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Ishtiak-Ahmed K, Rohde C, Otte C, Gasse C, Köhler-Forsberg O. Comparative effectiveness of selective serotonin reuptake inhibitors (SSRIs) for depression in 43,061 older adults with chronic somatic diseases: A Danish target trial emulation study. Gen Hosp Psychiatry 2024; 87:83-91. [PMID: 38354442 DOI: 10.1016/j.genhosppsych.2024.02.002] [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: 12/03/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To investigate the comparative effectiveness of commonly used selective serotonin reuptake inhibitors (SSRIs) for comorbid depression in older adults with chronic somatic diseases by applying a target-trial-emulation framework. METHODS Danish target-trial-emulation study including 43,061 individuals aged ≥65 years (54.1% females, mean age 77.8 years) with a first redeemed prescription for depression with sertraline (n = 6673), escitalopram (n = 7104) or citalopram (n = 29,284) in 2006-2017. Individuals had cancer, cardiovascular diseases (CVD), chronic-obstructive-pulmonary-disease (COPD)/asthma, diabetes, neurodegenerative disorders, or osteoporosis. Outcomes were treatment switching, combination/augmentation, psychiatric hospital contact for depression, and any psychiatric in-patient care. Follow-up was one year and adjusted Cox regression analyses calculated hazard rate ratios (HRR) within each somatic disease. RESULTS Across all six disease groups and four outcomes, we found that citalopram use, compared with sertraline, was associated with lower risks in several analyses, with statistically significant results in cancer, CVD, COPD/asthma, and diabetes (e.g., HRRs for psychiatric hospital contacts for depression/any psychiatric in-patient care ranging between 0.47 and 0.61). For escitalopram, compared with sertraline, some analyses indicated poorer outcomes with significantly higher risks for combination/augmentation treatment (HRRs ranging between 1.15 and 1.40). CONCLUSIONS Although observational studies are prone to confounding, these findings indicate clinically relevant differences between the SSRIs, with better outcomes in citalopram users and poorer outcomes in escitalopram users than sertraline, urging the need for clinical studies in this vulnerable patient population.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark.
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Christian Otte
- Department of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; German Center for Mental Health (DZPG), Berlin, Germany
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; Department of Psychiatry and Neurosciences, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
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Ishtiak-Ahmed K, Musliner KL, Christensen KS, Mortensen EL, Nierenberg AA, Gasse C. Real-World Evidence on Clinical Outcomes of Commonly Used Antidepressants in Older Adults Initiating Antidepressants for Depression: A Nationwide Cohort Study in Denmark. Am J Psychiatry 2024; 181:47-56. [PMID: 37849303 DOI: 10.1176/appi.ajp.20230356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The authors investigated the clinical outcomes of commonly used antidepressants among older adults who initiated first-time antidepressants for depression by analyzing the 1-year risk of selected clinically relevant outcomes. METHODS This cohort study used nationwide Danish registry data and included all older adults who redeemed a first-time (since 1995) antidepressant prescription with an indication of depression between 2006 and 2017. Only the 10 most frequently redeemed antidepressants were included in the analyses. Outcomes included discontinuation, switching, augmentation, psychiatric hospital contacts, suicide attempt or self-harm, fall-related injuries, cardiovascular events, and all-cause mortality. Incidence rate ratios (IRRs) and 95% confidence intervals were estimated using Poisson regression models, controlling for potential confounders. RESULTS The study sample included 93,883 older adults (mean age, 78.0 years, SD=7.5 years; 56% female). The most frequently prescribed antidepressants were selective serotonin reuptake inhibitors (citalopram, 47.04%; escitalopram, 11.81%; fluoxetine, 0.55%; paroxetine, 0.52%; sertraline, 11.17%), serotonin-norepinephrine reuptake inhibitors (duloxetine, 0.71%; venlafaxine, 1.54%), a tricyclic antidepressant (amitriptyline, 1.86%), and two atypical antidepressants (mianserin, 1.93%; mirtazapine, 22.87%). Compared with users of sertraline (the reference drug in this analysis, as Danish guidelines recommend it as the first-choice treatment for depression), users of most of the other nine antidepressants had a significantly higher risk of discontinuation (e.g., mirtazapine: IRR=1.55, 95% CI=1.50-1.61; venlafaxine: IRR=1.22, 95% CI=1.12-1.32), switching (amitriptyline: IRR=1.45, 95% CI=1.15-1.81; venlafaxine: IRR=1.47, 95% CI=1.20-1.80), augmentation, cardiovascular events, and mortality. Overall, mirtazapine and venlafaxine users had the most adverse outcomes compared with sertraline users. These results remained consistent in analyses stratified by sex and age (≤75 years vs. >75 years). CONCLUSIONS This real-world evidence suggests that clinical outcomes may vary among initiators of commonly used antidepressants in older adults, which may inform benefit-risk evaluation at treatment initiation, and highlights the importance of careful selection of antidepressant treatment.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Katherine L Musliner
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Kaj Sparle Christensen
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Erik Lykke Mortensen
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Andrew A Nierenberg
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Christiane Gasse
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
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Therman Soerensen K, Ishtiak-Ahmed K, Gasse C, Sparle Christensen K. Antidepressant treatment initiation and public sick-leave compensation in the following year: a register-based prospective cohort study in Denmark. Nord J Psychiatry 2023; 77:523-531. [PMID: 36734806 DOI: 10.1080/08039488.2023.2173289] [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: 09/05/2022] [Revised: 12/16/2022] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Mental disorders have caused increasing sickness absence and related benefit claims in the OECD countries. This study investigates the association between antidepressant treatment initiation and public sick leave compensation (PLSC) in the following year in Denmark. METHODS The study was designed as a register-based prospective cohort study. We included 39,401 adults (aged 18-65 years) with at least 12 consecutive months of full-time labour market attachment who had initiated first-time antidepressant monotherapy for depression or anxiety between 1 January 2015 and 31 December 2018. PLSC was estimated for the year following the incident prescription of various antidepressants for depression or anxiety disorders. RESULTS The most frequently prescribed antidepressant medication was SSRIs (66.8%), with sertraline being the leading choice. Compared with sertraline, mirtazapine and mianserin were associated with the highest risks of PSLC in the year following initiation, with IRRs of 2.74 (95% CI: 2.63 to 2.86) and 5.79 (95% CI: 5.18 to 6.47), respectively. Compared with sertraline, citalopram (IRR 1.22, 95%CI 1.17-1.28), venlafaxine (IRR 1.34, 95%CI 1.23-1.45) and duloxetine (IRR 1.48, 95%CI 1.35-1.62) were all associated with increased PSLC. In contrast, paroxetine (IRR 0.85, 95% CI 0.74-0.98), fluoxetine (IRR 0.51, 95%CI 0.42-0.62) and vortioxetine (IRR 0.78, 95% CI 0.63-0.97) were all associated with a significantly lower risk of PSLC compared with sertraline. CONCLUSIONS Antidepressant treatment initiation was associated with PLSC. The highest risk of PLSC was seen for antidepressants with sedative side effects. Some types of antidepressants were associated with a lower risk of PLSC in the year following treatment initiation.
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Affiliation(s)
| | | | | | - Kaj Sparle Christensen
- Department of Public Health, Aarhus University & Research Unit for General Practice, Aarhus, Denmark
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Ishtiak-Ahmed K, Christensen KS, Gasse C. Do sociodemographic and clinical factors affect the selection of initial antidepressant treatment for depression in older adults? Results from a nationwide descriptive study in Denmark. J Affect Disord 2023; 334:21-25. [PMID: 37146907 DOI: 10.1016/j.jad.2023.04.110] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND The choice of antidepressants for initial pharmacological treatment of depression in older adults and associated patients' characteristics are understudied. We aimed to describe the first selected antidepressant (first-choice) for depression in older adults (≥65 years) and whether patients' sociodemographic and clinical characteristics influence selecting an alternative first-choice (any other antidepressant than the nationally recommended first-choice sertraline) in Denmark. METHODS Register-based cross-sectional study including all older adults who redeemed their first antidepressant prescription for depression at community pharmacies in Denmark in 2015-2019. We analyzed the effect of patients' characteristics on the first-choice antidepressant selection using multinomial logistic regression. RESULTS Among 34,337 older adults with a first antidepressant-prescription, over two-thirds filled alternative first-choice antidepressants than sertraline (28.9 %): escitalopram or citalopram (30.3 %) or mirtazapine (34.4 %). Socially disadvantaged older adults (e.g., with short educational attainment, being single, or of non-western ethnicity) and clinically vulnerable older adults (e.g., having somatic diagnoses and hospital contacts) were more likely to use alternative first-choice antidepressants. LIMITATIONS Information on prescribers and in-hospital medications was not included in this study. CONCLUSIONS Further investigation of the first antidepressant selection and its impact on depression treatment outcomes in older adults is necessary. Moreover, for older patients, national guidelines on depression treatment should be more specific. ARTICLE SUMMARY Antidepressant selection for initial pharmacological treatment of depression in older adults can be difficult due to comorbidity, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics. Real-world evidence/knowledge on first-choice antidepressant selection and associated user characteristics are rare. This Danish register-based cross-sectional study found over two-thirds of older adults filled alternative antidepressants (primarily escitalopram/citalopram or mirtazapine) than nationally recommended first-choice sertraline for depression treatment and identified wide-ranging sociodemographic and clinical factors influencing the first antidepressant selection.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus 8200 Aarhus N, Denmark.
| | - Kaj Sparle Christensen
- Department of Public Health, Aarhus University, Aarhus 8000 Aarhus C, Denmark; Research Unit for General Practice, Aarhus University, Aarhus 8000 Aarhus C, Denmark
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus 8200 Aarhus N, Denmark
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Ishtiak-Ahmed K, Köhler-Forsberg O, Mortensen EL, Nierenberg AA, Gasse C. Concurrent use of polypharmacy and potentially inappropriate medications with antidepressants in older adults: A nationwide descriptive study in Denmark during 2015-2019. Gen Hosp Psychiatry 2023; 82:66-74. [PMID: 36989765 DOI: 10.1016/j.genhosppsych.2023.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 02/10/2023] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Concurrent polypharmacy and potentially-inappropriate-medication (PIMs) use with antidepressants in older adults is understudied. We investigated the prevalence and associated user characteristics of concurrent polypharmacy (≥5 drugs) and PIMs with antidepressants in all older adults (≥65 years) in Denmark based on prescriptions filled at community pharmacies during 2015-2019. METHOD We applied a cross-sectional and cohort study design using socio-demographic and clinical data from Danish registers. RESULTS A total of 261,479 older adults (mean age 76 years, females 63%) redeemed at least one prescription of antidepressants during 2015-2019. The prevalence of polypharmacy was 73%, and PIMs was 56%, with over 80% using at least one other nervous system drug or cardiovascular system drug concomitantly with antidepressants. Characteristics associated with higher concurrent use of polypharmacy and PIM with antidepressants were older age, marital status as widow/widower/separated/single, place of residence predominantly in the rural regions, non-western origin, and having somatic diagnoses. Some characteristics showed opposite directions of the associations with the two outcomes, including previous antidepressant use and psychiatric diagnoses being associated with higher use of polypharmacy but lower use of PIM. CONCLUSION High polypharmacy and PIM use with antidepressants underline the importance of regularly reviewing pharmacological treatments in older adults with depression.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, (8200 Aarhus N), Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, (8200 Aarhus, N), Denmark.
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, (8200 Aarhus N), Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, (8200 Aarhus, N), Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, 1353 Copenhagen K, Denmark
| | - Andrew A Nierenberg
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, (8200 Aarhus N), Denmark; Dauten Family Center for Bipolar Treatment Innovation, MA, General Hospital, Boston, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, (8200 Aarhus N), Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, (8200 Aarhus, N), Denmark
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Thiele LS, Ishtiak-Ahmed K, Thirstrup JP, Agerbo E, Lunenburg CATC, Müller DJ, Gasse C. Clinical Impact of Functional CYP2C19 and CYP2D6 Gene Variants on Treatment with Antidepressants in Young People with Depression: A Danish Cohort Study. Pharmaceuticals (Basel) 2022; 15:ph15070870. [PMID: 35890168 PMCID: PMC9318115 DOI: 10.3390/ph15070870] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 06/15/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The clinical impact of the functional CYP2C19 and CYP2D6 gene variants on antidepressant treatment in people with depression is not well studied. Here, we evaluate the utility of pharmacogenetic (PGx) testing in psychiatry by investigating the association between the phenotype status of the cytochrome P450 (CYP) 2C19/2D6 enzymes and the one-year risks of clinical outcomes in patients with depression with incident new-use of (es)citalopram, sertraline, or fluoxetine. Methods: This study is a population-based cohort study of 17,297 individuals who were born between 1981 and 2005 with a depression diagnosis between 1996 and 2012. Using array-based single-nucleotide-polymorphism genotype data, the individuals were categorized according to their metabolizing status of CYP2C19/CYP2D6 as normal (NM, reference group), ultra-rapid- (UM), rapid- (RM), intermediate- (IM), or poor-metabolizer (PM). The outcomes were treatment switching or discontinuation, psychiatric emergency department contacts, and suicide attempt/self-harm. By using Poisson regression analyses, we have estimated the incidence rate ratios (IRR) with 95% confidence intervals (95% CI) that were adjusted for covariates and potential confounders, by age groups (<18 (children and adolescents), 19−25 (young adults), and 26+ years (adults)), comparing the outcomes in individuals with NM status (reference) versus the mutant metabolizer status. For statistically significant outcomes, we have calculated the number needed to treat (NNT) and the number needed to genotype (NNG) in order to prevent one outcome. Results: The children and adolescents who were using (es)citalopram with CYP2C19 PM status had increased risks of switching (IRR = 1.64 [95% CI: 1.10−2.43]) and suicide attempt/self-harm (IRR = 2.67 [95% CI; 1.57−4.52]). The young adults with CYP2C19 PM status who were using sertraline had an increased risk of switching (IRR = 2.06 [95% CI; 1.03−4.11]). The young adults with CYP2D6 PM status who were using fluoxetine had an increased risk of emergency department contacts (IRR = 3.28 [95% CI; 1.11−9.63]). No significant associations were detected in the adults. The NNG for preventing one suicide attempt/suicide in the children who were using (es)citalopram was 463, and the NNT was 11. Conclusion: The CYP2C19 and CYP2D6 PM phenotype statuses were associated with outcomes in children, adolescents, and young adults with depression with incident new-use of (es)citalopram, sertraline, or fluoxetine, therefore indicating the utility of PGx testing, particularly in younger people, for PGx-guided antidepressant treatment.
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Affiliation(s)
- Liv S. Thiele
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
| | - Kazi Ishtiak-Ahmed
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Janne P. Thirstrup
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research (NCRR), Aarhus BSS, Aarhus University, 8210 Aarhus, Denmark;
- Centre for Integrated Register-Based Research Aarhus University (CIRRAU), 8210 Aarhus, Denmark
| | - Carin A. T. C. Lunenburg
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Daniel J. Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada;
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark
- Correspondence: ; Tel.: +45-51191476
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Ishtiak-Ahmed K, Lunenburg C, Thirstrup J, Clausen L, Thomsen P, Gasse C. Pharmacogenetic CYP2D6 variability, phenoconversion and treatment outcomes: A Danish population-based cohort study in 6,798 individuals initiating atomoxetine treatment. Eur Psychiatry 2022. [PMCID: PMC9567364 DOI: 10.1192/j.eurpsy.2022.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Atomoxetine, a first-line treatment option for ADHD, is affected by pharmacogenetic (PGx) variation of the drug-metabolizing enzyme CYP2D6. Despite the recommendation of CYP2D6 testing, the use of PGx-guided dosing remains low in Denmark.
Objectives
We investigated wide-ranging clinical outcomes in atomoxetine users in association with PGx variability.
Methods
We analyzed 6,798 individuals (55% children) with a first prescription for atomoxetine identified from the Danish population-based iPSYCH case-cohort study linking biobank information with Danish registers. Individuals were categorized based on their single-nucleotide-polymorphism-based CYP2D6 genotype into normal (NM), intermediate (IM), and poor metabolizer (PM). Clinical outcomes included treatment switching, discontinuation, psychiatric inpatient-, outpatient-, and emergency contact, suicide attempt/self-harm, sleep problem, and depression. Individuals’ CYP2D6-status could change due to drug-drug-interactions of weak, intermediate, or strong-CYP2D6 inhibitors (phenoconversion), which we accounted for by time-varying phenotype assessment. Incidence rate ratios (IRR) were estimated using Poisson regression analyses and adjusted for a wide range of potential confounders and covariates.
Results
Over two-thirds of the individuals had a hospital diagnosis of ADHD at the first atomoxetine prescription. The distribution of CYP2D6 phenotypes was similar in children and adults. IM/PM children had a significantly higher risk of a sleeping problem compared with NM children (IRR 1.25, 95% CI 1.01-1.54). Compared with NM adults, those with IM/PM had a higher risk of switching (1.15, 95% CI 0.98-1.35).
Conclusions
This is the first study showing the potential impact of PGx variability on clinical outcomes of atomoxetine users in a population-based setting, highlighting the utility of PGx testing.
Disclosure
No significant relationships.
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Mushtaq M, Ishtiak-Ahmed K, Thirstrup J, Gasse C. Pharmacogenetics and antidepressant treatment outcomes in pregnancy: a Danish-population based study. Eur Psychiatry 2022. [PMCID: PMC9567066 DOI: 10.1192/j.eurpsy.2022.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Depression in pregnancy is common and often requires treatment with antidepressant drugs. Most antidepressants are metabolized by the cytochrome P450 system (CYP), in particular CYP2C19 and -2D6, both of which are genetically polymorphic. Additionally, the activity of these enzymes is altered during pregnancy.
Objectives
To investigate pharmacogenetic variability regarding CYP2C19 and -2D6 in pregnant users of antidepressants and treatment outcomes.
Methods
The study population comprises all women born between 1981-1999, who gave birth to at least one child before December 2015 identified from the large Danish population-based iPSYCH2012 case-cohort study sample linked to information on genetic variants, prescription drug use and outcome data. Pharmacogenetic genotypes and phenotypes of CYP2C19 and CYP2D6 will be categorized into poor, (PM), intermediate, (IM), extensive, (EM), rapid (RM) and ultra-rapid metabolizers (RM) using array-based SNP information. Antidepressant drug use and comedication during pregnancy will be assessed based on prescription data. Outcomes include treatment discontinuation, switching and psychiatric hospitalizations. Cox regression analysis will be performed to estimate the hazard ratios comparing the rates of the different outcomes in people with different phenotypes, compared with EM adjusted for a number of confounding factors.
Results
Based on previous research we will be able to identify approximately 6531 pregnant women with a psychiatric history. Among those, we estimate to find 14 PM, 161 IM, 285 EM, 168 RM and 25 UM of CYP2C19, and 27 PM, 218 IM and 408 EM of CYP2D6. Exposure to antidepressants is estimated at 10%.
Conclusions
We expect to be able to present the results at the conference.
Disclosure
No significant relationships.
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Thiele L, Ishtiak-Ahmed K, Thirstrup J, Lunenburg C, Müller D, Gasse C. Clinical impact of functional CYP2C19 and CYP2D6 gene variants on treatment outcomes in patients with depression: a Danish cohort study. Eur Psychiatry 2022. [PMCID: PMC9565563 DOI: 10.1192/j.eurpsy.2022.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Pharmacogenetic (PGx) targets to optimize drug therapy, but its implementation is rare. Objectives We evaluate the clinical utility of PGx testing in psychiatry by investigating the one-year risks of clinical outcomes in patients with depression taking sertraline, (es)citalopram or fluoxetine by their Cytochrome P450 (CYP) 2C19/2D6 phenotypes. Methods We investigated 17,297 individuals born between 1981-2005 with a depression diagnosis between 1996-2012 from the iPsych2012 case-cohort. Based on array-based single-nucleotide-polymorphism genotype data, individuals were phenotyped as CYP2C19/CYP2D6 normal (NM, reference group), ultra-rapid- (UM), rapid- (RM), intermediate- (IM), or poor-metabolizer (PM). Outcomes were treatment switching or discontinuation, psychiatric in-, out-, and emergency room contacts (ER), and suicide attempt/self-harm. Incidence rate ratios (IRR) by age groups were estimated using Poisson regression analysis with 95% confidence intervals, adjusted for potential confounders. Results Risks of switching (IRR=1.89[1.22-2.93]), ERs (1.69 [1.01-2.81]) and suicide attempt/self-harm (2.73 [1.49-5.01]) were higher in CYP2C19 PMs <19 years taking (es)citalopram. Fluoxetine users <19 years had a decreased risk of discontinuation in CYP2D6 PMs (0.5 [0.27-0.95]) and decreased risk of out-patient contacts in CYP2D6 PMs and IMs (IRRIM=0.83 [0.68-1.00] and IRRPM=0.59 [ 0.37-0.96]). We observed an increased risk for ERs in CYP2D6 PMs aged 19-25 years taking fluoxetine (4.53 [1.54-13.35]). In CYP2C19 UMs >25 years taking (es)citalopram the risk of suicide attempt/self-harm was more than three-fold increased (3.64 [ 1.01-13.19]). We found no significant results in users of sertraline. Conclusions PGx variability was associated with treatment outcomes in depression in patients with CYP2C19 PM or UM status taking (es)citalopram, or CYP2D6 PM or IM status taking fluoxetine. Disclosure No significant relationships.
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Ishtiak-Ahmed K, Gasse C. Prevalence, incidence, and determinants of hospital contact due to depression in older adults: A Danish nationwide register-based descriptive study. The American Journal of Geriatric Psychiatry 2022. [DOI: 10.1016/j.jagp.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nørgaard A, Jensen-Dahm C, Wimberley T, Svendsen JH, Ishtiak-Ahmed K, Laursen TM, Waldemar G, Gasse C. Effect of antipsychotics on mortality risk in patients with dementia with and without comorbidities. J Am Geriatr Soc 2022; 70:1169-1179. [PMID: 35029305 DOI: 10.1111/jgs.17623] [Citation(s) in RCA: 3] [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: 03/22/2021] [Revised: 11/14/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND We investigated the mortality risk associated with the initiation of antipsychotic treatment among patients with dementia and whether comorbidities related to the cardiovascular system and diabetes interact with antipsychotic treatment to increase the mortality risk beyond the risk of death independently associated with antipsychotics and comorbidity alone. METHODS We designed a matched cohort study using nationwide registry data. All Danish residents aged 65-95 years diagnosed with dementia between 2009 and 2014 were included. Dementia was assessed as a first-time registered dementia diagnosis in the Danish National Patient Register or the Danish Psychiatric Central Research Register and/or a first-time prescription for antidementia medication. Patients exposed to antipsychotics were matched with up to three unexposed patients. Cox proportional hazards models were used to compare rates of death within 180 days after the initiation of antipsychotic treatment. The models were adjusted for potential confounders. Analyses were stratified for diabetes, heart disease, and cerebrovascular disease, and we calculated the relative excess risk due to interaction (RERI). RESULTS The study cohort included 8244 exposed patients and 24,730 unexposed patients. A total of 5938 patients died during the first 180 days of follow-up. Patients exposed to antipsychotics had a significantly higher adjusted risk of death (hazard ratio: 1.35, 95% confidence interval: 1.27-1.43) than unexposed patients. Crude mortality rates were higher among patients with heart disease and diabetes when antipsychotic treatment was initiated compared with patients without comorbidities. Relative risk estimates did not differ between patients with and without heart disease, cerebrovascular disease, and diabetes, and RERI suggested no positive additive interaction. Risk analysis suggested higher mortality in patients without cerebrovascular disease who initiated antipsychotics. CONCLUSION This nationwide study adds to the evidence that antipsychotic treatment is associated with increased mortality and suggests that attention should be paid to all initiators of antipsychotics irrespective of cardiovascular disease and diabetes.
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Affiliation(s)
- Ane Nørgaard
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty and Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Jensen-Dahm
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty and Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Theresa Wimberley
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty and Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Thomas Munk Laursen
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty and Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
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Lunenburg CATC, Ishtiak-Ahmed K, Werge T, Gasse C. Life-time Actionable Pharmacogenetic Drug Use: A Population-based Cohort Study in 86 040 Young People With and Without Mental Disorders in Denmark. Pharmacopsychiatry 2021; 55:95-107. [PMID: 34753194 PMCID: PMC8964272 DOI: 10.1055/a-1655-9500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective
To describe life-time use of current actionable pharmacogenetic
(PGx) somatic and psychotropic drugs according to international PGx consortia in
people with and without hospital-diagnosed mental disorders in the Danish
population.
Methods
Population- and register-based observational drug utilization
study in 56 065 individuals with mental disorders, i. e.
attention-deficit/hyperactivity disorder, autism, bipolar disorder,
depression and schizophrenia, and a random, representative sample of
29 975 individuals of the Danish population, born between 1981 and 2005.
Individuals were followed from 1995 or birth until 2016 (for a maximum of 22
years). We report prevalence and incidence rates of PGx drug use by age, sex and
mental disorders based on redeemed prescriptions between 1995 and 2016.
Results
Of the 69 PGx drugs, prescriptions of 39 drugs had been redeemed
by the study population by 35 years of age. The use of at least 1 PGx drug
varied between 23.1% in males without mental disorders and 97.2%
in females with schizophrenia. Males with ADHD or autism were the youngest
first-time PGx drug users at a mean of 11.6 years. The mean number of different
PGx drugs used was 1.2 in males without mental disorders and 5.6 in individuals
with schizophrenia. The prevalence of different PGx drugs linked to more than
one gene was 25.3% in males without mental disorders to 94.1% in
females with schizophrenia.
Conclusion
PGx drugs are commonly used by younger people, more often by
individuals with mental disorders and by females. Panel-based PGx testing could
contribute to treatment decisions at a very young age.
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Affiliation(s)
- Carin A T C Lunenburg
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Lundbeck Foundation Center for GeoGenetics, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Centre for Integrated Register-based Research Aarhus University (CIRRAU), Aarhus, Denmark
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13
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Appel AM, Brønnum-Hansen H, Garde AH, Hansen ÅM, Ishtiak-Ahmed K, Islamoska S, Mortensen EL, Nabe-Nielsen K. Socioeconomic Position and Late-Onset Dementia: A Nationwide Register-Based Study. J Aging Health 2021; 34:184-195. [PMID: 34388948 DOI: 10.1177/08982643211037200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Previous research on the association between socioeconomic position (SEP) and dementia has not sufficiently accounted for the complex relationship between education and occupation. We investigated the independent and joint effects of educational attainment and occupation-based SEP on dementia. METHODS We used register-based information about educational attainment, occupation-based SEP, and dementia from 1,210,720 individuals. Information about cognitive ability at conscription was available for a subsample of men. RESULTS When mutually adjusted, lower educational attainment and occupation-based SEP were associated with higher dementia risk in a dose-response manner. Higher occupation-based SEP partly mitigated the higher dementia risk associated with lower educational attainment. After adjusting for cognitive ability in a subgroup of men, only unskilled work was associated with higher dementia risk. DISCUSSION Occupation-based SEP is independently associated with dementia and may mitigate the higher dementia risk associated with short education. Future research should elucidate the mechanisms underlying social inequality in dementia.
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Affiliation(s)
- Andreas M Appel
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark.,Danish Dementia Research Centre, 53146Rigshospitalet, Copenhagen, Denmark
| | | | - Anne H Garde
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark.,2686The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark.,2686The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Depression and Anxiety, 1006Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, 1006Aarhus University, Aarhus, Denmark
| | - Sabrina Islamoska
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark
| | - Erik L Mortensen
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark
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Abstract
OBJECTIVE Involuntary electroconvulsive therapy (ECT) can be a lifesaving intervention for patients suffering from potentially lethal conditions who are unable to give informed consent. However, its use is not widespread, probably partly because of the scarce data on hard outcomes following involuntary ECT. In Denmark, involuntary ECT is only used when patients are at imminent/potential risk of dying if not receiving ECT. Here, we aimed to estimate the 1-year survival rate after the administration of involuntary ECT as a proxy for the effectiveness of this treatment. METHODS We conducted a register-based cohort study involving (i) all patients receiving involuntary ECT in Denmark between 2008 and 2019, (ii) age- and sex-matched patients receiving voluntary ECT, and (iii) age- and sex-matched individuals from the general population. One-year survival rates were compared via mortality rate ratios. RESULTS We identified 618 patients receiving involuntary ECT, 547 patients receiving voluntary ECT, and 3080 population-based controls. The survival rate in the year after involuntary ECT was 90%. For patients receiving involuntary ECT, the 1-year mortality rate ratios were 3.1 (95% confidence interval, 1.9-5.2) and 5.8 (95% confidence interval, 4.0-8.2) compared with those receiving voluntarily ECT and to the population-based controls, respectively. Risk factors for early death among patients receiving involuntary ECT were male sex, being 70 years or older and having organic mental disorder as the treatment indication. CONCLUSIONS Treatment with involuntary ECT is associated with a high survival rate, suggesting that the intervention is effective. However, patients receiving involuntary ECT constitute a high-risk population that should be monitored closely after this treatment.
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Islamoska S, Hansen ÅM, Ishtiak-Ahmed K, Garde AH, Andersen PK, Garde E, Taudorf L, Waldemar G, Nabe-Nielsen K. Stress diagnoses in midlife and risk of dementia: a register-based follow-up study. Aging Ment Health 2021; 25:1151-1160. [PMID: 32233797 DOI: 10.1080/13607863.2020.1742656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Previous studies indicated that stress diagnoses increase the risk of dementia. However, previous results may be biased by confounding, reverse causation and misclassification. Therefore, the main aim of this study was to investigate the association between clinically diagnosed stress in midlife and later dementia risk, while addressing limitations of previous studies. METHODS The study population was selected from all individuals in Denmark born 1935-1956. Individuals diagnosed with stress in midlife (aged 37-58 years) were matched (1:5) with individuals without stress diagnoses based on sex and birthdate (N = 103,484). Data were retrieved from national registers. Cox regression models were adjusted for socio-demographic factors and different morbidities. RESULTS We found a 2.20 (95% CI: 1.93-2.50) times higher rate of dementia among individuals with any stress diagnosis registered in midlife compared with no stress diagnosis. Hazard rate ratios of dementia were 1.73 (95% CI: 1.13-2.65) among individuals with acute stress reactions, 2.37 (95% CI: 2.05-2.74) among individuals with adjustment disorders, and 2.20 (95% CI: 1.73-2.80) among individuals with unspecified stress reactions. Individuals with PTSD and other stress reactions had non-significantly elevated rates of dementia. Adjustment for confounding only slightly attenuated the association, and reverse causation did not appear to bias the results substantially. CONCLUSION Our results support the hypothesis that severe stress in midlife is an important risk factor for dementia. This finding emphasizes the importance of identifying and treating severe stress in midlife to reduce potential detrimental consequences for brain health in later life.
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Affiliation(s)
- Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Center for the Working Environment, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Center for the Working Environment, Copenhagen, Denmark
| | - Per Kragh Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lærke Taudorf
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Lunenburg C, Ishtiak-Ahmed K, Werge T, Gasse C. Pharmacogenetic drug use in young danish individuals with severe mental disorders. Eur Psychiatry 2021. [PMCID: PMC9471862 DOI: 10.1192/j.eurpsy.2021.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionPharmacogenetics (PGx) studies genetic variance and related differences in drug outcomes. PGx guidelines for psychotropic drugs are available (PGx drugs), but PGx testing is used only limitedly in psychiatric clinical practice.ObjectivesThe aim of this study is to pinpoint different aspects of PGx drug use in the population, to support clinical uptake of PGx.MethodsThis drug utilization study investigated prescription PGx drug use in 56,065 young individuals with different severe mental disorders (SMD) in the Danish iPSYCH sample (born 1981-2005). We investigated the number of PGx drug users (incidence, prevalence), age (at first PGx drug use), sex, multiple PGx drugs per user (in light of panel-based PGx testing) and concomitant use of PGx drugs (in light of combinatorial PGx testing).ResultsWe identified substantial PGx drug use in terms of incidence rates (e.g. 333 per 10,000 person years for the anticonvulsant lamotrigine) and prevalence (e.g. 15,260 users for the antidepressant citalopram) in patients with SMD. The age of first time PGx drug use ranged from 11.6-20 years, depending on SMD and sex. On average, more than one PGx drug was used by a single person (range 1.6-5.6 drugs, depending on SMD) or even used concomitantly (41-69%) affecting mostly two different PGx genes (84-92% of concomitant PGx drug users).ConclusionsPGx drugs were frequently used in young individuals with SMD, often subsequently and concomitantly, arguing for panel-based/combinatorial PGx testing over single-gene testing. PGx testing could be applied already at a very young age.DisclosureWe thank the iPSYCH consortium, in specific the iPSYCH PI’s (Merete Nordentoft, Anders Børglum, Preben B. Mortensen, Ole Mors, Thomas Werge and David M. Hougaard). The iPSYCH project is funded by the Lundbeck Foundation Denmark and the universities and un
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Lunenburg C, Ishtiak-Ahmed K, Thirstrup J, Gasse C. Pharmacogenetics and adhd treatment outcomes in the danish population-based IPSYCH sample. Eur Psychiatry 2021. [PMCID: PMC9471865 DOI: 10.1192/j.eurpsy.2021.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Pharmacogenetics (PGx) studies genetic variance and related differences in drug outcomes. The aim of PGx testing is to increase therapy efficacy and safety, by applying e.g. dose adjustments in patients with a specific geno- or phenotype. PGx guidelines for psychotropic drugs are available (PGx drugs), including atomoxetine used in the treatment of attention deficit hyperactivity disorder (ADHD). In Denmark, broad implementation of PGx is currently still low, possibly due to the lack of population-based studies investigating the real-world impact of PGx variability. Objectives The aim of this study is to investigate the association of PGx variability (patients’ genotype/phenotype) in users of atomoxetine and different treatment outcomes in a large population-based sample of individuals with ADHD. Methods This study will use data of the large Danish population-based iPSYCH case-cohort study sample including information on genetic variants, prescription drug use and outcome data, e.g. psychiatric and somatic hospitalizations and death. The study population comprises all individuals diagnosed with ADHD born 1981-2005 with at least one prescription for atomoxetine between 1995 and 2016. All individuals will be categorized according to their CYP2D6 phenotypes. We will perform Cox regression analysis to estimate the hazard ratios comparing the rates of the different outcomes in people with different phenotypes adjusted for a number of confounding factors. Results We have identified approximately 20,000 individuals with ADHD, of whom an estimated 10-20% have filled at least one prescription of atomoxetine. Conclusions We expect results in the beginning of 2021. Disclosure We thank the iPSYCH consortium, in specific the iPSYCH PI’s (Merete Nordentoft, Anders Børglum, Preben B. Mortensen, Ole Mors, Thomas Werge and David M. Hougaard). The iPSYCH project is funded by the Lundbeck Foundation Denmark and the universities and un
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18
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Salagre E, Rohde C, Ishtiak-Ahmed K, Gasse C, Østergaard S. The effectiveness of involuntary electroconvulsive therapy (ECT): A population-based study. Eur Psychiatry 2021. [PMCID: PMC9471900 DOI: 10.1192/j.eurpsy.2021.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionInvoluntary electroconvulsive therapy (ECT) can be a life-saving intervention for patients suffering from potentially lethal conditions who are unable to give informed consent. However, its use is not widespread, probably partly due to the scarce data on hard outcomes following involuntary ECT. In Denmark, involuntary ECT is only used when patients are at imminent/potential risk of dying if not receiving ECT.ObjectivesWe aimed to assess the effectiveness of involuntary ECT by estimating the 1-year survival following its administration.MethodsWe conducted a register-based cohort study involving i) all patients receiving involuntary ECT in Denmark between 2008 and 2019, ii) age and sex-matched patients receiving voluntary ECT, and iii) age and sex-matched individuals from the general population. 1-year survival rates were compared via mortality rate ratios.ResultsWe identified 618 patients receiving involuntary ECT, 547 patients receiving voluntary ECT, and 3,080 population-based controls. The survival rate in the year after involuntary ECT was 90%. For patients receiving involuntary ECT, the 1-year mortality rate ratios were 3.1 (95% confidence interval (CI)= 1.9-5.2) and 5.8 (95%CI = 4.0-8.2) compared to those receiving voluntarily ECT and to the population-based controls, respectively. Risk factors for early death among patients receiving involuntary ECT were male sex, being ≥70 years old and having organic mental disorder as the treatment indication.ConclusionsTreatment with involuntary ECT is associated with a high survival rate, suggesting that the intervention is effective. However, patients receiving involuntary ECT constitute a high-risk population that should be monitored closely after this treatment.DisclosureNo significant relationships.
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Köhler-Forsberg O, Petersen L, Ishtiak-Ahmed K, Østergaard SD, Gasse C. Medical diseases prior to first-time depression diagnosis and subsequent risk of admissions for depression: A nationwide study of 117,585 patients. J Affect Disord 2020; 276:1030-1037. [PMID: 32763587 DOI: 10.1016/j.jad.2020.07.057] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/02/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Medical diseases and depression frequently co-occur, but it remains uncertain whether specific medical diseases or the disease load, affect the clinical course of depression. METHODS We identified all adults (≥18 years) at their first hospital-based diagnosis of unipolar depression in Denmark between 1996 and 2015. All medical hospital contacts since 1977 and all drug prescriptions during the previous year were identified. We followed patients for up to five years regarding hospital admissions with depression and performed adjusted Cox regression analyses calculating hazard rate ratios (HRR) including 95%-confidence intervals (CI) to test the association between medical diseases and depression admission following the index depressive episode. RESULTS Among 117,585 patients with depression (444,696 person-years follow-up), any prior medical hospital contact (N = 114,206; 97.1%) was associated with increased risks of admission for depression among individuals aged 18-30 (HRR=1.50; 95%CI=1.15-1.95), 31-65 (HRR=1.69; 95%CI=1.28-2.21), and >65 years (HRR=1.38; 95%CI=1.10-1.75), fitting a dose-response relationship (p<0.005) with increasing number of prior medical diseases among those aged <65. All specific medical diseases were associated with increased risks of admission for depression, particularly among individuals aged<65 (HRR ranging from 1.57 to 2.38). Drug prescriptions and medical hospital contacts in the year before the depression diagnosis were associated with reduced risks of admission. CONCLUSION The medical load seems to be associated with an increased risk for depression admission, particularly among individuals aged <65. The lower risk for people in medical care during the previous year may indicate better compliance and care/treatment.
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Affiliation(s)
- Ole Köhler-Forsberg
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus University, Denmark; Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH
| | - Kazi Ishtiak-Ahmed
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
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Nabe-Nielsen K, Rod NH, Hansen ÅM, Prescott E, Grynderup MB, Islamoska S, Ishtiak-Ahmed K, Garde AH, Gyntelberg F, Mortensen EL, Phung TKT, Waldemar G, Westendorp RGJ. Perceived stress and dementia: Results from the Copenhagen city heart study. Aging Ment Health 2020; 24:1828-1836. [PMID: 31184203 DOI: 10.1080/13607863.2019.1625304] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: We investigated if perceived stress in midlife increased the risk of dementia. Furthermore, we explored differences between subgroups related to sex, age and employment status when reporting stress.Methods: In this longitudinal study, we used information on perceived stress from 10,814 participants (mean age 56.7 years). Participants were followed through Danish national registers for development of dementia. Participants were considered at risk of dementia from the date they turned 60 years. Perceived stress was assessed as a combination of self-reported intensity and frequency of stress, and categorized into low (score 0-1), medium (score 2-4), and high stress (score 5-6). We used Poisson regression to estimate incidence rate ratios (IRR) and their 95% confidence intervals (CI) and adjusted for sociodemographic factors and psychiatric morbidity at baseline (main model) as well as cardio/cerebrovascular diseases and health behaviors at baseline (additional model).Results: The mean follow-up time was 13.8 years, and 1,519 participants were registered with dementia. Dementia risk was higher in participants reporting medium stress (IRR = 1.11, 95% CI: 0.99-1.24) and high stress (IRR = 1.36, 95% CI: 1.13-1.65). Adjustment for cardio/cerebrovascular diseases and health behaviors did not alter the results. We did not find strong support for differences between subgroups, although the association between stress and dementia was stronger for those who were employed at the time of reporting high stress.Conclusion: Our results provide empirical support for an effect of perceived stress on the risk of dementia in old age.
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Affiliation(s)
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Finn Gyntelberg
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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21
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Lunenburg CATC, Hauser AS, Ishtiak-Ahmed K, Gasse C. Primary Care Prescription Drug Use and Related Actionable Drug-Gene Interactions in the Danish Population. Clin Transl Sci 2020; 13:798-806. [PMID: 32166845 PMCID: PMC7359946 DOI: 10.1111/cts.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/14/2020] [Indexed: 12/14/2022] Open
Abstract
Pharmacogenetics (PGx) aims to improve drug therapy using the individual patients' genetic make-up. Little is known about the potential impact of PGx on the population level, possibly hindering implementation of PGx in clinical care. Therefore, we investigated how many patients use actionable PGx drugs, have actionable genotypes or phenotypes and which patients could benefit the most of PGx testing. We included PGx recommendations from two international PGx consortia (Clinical Pharmacogenetics Implementation Consortium (CPIC) and Dutch Pharmacogenetics Working Group (DPWG)). Using data from publically accessible sales information drawn from the Danish Register of Medicinal Product Statistics (MEDSTAT), we identified the number of users of actionable prescription PGx drugs among the total Danish population in 2017. We estimated actionable genotypes or phenotypes based on reported frequencies from literature. We identified 49 drug-gene interactions related to 41 unique prescription drugs. The estimated median frequency of actionable genotypes or phenotypes among prescription drug users was 25% (interquartile range 7-26%). Six of 41 drugs were used more than twice as much in women. Actionable PGx drugs were most frequently used by 45-79 year old patients (62%), followed by 25-44 year old patients (18%). Almost half of the actionable PGx drugs (19/41) were psychotropics (i.e., antidepressants, antipsychotics, or psychostimulants). PGx testing can have a substantial impact on the population, as one in four prescription drug users has an actionable genotype or phenotype and could thus benefit from PGx testing. We advocate for prospective panel-based PGx testing at the time of the first PGx drug prescription ("as needed"), with PGx results ready prior to start of the first, and all future, therapies.
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Affiliation(s)
| | | | - Kazi Ishtiak-Ahmed
- Department of Depression and Anxiety, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christiane Gasse
- Department of Depression and Anxiety, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
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22
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Islamoska S, Ishtiak-Ahmed K, Hansen ÅM, Grynderup MB, Mortensen EL, Garde AH, Gyntelberg F, Prescott EIB, Török E, Waldemar G, Nabe-Nielsen K. Vital Exhaustion and Incidence of Dementia: Results from the Copenhagen City Heart Study. J Alzheimers Dis 2020; 67:369-379. [PMID: 30584138 PMCID: PMC6398840 DOI: 10.3233/jad-180478] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychological distress is potentially linked to the risk of dementia through neurologic and cardiovascular mechanisms. Vital exhaustion (VE) is a mental state of psychological distress, which could be a risk factor for dementia. OBJECTIVE To investigate whether VE is a risk factor for dementia in later life. METHODS We used data from 6,807 participants attending the third survey of the Copenhagen City Heart Study in 1991-1994. VE was assessed by 17 symptoms (score: 0-17) from the Maastricht Questionnaire. Information on dementia was obtained from national registers. Risk time for dementia was counted from five years after VE assessment for participants > 55 years at the time of VE assessment. For younger participants, risk time for dementia was counted from the year they turned 60 years and onwards. Participants were followed until 2016. We used Poisson regression to calculate incidence rate ratios (IRR) and their 95% confidence intervals (CI). RESULTS During an average follow-up of 10 years, 872 participants were registered with dementia. We found a dose-response relation between the number of VE symptoms and the incidence of dementia. For every additional VE symptom, the dementia incidence increased by 2% (IRR = 1.024; 95% CI: 1.004-1.043). Adjustment for socio-demographic and health-related factors did not change the results substantially. Neither did stratification by age, sex, educational level, and marital status. CONCLUSION We found evidence that VE is a risk factor for dementia. Our sensitivity analyses supported that this association was not only due to VE being a potential prodromal sign of dementia.
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Affiliation(s)
- Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Finn Gyntelberg
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Eszter Török
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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23
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Ishtiak-Ahmed K, Hansen ÅM, Mortensen EL, Garde AH, Brødsgaard Grynderup M, Gyntelberg F, Islamoska S, Lund R, Phung TKT, Prescott E, Waldemar G, Nabe-Nielsen K. Midlife Forgetfulness and Risk of Dementia in Old Age: Results from the Danish Working Environment Cohort Study. Dement Geriatr Cogn Disord 2020; 47:264-273. [PMID: 31319407 DOI: 10.1159/000500184] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/06/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite the current evidence of a high prevalence of forgetfulness in middle-aged individuals, and the evidence of a link between midlife memory complaints and biological changes in the brain, no previous study has yet investigated midlife forgetfulness in relation to risk of dementia in old age. AIMS We investigated whether midlife forgetfulness was an indicator of an increased risk of dementia in old age. METHODS We used data from 3,136 employed men and women who participated in the Danish Work Environment Cohort Study in 1990. These data were linked to Danish national registers. Participants were asked whether their closest relative had ever told them that they were forgetful. Incidence rate ratios (IRR) were estimated using Poisson regression analysis. RESULTS At baseline, 749 (24%) study participants were categorized as forgetful, and 86 (2.7%) participants were diagnosed with dementia during a total of 31,724 person-years at risk. After adjusting for sociodemographic factors, comorbidities, and work-related factors, midlife forgetfulness was associated with a higher risk of dementia (IRR = 1.82; 95% CI: 1.12-2.97). CONCLUSIONS This study is the first to investigate midlife forgetfulness and dementia, and the results suggest that midlife forgetfulness is an early indicator of an increased risk of dementia in old age.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark,
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Finn Gyntelberg
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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24
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Nabe-Nielsen K, Hansen ÅM, Ishtiak-Ahmed K, Grynderup MB, Gyntelberg F, Islamoska S, Mortensen EL, Phung TKT, Rod NH, Waldemar G, Westendorp RGJ, Garde AH. Night shift work, long working hours and dementia: a longitudinal study of the Danish Work Environment Cohort Study. BMJ Open 2019; 9:e027027. [PMID: 31129586 PMCID: PMC6538206 DOI: 10.1136/bmjopen-2018-027027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Shift work and long working hours are potential risk factors for dementia, but previous studies on shift work, long working hours and dementia are sparse and their findings are conflicting. Therefore, we investigated the effect of night shift work and long working hours on dementia. DESIGN A longitudinal study. SETTING Denmark. PARTICIPANTS 3435 occupationally active men and women from the general working population. METHODS Work schedule covered day work (reference) and shift schedules without/with night work. Working hours covered <27, 28-36, 37 (reference), 38-44, and ≥45 hours/week. As the primary outcome, we used register-based information about dementia, and estimated incidence rate ratios (IRR) and 95% CI. Estimates were adjusted for gender, age, psychosocial work factors and cardiovascular risk factors. RESULTS We identified 85 dementia cases during a mean of 9.8 years of follow-up. We found a positive, but statistically insignificant association between night shift work and dementia (IRR=2.01; 95% CI: 0.87-4.65). Post hoc analyses indicated that this was only due to a higher risk in permanent night workers (IRR=3.25; 95% CI: 1.35-7.83). The dementia risk was also significantly higher among participants working 38-44 hours/week (IRR=2.08; 95% CI: 1.11-3.90) compared with those working 37 hours/week. We found no indications of a higher risk of dementia in participants working <37 hours/week or ≥45 hours/week. CONCLUSION We did not find arguments that night shift work or long working hours increased dementia risk in general. However, we found a higher risk of dementia in specific subgroups, that is, permanent night workers and employees with moderately longer weekly working hours than the standard.
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Affiliation(s)
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Finn Gyntelberg
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- National Research Centre for the Working Environment, Copenhagen, Denmark
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25
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Ishtiak-Ahmed K, Hansen ÅM, Mortensen EL, Garde AH, Nørgaard A, Gyntelberg F, Rod NH, Islamoska S, Lund R, Phung TKT, Prescott E, Waldemar G, Nabe-Nielsen K. Prolonged or serious conflicts at work and incident dementia: a 23-year follow-up of the Copenhagen City Heart Study. Int Arch Occup Environ Health 2019; 92:165-173. [PMID: 30370497 PMCID: PMC6341042 DOI: 10.1007/s00420-018-1365-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/21/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Only a few studies have investigated the impact of negative aspects of social relations on cognitive function, and they have shown mixed results. Conflicts at work are part of the negative aspects of social relations, but the impact of experiencing conflicts at work has not yet been investigated as a risk factor for dementia. Therefore, we investigated whether experiencing prolonged or serious conflicts with a supervisor or colleagues at work was associated with incident dementia in old age. METHODS We analyzed data of 6,436 men and women from the third survey of the Copenhagen City Heart Study. At baseline in 1991-1994, the participants reported whether they had ever had a prolonged or serious conflict at work. The participants were followed until 2014. We used Poisson regression to estimate incidence rate ratios (IRR) and their 95% confidence intervals (CI). RESULTS After adjusting for potential confounders, the IRR for dementia was 1.53 (95% CI 0.77-3.03) among participants who had reported having prolonged or serious conflicts both with a supervisor and colleagues compared with participants who had never had such conflicts. In separate analyses stratified by sex, the IRRs were 2.14 (95% Cl 0.97-4.71) for men and 0.98 (95% Cl 0.29-3.32) for women. CONCLUSIONS Our findings did not support an overall association between experiencing prolonged or serious conflicts at work and incident dementia. However, because of the large differences in the point estimates for men and women, future research could aim at investigating potential sex differences regarding the association between conflicts at work and dementia.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Ane Nørgaard
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen Section 6911, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Finn Gyntelberg
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Rikke Lund
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen Section 6911, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kirsten Nabe-Nielsen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
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26
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Rimi NA, Sultana R, Ishtiak-Ahmed K, Haider N, Azziz-Baumgartner E, Nahar N, Luby SP. Where backyard poultry raisers seek care for sick poultry: implications for avian influenza prevention in Bangladesh. BMC Public Health 2018; 18:969. [PMID: 30075714 PMCID: PMC6090748 DOI: 10.1186/s12889-018-5819-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/10/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In Bangladesh, backyard poultry raisers lack awareness of avian influenza and infrequently follow government recommendations for its prevention. Identifying where poultry raisers seek care for their ill poultry might help the government better plan how to disseminate avian influenza prevention and control recommendations. METHODS In order to identify where backyard poultry raisers seek care for their ill poultry, we conducted in-depth and informal interviews: 70 with backyard poultry raisers and six with local poultry healthcare providers in two villages, and five with government veterinary professionals at the sub-district and union levels in two districts during June-August 2009. RESULTS Most (86% [60/70]) raisers sought care for their backyard poultry locally, 14% used home remedies only and none sought care from government veterinary professionals. The local poultry care providers provided advice and medications (n = 6). Four local care providers had shops in the village market where raisers sought healthcare for their poultry and the remaining two visited rural households to provide poultry healthcare services. Five of the six local care providers did not have formal training in veterinary medicine. Local care providers either did not know about avian influenza or considered avian influenza to be a disease common among commercial but not backyard poultry. The government professionals had degrees in veterinary medicine and experience with avian influenza and its prevention. They had their offices at the sub-district or union level and lacked staffing to reach the backyard raisers at the village level. CONCLUSIONS The local poultry care providers provided front line healthcare to backyard poultry in villages and were a potential source of information for the rural raisers. Integration of these local poultry care providers in the government's avian influenza control programs is a potentially useful approach to increase poultry raisers' and local poultry care providers' awareness about avian influenza.
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Affiliation(s)
- Nadia Ali Rimi
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Rebeca Sultana
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- University of Copenhagen, Copenhagen, Denmark
| | - Najmul Haider
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Technical University of Denmark, Copenhagen, Denmark
| | | | - Nazmun Nahar
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Stephen P. Luby
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
- Stanford University, Stanford, California, USA
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27
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Nabe-Nielsen K, Garde AH, Ishtiak-Ahmed K, Gyntelberg F, Mortensen EL, Phung TKT, Rod NH, Waldemar G, Westendorp RG, Hansen ÅM. Shift work, long working hours, and later risk of dementia: A long-term follow-up of the Copenhagen Male Study. Scand J Work Environ Health 2017; 43:569-577. [PMID: 28707697 DOI: 10.5271/sjweh.3660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The aim of this study was to investigate the effect of shift work and long working hours in midlife on the risk of dementia in old age. Methods The present study comprised 4766 participants from the Copenhagen Male Study. We used information on shift work (collected in 1970-1971 and 1985-1986), long working hours defined as >45 hours per week (collected in 1970-1971), socioeconomic status, sleep, stress, and cardiovascular risk factors. Information about dementia diagnoses was obtained from registers. Participants were followed until 2014 (mean length of follow-up was 17.8 years). We employed Poisson regression for the survival analyses and estimated incidence rate ratios (IRR) and their 95% confidence intervals (CI). Results We found no statistically significant association between shift work (IRR 0.86, 95% CI 0.70-1.05) or long working hours (IRR 0.97, 95% CI 0.79-1.19) and dementia. Adjustment for potential confounders and mediators did not change the estimates. Working shifts at both time points of exposure assessment was not associated with a higher incidence of dementia compared with non-shift workers at both time points (IRR 0.99, 95% CI 0.69-1.42). The lowest incidence of dementia was observed among participants who reported shift work at one time point (only in 1985-1986: IRR 0.44, 95% CI 0.16-1.23 and only in 1970-1971: IRR 0.58, 95% CI 0.31-1.11). Conclusion We did not find positive evidence of an association between shift work or long working hours and the incidence of dementia, but the negative findings may reflect the crude assessment of shift work and long working hours, which is a major limitation of the present study.
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Affiliation(s)
- Kirsten Nabe-Nielsen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark. E-mail:
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28
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Ishtiak-Ahmed K, Carstensen B, Pedersen-Bjergaard U, Jørgensen ME. Incidence Trends and Predictors of Hospitalization for Hypoglycemia in 17,230 Adult Patients With Type 1 Diabetes: A Danish Register Linkage Cohort Study. Diabetes Care 2017; 40:226-232. [PMID: 27899494 DOI: 10.2337/dc16-0862] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 04/21/2016] [Accepted: 11/02/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to examine nationwide incidence trends and predictors of hospitalization for hypoglycemia (HH) in the adult population with type 1 diabetes in Denmark. RESEARCH DESIGN AND METHODS All 17,230 patients with type 1 diabetes aged 16 years and above registered in the Danish Adult Diabetes Database (DADD) from 2006 were followed to 2012 by linkage of registers. Incidence rates of HH were modeled by Poisson regression by calendar time, taking sex, age, diabetes duration, clinical variables, and previous HH into account. RESULTS A total of 2,369 events of HH occurred among 1,735 patients with type 1 diabetes of HH during 70,002 patient-years (mean follow-up 3.7 years). A decrease in incidence rate was observed with calendar time with an 8.4% (4.9-11.7%) annual decrease. Predictors of HH included previous HH, age, diabetes duration, albuminuria, and HbA1c. CONCLUSIONS This study revealed a decreasing trend in incidence of HH in patients with type 1 diabetes. Previous HH, longer diabetes duration, macroalbuminuria, and HbA1c were associated with increased risk of HH in type 1 diabetes, and attention to those factors is warranted in both clinical and public health aspects.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Steno Diabetes Centre, Gentofte, Denmark.,Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ulrik Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Centre, Gentofte, Denmark .,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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29
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Rimi NA, Sultana R, Ishtiak-Ahmed K, Rahman MZ, Hasin M, Islam MS, Azziz-Baumgartner E, Nahar N, Gurley ES, Luby SP. Understanding the failure of a behavior change intervention to reduce risk behaviors for avian influenza transmission among backyard poultry raisers in rural Bangladesh: a focused ethnography. BMC Public Health 2016; 16:858. [PMID: 27552983 PMCID: PMC4995615 DOI: 10.1186/s12889-016-3543-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/18/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The spread of the highly pathogenic avian influenza (HPAI) H5N1 virus among poultry and humans has raised global concerns and has motivated government and public health organizations to initiate interventions to prevent the transmission of HPAI. In Bangladesh, H5N1 became endemic in poultry and seven human H5N1 cases have been reported since 2007, including one fatality. This study piloted messages to increase awareness about avian influenza and its prevention in two rural communities, and explored change in villagers' awareness and behaviors attributable to the intervention. METHODS During 2009-10, a research team implemented the study in two rural villages in two districts of Bangladesh. The team used a focused ethnographic approach for data collection, including informal interviews and observations to provide detailed contextual information about community response to a newly emerging disease. They collected pre-intervention qualitative data for one month. Then another team disseminated preventive messages focused on safe slaughtering methods, through courtyard meetings and affixed posters in every household. After dissemination, the research team collected post-intervention data for one month. RESULTS More villagers reported hearing about 'bird flu' after the intervention compared to before the intervention. After the intervention, villagers commonly recalled changes in the color of combs and shanks of poultry as signs of avian influenza, and perceived zoonotic transmission of avian influenza through direct contact and through inhalation. Consequently the villagers valued covering the nose and mouth while handling sick and dead poultry as a preventive measure. Nevertheless, the team did not observe noticeable change in villagers' behavior after the intervention. Villagers reported not following the recommended behaviors because of the perceived absence of avian influenza in their flocks, low risk of avian influenza, cost, inconvenience, personal discomfort, fear of being rebuked or ridiculed, and doubt about the necessity of the intervention. CONCLUSIONS The villagers' awareness about avian influenza improved after the intervention, however, the intervention did not result in any measurable improvement in preventive behaviors. Low cost approaches that promote financial benefits and minimize personal discomfort should be developed and piloted.
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Affiliation(s)
- Nadia Ali Rimi
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Rebeca Sultana
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Kazi Ishtiak-Ahmed
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Md Zahidur Rahman
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Marufa Hasin
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - M. Saiful Islam
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Eduardo Azziz-Baumgartner
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
| | - Nazmun Nahar
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Emily S. Gurley
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Stephen P. Luby
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
- Stanford University, Stanford, CA USA
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Ishtiak-Ahmed K, Perski A, Mittendorfer-Rutz E. Risk markers of all-cause and diagnosis-specific disability pension--a prospective cohort study of individuals sickness absent due to stress-related mental disorders. BMC Public Health 2014; 14:805. [PMID: 25099303 PMCID: PMC4147178 DOI: 10.1186/1471-2458-14-805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 07/24/2014] [Indexed: 11/18/2022] Open
Abstract
Background Stress-related mental disorders rank among the leading causes of sickness absence in several European countries. The aim of this study was to investigate predictors of all-cause and diagnosis-specific disability pension in sickness absentees with stress-related mental disorders. Methods A cohort of 36304 non-retired individuals aged 16–64 years at 31.12.2004 with at-least one sickness absence spell due to stress-related mental disorders (SRMD) initiated in 2005 in Sweden was followed-up with regard to disability pension (2006–2010) by linkage of registers. Uni- and multivariate Hazard ratios (HR) with 95% Confidence Intervals, CI, were estimated using Cox regression for several risk markers. Results During the follow-up period, 2735 individuals (7.5%) were granted a disability pension, predominantly due to mental diagnoses (n = 2004, 73.3%). In the multivariate analyses, female sex, age exceeding 35 years, low educational level, being born in a country outside EU25 and Northern Europe, residing outside big cities, living alone, having had a long duration of the first spell due to SRMD (>90 days); mental disorders necessitating frequent specialised health care as well as comorbid somatic disorders were found to be predictive of granting disability pension. Some different patterns emerged for risk factors related to diagnosis-specific disability pension and for younger and older individuals. Conclusions Several predictors could be identified as risk markers for disability pension. The variation in the effect of risk markers with regard to age and diagnosis of disability pension speaks in favour of the importance of a person-centered approach in treatment and rehabilitation.
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Affiliation(s)
| | | | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, SE- 17177 Stockholm, Sweden.
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Rimi NA, Sultana R, Ishtiak-Ahmed K, Khan SU, Sharker MAY, Uz Zaman R, Azziz-Baumgartner E, Gurley ES, Nahar N, Luby SP. Poultry slaughtering practices in rural communities of Bangladesh and risk of avian influenza transmission: a qualitative study. Ecohealth 2013; 11:83-93. [PMID: 24306550 DOI: 10.1007/s10393-013-0885-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 06/02/2023]
Abstract
Slaughtering sick poultry is a risk factor for human infection with highly pathogenic avian influenza and is a common practice in Bangladesh. This paper describes human exposures to poultry during slaughtering process and the customs and rituals influencing these practices in two Bangladeshi rural communities. In 2009, we conducted 30 observations to observe slaughtering practices and 110 in-depth and short interviews and 36 group discussions to explore reasons behind those practices. The villagers reported slaughtering 103 poultry, including 20 sick poultry during 2 months. During different stages of slaughtering, humans, the environment, healthy poultry, and other animals were exposed to poultry blood and body parts. Women performed most of the slaughtering tasks, including evisceration. Defeathering required the most time and involved several persons. During festivals, ceremonies, and rituals, many people gathered and participated in the slaughtering of poultry. Exposure to poultry slaughtering created numerous opportunities for potential avian influenza transmission. Strategies that can be further tested to determine if they reduce the risk of transmission include skinning the carcasses of sick poultry, using hot water for defeathering and cleaning, using a bucket to contain slaughtering blood and carcass, burying the offal and encouraging handwashing.
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Affiliation(s)
- Nadia Ali Rimi
- Center for Communicable Diseases (CCD), icddr,b, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, GPO Box 128, Dhaka, 1212, Bangladesh,
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Ishtiak-Ahmed K, Perski A, Mittendorfer-Rutz E. Predictors of suicidal behaviour in 36,304 individuals sickness absent due to stress-related mental disorders -- a Swedish register linkage cohort study. BMC Public Health 2013; 13:492. [PMID: 23687984 PMCID: PMC3663733 DOI: 10.1186/1471-2458-13-492] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 05/14/2013] [Indexed: 11/10/2022] Open
Abstract
Background Stress-related mental disorders (SRMD), which correspond to the diagnostic code F43 in the International Classification of Diseases, version 10, rank among the leading causes of sickness absence in several European countries. Despite the size of this health problem, research on risk factors for severe medical outcomes, like suicidal behavior, is lacking to date. The aim of this study was to investigate predictors of suicide attempt and suicide among sickness absentees with SRMD. Methods A cohort of 36,304 non-retired individuals, aged 16–64 years on 31.12.2004, with at least one sickness absence spell due to SRMD, initiated in 2005, was followed up with regard to suicide attempt (2006–2009) and suicide (2006–2008). Univariate and multivariate hazard ratios (HR) with 95% confidence intervals (CI) were estimated for a number of predictors. Results During the follow-up period, 266 individuals attempted suicide and 34 committed suicide. In the multivariate analyses, the following factors increased the risk of suicide attempt: =< 25 years of age, low educational level, lone parenthood, > 1 sickness absence spell, long duration of the first spell of sickness absence due to SRMD (> 180 days), > 4 and > 8 days of inpatient care due to somatic or mental diagnoses (2000–2005), and > 4 and > 1 outpatient visits due to somatic or mental diagnoses (2001–2005), respectively. Hazard ratios ranged from 1.4 to 4.2. Health care due to mental diagnoses and > 1 spell of sickness absence regardless of diagnosis were predictive of suicide. Conclusions Several predictors related to socio-demographics, sickness absence and health-care consumption were identified as risk factors for suicidal behavior. Consideration of these risk factors is of both clinical and public health importance.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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