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Lindekilde N, Diaz LJ, Lasgaard M, Henriksen JE, Scheuer SH, Andersen GS, Rubin KH, Pouwer F. Elevated risk of developing type 2 diabetes in people with a psychiatric disorder: What is the role of health behaviors and psychotropic medication? J Diabetes Complications 2023; 37:108591. [PMID: 37820469 DOI: 10.1016/j.jdiacomp.2023.108591] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/31/2023] [Accepted: 08/19/2023] [Indexed: 10/13/2023]
Abstract
AIMS Several psychiatric disorders are linked with an increased risk of developing type 2 diabetes (T2D), but the mediating mechanisms are unclear. We aimed to investigate health behaviors, obesity, psychotropic medication use, and comorbidity as potential mediating mechanisms explaining these associations. METHODS We combined data from a large population-based survey with register-based data and followed a sample of 250,013 Danes (≥16 years) for up to 8.9 years. We conducted mediation analyses investigating 10 potential mediators of the associations between psychiatric disorders and incident T2D. RESULTS Individuals with a substance use disorder, schizophrenia, mood disorder, neurotic disorder, eating disorder, or a personality disorder had a significantly higher risk of developing T2D. Organic disorders, intellectual disabilities, developmental and behavioral disorders were not associated with T2D-risk. For all psychiatric disorders significantly associated with T2D, the use of antidepressant medication had the largest proportional mediating effect on the association (13-32 %). CONCLUSIONS Use of antidepressant medication had the largest contribution to the associations between psychiatric disorders and incident T2D. Future epidemiological studies and prevention studies should focus on optimizing the use of antidepressant medication with minimal side effects, and the promotion of health behaviors in individuals with a psychiatric disorder to prevent T2D.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Occupational and Environmental Medicine, Odense University Hospital, Denmark.
| | - Lars J Diaz
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Mathias Lasgaard
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Jan Erik Henriksen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | | | | | - Katrine H Rubin
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark; Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark; Department of Medical Psychology, Amsterdam UMC, the Netherlands
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2
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Aabakke AJM, Petersen TG, Wøjdemann K, Ibsen MH, Jonsdottir F, Rønneberg E, Andersen CS, Hammer A, Clausen TD, Milbak J, Burmester L, Zethner R, Lindved B, Thorsen‐Meyer A, Khalil MR, Henriksen B, Jønsson L, Andersen LLT, Karlsen KK, Pedersen ML, Hedermann G, Vestgaard M, Thisted D, Fallesen AN, Johansson JN, Møller DC, Dubietyte G, Andersson CB, Farlie R, Skaarup Knudsen A, Hansen L, Hvidman L, Sørensen AN, Rathcke SL, Rubin KH, Petersen LK, Jørgensen JS, Krebs L, Bliddal M. Risk factors for and pregnancy outcomes after SARS-CoV-2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS-CoV-2 diagnosis. Acta Obstet Gynecol Scand 2023; 102:282-293. [PMID: 36695168 PMCID: PMC9951376 DOI: 10.1111/aogs.14512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/08/2022] [Revised: 12/21/2022] [Accepted: 01/01/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION We identified risk factors and outcomes associated with SARS-CoV-2 infection in pregnancy in a universally tested population according to disease severity and validated information on SARS-CoV-2 during pregnancy in national health registers in Denmark. MATERIAL AND METHODS Cohort study using data from national registers and medical records including all pregnancies between March 1, 2020 and February 28, 2021. We compared women with a validated positive SARS-CoV-2 test during pregnancy with non-infected pregnant women. Risk factors and pregnancy outcomes were assessed by Poisson and Cox regression models and stratified according to disease severity defined by hospital admission status and admission reason (COVID-19 symptoms or other). Using medical record data on actual period of pregnancy, we calculated predictive values of the SARS-CoV-2 diagnosis in pregnancy in the registers. RESULTS SARS-CoV-2 infection was detected in 1819 (1.6%) of 111 185 pregnancies. Asthma was associated with infection (relative risk [RR] 1.63, 95% confidence interval [CI] 1.28-2.07). Risk factors for severe COVID-19 disease requiring hospital admission were high body mass index (median ratio 1.06, 95% CI 1.04-1.09), asthma (RR 7.47, 95% CI 3.51-15.90) and gestational age at the time of infection (gestational age 28-36 vs < 22: RR 3.53, 95% CI 1.75-7.10). SARS-CoV-2-infected women more frequently had hypertensive disorders in pregnancy (adjusted hazard ratio [aHR] 1.31, 95% CI 1.04-1.64), early pregnancy loss (aHR 1.37, 95% CI 1.00-1.88), preterm delivery before gestational age 28 (aHR 2.31, 95% CI 1.01-5.26), iatrogenically preterm delivery before gestational age 37 (aHR 1.49, 95% CI 1.01-2.19) and small-for-gestational age children (aHR 1.28, 95% CI 1.05-1.54). The associations were stronger among women admitted to hospital for any reason. The validity of the SARS-CoV-2 diagnosis in relation to pregnancy in the registers compared with medical records showed a negative predictive value of 99.9 (95% CI 99.9-100.0) and a positive predictive value of 82.1 (95% CI 80.4-83.7). CONCLUSIONS Women infected with SARS-CoV-2 during pregnancy were at increased risk of hypertensive disorders in pregnancy, early pregnancy loss, preterm delivery and having children small for gestational age. The validity of Danish national registers was acceptable for identification of SARS-CoV-2 infection during pregnancy.
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Affiliation(s)
- Anna J. M. Aabakke
- Department of Obstetrics and GynecologyCopenhagen University Hospital—HolbækHolbækDenmark,Department of Obstetrics and GynecologyCopenhagen University Hospital—North ZealandHillerødDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | | | - Karen Wøjdemann
- Department of Obstetrics and GynecologyCopenhagen University Hospital—BornholmRønneDenmark
| | - Mette H. Ibsen
- Department Obstetrics and GynecologyHospital of South West JutlandEsbjergDenmark
| | - Fjola Jonsdottir
- Department of Obstetrics and GynecologyCopenhagen University Hospital—Herlev and GentofteHerlevDenmark
| | - Elisabeth Rønneberg
- Department of Obstetrics and GynecologyCopenhagen University Hospital—Herlev and GentofteHerlevDenmark
| | | | - Anne Hammer
- Department of Obstetrics and GynecologyGødstrup HospitalHerningDenmark
| | - Tine D. Clausen
- Department of Obstetrics and GynecologyCopenhagen University Hospital—North ZealandHillerødDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Julie Milbak
- Department of Obstetrics and GynecologyCopenhagen University Hospital—North ZealandHillerødDenmark
| | - Lars Burmester
- Department of Obstetrics and GynecologyThe North Denmark Regional Hospital HjørringHjørringDenmark
| | - Rikke Zethner
- Department of Obstetrics and GynecologyCopenhagen University Hospital—HolbækHolbækDenmark,Department of Obstetrics and GynecologyCopenhagen University Hospital—Herlev and GentofteHerlevDenmark
| | - Birgitte Lindved
- Department of Obstetrics and GynecologyHorsens Regional HospitalHorsensDenmark
| | - Annette Thorsen‐Meyer
- Department of Obstetrics and GynecologyCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark
| | - Mohammed R. Khalil
- Department Obstetrics and GynecologyUniversity Hospital of Southern Denmark – KoldingKoldingDenmark
| | - Birgitte Henriksen
- Department Obstetrics and GynecologyUniversity Hospital of Southern Denmark – KoldingKoldingDenmark
| | - Lisbeth Jønsson
- Department Obstetrics and GynecologyNykøbing F. HospitalNykøbing FDenmark
| | - Lise L. T. Andersen
- Department of Obstetrics and GynecologyOdense University HospitalOdenseDenmark
| | - Kamilla K. Karlsen
- Department of Obstetrics and GynecologyOdense University HospitalOdenseDenmark
| | - Monica L. Pedersen
- Department of Obstetrics and GynecologyRanders Regional HospitalRandersDenmark
| | - Gitte Hedermann
- Department of Obstetrics and GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Marianne Vestgaard
- Department of Obstetrics and GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Dorthe Thisted
- Department of Obstetrics and GynecologyCopenhagen University Hospital—HolbækHolbækDenmark,Department of Obstetrics and GynecologyZealand University HospitalRoskildeDenmark
| | - Agnethe N. Fallesen
- Department of Obstetrics and GynecologyCopenhagen University Hospital – NæstvedSlagelseDenmark
| | - Josephine N. Johansson
- Department of Obstetrics and GynecologyCopenhagen University Hospital – NæstvedSlagelseDenmark
| | - Ditte C. Møller
- Department of Obstetrics and GynecologyHospital of South JutlandAabenraaDenmark
| | - Greta Dubietyte
- Department of Obstetrics and GynecologyHospital of South JutlandAabenraaDenmark
| | - Charlotte B. Andersson
- Department of Obstetrics and GynecologyThe North Denmark Regional Hospital ThistedThistedDenmark,Danish Center for Clinical Health Services Research (DACS)AalborgDenmark
| | - Richard Farlie
- Department of Obstetrics and GynecologyViborg Regional HospitalViborgDenmark
| | | | - Lea Hansen
- Department of Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
| | - Lone Hvidman
- Department of Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
| | - Anne N. Sørensen
- Department of Obstetrics and GynecologyAalborg University HospitalAalborgDenmark
| | - Sidsel L. Rathcke
- Department of Obstetrics and GynecologyAalborg University HospitalAalborgDenmark
| | - Katrine H. Rubin
- OPEN, Odense University HospitalOdenseDenmark,Research Unit OPEN, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Lone K. Petersen
- Department of Obstetrics and GynecologyOdense University HospitalOdenseDenmark,Research Unit OPEN, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Jan S. Jørgensen
- Department of Obstetrics and GynecologyOdense University HospitalOdenseDenmark
| | - Lone Krebs
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Department of Obstetrics and GynecologyCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark
| | - Mette Bliddal
- OPEN, Odense University HospitalOdenseDenmark,Research Unit OPEN, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
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Rubin KH, Haastrup PF, Nicolaisen A, Möller S, Wehberg S, Rasmussen S, Balasubramaniam K, Søndergaard J, Jarbøl DE. Developing and Validating a Lung Cancer Risk Prediction Model: A Nationwide Population-Based Study. Cancers (Basel) 2023; 15:cancers15020487. [PMID: 36672436 PMCID: PMC9856360 DOI: 10.3390/cancers15020487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Lung cancer can be challenging to diagnose in the early stages, where treatment options are optimal. We aimed to develop 1-year prediction models for the individual risk of incident lung cancer for all individuals aged 40 or above living in Denmark on 1 January 2017. The study was conducted using population-based registers on health and sociodemographics from 2007-2016. We applied backward selection on all variables by logistic regression to develop a risk model for lung cancer and applied the models to the validation cohort, calculated receiver-operating characteristic curves, and estimated the corresponding areas under the curve (AUC). In the populations without and with previously confirmed cancer, 4274/2,826,249 (0.15%) and 482/172,513 (0.3%) individuals received a lung cancer diagnosis in 2017, respectively. For both populations, older age was a relevant predictor, and the most complex models, containing variables related to diagnoses, medication, general practitioner, and specialist contacts, as well as baseline sociodemographic characteristics, had the highest AUC. These models achieved a positive predictive value (PPV) of 0.0127 (0.006) and a negative predictive value (NPV) of 0.989 (0.997) with a 1% cut-off in the population without (with) previous cancer. This corresponds to 1.2% of the screened population experiencing a positive prediction, of which 1.3% would be incident with lung cancer. We have developed and tested a prediction model with a reasonable potential to support clinicians and healthcare planners in identifying patients at risk of lung cancer.
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Affiliation(s)
- Katrine H. Rubin
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Peter F. Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Anne Nicolaisen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Sören Möller
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Dorte E. Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence:
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Thykjær AS, Andersen N, Bek T, Heegaard S, Hajari J, Laugesen CS, Möller S, Pedersen FN, Rosengaard L, Schielke KC, Kawasaki R, Højlund K, Rubin KH, Stokholm L, Grauslund J. Attendance in a national screening program for diabetic retinopathy: a population-based study of 205,970 patients. Acta Diabetol 2022; 59:1493-1503. [PMID: 35953626 PMCID: PMC9519674 DOI: 10.1007/s00592-022-01946-4] [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: 06/07/2022] [Accepted: 07/16/2022] [Indexed: 11/15/2022]
Abstract
AIMS A nationwide diabetic retinopathy (DR) screening program has been established in Denmark since 2013. We aimed to perform an evaluation of adherence to DR screenings and to examine whether non-adherence was correlated to DR progression. METHODS The population consisted of a register-based cohort, who participated in the screening program from 2013 to 2018. We analyzed age, gender, marital status, DR level (International Clinical DR severity scale, none, mild-, moderate-, severe non-proliferative DR (NPDR) and proliferative DR (PDR)), comorbidities and socioeconomic factors. The attendance pattern of patients was grouped as either timely (no delays > 33%), delayed (delays > 33%) or one-time attendance (unexplained). RESULTS We included 205,970 patients with 591,136 screenings. Rates of timely, delayed and one-time attendance were 53.0%, 35.5% and 11.5%, respectively. DR level at baseline was associated with delays (mild-, moderate-, severe NPDR and PDR) and one-time attendance (moderate-, severe NPDR and PDR) with relative risk ratios (RRR) of 1.68, 2.27, 3.14, 2.44 and 1.18, 2.07, 1.26, respectively (P < 0.05). Delays at previous screenings were associated with progression to severe NPDR or PDR (hazard ratio (HR) 2.27, 6.25 and 12.84 for 1, 2 and 3+ delays, respectively). Any given delay doubled the risk of progression (HR 2.28). CONCLUSIONS In a national cohort of 205,970 patients, almost half of the patients attended DR screening later than scheduled or dropped out after first screening episode. This was, in particular, true for patients with any levels of DR at baseline. DR progression in patients with delayed attendance, increased with the number of missed appointments.
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Affiliation(s)
- Anne Suhr Thykjær
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
| | - N Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - T Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - S Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - J Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - C S Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - S Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - F N Pedersen
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Rosengaard
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K C Schielke
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - R Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - K Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - K H Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Stokholm
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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5
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Bønløkke SE, Rand MS, Haddock B, Arup S, Smith CD, Jensen JEB, Schwarz P, Hovind P, Oturai PS, Jensen LT, Møller S, Eiken P, Rubin KH, Hitz MF, Abrahamsen B, Jørgensen NR. Baseline bone turnover marker levels can predict change in bone mineral density during antiresorptive treatment in osteoporotic patients: the Copenhagen bone turnover marker study. Osteoporos Int 2022; 33:2155-2164. [PMID: 35729342 DOI: 10.1007/s00198-022-06457-0] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
UNLABELLED Anti-resorptive osteoporosis treatment might be more effective in patients with high bone turnover. In this registry study including clinical data, high pre-treatment bone turnover measured with biochemical markers was correlated with higher bone mineral density increases. Bone turnover markers may be useful tools to identify patients benefitting most from anti-resorptive treatment. INTRODUCTION In randomized, controlled trials of bisphosphonates, high pre-treatment levels of bone turnover markers (BTM) were associated with a larger increase in bone mineral density (BMD). The purpose of this study was to examine this correlation in a real-world setting. METHODS In this registry-based cohort study of osteoporosis patients (n = 158) receiving antiresorptive therapy, the association between pre-treatment levels of plasma C-telopeptide of type I Collagen (CTX) and/or N-terminal propeptide of type I procollagen (PINP) and change in bone mineral density (BMD) at lumbar spine, total hip, and femoral neck upon treatment was examined. Patients were grouped according to their pre-treatment BTM levels, defined as values above and below the geometric mean for premenopausal women. RESULTS Pre-treatment CTX correlated with annual increase in total hip BMD, where patients with CTX above the geometric mean experienced a larger annual increase in BMD (p = 0.008) than patients with CTX below the geometric mean. The numerical pre-treatment level of CTX showed a similar correlation at all three skeletal sites (total hip (p = 0.03), femoral neck (p = 0.04), and lumbar spine (p = 0.0003)). A similar association was found for PINP where pre-treatment levels of PINP above the geometric mean correlated with a larger annual increase in BMD for total hip (p = 0.02) and lumbar spine (p = 0.006). CONCLUSION Measurement of pre-treatment BTM levels predicts osteoporosis patients' response to antiresorptive treatment. Patients with high pre-treatment levels of CTX and/or PINP benefit more from antiresorptive treatment with larger increases in BMD than patients with lower pre-treatment levels.
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Affiliation(s)
- S E Bønløkke
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - M S Rand
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - B Haddock
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - S Arup
- Medical Department, National Research Center for Bone Health, Zealand University Hospital Køge, Køge, Denmark
| | - C D Smith
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J E B Jensen
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - P Schwarz
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Hovind
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - P S Oturai
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - L T Jensen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - S Møller
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - P Eiken
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - K H Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - M F Hitz
- Medical Department, National Research Center for Bone Health, Zealand University Hospital Køge, Køge, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B Abrahamsen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N R Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Jarbøl DE, Hyldig N, Möller S, Wehberg S, Rasmussen S, Balasubramaniam K, Haastrup PF, Søndergaard J, Rubin KH. Can National Registries Contribute to Predict the Risk of Cancer? The Cancer Risk Assessment Model (CRAM). Cancers (Basel) 2022; 14:cancers14153823. [PMID: 35954486 PMCID: PMC9367495 DOI: 10.3390/cancers14153823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Early identification of individuals with an increased risk of cancer is an important challenge. Danish administrative registers may be useful in this respect because they cover the entire population and include comprehensive and consistently coded long-term data. We aimed to develop a predictive model based on Danish administrative registers to facilitate the automated identification of individuals at risk of any type of cancer. In addition to age, almost all the included factors contributed statistically significantly, but also only marginally, to the prediction models, which means that we have not overlooked obvious information available in the register. Future prediction studies should focus on specific cancer types where more precise risk estimations might be expected. It is our ultimate ambition that an effective model can be used at the point of care, integrated into electronic patient record systems to alert physicians of patients at a high risk of cancer. Abstract Purpose: To develop a predictive model based on Danish administrative registers to facilitate automated identification of individuals at risk of any type of cancer. Methods: A nationwide register-based cohort study covering all individuals in Denmark aged +20 years. The outcome was all-type cancer during 2017 excluding nonmelanoma skin cancer. Diagnoses, medication, and contact with general practitioners in the exposure period (2007–2016) were considered for the predictive model. We applied backward selection to all variables by logistic regression to develop a risk model for cancer. We applied the models to the validation cohort, calculated the receiver operating characteristic curves, and estimated the corresponding areas under the curve (AUC). Results: The study population consisted of 4.2 million persons; 32,447 (0.76%) were diagnosed with cancer in 2017. We identified 39 predictive risk factors in women and 42 in men, with age above 30 as the strongest predictor for cancer. Testing the model for cancer risk showed modest accuracy, with an AUC of 0.82 (95% CI 0.81–0.82) for men and 0.75 (95% CI 0.74–0.75) for women. Conclusion: We have developed and tested a model for identifying the individual risk of cancer through the use of administrative data. The models need to be further investigated before being applied to clinical practice.
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Affiliation(s)
- Dorte E. Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence:
| | - Nana Hyldig
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
| | - Sören Möller
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Peter F. Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Katrine H. Rubin
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
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7
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Clausen A, Möller S, Skjødt MK, Bech BH, Rubin KH. Evaluating the performance of the Charlson Comorbidity Index (CCI) in fracture risk prediction and developing a new Charlson Fracture Index (CFI): a register-based cohort study. Osteoporos Int 2022; 33:549-561. [PMID: 34993562 DOI: 10.1007/s00198-021-06293-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED The Charlson Comorbidity Index (CCI) may be applicable for predicting fracture risk since several diagnoses from the index are predictors of fracture. Main results were that the CCI was updated to predict risk of hip fracture with fair precision and that the index could be useful in detecting high-risk individuals. PURPOSE Several of the Charlson Comorbidity Index (CCI) diagnoses are validated predictors of fracture. The purpose of this study was to evaluate the performance of the CCI 1987 by Charlson et al. and of the CCI 2011 by Quan et al. in predicting major osteoporotic fracture (MOF) and hip fracture (HF). Furthermore, it was examined whether the index could be modified to improve fracture risk prediction. METHODS The study population included the entire Danish population aged 45 + years as per January 1, 2018. The cohort was split randomly 50/50 into a development and a validation cohort. CCI diagnoses and fracture outcomes were identified from hospital diagnoses. The weighting of diagnoses was updated in a new Charlson Fracture Index (CFI) using multivariable logistic regression. Predictive capabilities of the CCI 1987, the updated CCI 2011 and the new Charlson Fracture index were evaluated in the validation cohort by receiver operating characteristics (ROC) curves and area under the curve (AUC). RESULTS In the validation cohort, the 1987 and 2011 CCIs resulted in AUCs below or around 0.7 in prediction of MOF and HF in both sexes. The CFI resulted in AUCs < 0.7 in prediction of MOF in both sexes. In prediction of HF, the CFI resulted in AUC of 0.755 (95% CI 0.749; 0.761) in women and 0.782 (95% CI 0.772; 0.793) in men. CONCLUSION The 1987 and 2011 CCIs showed overall poor accuracy in fracture risk prediction. The CFI showed fair accuracy in prediction of HF in women and in men.
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Affiliation(s)
- A Clausen
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - S Möller
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M K Skjødt
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - B H Bech
- Department of Public Health - Department of Epidemiology, Aarhus University, Aarhus, Denmark
| | - K H Rubin
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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8
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Lindekilde N, Scheuer SH, Diaz LJ, Rubin KH, Plana-Ripoll O, Henriksen JE, Lasgaard M, Andersen GS, Pouwer F. Risk of Developing Type 2 Diabetes in Individuals With a Psychiatric Disorder: A Nationwide Register-Based Cohort Study. Diabetes Care 2022; 45:724-733. [PMID: 35043146 DOI: 10.2337/dc21-1864] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous studies have investigated the incidence of type 2 diabetes in individuals with psychiatric disorders, but most studies have focused on a specific psychiatric disorder or a selected sample. More population-based studies are needed to determine these associations in representative samples. We therefore aimed to determine these associations in a nationwide, register-based dynamic cohort study. RESEARCH DESIGN AND METHODS We analyzed data from 5,005,612 adults living in Denmark between 1995 and 2018, without prior diabetes. We investigated 10 different categories of psychiatric disorders and a composite group with any psychiatric disorder. Individuals with a psychiatric disorder were compared with individuals without using multivariable-adjusted Poisson regression to estimate incidence rate ratios (IRR) of type 2 diabetes. We modeled age-specific incidence rates (IR) for individuals with and without the specific psychiatric disorder. All models were stratified by sex. RESULTS In total, 334,739 individuals developed type 2 diabetes during follow-up. For all investigated categories of psychiatric disorders, we found increased IR of type 2 diabetes for individuals with versus those without a psychiatric disorder (IRR: men, 1.47 [95% CI 1.45-1.50]; women, 1.65 [95% CI 1.62-1.68]). When we examined age-specific IR, the largest differences were found in the younger population (<50 years). CONCLUSIONS We found that the IR of type 2 diabetes was higher in individuals with a psychiatric disorder compared with individuals without a psychiatric disorder and particularly high in the younger people with a psychiatric disorder. New studies into the prevention and early detection of type 2 diabetes in these groups are warranted.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Lars J Diaz
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Katrine H Rubin
- OPEN-Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Jan Erik Henriksen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mathias Lasgaard
- DEFACTUM-Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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9
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Lindekilde N, Scheuer SH, Rutters F, Knudsen L, Lasgaard M, Rubin KH, Henriksen JE, Kivimäki M, Andersen GS, Pouwer F. Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews. Diabetologia 2022; 65:440-456. [PMID: 34841451 DOI: 10.1007/s00125-021-05609-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/01/2021] [Indexed: 01/05/2023]
Abstract
AIMS/HYPOTHESIS Estimates of the global prevalence of type 2 diabetes vary between 6% and 9%. The prevalence of type 2 diabetes has been investigated in psychiatric populations but a critical appraisal of the existing evidence is lacking, and an overview is needed. This umbrella review summarises existing systematic reviews of observational studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder. METHODS We searched PubMed, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews from inception to 17 January 2021 and screened reference lists of included systematic reviews. On the basis of prespecified criteria, we included systematic reviews investigating the prevalence of type 2 diabetes in adults (aged ≥18 years) with a psychiatric disorder. Titles and abstracts of 5155 identified records and full texts of 431 selected studies were screened by two independent reviewers, based on predefined eligibility criteria and an a priori developed extraction form, following the PRISMA and MOOSE guidelines. Risk of bias was assessed with the ROBIS instrument. Data extracted from primary studies were synthesised using random-effects meta-analyses. RESULTS A total of 32 systematic reviews with 245 unique primary studies were identified and met inclusion criteria. Twelve had low risk of bias. They reported type 2 diabetes prevalence estimates ranging from 5% to 22% depending on the specific psychiatric disorder. We meta-analysed data for ten categories of psychiatric disorders and found the following prevalence estimates of type 2 diabetes: in people with a sleep disorder: 40%; binge eating disorder: 21%; substance use disorder: 16%; anxiety disorder: 14%; bipolar disorder: 11%; psychosis: 11%; schizophrenia: 10%; a mixed group of psychiatric disorders: 10%; depression: 9%; and in people with an intellectual disability 8%. All meta-analyses revealed high levels of heterogeneity. CONCLUSIONS/INTERPRETATION Type 2 diabetes is a common comorbidity in people with a psychiatric disorder. Future research should investigate whether routine screening for type 2 diabetes and subsequent prevention initiatives for these people are warranted. PROSPERO registration no. CRD42020159870.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | | | - Femke Rutters
- Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, location VUMC, Amsterdam, the Netherlands
| | | | - Mathias Lasgaard
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Katrine H Rubin
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Erik Henriksen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University of College London, London, UK
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
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10
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Larsen MEC, Thykjaer AS, Pedersen FN, Möller S, Laugesen CS, Andersen N, Andresen J, Hajari J, Heegaard S, Højlund K, Kawasaki R, Schielke KC, Rubin KH, Blaabjerg M, Stokholm L, Grauslund J. Diabetic retinopathy as a potential marker of Parkinson's disease: a register-based cohort study. Brain Commun 2021; 3:fcab262. [PMID: 34806000 PMCID: PMC8599077 DOI: 10.1093/braincomms/fcab262] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/31/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022] Open
Abstract
Neurodegeneration is an early event in the pathogenesis of diabetic retinopathy, and an association between diabetic retinopathy and Parkinson’s disease has been proposed. In this nationwide register-based cohort study, we investigated the prevalence and incidence of Parkinson’s disease among patients screened for diabetic retinopathy in a Danish population-based cohort. Cases (n = 173 568) above 50 years of age with diabetes included in the Danish Registry of Diabetic Retinopathy between 2013 and 2018 were matched 1:5 by gender and birth year with a control population without diabetes (n = 843 781). At index date, the prevalence of Parkinson’s disease was compared between cases and controls. To assess the longitudinal relationship between diabetic retinopathy and Parkinson’s disease, a multivariable Cox proportional hazard model was estimated. The prevalence of Parkinson’s disease was 0.28% and 0.44% among cases and controls, respectively. While diabetic retinopathy was not associated with present (adjusted odds ratio 0.93, 95% confidence interval 0.72–1.21) or incident Parkinson’s disease (adjusted hazard ratio 0.77, 95% confidence interval 0.56–1.05), cases with diabetes were in general less likely to have or to develop Parkinson’s disease compared to controls without diabetes (adjusted odds ratio 0.79, 95% confidence interval 0.71–0.87 and adjusted hazard ratio 0.88, 95% confidence interval 0.78–1.00). In a national cohort of more than 1 million persons, patients with diabetes were 21% and 12% were less likely to have prevalent and develop incident Parkinson’s disease, respectively, compared to an age- and gender-matched control population without diabetes. We found no indication for diabetic retinopathy as an independent risk factor for incident Parkinson’s disease.
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Affiliation(s)
- Maria E C Larsen
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Anne S Thykjaer
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense, Denmark
| | - Frederik N Pedersen
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,OPEN-Open Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark
| | - Caroline S Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, 4000 Roskilde, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, 2100 Copenhagen, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, 2100 Copenhagen, Denmark
| | - Javad Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, 2600 Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, 2600 Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,Department of Vision Informatics, University of Osaka, Osaka 656-0871, Japan
| | - Katja C Schielke
- Department of Ophthalmology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Katrine H Rubin
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,OPEN-Open Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark
| | - Morten Blaabjerg
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,Department of Neurology, Odense University Hospital, 5000 Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,OPEN-Open Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense, Denmark
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11
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Stokholm L, Schrøder K, Nøhr EA, Rubin KH, Jørgensen JS, Petersen LK, Bliddal M. The COVIDPregDK Study: A national survey on pregnancy during the early COVID-19 pandemic in Denmark. Scand J Public Health 2021; 50:703-710. [PMID: 34641709 DOI: 10.1177/14034948211048746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM We aimed to describe the aim, data collection and content from a survey completed among pregnant women during the first peak of the COVID-19 pandemic in Denmark. METHODS The declaration of the COVID-19 pandemic in early 2020 challenged pregnant women's mental well-being due to a concern for their unborn child and their need for healthcare services through pregnancy and birth. To explore how the COVID-19 pandemic and the intensified measures such as the lockdown of Denmark impacted pregnant women's well-being and mental health, we conducted a questionnaire survey in the spring of 2020 when the COVID-19 pandemic was at its first peak, and the consequences for pregnant women and the unborn child were very uncertain. All women residing in Denmark and registered with an ongoing pregnancy on 24 April 2020 were invited to participate. The questionnaire included background information, variables on COVID-19 symptoms and validated batteries of questions on loneliness, anxiety, stress, quality of life, meditation and prayers. Additional questions were included to examine concerns related to pregnancy and childbirth during the pandemic. COHORT CHARACTERISTICS Almost 18,000 women answered the questionnaire, which represents 60% of all invited women who experienced a national lockdown for the first time. Their median age was 30 years, and they were more likely to be multiparous. CONCLUSIONS Data from the COVIDPregDK Study will enable us to gain valuable knowledge on how the pandemic, the intensified measures from the health authorities and the national lockdown affected pregnant women's mental health and their concerns during the COVID-19 pandemic.
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Affiliation(s)
- Lonny Stokholm
- Open Patient data Explorative Network, Odense University Hospital, Denmark.,Research unit OPEN, Department of Clinical Research, University of Sourthern Denmark, Denmark
| | - Katja Schrøder
- Research Unit of Gynecology and Obstetrics, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark.,Research Unit of User Perspectives, Department of Public Health, University of Southern Denmark, Denmark
| | - Ellen A Nøhr
- Research Unit of Gynecology and Obstetrics, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Katrine H Rubin
- Open Patient data Explorative Network, Odense University Hospital, Denmark.,Research unit OPEN, Department of Clinical Research, University of Sourthern Denmark, Denmark
| | - Jan S Jørgensen
- Research Unit of Gynecology and Obstetrics, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Lone K Petersen
- Open Patient data Explorative Network, Odense University Hospital, Denmark.,Research unit OPEN, Department of Clinical Research, University of Sourthern Denmark, Denmark
| | - Mette Bliddal
- Open Patient data Explorative Network, Odense University Hospital, Denmark.,Research unit OPEN, Department of Clinical Research, University of Sourthern Denmark, Denmark
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12
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Skjødt MK, Ernst MT, Khalid S, Libanati C, Cooper C, Delmestri A, Rubin KH, Javaid MK, Martinez-Laguna D, Toth E, Prieto-Alhambra D, Abrahamsen B. The treatment gap after major osteoporotic fractures in Denmark 2005-2014: a combined analysis including both prescription-based and hospital-administered anti-osteoporosis medications. Osteoporos Int 2021; 32:1961-1971. [PMID: 33721032 PMCID: PMC8510950 DOI: 10.1007/s00198-021-05890-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED This study demonstrates a substantial and persistent anti-osteoporosis treatment gap in men and women ≥50 years old who sustained major osteoporotic fracture(s) between 2005 and 2014 in Denmark. This was not substantially reduced by including hospital-administered anti-osteoporosis treatments. Strengthened post-fracture organization of care and secondary fracture prevention is highly needed. INTRODUCTION The purpose of this study was to evaluate the Danish anti-osteoporosis treatment gap from 2005 to 2014 in patients sustaining a major osteoporotic fracture (MOF), and to assess the impact of including hospital-administered anti-osteoporosis medications (AOM) on the treatment gap among these patients. METHODS In this retrospective, registry-based study, we included men and women aged 50 years or older and living in Denmark, who sustained at least one MOF between 2005 and 2014. We applied a repeated cross-sectional design to generate cohorts of patients sustaining a first MOF, hip, vertebral, humerus, or forearm fracture, respectively, within each calendar year. We evaluated the treatment gap as the proportion of patients within each cohort not receiving treatment with AOM within 1 year of the fracture. Hospital-administered AOM was identified by SKS code. RESULTS The treatment gap among MOF patients decreased from 85% in 2005 to 79% in 2014. The gap was smaller among hip and vertebral fracture patients as compared to humerus and forearm fracture patients, and it was smaller in women than in men. The use of hospital-administered AOM was relatively uncommon, with a maximum of 0.9% of MOF patients initiating hospital-administered AOM (in 2012). We observed substantial variations in this proportion between fracture types and gender. Hospital-administered AOM was most commonly used among vertebral fracture patients. CONCLUSION A significant treatment gap among patients sustaining a major osteoporotic fracture was present throughout our analysis, and including hospital-administered AOM did not significantly improve the treatment gap assessment. Improved secondary fracture prevention is urgently needed.
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Affiliation(s)
- M K Skjødt
- Department of Medicine, Hospital of Holbaek, Smedelundsgade 60, DK-4300, Holbaek, Denmark.
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - M T Ernst
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - S Khalid
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | | | - C Cooper
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England, UK
| | - A Delmestri
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - K H Rubin
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - M K Javaid
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - D Martinez-Laguna
- GREMPAL Research Group, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), CIBERFES, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - E Toth
- UCB Pharma, Anderlecht, Belgium
| | - D Prieto-Alhambra
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - B Abrahamsen
- Department of Medicine, Hospital of Holbaek, Smedelundsgade 60, DK-4300, Holbaek, Denmark
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
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13
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Ali MS, Ernst M, Robinson DE, Caskey F, Arden NK, Ben-Shlomo Y, Nybo M, Rubin KH, Judge A, Cooper C, Javaid MK, Hermann AP, Prieto-Alhambra D. Correction to: Alendronate use and bone mineral density gains in women with moderate-severe (stages 3B-5) chronic kidney disease: an open cohort multivariable and propensity score analysis from Funen, Denmark. Arch Osteoporos 2021; 16:135. [PMID: 34533619 PMCID: PMC8448679 DOI: 10.1007/s11657-021-01001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Sanni Ali
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Public Health, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Martin Ernst
- OPEN, Department of Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Danielle E Robinson
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Fergus Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Katrine H Rubin
- OPEN, Department of Health, University of Southern Denmark, Odense, Denmark
| | - Andrew Judge
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Anne P Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Daniel Prieto-Alhambra
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- MRC Lifecourse Epidemiology Unit, Southampton, UK.
- GREMPAL Research Group (Idiap Jordi Gol Primary Care Research Institute) and CIBERFes, Universitat Autonoma de Barcelona, Barcelona, Spain.
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14
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Aabakke AJM, Krebs L, Petersen TG, Kjeldsen FS, Corn G, Wøjdemann K, Ibsen MH, Jonsdottir F, Rønneberg E, Andersen CS, Sundtoft I, Clausen T, Milbak J, Burmester L, Lindved B, Thorsen-Meyer A, Khalil MR, Henriksen B, Jønsson L, Andersen LLT, Karlsen KK, Pedersen ML, Klemmensen Å, Vestgaard M, Thisted D, Tatla MK, Andersen LS, Brülle AL, Gulbech A, Andersson CB, Farlie R, Hansen L, Hvidman L, Sørensen AN, Rathcke SL, Rubin KH, Petersen LK, Jørgensen JS, Stokholm L, Bliddal M. SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study. Acta Obstet Gynecol Scand 2021; 100:2097-2110. [PMID: 34467518 PMCID: PMC8652723 DOI: 10.1111/aogs.14252] [Citation(s) in RCA: 5] [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: 05/31/2021] [Revised: 07/23/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022]
Abstract
Introduction Assessing the risk factors for and consequences of infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) during pregnancy is essential to guide clinical care. Previous studies on SARS‐CoV‐2 infection in pregnancy have been among hospitalized patients, which may have exaggerated risk estimates of severe outcomes because all cases of SARS‐CoV‐2 infection in the pregnant population were not included. The objectives of this study were to identify risk factors for and outcomes after SARS‐CoV‐2 infection in pregnancy independent of severity of infection in a universally tested population, and to identify risk factors for and outcomes after severe infection requiring hospital admission. Material and methods This was a prospective population‐based cohort study in Denmark using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records. We included all pregnancies between March 1 and October 31, 2020 and compared women with a positive SARS‐CoV‐2 test during pregnancy to non‐infected pregnant women. Cases of SARS‐CoV‐2 infection in pregnancy were both identified prospectively and through register linkage to ensure that all cases were identified and that cases were pregnant during infection. Main outcome measures were pregnancy, delivery, maternal, and neonatal outcomes. Severe infection was defined as hospital admission due to coronavirus disease 2019 (COVID‐19) symptoms. Results Among 82 682 pregnancies, 418 women had SARS‐CoV‐2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID‐19. Risk factors for infection were asthma (odds ratio [OR] 2.19, 95% CI 1.41–3.41) and being foreign born (OR 2.12, 95% CI 1.70–2.64). Risk factors for hospital admission due to COVID‐19 included obesity (OR 2.74, 95% CI 1.00–7.51), smoking (OR 4.69, 95% CI 1.58–13.90), infection after gestational age (GA) 22 weeks (GA 22–27 weeks: OR 3.77, 95% CI 1.16–12.29; GA 28–36 weeks: OR 4.76, 95% CI 1.60–14.12), and having asthma (OR 4.53, 95% CI 1.39–14.79). We found no difference in any obstetrical or neonatal outcomes. Conclusions Only 1 in 20 women with SARS‐CoV‐2 infection during pregnancy required admission to hospital due to COVID‐19. Risk factors for admission comprised obesity, smoking, asthma, and infection after GA 22 weeks. Severe adverse outcomes of SARS‐CoV‐2 infection in pregnancy were rare.
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Affiliation(s)
- Anna J M Aabakke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Holbaek, Holbaek, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Krebs
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Tanja G Petersen
- OPEN-Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Frank S Kjeldsen
- OPEN-Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Giulia Corn
- Department of Epidemiology Research and Division of Infectious Diseases Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Karen Wøjdemann
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Bornholm, Rønne, Denmark
| | - Mette H Ibsen
- Department Obstetrics and Gynecology, Hospital of South West Jutland, Esbjerg, Denmark
| | - F Jonsdottir
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Elisabeth Rønneberg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Charlotte S Andersen
- Department Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Iben Sundtoft
- Department Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Tine Clausen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | - Julie Milbak
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | - Lars Burmester
- Department of Obstetrics and Gynecology, The North Denmark Regional Hospital Hjørring, Hjørring, Denmark
| | - Birgitte Lindved
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Annette Thorsen-Meyer
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Mohammed R Khalil
- Department Obstetrics and Gynecology, University Hospital of Southern Denmark-Kolding, Kolding, Denmark
| | - Birgitte Henriksen
- Department Obstetrics and Gynecology, University Hospital of Southern Denmark-Kolding, Kolding, Denmark
| | - Lisbeth Jønsson
- Department Obstetrics and Gynecology, Nykøbing F. Hospital, Nykøbing F, Denmark
| | - Lise L T Andersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Kamilla K Karlsen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Monica L Pedersen
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
| | - Åse Klemmensen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Marianne Vestgaard
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Dorthe Thisted
- Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark
| | - Manrinder K Tatla
- Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark
| | - Line S Andersen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Slagelse, Slagelse, Denmark
| | - Anne-Line Brülle
- Department of Obstetrics and Gynecology, Hospital of South Jutland, Aabenraa, Denmark
| | - Arense Gulbech
- Department of Obstetrics and Gynecology, Hospital of South Jutland, Aabenraa, Denmark
| | - Charlotte B Andersson
- Department of Obstetrics and Gynecology, The North Denmark Regional Hospital Thisted, Thisted, Denmark.,Danish Center for Clinical Health Services Research (DACS), Aalborg, Denmark
| | - Richard Farlie
- Department of Obstetrics and Gynecology, Viborg Regional Hospital, Viborg, Denmark
| | - Lea Hansen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne N Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Sidsel L Rathcke
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Katrine H Rubin
- OPEN-Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lone K Petersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan S Jørgensen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- OPEN-Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Bliddal
- OPEN-Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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15
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Grauslund J, Stokholm L, Thykjær AS, Möller S, Laugesen CS, Andresen J, Bek T, la Cour M, Heegaard S, Højlund K, Kawasaki R, Hajari J, Kyvik KO, Schielke KC, Rubin KH, Rasmussen ML. Inverse Cross-sectional and Longitudinal Relationships between Diabetic Retinopathy and Obstructive Sleep Apnea in Type 2 Diabetes. Ophthalmology Science 2021; 1:100011. [PMID: 36246011 PMCID: PMC9559880 DOI: 10.1016/j.xops.2021.100011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/02/2022]
Abstract
Purpose Design Participants Methods Main Outcome Measures Results Conclusions
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16
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Grauslund J, Thykjær AS, Kawasaki R, Højlund K, Andersen N, Andresen J, Bek T, la Cour M, Heegaard S, Kessel L, Laugesen CS, Schielke KC, Rubin KH, Stokholm L. Identification and Characterization of Patients With Rapid Progression of Diabetic Retinopathy in the Danish National Screening Program. Diabetes Care 2021; 44:e1-e3. [PMID: 33177171 DOI: 10.2337/dc20-1534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Anne S Thykjær
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet Glostrup, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet Glostrup, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet Glostrup, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Caroline S Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Katja C Schielke
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Katrine H Rubin
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN - Open Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN - Open Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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17
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Manniche C, Stokholm L, Ravn SL, Andersen TE, Brandt LP, Rubin KH, Schiøttz-Christensen B, Andersen LL, Skousgaard SG. Long-Term Opioid Therapy in Spine Center Outpatients: Protocol for the Spinal Pain Opioid Cohort (SPOC) Study. JMIR Res Protoc 2020; 9:e21380. [PMID: 32663155 PMCID: PMC7468635 DOI: 10.2196/21380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/13/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023] Open
Abstract
Background Spinal pain is the leading cause of patient-years lived with chronic pain and disability worldwide. Although opioids are well documented as an effective short-term pain-relieving medication, more than a few weeks of treatment may result in a diminishing clinical effect as well as the development of addictive behavior. Despite recognition of opioid addiction in pain patients as a major problem commonly experienced in the clinic, no reference material exists on the scope of long-term problems in novel opioid users and the link to clinical outcomes. Objective The main aims of this study are to describe baseline and follow-up characteristics of the Spinal Pain Opioid Cohort (SPOC), to evaluate the general use of opioids in spinal pain when an acute pain episode occurs, and to demonstrate the prevalence of long-term opioid therapy (LTOT). Methods Prospective clinical registry data were collected from an outpatient spine center setting during 2012-2013 including patients with a new spinal pain episode lasting for more than 2 months, aged between 18 and 65 years who had their first outpatient visit in the center. Variables include demographics, clinical data collected in SpineData, the Danish National Patient Register, and The Danish National Prescription Registry. The primary outcome parameter is long-term prescription opioid use registered from 4 years before the first spine center visit to 5 years after. Results This is an ongoing survey. It is estimated that more than 8000 patients fulfill the SPOC inclusion criteria. In 2019, we began the intellectual process of identifying the most relevant supplementary data available from the wide range of existing national registries available in Denmark. We have now begun merging SpineData with relevant opioid data from Danish national registers and will continue to extract data up to 2021-2022. We will also be looking at data regarding somatic or psychiatric hospitalization patterns, patient usage of health care resources, as well as their working status and disability pensions. Conclusions To our knowledge, this survey will be the first to document the scope of long-term problems regarding LTOT and opioid addiction following new spinal pain episodes and comparing descriptive follow-up data between substance users and nonusers. Trial Registration ISRCTN Registry ISRCTN69685117; http://www.isrctn.com/ISRCTN69685117 International Registered Report Identifier (IRRID) DERR1-10.2196/21380
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Affiliation(s)
- Claus Manniche
- Department of Occupational and Environmental Medicine, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Sophie L Ravn
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
| | - Tonny E Andersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Lars Pa Brandt
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Katrine H Rubin
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Middlefart Hospital-Lillebælt Hospital, Middelfart, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Lars L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Søren G Skousgaard
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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18
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Skjødt MK, Khalid S, Ernst M, Rubin KH, Martinez-Laguna D, Delmestri A, Javaid MK, Cooper C, Libanati C, Toth E, Abrahamsen B, Prieto-Alhambra D. Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom. Osteoporos Int 2020; 31:1535-1544. [PMID: 32185437 PMCID: PMC7360649 DOI: 10.1007/s00198-020-05358-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 11/27/2019] [Accepted: 02/18/2020] [Indexed: 01/06/2023]
Abstract
UNLABELLED This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88-90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed. INTRODUCTION Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an anti-osteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015. METHODS This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture. RESULTS A total of 648,369 fracture patients were included. Mean age 70.2-78.9 years; 22.2-31.7% were men. In Denmark, the treatment gap was stable at approximately 88-90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap-though never smaller than 63%-was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women. CONCLUSION Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.
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Affiliation(s)
- M K Skjødt
- Department of Medicine, Hospital of Holbaek, Holbaek, Region Zealand, Denmark
- Department of Medicine, Hospital of Slagelse, Slagelse, Region Zealand, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - S Khalid
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
| | - M Ernst
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - K H Rubin
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - D Martinez-Laguna
- GREMPAL Research Group, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), CIBERFES, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - A Delmestri
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
| | - M K Javaid
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
| | - C Cooper
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England
| | | | - E Toth
- UCB Pharma, Anderlecht, Belgium
| | - B Abrahamsen
- Department of Medicine, Hospital of Holbaek, Holbaek, Region Zealand, Denmark.
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England.
| | - D Prieto-Alhambra
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
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19
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Ljungdalh JS, Rubin KH, Durup J, Houlind KC. Reoperation after antireflux surgery: a population-based cohort study. Br J Surg 2020; 107:1633-1639. [DOI: 10.1002/bjs.11672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/23/2020] [Accepted: 04/15/2020] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Antireflux surgery for gastro-oesophageal reflux disease (GORD) and/or hiatal hernia is effective. Between 10 and 20 per cent of patients undergo reoperation for recurrent symptoms. Most studies are undertaken in a single centre and possibly underestimate the rate of reoperation. The aim of this nationwide population-based cohort study was to investigate long-term reoperation rates after antireflux surgery.
Methods
This study included patients who underwent antireflux surgery between 2000 and 2017 in Denmark, and were registered in the Danish nationwide health registries. Reoperation rates were calculated for 1, 5, 10 and 15 years after the primary antireflux operation for GORD and/or hiatal hernia. Duration of hospital stay, 30- and 90-day mortality and morbidity, and use of endoscopic pneumatic dilatation were assessed.
Results
This study included a total of 4258 antireflux procedures performed in 3717 patients. Some 3252 patients had only primary antireflux surgery and 465 patients underwent reoperation. The 1-, 5-, 10- and 15-year rates of repeat antireflux surgery were 3·1, 9·3, 11·7 and 12·8 per cent respectively. Thirty- and 90-day mortality rates were similar for primary surgery (0·4 and 0·6 per cent respectively) and reoperations. The complication rate was higher for repeat antireflux surgery (7·0 and 8·3 per cent at 30 and 90 days respectively) than primary operation (3·4 and 4·8 per cent). A total of 391 patients (10·5 per cent of all patients) underwent endoscopic dilatation after primary antireflux surgery, of whom 95 (24·3 per cent) had repeat antireflux surgery.
Conclusion
In this population-based study in Denmark, the reoperation rate 15 years after antireflux surgery was 12·8 per cent. Reoperations were associated with more complications.
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Affiliation(s)
- J S Ljungdalh
- Department of Surgery, Kolding Hospital, part of Hospital Lillebaelt, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - K H Rubin
- Department of Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - J Durup
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - K C Houlind
- Department of Vascular Surgery, Kolding Hospital, part of Hospital Lillebaelt, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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20
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Ali MS, Ernst M, Robinson DE, Caskey F, Arden NK, Ben-Shlomo Y, Nybo M, Rubin KH, Judge A, Cooper C, Javaid MK, Hermann AP, Prieto-Alhambra D. Alendronate use and bone mineral density gains in women with moderate-severe (stages 3B-5) chronic kidney disease: an open cohort multivariable and propensity score analysis from Funen, Denmark. Arch Osteoporos 2020; 15:81. [PMID: 32483674 PMCID: PMC8448716 DOI: 10.1007/s11657-020-00746-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/21/2019] [Accepted: 04/30/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Bisphosphonates are contraindicated in moderate-to-severe chronic kidney disease patients. However, they are used to prevent fragility fractures in patients with impaired kidney function, despite a lack of evidence on their effects on bone density in these patients. We demonstrated that Alendronate had a positive effect on bone in these patients. PURPOSE This study aimed to assess the association between alendronate use and bone mineral density (BMD) change in subjects with moderate-severe chronic kidney disease (CKD). METHODS We created a cohort of CKD stage 3B-5 patients by linking all DXA-based measurements in the Funen area, Denmark, to biochemistry, national health registries and filled prescriptions. Exposure was dispensation of alendronate and the outcome was annualized percentage change in BMD at the femoral neck, total hip and lumbar spine. Individuals were followed from first BMD to the latest of subsequent DXA measurements. Alendronate non-users were identified using incidence density sampling and matched groups were created using propensity scores. Linear regression was used to estimate average differences in the annualized BMD. RESULTS Use of alendronate was rare in this group of patients: propensity score matching (PSM) resulted in 71 alendronate users and 142 non-users with stage 3B-5 CKD (as in the 1 year before DXA). Whilst alendronate users gained an average 1.07% femoral neck BMD per year, non-users lost an average of 1.59% per annum. The PSM mean differences in annualized BMD were + 2.65% (1.32%, 3.99%), + 3.01% (1.74%, 4.28%) and + 2.12% (0.98%, 3.25%) at the femoral neck, total hip and spine BMD, respectively, all in favour of alendronate users. CONCLUSION In a real-world cohort of women with stage 3B-5 CKD, use of alendronate appears associated with a significant improvement of 2-3% per year in the femoral neck, total hip and spine BMD. More data are needed on the anti-fracture effectiveness and safety of bisphosphonate therapy in moderate-severe CKD.
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Affiliation(s)
- M Sanni Ali
- Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Public Health, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Martin Ernst
- OPEN, Department of Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Danielle E Robinson
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Fergus Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Katrine H Rubin
- OPEN, Department of Health, University of Southern Denmark, Odense, Denmark
| | - Andrew Judge
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Anne P Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Daniel Prieto-Alhambra
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- MRC Lifecourse Epidemiology Unit, Southampton, UK.
- GREMPAL Research Group (Idiap Jordi Gol Primary Care Research Institute) and CIBERFes, Universitat Autonoma de Barcelona, Barcelona, Spain.
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Bliddal M, Möller S, Vinter CA, Rubin KH, Gagne JJ, Pottegård A. Validation of a comorbidity index for use in obstetric patients: A nationwide cohort study. Acta Obstet Gynecol Scand 2019; 99:399-405. [DOI: 10.1111/aogs.13749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Mette Bliddal
- Department of Clinical Research University of Southern Denmark Odense Denmark
- OPEN – Open Patient data Explorative Network Odense University Hospital Odense Denmark
| | - Sören Möller
- Department of Clinical Research University of Southern Denmark Odense Denmark
- OPEN – Open Patient data Explorative Network Odense University Hospital Odense Denmark
| | - Christina A. Vinter
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Obstetrics and Gynecology Odense University Hospital Odense Denmark
| | - Katrine H. Rubin
- Department of Clinical Research University of Southern Denmark Odense Denmark
- OPEN – Open Patient data Explorative Network Odense University Hospital Odense Denmark
| | - Joshua J. Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Anton Pottegård
- Clinical Pharmacology Department of Public Health University of Southern Denmark Odense Denmark
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22
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Tenstad HB, Nilsson AC, Dellgren CD, Lindegaard HM, Rubin KH, Lillevang ST. Predictive values of anti-cyclic citrullinated peptide antibodies and rheumatoid factor in relation to serological aspects of the ACR/EULAR 2010 classification criteria for rheumatoid arthritis. Scand J Rheumatol 2019; 49:18-20. [PMID: 31264518 DOI: 10.1080/03009742.2019.1609079] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: In this retrospective population-based register study, we wanted to determine the positive predictive values (PPVs) of immunoglobulin M rheumatoid factor (IgM RF) and anti-citrullinated protein antibodies (ACPAs) at 3 × upper normal limit (UNL), since they are weighted equally in the American College of Rheumatology (ACR)/ European League Against Rheumatism (EULAR) 2010 criteria for rheumatoid arthritis (RA).Methods: Test results, ordering unit, test date, and patient social security number were collected from the Department of Clinical Immunology at Odense University Hospital from 2007 to 2016 and merged with patient diagnosis from the Danish National Patient Registry.Results: The PPV of IgM RF at 3 × UNL was 14%, compared to a PPV of 43% for ACPAs at 3 × UNL.Conclusion: The PPV of ACPAs is higher than the PPV of IgM RF at 3 × UNL. These findings are not reflected in the ACR/EULAR 2010 classification criteria for RA.
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Affiliation(s)
- H B Tenstad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - A C Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - C D Dellgren
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - H M Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - K H Rubin
- Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - S T Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
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23
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Høiberg MP, Rubin KH, Holmberg T, Rothmann MJ, Möller S, Gram J, Bech M, Brixen K, Hermann AP. Use of antiosteoporotic medication in the Danish ROSE population-based screening study. Osteoporos Int 2019; 30:1223-1233. [PMID: 30911782 DOI: 10.1007/s00198-019-04934-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
UNLABELLED Use of antiosteoporotic medication in the population-based, risk-stratified osteoporosis strategy evaluation (ROSE) screening study, comparing the use of FRAX followed by DXA with usual care, was examined. Screening increased the overall use of medication. Being recommended treatment by the hospital and higher age increased the likelihood of starting medication, but, nevertheless, a large percentage opted not to start treatment. INTRODUCTION The aim of the study was to examine the impact on medication prescription, adherence, and persistence of osteoporotic medicine in the randomized population-based ROSE screening study for osteoporosis. METHODS The Danish ROSE study included a population-based random sample of women aged 65-81 years randomized to either a two-step screening program consisting of FRAX followed by DXA for high-risk participants or opportunistic screening for osteoporosis (usual care). This sub-study on the intention-to-treat population examined the impact of the screening program on antiosteoporotic medication redemption rates, adherence, and persistence using Danish registers. RESULTS A total of 30,719 of 34,229 women were treatment-naïve. Significantly more participants in the screening group started on antiosteoporotic medication, but no differences in adherence and persistence rates were found. Higher age was associated with a higher likelihood of starting medication. A low Charlson comorbidity score (= 1) was associated with higher treatment initiation but lower adherence and persistence of antiosteoporotic treatment. A total of 31.7% of participants advised to initiate treatment did not follow the advice. CONCLUSIONS Screening for osteoporosis using FRAX followed by DXA increased the overall use of antiosteoporotic medication in the screening group without differences in adherence and persistence rates. A large percentage of participants advised to initiate treatment did nevertheless fail to do so.
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Affiliation(s)
- M P Høiberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Research, Hospital of Southern Norway, Egsveien 4, N-4604, Kristiansand, Norway.
| | - K H Rubin
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - T Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - M J Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - S Möller
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - J Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - M Bech
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - K Brixen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A P Hermann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Holmberg T, Möller S, Rothmann MJ, Gram J, Herman AP, Brixen K, Tolstrup JS, Høiberg M, Bech M, Rubin KH. Socioeconomic status and risk of osteoporotic fractures and the use of DXA scans: data from the Danish population-based ROSE study. Osteoporos Int 2019; 30:343-353. [PMID: 30465216 DOI: 10.1007/s00198-018-4768-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED There is a need of studies exploring the link between socioeconomic status and DXA scans and osteoporotic fracture, which was the aim of the present study. No differences in socioeconomic status and risk of osteoporotic fractures were found. However, women with further/higher education and higher income are more often DXA-scanned. INTRODUCTION Lower socioeconomic status is known to be associated with a range of chronic conditions and with access to health care services. The link between socioeconomic status and the use of DXA scans and osteoporotic fracture, however, needs to be explored more closely. Therefore, the aim of this study was to examine the relationship between socioeconomic status and both DXA scan utilization and major osteoporotic fractures (MOF) using a population-based cohort of Danish women and national registers. METHODS The study included 17,155 women (65-81 years) sampled from the Risk-stratified Osteoporosis Strategy Evaluation study (ROSE). Information on socioeconomic background, DXA scans, and MOFs was retrieved from national registers. Competing-risk regression analyses were performed. Mean follow-up was 4.8 years. RESULTS A total of 4245 women had a DXA scan (24.7%) and 1719 (10.0%) had an incident MOF during follow-up. Analyses showed that women with basic education had a lower probability of undergoing DXA scans than women with further or higher education (greater than upper secondary education and vocational training education) (subhazard ratio (SHR) = 0.82; 95% CI 0.75-0.89, adjusted for age and comorbidity). Moreover, women with disposable income in the low and medium tertiles had a lower probability of undergoing DXA scans than women in the high-income tertile (SHR = 0.90; 95% CI 0.84-0.97 and SHR = 0.88, 95% CI 0.82-0.95, respectively, adjusted for age and comorbidity). No association between socioeconomic background and probability of DXA was found in adjusted analyses. CONCLUSION The study found no differences in risk of osteoporotic fractures depending on socioeconomic status. However, women with further or higher education as well as higher income are more often DXA-scanned.
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Affiliation(s)
- T Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1355, Copenhagen K, Denmark.
| | - S Möller
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - M J Rothmann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - A P Herman
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K Brixen
- Odense University Hospital, Odense, Denmark
| | - J S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1355, Copenhagen K, Denmark
| | - M Høiberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Hospital of Southern Norway, Kristiansand, Norway
| | - M Bech
- Department of Political Science, Aarhus University, Aarhus, Denmark
| | - K H Rubin
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Rubin KH, Andersen MS, Abrahamsen B, Glintborg D. Socioeconomic status in Danish women with polycystic ovary syndrome: A register-based cohort study. Acta Obstet Gynecol Scand 2018; 98:440-450. [PMID: 30516823 DOI: 10.1111/aogs.13514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 09/10/2018] [Accepted: 12/01/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Low socioeconomic status (SES) may be associated with increased risk of polycystic ovary syndrome (PCOS) and vice versa. Possible associations between SES, obesity and ethnicity in PCOS are undetermined. MATERIAL AND METHODS National register-based study including women with PCOS aged 25 years or above (PCOS Denmark and an embedded cohort; PCOS Odense University Hospital [OUH]) and one control population. PCOS Denmark (n = 13 891) included women with PCOS in the Danish National Patient Register. Women in PCOS OUH underwent clinical examination (n = 814). Three age-matched controls were included per patient (n = 41 584). The main outcome measure was SES (personal income, occupational status and education). RESULTS The median (Q1; Q3) age of women in PCOS Denmark and controls was 33 (29; 39) years. Women with personal income in the lower tertile had a higher probability of a PCOS diagnosis than women in the high-income tertile (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.4-1.6). Women who were unemployed or on welfare payment (aOR 1.5, 95% CI 1.4-1.6), or who retired early (OR 1.8, 95% CI 1.7-2.0) had a higher probability of a PCOS diagnosis than women affiliated to the labor market. Women originating from the Middle East more often had PCOS (aOR 3.2, 95% CI 2.8-3.7) compared with women originating from Europe. In PCOS OUH, SES was lower in obese than in normal weight women. CONCLUSIONS A diagnosis of PCOS was associated with lower SES. In PCOS, women of foreign origin and women with obesity more often had low SES.
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Affiliation(s)
- Katrine H Rubin
- Odense Patient data Explorative Network-OPEN, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | | | - Bo Abrahamsen
- Odense Patient data Explorative Network-OPEN, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.,Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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26
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Rubin KH, Rothmann MJ, Holmberg T, Høiberg M, Möller S, Barkmann R, Glüer CC, Hermann AP, Bech M, Gram J, Brixen K. Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study. Osteoporos Int 2018; 29:567-578. [PMID: 29218381 DOI: 10.1007/s00198-017-4326-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/23/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED The Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study investigated the effectiveness of a two-step screening program for osteoporosis in women. We found no overall reduction in fractures from systematic screening compared to the current case-finding strategy. The group of moderate- to high-risk women, who accepted the invitation to DXA, seemed to benefit from the program. INTRODUCTION The purpose of the ROSE study was to investigate the effectiveness of a two-step population-based osteoporosis screening program using the Fracture Risk Assessment Tool (FRAX) derived from a self-administered questionnaire to select women for DXA scan. After the scanning, standard osteoporosis management according to Danish national guidelines was followed. METHODS Participants were randomized to either screening or control group, and randomization was stratified according to age and area of residence. Inclusion took place from February 2010 to November 2011. Participants received a self-administered questionnaire, and women in the screening group with a FRAX score ≥ 15% (major osteoporotic fractures) were invited to a DXA scan. Primary outcome was incident clinical fractures. Intention-to-treat analysis and two per-protocol analyses were performed. RESULTS A total of 3416 fractures were observed during a median follow-up of 5 years. No significant differences were found in the intention-to-treat analyses with 34,229 women included aged 65-80 years. The per-protocol analyses showed a risk reduction in the group that underwent DXA scanning compared to women in the control group with a FRAX ≥ 15%, in regard to major osteoporotic fractures, hip fractures, and all fractures. The risk reduction was most pronounced for hip fractures (adjusted SHR 0.741, p = 0.007). CONCLUSIONS Compared to an office-based case-finding strategy, the two-step systematic screening strategy had no overall effect on fracture incidence. The two-step strategy seemed, however, to be beneficial in the group of women who were identified by FRAX as moderate- or high-risk patients and complied with DXA.
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Affiliation(s)
- K H Rubin
- OPEN-Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense C, Denmark.
| | - M J Rothmann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - T Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - M Høiberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Research, Hospital of Southern Norway, Kristiansand, Norway
| | - S Möller
- OPEN-Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense C, Denmark
| | - R Barkmann
- Department of Diagnostic Radiology, Molecular Imaging North Competence Center (MOIN CC), University Hospital Schleswig-Holstein in Kiel, Kiel, Germany
| | - C C Glüer
- Department of Diagnostic Radiology, Molecular Imaging North Competence Center (MOIN CC), University Hospital Schleswig-Holstein in Kiel, Kiel, Germany
| | - A P Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M Bech
- VIVE, The Danish Centre of Applied Social Science, Copenhagen, Denmark
| | - J Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - K Brixen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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27
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Rothmann MJ, Möller S, Holmberg T, Højberg M, Gram J, Bech M, Brixen K, Hermann AP, Glüer CC, Barkmann R, Rubin KH. Non-participation in systematic screening for osteoporosis-the ROSE trial. Osteoporos Int 2017; 28:3389-3399. [PMID: 28875257 DOI: 10.1007/s00198-017-4205-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Population-based screening for osteoporosis is still controversial and has not been implemented. Non-participation in systematic screening was evaluated in 34,229 women age 65-81 years. Although participation rate was high, non-participation was associated with comorbidity, aging other risk factors for fractures, and markers of low social status, e.g., low income, pension, and living alone. A range of strategies is needed to increase participation, including development of targeted information and further research to better understand the barriers and enablers in screening for osteoporosis. INTRODUCTION Participation is crucial to the success of a screening program. The objective of this study was to analyze non-participation in Risk-stratified Osteoporosis Strategy Evaluation, a two-step population-based screening program for osteoporosis. METHODS Thirty-four thousand two hundred twenty-nine women aged 65 to 81 years were randomly selected from the background population and randomized to either a screening group (intervention) or a control group. All women received a self-administered questionnaire designed to allow calculation of future risk of fracture based on FRAX. In the intervention group, women with an estimated high risk of future fracture were invited to DXA scanning. Information on individual socioeconomic status and comorbidity was obtained from national registers. RESULTS A completed questionnaire was returned by 20,905 (61%) women. Non-completion was associated with older age, living alone, lower education, lower income, and higher comorbidity. In the intervention group, ticking "not interested in DXA" in the questionnaire was associated with older age, living alone, and low self-perceived fracture risk. Women with previous fracture or history of parental hip fracture were more likely to accept screening by DXA. Dropping out when offered DXA, was associated with older age, current smoking, higher alcohol consumption, and physical impairment. CONCLUSIONS Barriers to population-based screening for osteoporosis appear to be both psychosocial and physical in nature. Women who decline are older, have lower self-perceived fracture risk, and more often live alone compared to women who accept the program. Dropping out after primary acceptance is associated not only with aging and physical impairment but also with current smoking and alcohol consumption. Measures to increase program participation could include targeted information and reducing physical barriers for attending screening procedures.
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Affiliation(s)
- M J Rothmann
- Department of Endocrinology, Odense University Hospital, Kloevervaenget 10, 6.sal, 5000, Odense C, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - S Möller
- Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - T Holmberg
- Department of Health Promotion and Prevention, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - M Højberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Research, Hospital of Southern Norway, Kristiansand, Norway
| | - J Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - M Bech
- KORA, the Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - K Brixen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Odense, Denmark
| | - A P Hermann
- Department of Endocrinology, Odense University Hospital, Kloevervaenget 10, 6.sal, 5000, Odense C, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - C-C Glüer
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, Christian-Albrechts-Universitäts zu Kiel, Kiel, Germany
| | - R Barkmann
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, Christian-Albrechts-Universitäts zu Kiel, Kiel, Germany
| | - K H Rubin
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
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28
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Høiberg MP, Rubin KH, Hermann AP, Brixen K, Abrahamsen B. Diagnostic devices for osteoporosis in the general population: A systematic review. Bone 2016; 92:58-69. [PMID: 27542659 DOI: 10.1016/j.bone.2016.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/09/2016] [Accepted: 08/14/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A diagnostic gap exists in the current dual photon X-ray absorptiometry (DXA) based diagnostic approach to osteoporosis. Other diagnostic devices have been developed, but no comprehensive review concerning the applicability of these diagnostic devices for population-based screening have been performed. MATERIAL AND METHODS A systematic review of Embase, Medline and the Cochrane Central Register for Controlled Trials was performed for population-based studies that focused on technical methods that could either indicate bone mineral density (BMD) by DXA, substitute for DXA in prediction of fracture risk, or that could have an incremental value in fracture prediction in addition to DXA. Quality of included studies was rated by QUADAS 2. RESULTS Many other technical devices have been tested in a population-based setting. Five studies aiming to indicate BMD and 17 studies aiming to predict fractures were found. Overall, the latter studies had higher methodological quality. The highest number of studies was found for quantitative ultrasound (QUS). The ability to indicate BMD or predict fractures was moderate to minor for all examined devices, using reported area under the curve (AUC) of Receiver Operating Characteristic curves values as standard. CONCLUSIONS Of the methods assessed, only QUS appears capable of perhaps replacing DXA as standalone examination in the future whilst radiographic absorptiometry could provide important information in areas with scarcity of DXA. QUS may be of added value even after DXA has been performed. Evaluation of proposed cutoff-values from population-based studies in separate population-based cohorts is still lacking for most examination devices.
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Affiliation(s)
- M P Høiberg
- Department of Research, Hospital of Southern Norway, Kristiansand, Norway; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - K H Rubin
- OPEN, Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University hospital, Denmark.
| | - A P Hermann
- Department of Medical Endocrinology, Odense University Hospital, Odense, Denmark.
| | - K Brixen
- Department of Medical Endocrinology, Odense University Hospital, Odense, Denmark.
| | - B Abrahamsen
- OPEN, Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University hospital, Denmark; Department of Medicine, Holbæk Hospital, Holbæk, Denmark.
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29
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Hawley S, Javaid MK, Rubin KH, Judge A, Arden NK, Vestergaard P, Eastell R, Diez-Perez A, Cooper C, Abrahamsen B, Prieto-Alhambra D. Incidence and Predictors of Multiple Fractures Despite High Adherence to Oral Bisphosphonates: A Binational Population-Based Cohort Study. J Bone Miner Res 2016; 31:234-44. [PMID: 26174968 DOI: 10.1002/jbmr.2595] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 01/19/2015] [Revised: 07/03/2015] [Accepted: 07/07/2015] [Indexed: 12/12/2022]
Abstract
Oral bisphosphonates (BPs) are highly effective in preventing fractures and are recommended first-line therapies for patients with osteoporosis. We identified the incidence and predictors of oral BP treatment failure, defined as the incidence of two or more fractures while on treatment (≥2 FWOT) among users with high adherence. Fractures were considered from 6 months after treatment initiation and up to 6 months after discontinuation. Data from computerized records and pharmacy invoices were obtained from Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP; Catalonia, Spain) and Danish Health Registries (Denmark) for all incident users of oral BPs in 2006-2007 and 2000-2001, respectively. Fine and Gray survival models using backward-stepwise selection (p-entry 0.049; p- exit 0.10) and accounting for the competing risk of therapy cessation were used to identify predictors of ≥2 FWOT among patients having persisted with treatment ≥6 months with overall medication possession ratio (MPR) ≥80%. Incidence of ≥2 FWOT was 2.4 (95% confidence interval [CI], 1.8 to 3.2) and 1.7 (95% CI, 1.2 to 2.2) per 1000 patient-years (PYs) within Catalonia and Denmark, respectively. Older age was predictive of ≥2 FWOT in both Catalonian and Danish cohorts: subhazard ratio (SHR) = 2.28 (95% CI, 1.11 to 4.68) and SHR = 2.61 (95% CI, 0.98 to 6.95), respectively, for 65 to <80 years; and SHR = 3.19 (95% CI, 1.33 to 7.69) and SHR = 4.88 (95% CI, 1.74 to 13.7), respectively, for ≥80 years. Further significant predictors of ≥2 FWOT identified within only one cohort were dementia, SHR = 4.46 (95% CI, 1.02 to 19.4) (SIDIAP); and history of recent or older fracture, SHR = 3.40 (95% CI, 1.50 to 7.68) and SHR = 2.08 (95% CI: 1.04-4.15), respectively (Denmark). Even among highly adherent users of oral BP therapy, a minority sustain multiple fractures while on treatment. Older age was predictive of increased risk within both study populations, as was history of recent/old fracture and dementia within one but not both populations. Additional and/or alternative strategies should be investigated for these patients.
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Affiliation(s)
- Samuel Hawley
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M Kassim Javaid
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Katrine H Rubin
- Odense Patient Data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Andrew Judge
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Nigel K Arden
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Peter Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Richard Eastell
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
| | - Adolfo Diez-Perez
- Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona and Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III, Barcelona, Spain
| | - Cyrus Cooper
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Bo Abrahamsen
- Odense Patient Data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Research Centre for Ageing and Osteoporosis, Glostrup Hospital, Glostrup, Denmark
| | - Daniel Prieto-Alhambra
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona and Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III, Barcelona, Spain.,Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group, Institut d'Investigació en Atenció Primària (IDIAP) Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Dennison E, Rubin KH, Harvey N, Walker-Bone KE, Schwarz P, Cooper C, Abrahamsen B. Gout is associated with an excess risk of osteoporotic fracture: findings from a Danish registry. ACTA ACUST UNITED AC 2014. [DOI: 10.1530/boneabs.3.oc4.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abrahamsen B, Rubin KH, Eiken PA, Eastell R. Characteristics of patients who suffer major osteoporotic fractures despite adhering to alendronate treatment: a National Prescription registry study. Osteoporos Int 2013; 24:321-8. [PMID: 23070480 DOI: 10.1007/s00198-012-2184-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 10/01/2012] [Indexed: 01/26/2023]
Abstract
UNLABELLED Antiresorptive treatment reduces the risk of fractures, but most patients remain at elevated risk. We used health registers to identify predictors of new major osteoporotic fractures in patients adhering to alendronate. Risk factors showed a different pattern than in the general population and included dementia, ulcer disease, and Parkinson's disease. INTRODUCTION Antiresorptives reduce the excess risk of fractures in patients with osteoporosis, but most patients remain at elevated risk. In some countries, patients must sustain fractures while on bisphosphonate (BP) treatment to qualify for more expensive treatment. It is unclear if patients who fracture on BP can be viewed as a distinct subgroup. METHODS The National Prescription registry was used to identify 38,088 new alendronate users. The outcome was major osteoporotic fractures 6+ months after filling the first prescription in patients with a medication possession ratio > 80 %. RESULTS One thousand and seventy-two (5.5 %) patients sustained major osteoporotic fractures. The risk increased with age and was lower in men. The most important risk factor was the number of comedications (hazard ratio (HR) 1.04, 95 % CI 1.03-1.06, for each drug). Dementia (HR 1.81, 95 % CI 1.18-2.78), prior fracture (one: HR 1.17, 95 % CI 1.02-1.34; multiple: HR 1.34, 95 % CI 1.08-1.67), and ulcer disease (HR 1.45, 95 % CI 1.04-2.03) also increased the risk. Diabetes did not influence fracture risk, nor did rheumatic disorders. The risk was lower in glucocorticoid users (HR 0.78, 95 % CI 0.65-0.93). CONCLUSION Risk factors while adhering to BP show a somewhat different pattern than that of the general population and FRAX. Ulcer disease and dementia may impair the ability to use the medications correctly. Though this is an observational study and associations may not be causal, it may be prudent to include dementia, ulcer disease, and Parkinson's disease to capture the risk of fractures on treatment. Lower risk in patients treated with glucocorticoids and in men probably reflects a lower treatment threshold related to guidelines.
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Affiliation(s)
- B Abrahamsen
- Odense Patient data Exploratory Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Frost M, Gudex C, Rubin KH, Brixen K, Abrahamsen B. Pattern of use of DXA scans in men: a cross-sectional, population-based study. Osteoporos Int 2012; 23:183-91. [PMID: 21359668 DOI: 10.1007/s00198-011-1589-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/22/2010] [Indexed: 12/19/2022]
Abstract
UNLABELLED Osteoporosis in men is underdiagnosed. The use of dual-emission X-ray absorptiometry (DXA) was evaluated in almost 5,000 men aged 60-74 years. DXA was infrequent, despite the presence of multiple risk factors for osteoporosis and a high FRAX score. There is a need for improved targeting of DXA scans for men at high risk. INTRODUCTION Clinical and socioeconomic factors associated with bone mass assessment (DXA) in men have seldom been evaluated. This study aimed to evaluate factors associated with the use of DXA in men. METHODS Self-report information on prior DXA and osteoporosis risk factors were obtained from the baseline data of a study investigating the health perspectives of men aged 60-75 years. Socioeconomic and comorbidity data were retrieved from national registers. The FRAX algorithm was used to calculate the absolute fracture risk. Regression analysis was used to identify factors significantly associated with previous DXA scan. RESULTS Of the 4,696 men returning questionnaires (50% response rate), 2.7% had prior DXA but 48% had at least one osteoporosis risk factor. Previous DXA was associated with oral glucocorticoid treatment, secondary osteoporosis, rheumatoid arthritis, fracture after age 50, falls within the previous year, smoking, and higher age. Twenty-one percent of men with prior DXA and 10% of men without prior DXA had greater than 20% risk of a major osteoporotic fracture within the next 10 years. One third of those with previous DXA had none of the FRAX osteoporosis risk factors. When family history of osteoporosis and falls were included as risk factors, 18% with previous DXA had no clinical risk factors for osteoporosis. CONCLUSIONS DXA was infrequent in this group of elderly men, despite the presence of risk factors for osteoporosis. DXA was also used despite a low fracture risk. There is a need for improved targeting of DXA scans for men at high risk.
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Affiliation(s)
- M Frost
- Department of Endocrinology, Odense University Hospital, DK-5000, Odense, Denmark.
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Rubin KH, Abrahamsen B, Hermann AP, Bech M, Gram J, Brixen K. Prevalence of risk factors for fractures and use of DXA scanning in Danish women. A regional population-based study. Osteoporos Int 2011; 22:1401-9. [PMID: 20683710 DOI: 10.1007/s00198-010-1348-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 06/28/2010] [Indexed: 11/28/2022]
Abstract
SUMMARY To determine the relationship between risk factors and use of DXA scans. Our study showed a relatively high use of DXA in low-risk women and the relatively low coverage in women with multiple risk factors. Moreover, distance to DXA clinics, age, and socio-economic factors are associated with the use of DXA. INTRODUCTION To determine the relationship between risk factors for fracture and use of DXA scans in Danish women in relation to distance to DXA clinics and socio-economic factors. METHODS From the Danish National Civil Register we randomly selected 5,000 women aged 40-90 years living in the region of Southern Denmark to receive a mailed questionnaire concerning risk factors for fractures. RESULTS The respondents rate was 84% and 77% of the invited population were available for analysis. A total of 10.3% of the women without risk factors and only 36% of the women with three or more risk factors had a history of DXA. The likelihood of a history of DXA was higher with increasing FRAX(™) 10-year risk; i.e., 8.7% and 30.2% in patients with a 10-year fracture risk of 0-14.9% and 25-100%, respectively. In women with less than 10 km to nearest DXA facility, 20.2% had a history of DXA, while 11.5% of those with more than 40 km to the nearest scanner had a history of DXA. Logistic regression analysis showed that distance, fracture risk, oral glucocorticoids, low-energy fracture, conditions associated with secondary osteoporosis, low BMI, history of falls, age 65-79 years, spouse status, and income were significantly associated with having a history of DXA. CONCLUSIONS Our study showed a relatively high use of DXA in low-risk women and the relatively low coverage in women with multiple risk factors. Moreover, distance to DXA clinics, age, and a number of socio-economic factors are associated with the use of DXA.
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Affiliation(s)
- K H Rubin
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Tolstoy M, Cowen JP, Baker ET, Fornari DJ, Rubin KH, Shank TM, Waldhauser F, Bohnenstiehl DR, Forsyth DW, Holmes RC, Love B, Perfit MR, Weekly RT, Soule SA, Glazer B. A sea-floor spreading event captured by seismometers. Science 2006; 314:1920-2. [PMID: 17124289 DOI: 10.1126/science.1133950] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Two-thirds of Earth's surface is formed at mid-ocean ridges, yet sea-floor spreading events are poorly understood because they occur far beneath the ocean surface. At 9 degrees 50'N on the East Pacific Rise, ocean-bottom seismometers recently recorded the microearthquake character of a mid-ocean ridge eruption, including precursory activity. A gradual ramp-up in activity rates since seismic monitoring began at this site in October 2003 suggests that eruptions may be forecast in the fast-spreading environment. The pattern culminates in an intense but brief (approximately 6-hour) inferred diking event on 22 January 2006, followed by rapid tapering to markedly decreased levels of seismicity.
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Affiliation(s)
- M Tolstoy
- Lamont-Doherty Earth Observatory (LDEO) of Columbia University, Palisades, NY 10964, USA.
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Graham DW, Blichert-Toft J, Russo CJ, Rubin KH, Albarède F. Cryptic striations in the upper mantle revealed by hafnium isotopes in southeast Indian ridge basalts. Nature 2006; 440:199-202. [PMID: 16525470 DOI: 10.1038/nature04582] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 01/12/2006] [Indexed: 11/09/2022]
Abstract
The Earth's mantle is isotopically heterogeneous on length scales ranging from centimetres to more than 10(4) kilometres. This heterogeneity originates from partial melt extraction and plate tectonic recycling, whereas stirring during mantle convection tends to reduce it. Here we show that mid-ocean ridge basalts from 2,000 km along the southeast Indian ridge (SEIR) display a bimodal hafnium isotopic distribution. This bimodality reveals the presence of ancient compositional striations (streaks) in the Indian Ocean upper mantle. The number density of the streaks is described by a Poisson distribution, with an average thickness of approximately 40 km. Such a distribution is anticipated for a well-stirred upper mantle, in which heterogeneity is continually introduced by plate tectonic recycling, and redistributed by viscous stretching and convective refolding.
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Affiliation(s)
- D W Graham
- College of Oceanic and Atmospheric Sciences, Oregon State University, Corvallis, Oregon 97331, USA.
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Rubin KH, van der Zander I, Smith MC, Bergmanis EC. Minimum speed limit for ocean ridge magmatism from 210Pb–226Ra–230Th disequilibria. Nature 2005; 437:534-8. [PMID: 16177787 DOI: 10.1038/nature03993] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 07/01/2005] [Indexed: 11/08/2022]
Abstract
Although 70 per cent of global crustal magmatism occurs at mid-ocean ridges-where the heat budget controls crustal structure, hydrothermal activity and a vibrant biosphere-the tempo of magmatic inputs in these regions remains poorly understood. Such timescales can be assessed, however, with natural radioactive-decay-chain nuclides, because chemical disruption to secular equilibrium systems initiates parent-daughter disequilibria, which re-equilibrate by the shorter half-life in a pair. Here we use 210Pb-226Ra-230Th radioactive disequilibria and other geochemical attributes in oceanic basalts less than 20 years old to infer that melts of the Earth's mantle can be transported, accumulated and erupted in a few decades. This implies that magmatic conditions can fluctuate rapidly at ridge volcanoes. 210Pb deficits of up to 15 per cent relative to 226Ra occur in normal mid-ocean ridge basalts, with the largest deficits in the most magnesium-rich lavas. The 22-year half-life of 210Pb requires very recent fractionation of these two uranium-series nuclides. Relationships between 210Pb-deficits, (226Ra/230Th) activity ratios and compatible trace-element ratios preclude crustal-magma differentiation or daughter-isotope degassing as the main causes for the signal. A mantle-melting model can simulate observed disequilibria but preservation requires a subsequent mechanism to transport melt rapidly. The likelihood of magmatic disequilibria occurring before melt enters shallow crustal magma bodies also limits differentiation and heat replenishment timescales to decades at the localities studied.
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Affiliation(s)
- K H Rubin
- Department of Geology and Geophysics, Hawaii Center for Volcanology, University of Hawaii, 1680 East-West Road, Honolulu, Hawaii 96822, USA.
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Abstract
OBJECTIVES Infant temperament is thought to provide one of the fundamental bases for social and emotional development. Few studies have examined the direct and indirect influences of early temperament and physiological disposition on later development. METHOD This article presents results of a longitudinal study that took place between the years 1989 and 1996 in which the relations between maternal reports of negative reactivity at 9 months of age and maternal ratings and laboratory observations of social wariness and sociability at 4 years of age (n = 97) were examined. Also examined were the moderating roles of (1) frontal electroencephalogram (EEG) asymmetry as assessed at 9 months of age and (2) the child's gender. RESULTS Negative reactivity predicted social wariness for infants with right frontal EEG asymmetry, but not for those with left frontal EEG asymmetry and for boys but not girls. The only significant predictor of sociability was gender. Specifically, at 4 years of age girls were rated higher on the measure of sociability than were boys. CONCLUSION The findings are discussed in terms of the roles of frontal EEG asymmetry and gender in moderating the impact of temperamental negative reactivity on later social behavior.
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Affiliation(s)
- H A Henderson
- Department of Human Development, University of Maryland, 3304 Benjamin Bldg., College Park, MD 20742, USA
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Fox NA, Henderson HA, Rubin KH, Calkins SD, Schmidt LA. Continuity and discontinuity of behavioral inhibition and exuberance: psychophysiological and behavioral influences across the first four years of life. Child Dev 2001; 72:1-21. [PMID: 11280472 DOI: 10.1111/1467-8624.00262] [Citation(s) in RCA: 533] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Four-month-old infants were screened (N = 433) for temperamental patterns thought to predict behavioral inhibition, including motor reactivity and the expression of negative affect. Those selected (N = 153) were assessed at multiple age points across the first 4 years of life for behavioral signs of inhibition as well as psychophysiological markers of frontal electroencephalogram (EEG) asymmetry. Four-month temperament was modestly predictive of behavioral inhibition over the first 2 years of life and of behavioral reticence at age 4. Those infants who remained continuously inhibited displayed right frontal EEG asymmetry as early as 9 months of age while those who changed from inhibited to noninhibited did not. Change in behavioral inhibition was related to experience of nonparental care. A second group of infants, selected at 4 months of age for patterns of behavior thought to predict temperamental exuberance, displayed a high degree of continuity over time in these behaviors.
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Affiliation(s)
- N A Fox
- Department of Human Development, University of Maryland, College Park 20742, USA.
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Abstract
Giant tsunamis, generated by submarine landslides in the Hawaiian Islands, have been thought to be responsible for the deposition of chaotic gravels high on the southern coastal slopes of the islands of Lana'i and Moloka'i, Hawaii. Here we investigate this hypothesis, using uranium-thorium dating of the Hulopoe gravel (on Lana'i) and a study of stratigraphic relationships, such as facies changes and hiatuses, within the deposit. The Hulopoe gravel contains corals of two age groups, representing marine isotope stages 5e and 7 (approximately 135,000 and 240,000 years ago, respectively), with significant geographical and stratigraphic ordering. We show that the Hulopoe gravel was formed by multiple depositional events, separated by considerable periods of time, thus invalidating the main premise of the 'giant wave' hypothesis. Instead, the gravels were probably deposited during interglacial periods (when sea level was relatively high) by typical Hawaiian shoreline processes such as seasonal wave patterns, storm events and possibly 'normal' tsunamis, and reached their present height by uplift of Lana'i.
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Affiliation(s)
- K H Rubin
- Department of Geology and Geophysics, SOEST, University of Hawaii, Honolulu 96822, USA.
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Hastings PD, Rubin KH. Predicting mothers' beliefs about preschool-aged children's social behavior: evidence for maternal attitudes moderating child effects. Child Dev 1999; 70:722-41. [PMID: 10368918 DOI: 10.1111/1467-8624.00052] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Maternal beliefs about children's social behavior may be important contributors to socialization and development, but little is known about how such beliefs form. Transactional models suggest that children's characteristics may influence parents. At 2 years of age, the shy and aggressive behaviors of 65 toddlers (28 females) were observed during interactions with an unfamiliar peer; as well, mothers described the extent to which they advocated protective and authoritarian childrearing attitudes. These variables were used to predict mothers emotions, attributions, parenting goals, and socialization strategies in response to vignettes depicting aggressive and withdrawn child behaviors 2 years later. Most child effects were moderated by maternal attitudes or gender effects. Authoritarian mothers of aggressive toddlers were most likely to report high control and anger, to blame their children for aggression, and to focus on obtaining compliance rather than teaching skills to their children. Protective mothers reported that they would use warmth and involvement to comfort withdrawn children, especially their daughters.
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Affiliation(s)
- P D Hastings
- National Institute of Mental Health, Section on Developmental Psychopathology, National Institutes of Health, Bethesda, MD 20892, USA.
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Rubin KH, Hastings P, Chen X, Stewart S, McNichol K. Intrapersonal and maternal correlates of aggression, conflict, and externalizing problems in toddlers. Child Dev 1998; 69:1614-29. [PMID: 9914642] [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: 02/09/2023]
Abstract
Research has shown that 2-year-olds engage in peer-directed aggression and initiation of conflict. However, there has been little consideration of the factors associated with variability in toddlers' aggression. One hundred and four toddlers (52 females) were observed for 35 min of free play with a same-sex peer, with both mothers present. Experience in early out-of-home care was not related to aggression. Toddlers' observed and mother-rated dysregulated temperament, and mothers' use of warmth and negative dominance during interactions with their children, were used to predict toddlers' aggression and maternal ratings of externalizing difficulties. Boys were observed to be more aggressive than girls. Regression analyses showed that, after controlling for main effects, the interaction of child gender, temperament, and maternal negative dominance predicted both outcomes. Observed aggression and mother-reported externalizing problems were associated significantly with dysregulated temperament only for boys with mothers who demonstrated relatively high levels of negative dominance.
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Affiliation(s)
- K H Rubin
- Center for Children, Relationships, and Culture, University of Maryland, College Park 20742-1131, USA.
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Chen X, Hastings PD, Rubin KH, Chen H, Cen G, Stewart SL. Child-rearing attitudes and behavioral inhibition in Chinese and Canadian toddlers: a cross-cultural study. Dev Psychol 1998. [PMID: 9681259 DOI: 10.1037//0012-1649.34.4.677] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral inhibition data were collected from samples of 2-year-olds from the People's Republic of China and Canada. Information on child-rearing attitudes and beliefs was obtained from mothers of the children. Chinese toddlers were significantly more inhibited than their Canadian counterparts. Inhibition was associated positively with mothers' punishment orientation and negatively with mothers' acceptance and encouragement of achievement in the Canadian sample. However, the directions of the relations were opposite in the Chinese sample; child inhibition was associated positively with mothers' warm and accepting attitudes and negatively with rejection and punishment orientation. The results indicated different adaptational meanings of behavioral inhibition across cultures.
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Affiliation(s)
- X Chen
- Department of Psychology, University of Western Ontario, London, Canada.
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Abstract
The study of social and emotional development is recognized for its complexity. To better understand developmental norms, and deviations thereof, researchers typically focus on individual (e.g., temperament), interactional (e.g., parenting behaviors), and relational (e.g., attachment, friendship) levels of analysis. Often forgotten, however, is the extent to which cultural beliefs and norms play a role in the interpretation of the acceptability of individual characteristics and the types and the ranges of interactions and relationships that are likely or permissible. This special issue comprises four sections in which culture is examined insofar as it relates to the aforementioned levels of social analysis: "Emotional Development," "Parenting and Parent-Child Relationships," "Social Cognition and Social Relationships," and "Social and Emotional Adjustment and Maladjustment." Each section is followed by a commentary.
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Affiliation(s)
- K H Rubin
- University of Maryland College Park, Center for Children, Relationships, and Culture 20742-1131, USA.
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Chen X, Hastings PD, Rubin KH, Chen H, Cen G, Stewart SL. Child-rearing attitudes and behavioral inhibition in Chinese and Canadian toddlers: a cross-cultural study. Dev Psychol 1998; 34:677-86. [PMID: 9681259 DOI: 10.1037/0012-1649.34.4.677] [Citation(s) in RCA: 214] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral inhibition data were collected from samples of 2-year-olds from the People's Republic of China and Canada. Information on child-rearing attitudes and beliefs was obtained from mothers of the children. Chinese toddlers were significantly more inhibited than their Canadian counterparts. Inhibition was associated positively with mothers' punishment orientation and negatively with mothers' acceptance and encouragement of achievement in the Canadian sample. However, the directions of the relations were opposite in the Chinese sample; child inhibition was associated positively with mothers' warm and accepting attitudes and negatively with rejection and punishment orientation. The results indicated different adaptational meanings of behavioral inhibition across cultures.
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Affiliation(s)
- X Chen
- Department of Psychology, University of Western Ontario, London, Canada.
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Abstract
The study of social and emotional development is recognized for its complexity. To better understand developmental norms, and deviations thereof, researchers typically focus on individual (e.g., temperament), interactional (e.g., parenting behaviors), and relational (e.g., attachment, friendship) levels of analysis. Often forgotten, however, is the extent to which cultural beliefs and norms play a role in the interpretation of the acceptability of individual characteristics and the types and the ranges of interactions and relationships that are likely or permissible. This special issue comprises four sections in which culture is examined insofar as it relates to the aforementioned levels of social analysis: "Emotional Development," "Parenting and Parent-Child Relationships," "Social Cognition and Social Relationships," and "Social and Emotional Adjustment and Maladjustment." Each section is followed by a commentary.
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Affiliation(s)
- K H Rubin
- University of Maryland College Park, Center for Children, Relationships, and Culture 20742-1131, USA.
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Booth CL, Rubin KH, Rose-Krasnor L. Perceptions of emotional support from mother and friend in middle childhood: links with social-emotional adaptation and preschool attachment security. Child Dev 1998; 69:427-42. [PMID: 9586217] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Children's (N = 58) perceptions of emotional support from mother and best friend were assessed at age 8. Perceptions of support from mother were predicted by attachment security at age 4, suggesting continuity in the children's internal working model of self in relation to mother. Preschool attachment security predicted age 8 perceptions of maternal support better than the mother's actual behavior at age 8. Identification of the best friend as a member of one's emotional support network was not related to security, but was positively related to social competence. However, among insecurely attached children, the greater the reliance on the best friend for emotional support, the greater the externalizing problems. Compensatory effects of best friend support on the social-emotional adaptation of insecurely attached children were not found.
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Affiliation(s)
- C L Booth
- University of Washington, Seattle 98195-7920, USA.
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Abstract
In recent years, researchers have uncovered a link between iris pigmentation and inhibition/social wariness among young children (e.g., Rosenberg & Kagan, 1987, 1989; Rubin & Both, 1989). In the present study, 152 Caucasian preschool-aged (Mage = 54.09 months, SD = 5.84) children (77 males) with either blue (n = 84) or brown (n = 68) eyes, were compared in terms of parental and teacher ratings of social wariness, social play, and aggression. A significant Eye Color x Gender Interaction was found in terms of indices of social wariness; blue-eyed males were rated as more socially wary than brown-eyed males, while blue- and brown-eyed females did not differ in this regard. These results supported the notion that eye color is a marker variable for social wariness in young children.
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Affiliation(s)
- R J Coplan
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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Abstract
A sample of children in Shanghai, P.R. China, initially aged 10 and 12 years, participated in this 2-year longitudinal project. Information on academic achievement and indexes of social adjustment, including social competence, aggression, social inhibition, leadership, and peer acceptance, was collected from multiple sources. It was found that academic achievement predicted children's social competence and peer acceptance. In turn, children's social functioning and adjustment, including social competence, aggression-disruption, leadership, and peer acceptance, uniquely contributed to academic achievement. These results generally supported the "reciprocal effects" model concerning the relations between academic achievement and social adjustment (S. P. Hinshaw, 1992).
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Affiliation(s)
- X Chen
- Department of Psychology, University of Western Ontario, London, Canada
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Abstract
Previous research has shown that infants who display a high frequency of motor activity and negative affect at 4 months of age are likely to be behaviorally inhibited toddlers. We examined social behaviors, maternal report of temperament, salivary cortisol, and baseline startle responses at age 4 in a sample of children, some of whom displayed a high frequency of motor activity and negative affect at 4 months of age. Infants who displayed this temperamental profile were reported by their mothers as more shy at age 4 compared with other children. We also found that 4-year-olds who displayed a high frequency of wary behavior during peer play exhibited relatively high morning salivary cortisol, were reported as contemporaneously shy by their mothers, and were behaviorally inhibited at 14 months of age. There were no significant relations found between baseline startle and morning salivary cortisol and measures of shyness at age 4. We speculate that high levels of cortisol in shy children may induce changes in the amygdala, exacerbating their fearfulness.
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Affiliation(s)
- L A Schmidt
- Institute for Child Study, University of Maryland, College Park 20742, USA
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Rubin KH, Hastings PD, Stewart SL, Henderson HA, Chen X. The consistency and concomitants of inhibition: some of the children, all of the time. Child Dev 1997; 68:467-83. [PMID: 9249961] [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: 02/05/2023]
Abstract
Toddlers displaying extremely inhibited behavior may be at risk for becoming socially withdrawn. However, behavioral inhibition may be a multifaceted characteristic, and its concurrent relation to toddler wariness with peers has not been examined. In this study, 108 toddlers (54 females) and their mothers were observed in novel situations involving unfamiliar settings, adults, and peers. Vagal tone, temperament, separation-reunion behavior, and maternal oversolicitousness also were assessed. There was little consistency of inhibited behavior across the 3 situations. Consistently inhibited toddlers had fearful temperaments, showed distress following maternal separation, and had mothers who were warm and controlling but unresponsive to children's cues during interaction. Toddlers with highly fearful temperaments and highly oversolicitous mothers were the most inhibited across contexts.
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Affiliation(s)
- K H Rubin
- Center for Children, Relationships, and Culture, University of Maryland, College Park 20742-1131, USA.
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