the adverse effect of alcohol use on surgical outcomes. The number needed to screen to identify eligible patients for alcohol intervention studies in surgical settings seems to be extremely high. This may indicate that these studies are difficult to perform. Nevertheless, timing, duration and intensity of alcohol cessation interventions need to be subject to further investigation.
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Affiliation(s)
- Kristian Oppedal
- Alcohol and Drug Research Western Norway (KoRFor), Stavanger University Hospital, Stavanger, Norway.
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Bradley KA, Rubinsky AD, Sun H, Blough DK, Tønnesen H, Hughes G, Beste LA, Bishop MJ, Hawn MT, Maynard C, Harris AS, Hawkins EJ, Bryson CL, Houston TK, Henderson WG, Kivlahan DR. Prevalence of alcohol misuse among men and women undergoing major noncardiac surgery in the Veterans Affairs health care system. Surgery 2012; 152:69-81. [DOI: 10.1016/j.surg.2012.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 02/09/2012] [Indexed: 12/01/2022]
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Neumann T, Rasmussen M, Ghith N, Heitmann BL, Tønnesen H. The Gold Standard Programme: smoking cessation interventions for disadvantaged smokers are effective in a real-life setting. Tob Control 2012; 22:e9. [PMID: 22705716 PMCID: PMC3812829 DOI: 10.1136/tobaccocontrol-2011-050194] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates. Design Observational prospective cohort study. Setting GSPs in pharmacies, hospitals and communities in Denmark, reporting to the national Smoking Cessation Database. Participants Disadvantaged patients, defined as patients with a lower level of education and those receiving unemployment benefits. Interventions 6-week manualised GSP smoking cessation interventions performed by certified staff. Main outcome measures 6 months of continuous abstinence, response rate: 80%. Results Continuous abstinence of the 16 377 responders was 34% (of all 20 588 smokers: 27%). Continuous abstinence was lower in 5738 smokers with a lower educational level (30% of responders and 23% of all) and in 840 unemployed (27% of responders and 19% of all). In respect to modifiable factors, continuous abstinence was found more often after programmes in one-on-one formats (vs group formats) among patients with a lower educational level, 34% (vs 25%, p=0.037), or among unemployed, 35% (vs 24%, p=0.099). The variable ‘format’ stayed in the final model of multivariable analyses in patients with a lower educational level, OR=1.31 (95% CI 1.05 to 1.63). Conclusions Although continuous abstinence was lower among disadvantaged smokers, the absolute difference was small. If the programme had been as effective in disadvantaged as in non-disadvantaged groups, there would have been an extra 46 or 8 quitters annually, respectively. Promoting individual interventions among those with a low education may increase the effectiveness of GSP.
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Affiliation(s)
- Tim Neumann
- WHO CC, Clinical Health Promotion Centre, Bispebjerg University Hospital, Copenhagen, Denmark
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Rubinsky AD, Sun H, Blough DK, Maynard C, Bryson CL, Harris AH, Hawkins EJ, Beste LA, Henderson WG, Hawn MT, Hughes G, Bishop MJ, Etzioni R, Tønnesen H, Kivlahan DR, Bradley KA. AUDIT-C Alcohol Screening Results and Postoperative Inpatient Health Care Use. J Am Coll Surg 2012; 214:296-305.e1. [DOI: 10.1016/j.jamcollsurg.2011.11.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/18/2011] [Accepted: 11/21/2011] [Indexed: 11/27/2022]
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Oppedal K, Nesvåg S, Pedersen B, Daltveit JT, Tønnesen H. Hazardous drinkers in Norwegian hospitals – a cross-sectional study of prevalence and drinking patterns among somatic patients. Nor J Epidemiol 2011. [DOI: 10.5324/nje.v21i1.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: High alcohol intake has been associated with increased risk of hospital admission, increased complication rates, and prolonged hospital stay. Thus, hospital admission may present a relevant opportunity for alcohol intervention. To understand the potential of alcohol interventions we need knowledge about patients’ drinking patterns. The aim of this study was therefore to determine the drinking patterns in a Norwegian hospital population.Methods: A multicentre cross-sectional survey was carried out at three university hospitals. Patients were asked about alcohol intake one month prior to admission/outpatient treatment. The questionnaire included weekly alcohol intake calculated by frequency X quantity as well as episodes of binge drinking (drinking more than 5 AU during a single day). AUDIT-C was used to determine the frequency of patients having a hazardous drinking pattern during the 12 months prior to hospital treatment.Results: In total we assessed 2,932 patients for eligibility. A total of 2,350 patients fulfilled the inclusion criteria. We included 1,522 patients (65%) in the analyses. Six percent of the women and 11% of the men reported drinking more than the weekly limits of nine alcohol units (AU) for women and 14 AU for men. Fourteen percent of the women and 29% of the men reported binge drinking during the last month. The frequency of women scoring more or equal to 4 points on AUDIT-C was 20%. The frequency of men scoring more or equal to 5 points was 25%.Conclusion: Hazardous drinking among Norwegian hospital patients may be more prevalent than what has been reported for the Norwegian population in general. Binge drinking is the dominant drinking pattern.
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Højgaard B, Olsen KR, Pisinger C, Tønnesen H, Gyrd-Hansen D. The potential of smoking cessation programmes and a smoking ban in public places: Comparing gain in life expectancy and cost effectiveness. Scand J Public Health 2011; 39:785-96. [DOI: 10.1177/1403494811421416] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Interventions aimed at reducing the number of smokers are generally believed to be cost effective. However as the cost of the interventions should be paid up front whereas the gains in life years only appear in the future – the budgetary consequences might be a barrier to implementing such interventions. Aims: The aim of the present paper was to assess the long-term cost effectiveness as well as the short-term (10 years) budget consequences of cessation programmes and a smoking ban in enclosed public places. Methods: We develop a population-based Markov model capable of analyzing both interventions and assess long-term costs effectiveness as well as short-term budgetary consequences and outcome gains. The smoking cessation programme model was based on data from the Danish National Smoking Cessation Database (SCDB), while the model of the smoking ban was based on effect estimates found in the literature. Results: On a population level the effect of a smoking ban has the largest potential compared with the effect of smoking cessation programmes. Our results suggest that smoking cessation programmes are cost saving and generate life-years, whereas the costs per life-year gained by a smoking ban are 40,645 to 64,462 DKK (100 DKK = €13.4). These results are conservative as they do not include the healthcare cost saving related to reduced passive smoking. Conclusions: Our results indicate that smoking cessation programmes and a smoking ban in enclosed public places both in the short term and the long term are cost-effective strategies compared with the status quo.
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Affiliation(s)
- Betina Højgaard
- Danish Institute for Health Services Research, Denmark
- Institute of Public Health – Health Economics Unit, University of Southern Denmark, Denmark
| | - Kim Rose Olsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Hanne Tønnesen
- WHO Collaborating Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Dorte Gyrd-Hansen
- Danish Institute for Health Services Research, Denmark
- Institute of Public Health – Health Economics Unit, University of Southern Denmark, Denmark
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Pedersen B, Oppedal K, Egund L, Tønnesen H. Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review. BMC Surg 2011. [PMID: 21943382 DOI: 10.1186/1471-2482-11-26]available] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs. METHODS A systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics. RESULTS The literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months.Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients.The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up. CONCLUSIONS Most emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.
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Affiliation(s)
- Bolette Pedersen
- WHO Collaborating Centre for Evidence-based Health Promotion in Hospitals and Health Services, Bispebjerg University Hospital, Copenhagen NV, Denmark.
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Pedersen B, Oppedal K, Egund L, Tønnesen H. Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review. BMC Surg 2011; 11:26. [PMID: 21943382 PMCID: PMC3189859 DOI: 10.1186/1471-2482-11-26] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 09/23/2011] [Indexed: 12/03/2022] Open
Abstract
Background In the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs. Methods A systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics. Results The literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months. Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients. The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up. Conclusions Most emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.
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Affiliation(s)
- Bolette Pedersen
- WHO Collaborating Centre for Evidence-based Health Promotion in Hospitals and Health Services, Bispebjerg University Hospital, Copenhagen NV, Denmark.
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Abstract
BACKGROUND Alcohol use disorders (AUD) involving hazardous, harmful, and addictive misuse of alcohol are widespread in most parts of the world. The aim of this study was to review the effect of disulfiram in the treatment of patients with AUD. The effect of disulfiram was evaluated according to the primary outcome of an intake of alcohol below 30 and 20 g/d for men and women, respectively, as well as secondary outcomes such as days until relapse, alcohol intake, and numbers of drinking days. METHODS A systematic review of the literature was conducted using MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). RESULTS Eleven randomized controlled trials were included with a total of 1,527 patients. They compared disulfiram treatment with placebo, none or other abstinence-supportive treatments. Overall, 6 studies reported of a significant better effect on abstinence for patients treated with disulfiram. Six of 9 studies measuring secondary outcomes reported that patients treated with disulfiram had significantly more days until relapse and fewer drinking days, respectively. The quality of the included studies was moderate. Heterogeneity was significant in most of the meta-analyses, but valid results were found regarding the effect of disulfiram versus placebo over 12 months and unsupervised disulfiram versus other or no treatment. The vast majority of significant studies were of shorter duration, while only 3 studies of 12 months were significant regarding more days until relapse and/or reduction in drinking days. CONCLUSIONS Supervised treatment with disulfiram has some effect on short-term abstinence and days until relapse as well as number of drinking days when compared with placebo, none, or other treatments for patients with alcohol dependency or abuse. Long-term effect on abstinence has not been evaluated yet. However, there is a need for more homogeneous and high-quality studies in the future regarding the efficacy of disulfiram.
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Affiliation(s)
- Charlotte H Jørgensen
- WHO Collaborating Centre for Evidence Based Health Promotion in Hospitals & Health Services, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
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Bradley KA, Rubinsky AD, Sun H, Bryson CL, Bishop MJ, Blough DK, Henderson WG, Maynard C, Hawn MT, Tønnesen H, Hughes G, Beste LA, Harris AHS, Hawkins EJ, Houston TK, Kivlahan DR. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery. J Gen Intern Med 2011; 26:162-9. [PMID: 20878363 PMCID: PMC3019325 DOI: 10.1007/s11606-010-1475-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed. OBJECTIVE To evaluate whether results of alcohol screening with the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) questionnaire-up to a year before surgery-were associated with the risk of postoperative complications. DESIGN This is a cohort study. SETTING AND PARTICIPANTS Male Veterans Affairs (VA) patients were eligible if they had major noncardiac surgery assessed by the VA's Surgical Quality Improvement Program (VASQIP) in fiscal years 2004-2006, and completed the AUDIT-C alcohol screening questionnaire (0-12 points) on a mailed survey within 1 year before surgery. MAIN OUTCOME MEASURE One or more postoperative complication(s) within 30 days of surgery based on VASQIP nurse medical record reviews. RESULTS Among 9,176 eligible men, 16.3% screened positive for alcohol misuse with AUDIT-C scores ≥ 5, and 7.8% had postoperative complications. Patients with AUDIT-C scores ≥ 5 were at significantly increased risk for postoperative complications, compared to patients who drank less. In analyses adjusted for age, smoking, and days from screening to surgery, the estimated prevalence of postoperative complications increased from 5.6% (95% CI 4.8-6.6%) in patients with AUDIT-C scores 1-4, to 7.9% (6.3-9.7%) in patients with AUDIT-Cs 5-8, 9.7% (6.6-14.1%) in patients with AUDIT-Cs 9-10 and 14.0% (8.9-21.3%) in patients with AUDIT-Cs 11-12. In fully-adjusted analyses that included preoperative covariates potentially in the causal pathway between alcohol misuse and complications, the estimated prevalence of postoperative complications increased significantly from 4.8% (4.1-5.7%) in patients with AUDIT-C scores 1-4, to 6.9% (5.5-8.7%) in patients with AUDIT-Cs 5-8 and 7.5% (5.0-11.3%) among those with AUDIT-Cs 9-10. CONCLUSIONS AUDIT-C scores of 5 or more up to a year before surgery were associated with increased postoperative complications.
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Affiliation(s)
- Katharine A Bradley
- Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA 98101, USA.
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Pedersen B, Alva-Jørgensen P, Raffing R, Tønnesen H. Fractures and alcohol abuse - patient opinion of alcohol intervention. Open Orthop J 2011; 5:7-12. [PMID: 21464911 PMCID: PMC3069357 DOI: 10.2174/1874325001105010007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/13/2010] [Accepted: 08/26/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To clarify patient opinions about alcohol intervention in relation to surgery before investigating the effect in a Scandinavian multi-centre randomized trial. MATERIAL AND METHODS A qualitative study. Thirteen consecutive alcohol patients with fractures participated after informed consent. They were interviewed during their hospital stay. The number of participants was based on the criteria of data-saturation. The analysis followed the applied qualitative framework model aimed at evaluation of specific participant needs within a larger overall project. RESULTS All patients regarded alcohol intervention in relation to surgery as a good idea. They did not consider quit drinking as a major problem during their hospital stay and had all remained abstinent in this period. About half of the patients were ready or partly ready to participate in an alcohol intervention. Patient opinions and their readiness to participate were expressed in four groups, which also reflected their readiness to stop drinking in the perioperative period, their general acceptance of supportive disulfiram as part of an alcohol intervention as well as their awareness of postoperative complications. CONCLUSION This study clarified that the patients found alcohol intervention relevant in relation to surgery.
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Affiliation(s)
- Bolette Pedersen
- WHO Collaborating Centre for Evidence-based Health Promotion in Hospitals and Health Services & Department of Orthopaedic Surgery, Bispebjerg University Hospital, Copenhagen NV, Denmark
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Lindström D, Tønnesen H, Adami J. [Smoking cessation in surgical interventions. Dramatic drop in the risk of postoperative complications]. Lakartidningen 2010; 107:2634-2635. [PMID: 21137530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- David Lindström
- Institutionen för klinisk forskning och utbildning, Karolinska institutet, Stockholm.
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