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Glintborg D, Møller JJK, Rubin KH, Lidegaard Ø, T'Sjoen G, Larsen MLJØ, Hilden M, Andersen MS. Gender-affirming treatment and mental health diagnoses in Danish transgender persons: a nationwide register-based cohort study. Eur J Endocrinol 2023; 189:336-345. [PMID: 37672620 DOI: 10.1093/ejendo/lvad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023]
Abstract
IMPORTANCE Gender affirming treatment aims to improve mental health. OBJECTIVE To investigate longitudinal mental health outcomes in Danish transgender persons. DESIGN National register-based cohort study in Danish transgender persons with diagnosis code of "gender identity disorder" during the period 2000-2021. PARTICIPANTS Five age-matched controls of the same sex at birth and five age-matched controls of the other sex at birth were included for each transgender person. MAIN OUTCOMES Diagnosis codes of mental and behavioral disorders and/or prescription of psychopharmacological agents until June 2022. RESULTS The cohort included 3812 transgender persons with median age (interquartile range) 19 (15; 24) years for persons assigned female at birth (AFAB, N = 1993) and 23 (19; 33) years for persons assigned male at birth (AMAB, N = 1819) and 38 120 controls. Follow up duration was up to 10 years with mean (standard deviation) 4.5 (4.3) years. In transgender persons AFAB compared to control women, the odds ratio (OR) (95% confidence interval) for mental and behavioral disorders was 6.7 (5.5; 8.1) before the index date, 9.9 (8.4; 11.7) at 1 year, 5.8 (4.4; 7.7) at 5 years, and 3.4 (2.1; 7.5) at 8 years follow up. In transgender persons AMAB compared to control men, corresponding ORs were 5.0 (4.0; 6.4), 11.3 (9.3; 13.7), 4.8 (3.5; 6.5), and 6.6 (4.2; 10.3) at 8 years follow up (all P < .001). CONCLUSION The OR for mental health disorders was higher in transgender persons compared to controls and remained elevated throughout follow up, especially in transgender persons AMAB.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, DK 5000 Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, DK 5000 Odense, Denmark
| | - Jens-Jakob Kjer Møller
- OPEN-Open Patient Data Explorative Network, Odense University Hospital, DK 5000 Odense, Denmark
| | - Katrine Hass Rubin
- OPEN-Open Patient Data Explorative Network, Odense University Hospital, DK 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, DK 5000 Odense, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK 2100 Copenhagen, Denmark
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, 9000 Gent, Belgium
| | - Mie-Louise Julie Ørsted Larsen
- Department of Gynecology, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
- Department of Gynaecology, Centre for Gender Identity, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
| | - Malene Hilden
- Department of Gynecology, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
- Department of Gynaecology, Centre for Gender Identity, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, DK 5000 Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, DK 5000 Odense, Denmark
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Glintborg D, Rubin KH, Petersen TG, Lidegaard Ø, T'Sjoen G, Hilden M, Andersen MS. Cardiovascular risk in Danish transgender persons: a matched historical cohort study. Eur J Endocrinol 2022; 187:463-477. [PMID: 35900321 DOI: 10.1530/eje-22-0306] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/13/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cardiovascular risk could be increased in transgender persons, but the mechanism is undetermined. AIM The aim of this study was to assess the risk of cardiovascular outcomes in Danish transgender persons compared to controls. METHODS The study design was a historical register-based cohort study in Danish transgenders and age-matched controls. The main outcome measure was cardiovascular diagnosis (any CVD) including medicine prescriptions for CVD during 2000-2018. The transgender cohort (n = 2671) included persons with International Classification of Diseases-10 diagnosis code of 'gender identity disorder' (n = 1583) and persons with legal sex change (n = 1088), 1270 were assigned female at birth (AFAB) and 1401 were assigned male at birth (AMAB). Controls (n = 26 710) were matched by age (n = 5 controls of same and n = 5 controls of other birth sex) of the respective transgender. RESULTS The median (interquartile range) age at study inclusion was 22 (18; 29) years for AFAB and 26 (21; 39) years for AMAB. The mean (s.d.) follow-up time was 4.5 (4.2) years for AFAB and 5.7 (4.8) years for AMAB. The hazard ratio (HR) for any CVD was significantly higher in transgenders vs controls of same and other birth sex, with highest adjusted HR in transgenders AFAB vs control men: 2.20 (95% CI: 1.64;2.95), P < 0.001. Gender-affirming hormone treatment (GAHT) explained part of elevated risk of CVD in transgenders AFAB, whereas GAHT did not contribute to the elevated risk of CVD in transgenders AMAB. CONCLUSIONS The risk of cardiovascular diagnosis was increased in transgenders. The mechanism should be further investigated.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Katrine Hass Rubin
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tanja Gram Petersen
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Kobenhavn, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Guy T'Sjoen
- Department of Endocrinology and Centre for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Malene Hilden
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Kobenhavn, Denmark
- Centre for Gender Identity, Department of Gynaecology, Rigshospitalet, University of Copenhagen, Kobenhavn, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Glintborg D, Rubin KH, Kristensen SB, Lidegaard Ø, T'Sjoen G, Hilden M, Andersen MS. Gender affirming hormonal treatment in Danish transgender persons. A nationwide register-based study. Andrology 2022; 10:885-893. [PMID: 35366390 PMCID: PMC9322260 DOI: 10.1111/andr.13181] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gender affirming hormonal treatment (GAHT) is a cornerstone in transgender care. National data are sparse regarding use of hormonal treatment by transgender persons. AIM To assess use of GAHT in transgender persons. DESIGN National register-based cohort study in Danish transgender persons followed from 2000 until 2018. The main outcome measure was prescription and purchase of GAHT. Persons with ICD-10 diagnosis code of "gender identity disorder" (CGI-cohort) and persons with legal sex change but without diagnosis (CPR-cohort) were included. In the CGI-cohort, transgender women were defined by prescription of estrogen and/or cyproterone acetate and/or testosterone-5-alpha reductase inhibitors and transgender men were defined by prescription of testosterone after study inclusion. Discontinuation of GAHT was defined as no purchase of GAHT ≥ 13 months or shift from feminizing to masculinizing hormone treatment, or vice versa. RESULTS The cohort included 2789 transgender persons (n = 1717, CGI-cohort and n = 1072, CPR-cohort). The median age (interquartile range) at study inclusion was 26.1 (17.7) years for persons assigned male at birth (n = 1447) and 22.5 (10.5) years for persons assigned female at birth (n = 1342). In the CGI-cohort, the event rate for GAHT in transgender women increased from 4.0 (95% CI: [3.1; 5.2]) events per 100 person in year 2000-2005 to 20.6 [17.8; 23.7] between 2014 -2018. In transgender men, the event rate of GAHT increased from 4.2 [2.8; 6.2] to 18.8 [16.4; 21.6]. The rate of discontinuation of GAHT was 0.06 (95% CI 0.049; 0.071) per person year. CONCLUSIONS The event rate of GAHT increased during 2000-2018. Our data suggested high adherence to GAHT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital.,Institute of Clinical research, University of Southern Denmark
| | - Katrine Hass Rubin
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Denmark.,Research unit OPEN, department of clinical research, University of southern Denmark
| | - Simon Bang Kristensen
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Denmark.,Research unit OPEN, department of clinical research, University of southern Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet, University of Copenhagen.,Department of Clinical Medicine, University of Copenhagen
| | - Guy T'Sjoen
- Dept. of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Malene Hilden
- Department of Gynecology, Rigshospitalet, University of Copenhagen.,Centre for Gender Identity, Department of Gynaecology, Rigshospitalet, University of Copenhagen
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital.,Institute of Clinical research, University of Southern Denmark
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Mikkelsen AP, Greiber IK, Scheller NM, Hilden M, Lidegaard Ø. Cyproterone acetate and risk of meningioma: a nationwide cohort study. J Neurol Neurosurg Psychiatry 2022; 93:222-223. [PMID: 34187864 DOI: 10.1136/jnnp-2021-326138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/20/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Anders Pretzmann Mikkelsen
- Department of Gynaecology, Rigshospitalet, Copenhagen, Denmark .,Deptartment of Clinical Medicine, University of Copenhagen, Cobenhavn, Denmark
| | - Iben Katinka Greiber
- Deptartment of Clinical Medicine, University of Copenhagen, Cobenhavn, Denmark.,Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Nikolai Madrid Scheller
- Department of Gynaecology, Rigshospitalet, Copenhagen, Denmark.,Department of Surgery, Queen Ingrid's Hospital, Nuuk, Greenland
| | - Malene Hilden
- Department of Gynaecology, Rigshospitalet, Copenhagen, Denmark.,Centre for Gender Identity, Rigshospitalet, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of Gynaecology, Rigshospitalet, Copenhagen, Denmark.,Deptartment of Clinical Medicine, University of Copenhagen, Cobenhavn, Denmark
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Yu P, Xie W, Liu L, Hilden M, Powell M. A consolidated summary on the evolution of a dynamic tumbling mill model. POWDER TECHNOL 2021. [DOI: 10.1016/j.powtec.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Glintborg D, Rubin KH, Kristensen SBM, Lidegaard Ø, T’Sjoen G, Burgwal A, Hilden M, Andersen MS. Socioeconomic status in Danish transgender persons: a nationwide register-based cohort study. Endocr Connect 2021; 10:1155-1166. [PMID: 34414901 PMCID: PMC8494405 DOI: 10.1530/ec-21-0119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gender dysphoria could be associated with low socioeconomic status (SES). SES could be modified by age, ethnic background, and medical morbidity. AIM To determine SES in a national study population including transgender persons in Denmark. METHODS National register-based cohort study in Danish transgender persons and age-matched controls. The transgender study cohort included persons with ICD-10 diagnosis code of 'gender identity disorder' and/or persons with legal sex change and persons who fulfiled the inclusion criteria during 2000-2018. The main outcome measure was SES including personal income, occupational status, and education. RESULTS The cohort included 2770 transgender persons and 27,700 controls. In the transgender study cohort, 1437 were assigned male at birth (AMAB), median age (interquartile range, IQR) 26.0 (17.3) years, and 1333 were assigned female at birth (AFAB), median age 22.5 (10.3) years. Adjusting for age and sex, the relative risk ratio (RRR) of low vs high personal income was 5.6 (95% CI: 4.9; 6.3) in transgender persons compared to controls. The RRR of low vs high income was 6.9 (5.8; 8.3) in persons AMAB compared to control males and 4.7 (3.9; 5.6) in persons AFAB compared to control females. The RRR of low vs high income was 3.7 (3.2; 4.3) in transgender persons of Danish origin compared to controls. The Charlson comorbidity index was comparable in transgender persons vs controls. CONCLUSIONS Being transgender was negatively associated with SES. In transgender persons, the risk of low vs high income could be more pronounced in transgender persons of foreign origin.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Correspondence should be addressed to D Glintborg:
| | - Katrine Hass Rubin
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Simon Bang Mohr Kristensen
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Guy T’Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Aisa Burgwal
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Malene Hilden
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Gender Identity, Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hilden M, Glintborg D, Andersen MS, Kyster N, Rasmussen SC, Tolstrup A, Lidegaard Ø. Gender incongruence in Denmark, a quantitative assessment. Acta Obstet Gynecol Scand 2021; 100:1800-1805. [PMID: 34296426 DOI: 10.1111/aogs.14227] [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] [Received: 02/25/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The number of persons with gender incongruence referred to health care is increasing, but national data on the incidence of gender incongruence are lacking. The aim of this study was to quantify the development in number of individuals with gender incongruence over time and to estimate the national incidence in Denmark. MATERIAL AND METHODS Historical descriptive cohort study. Individuals older than 18 years with legal sex-change in their person registration number were achieved from Statistics Denmark, and the National Health Register provided data on contact diagnoses related to gender-identity conditions. By combining these two data sources, we made estimates on incidence and incidence rates for individuals with gender incongruence in Denmark through a 41-year period 1980-2020. RESULTS Through 1980-2020, the annual number of legal sex-changes increased in individuals assigned female at birth from 5 to approximately 170 and among individuals assigned male at birth from 10 to approximately 150. The cumulative number of legal sex-changes at the end of 2019 was 1275 assigned female at birth and 1422 assigned male at birth and 66% of the legal sex-changes were in individuals below 30 years. Correspondingly, the annual number of contacts with the healthcare system due for gender-identity-related conditions increased from 30 during 1990-1999 to around 500 in 2017 (both genders combined), with a 10-fold increase from 2010 to 2017. CONCLUSIONS The number of legal sex-changes and healthcare contacts due to gender-identity-related diagnoses increased substantially over the last 40 years with a more than 10-fold increase during the last decade. This calls for research on possible explanations for this increase, for research on the short-term and long-term health consequences of hormonal and surgical treatment regimens and for ensuring adequate healthcare facilities.
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Affiliation(s)
- Malene Hilden
- Center for Gender Identity, Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | - Natacha Kyster
- Center for Gender Identity, Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Steen Christian Rasmussen
- Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anders Tolstrup
- Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Tolstrup A, Holmgaard R, Thomsen MV, Hilden M, Zetner D, Rosenberg J. [Sex reassignment surgery in Denmark]. Ugeskr Laeger 2020; 182:V05190270. [PMID: 32089153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This review summarises the knowledge of sex reassignment surgery in Denmark. Sex reassignment surgery aims at confirming a transgender person's gender identity and can consist of surgery on breasts, genitals, thyroid cartilage, vocal cords as well as facial and body contours. In Denmark, most procedures are performed at a highly specialised level after referral to Center for Gender Identity. Some choose to get procedures performed abroad. Depending on the surgical procedure additional surgery can be necessary, however, patient satisfaction is generally high. Surgery has been shown to increase patients' quality of life and decrease gender dysphoria.
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Abstract
SummaryIn in vitro and in vivo investigations of two patients with congenital factor XIII-deficiency it was demonstrated that cryoprecipitate contains a high factor XIII-activity. Cryoprecipitate in small amounts, given as intravenous injections every 3 or 4 weeks seems to be useful as a prophylactic treatment of patients with severe haemorrhagic due to factor XHI-deficiency.
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Larsen ML, Hilden M. Male victims of sexual assault; 10 years' experience from a Danish Assault Center. J Forensic Leg Med 2016; 43:8-11. [DOI: 10.1016/j.jflm.2016.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/31/2016] [Accepted: 06/26/2016] [Indexed: 11/26/2022]
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Larsen ML, Hilden M, Skovlund CW, Lidegaard Ø. Somatic health of 2500 women examined at a sexual assault center over 10 years. Acta Obstet Gynecol Scand 2016; 95:872-8. [DOI: 10.1111/aogs.12903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 03/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Mie-Louise Larsen
- Centre for Victims of Sexual Assault; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Malene Hilden
- Centre for Victims of Sexual Assault; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
- Department of Obstetrics and Gynecology; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Charlotte W. Skovlund
- Department of Obstetrics and Gynecology; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Øjvind Lidegaard
- Department of Obstetrics and Gynecology; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
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Abstract
OBJECTIVE To describe the victims of sexual assault and the circumstances in which the assaults occur. DESIGN Descriptive case study. SETTING Centre for Victims of Sexual Assault (CVSA), Rigshospitalet, Copenhagen, Denmark. POPULATION OR SAMPLE A total of 2541 women attending CVSA from 2001 to 2010. METHODS All women attending CVSA underwent a standardised data collection procedure. Descriptive bivariate analysis and logistic regression analysis were performed. MAIN OUTCOME MEASURES Associations between different assault characteristics and (1) the age of the victim and (2) the relationship between victim and perpetrator. RESULTS Two-thirds of the victims were aged 15-24 years. Seventy-five percent had met the perpetrator before the sexual assault and 70% reported the assault to the police. A physical injury was found in 53, and 27% sustained an anogenital lesion. Alcohol was involved in 60% of the cases. One-third of the victims had experienced a previous sexual assault(s). Women were more likely to report to the police when they were assaulted by a stranger (odds ratio [OR] 1.9, 95% confidence interval [95% CI] 1.3-2.6) and sustained a physical injury (OR 1.7, 95% CI 1.4-2.2) or anogenital lesion (OR 1.5, 95% CI 1.1-2.0). Women aged 45 years or older were more likely to sustain a physical injury (OR 2.0, 95% CI 1.2-3.2) or an anogenital lesion (OR 2.1, 95% CI 1.4-3.2). CONCLUSIONS Our results challenge the typical stereotype of a violent rape attack by a stranger, which is important in creating an environment where women are not reluctant to seek help after a sexual assault. Young age and drinking alcohol were risk factors for sexual assault, and we need to address this when considering preventive strategies.
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Affiliation(s)
- M-L Larsen
- Centre for Victims of Sexual Assault, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Hilden M, Sidenius K. P904 Physical and mental handicaps among women examined at center for victims of sexual assault (CFVSA) in Copenhagen. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lund B, Sorensen OH, Hilden M, Lund B. The hepatic conversion of vitamin D in alcoholics with varying degrees of liver affection. Acta Med Scand 2009; 202:221-4. [PMID: 910639 DOI: 10.1111/j.0954-6820.1977.tb16815.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The seasonal variations in circulating 25-hydroxycholecalciferol (25-HCC) were studied in 102 alcoholics with fatty liver disease without histologic signs of cirrhosis and in 35 patients with alcoholic cirrhosis. The mean levels were compared with those of normal persons. Alcoholics had generally lower 25-HCC values than the controls, particularly in the summer. This was primarily explained by insufficient diet and reduced exposure to sunshine. The ability of the liver to hydroxylate in the 25-position was studied in three groups of alcoholics with 1) fatty liver disease without cirrhosis, 2) compensated cirrhosis, 3) severely incompensated liver cirrhosis. All three groups exhibited a significant increase in serum 25-HCC following the peroral administration of cholecalciferol at a dose of 1 200 U daily for 7 days. Similar rises were seen 7 days after a single injection of 10 000 U cholecalciferol. This indicates a normal intestinal absorption of vitamin D, even in advanced alcoholic liver disease, and is inconsistent with a severely damaged 25-hydroxylation capacity in these patients. Osteomalacia due to impaired liver hydroxylation of vitamin D can hardly explain the increased fracture rate and the decreased bone mass, which have been described in alcoholics.
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Dietrichson O, Zoffmann H, Christoffersen P, Hilden M, Juhl E, Thomsen AC. Acute hepatitis: a prognostic study with observation time up to 37 years. A follow-up of the Iversen/Roholm liver biopsy material. Acta Med Scand 2009; 202:271-6. [PMID: 920245 DOI: 10.1111/j.0954-6820.1977.tb16826.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Re-evaluation of 890 consecutive liver biopsies from 1939-59 gave the diagnosis of acute hepatitis in 147 patients. A follow-up study of these patients was performed 15-37 years after the diagnostic biopsy, based on repeated liver biopsies, biochemical liver tests, autopsy reports and death certificates. Two patients died from acute liver failure, and development of cirrhosis was documented or strongly suspected in 22 patients (15 percent). A comparison between these 24 patients with a malignant course of hepatitis and 86 patients with a well documented uncomplicated disease, revealed a significantly larger number of women, a higher age, and more cases with piece-meal necrosis, confluent necrosis and marked portal inflammation in the intitial liver biopsy in the group with the poor prognosis.
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Key Words
- Adolescents
- Adolescents, Male
- Age Factors
- Biology
- Blood Coagulation Effects
- Clinical Research
- Contraception
- Contraceptive Agents, Estrogen--administraction and dosage
- Contraceptive Agents, Estrogen--side effects
- Contraceptive Agents, Estrogen--therapeutic use
- Contraceptive Agents, Female--administraction and dosage
- Contraceptive Agents, Female--side effects
- Contraceptive Agents, Female--therapeutic use
- Contraceptive Agents, Progestin--administraction and dosage
- Contraceptive Agents, Progestin--side effects
- Contraceptive Agents, Progestin--therapeutic use
- Contraceptive Agents--administraction and dosage
- Contraceptive Agents--side effects
- Contraceptive Agents--therapeutic use
- Contraceptive Methods--administraction and dosage
- Contraceptive Methods--side effects
- Contraceptive Methods--therapeutic use
- Demographic Factors
- Family Planning
- Hematological Effects
- Hemic System
- Lynestrenol--administraction and dosage
- Lynestrenol--side effects
- Lynestrenol--therapeutic use
- Mestranol--administraction and dosage
- Mestranol--side effects
- Mestranol--therapeutic use
- Oral Contraceptives, Combined
- Oral Contraceptives--administraction and dosage
- Oral Contraceptives--side effects
- Oral Contraceptives--therapeutic use
- Physiology
- Population
- Population Characteristics
- Research Methodology
- Youth
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Swahnberg K, Schei B, Hilden M, Halmesmäki E, Sidenius K, Steingrimsdottir T, Wijma B. Patients’ experiences of abuse in health care: a Nordic study on prevalence and associated factors in gynecological patients. Acta Obstet Gynecol Scand 2007; 86:349-56. [PMID: 17364312 DOI: 10.1080/00016340601185368] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In an earlier Swedish study conducted with The NorVold Abuse Questionnaire, we found that one-third of female patients who had experienced adult abuse in health care (AAHC) had a background of childhood emotional, physical and/or sexual abuse (EPSA) ('revictimised'). But since the majority of women with AAHC were 'new victims' without such a background, there might be other factors associated with AAHC. The present study aimed to map prevalence of abuse in health care (AHC), and associated variables among new victims and revictimised patients. METHODS We carried out a cross-sectional questionnaire study at 5 Nordic gynecological clinics. Associations between AAHC and other variables were tested in a multivariate model in 4 groups of women with adult EPSA, childhood EPSA, childhood and adult EPSA, and no EPSA. RESULTS The response rate was 77% (n=3,641). The overall prevalence of any lifetime experience of AHC was 13-28%. High educational level, physical complaints, post-traumatic stress symptoms, and sleeping problems were associated with AAHC in women without EPSA (new victims). Poor self-rated health was strongly associated with AAHC in the 3 groups of women with EPSA. CONCLUSION AHC is commonly reported by gynecological patients in the Nordic countries, but not yet properly explored or understood. The most important factors associated with AAHC were high educational level and poor self-rated health.
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Affiliation(s)
- Katarina Swahnberg
- Division of Gender and Medicine, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Sweden, and Department of Gynecology, St. Olav Hospital, Trondheim, Norway.
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Abstract
OBJECTIVES To evaluate the presence and extFent of genitoanal injury among sexually assaulted women and to estimate the risk of injury in subgroups according to the type of assault and to the sexually assaulted women's susceptibility to injury. STUDY DESIGN A case-control study of 249 women exposed to sexual assault. Injury identified by gross visualization. Women with and without injury were compared. Logistic regressions analyses were performed to calculate the risk of injury. RESULTS Thirty-two percent sustained genitoanal injury. Anal penetration and assaults on women without prior sexual experience were associated with genitoanal injury. CONCLUSIONS Most women do not have visible genitoanal injuries. The risk of sustaining genitoanal injury during a sexual assault is higher among women without prior sexual intercourse experience and among women exposed to anal penetration. The severity of the assault is a poor predictor of genitoanal injury.
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Affiliation(s)
- Malene Hilden
- Center for Victims of Sexual Assault 4031, Copenhagen University Hospital Rigshospitalet, Denmark.
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Abstract
OBJECTIVES The aim of this study was to determine whether there was an association between any lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Furthermore, we wanted to ascertain if adult victims of perceived abuse in the health care system reported exposure to childhood emotional, physical and/or sexual abuse more often than non-victims did. DESIGN A cross sectional questionnaire study. The first hypothesis was tested in the total sample, and the second hypothesis in a case-control analysis. The cases were those women who reported perceived experiences of abuse in the health care system as adults. Exposure was defined as experience of emotional, physical and/or sexual abuse in childhood. SETTINGS Three Swedish gynaecological clinics. SAMPLE A total of 2439 gynaecology patients (response rate 81%). METHODS Postal questionnaire. MAIN OUTCOME MEASURE Associations between experiences of emotional, physical and/or sexual abuse, and perceived abuse in the health care system; all operationalised in The NorVold Abuse Questionnaire (NorAQ). RESULTS A general association was found between lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Adult victims of abuse in the health care system reported experiences of emotional, physical and/or sexual abuse in childhood more often than non-victims did. These findings also held after adjustment for age and educational level. CONCLUSIONS We found associations between experiences of any lifetime abuse and perceived abuse in the health care system. Adult victimisation in the health care system was associated with childhood exposure to emotional, physical and/or sexual abuse. These associations call for attention and need to be further investigated.
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Affiliation(s)
- Katarina Swahnberg
- Division of Gender and Medicine, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, S-581 85 Linköping, Sweden
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Hilden M, Schei B, Swahnberg K, Halmesmäki E, Langhoff-Roos J, Offerdal K, Pikarinen U, Sidenius K, Steingrimsdottir T, Stoum-Hinsverk H, Wijma B. A history of sexual abuse and health: a Nordic multicentre study. BJOG 2004; 111:1121-7. [PMID: 15383115 DOI: 10.1111/j.1471-0528.2004.00205.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine if a history of sexual abuse is associated with objective and subjective indicators of health and if certain abusive incidents had a stronger impact on health than others. DESIGN A cross-sectional, multicentre study. SETTING Five gynaecological departments in the five Nordic countries. SAMPLE Three thousand five hundred and thirty-nine gynaecology patients. METHODS The NorVold Abuse Questionnaire (NorAQ) on abuse history and current health was mailed to all patients who consented to participate. MAIN OUTCOME MEASURES Reason for index visit at the gynaeocological clinic as well as several questions on health were recorded. General health status was measured as self-estimated health, psychosomatic symptoms (headache, abdominal pain, muscle, weakness, dizziness), number of health care visits and number of periods on sick leave. RESULT A history of sexual abuse was reported by 20.7% of respondents. A history of sexual abuse was significantly associated with chronic pelvic pain as reason for index visit (P < 0.01), laparoscopic surgery (P < 0.01), psychosomatic symptoms (P < 0.01), self-estimated poor health (P < 0.01), many health care visits (P < 0.01) and high incidence of sick leave (P < 0.01). Several subgroups within the group of sexually abused women were more likely to report poor health: women abused as both children and adults, women who experienced additional emotional and/or physical abuse and women abused by a person they knew. CONCLUSION Sexual abuse has a profound impact on women's health. Taking a history of sexual abuse seems particularly warranted when the patient presents with chronic pelvic pain or symptoms of a vague and diffuse nature.
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Affiliation(s)
- Malene Hilden
- Centre for Victims of Sexual Assault, Rigshospitalet, Copenhagen, Denmark
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Swahnberg K, Wijma B, Schei B, Hilden M, Irminger K, Wingren GB. Are sociodemographic and regional and sample factors associated with prevalence of abuse? Acta Obstet Gynecol Scand 2004; 83:276-88. [PMID: 14995925 DOI: 10.1111/j.0001-6349.2004.0222.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aims of the present study were: 1) to estimate the prevalence of emotional, physical and sexual abuse and abuse in the health care system, and 2) to study the associations between prevalence of abuse and sociodemographic and sample variables. METHODS This cross-sectional study used a validated postal questionnaire in four Swedish samples; patients at three gynecologic clinics with different character and in different regions (n = 2439) and women in one randomized population sample (n = 1168). RESULTS Any lifetime emotional abuse was reported by 16.8-21.4% of the women; physical abuse by 32.1-37.5%; sexual abuse by 15.9-17.0%; and abuse in the health care system by 14.0-19.7%. For 7-8% abuse had included life threats and 9-20% of all women in the study currently suffered from their experiences of abuse. Most women had not disclosed their background of abuse to the gynecologist. There were differences in sociodemographic variables between the four samples. Generally, in the multivariate analyses we found associations between prevalence of abuse and age, educational level, civil status and occupation, but no consistent association between prevalence of abuse and sample variables. CONCLUSION Lifetime prevalence rates of the four kinds of abuse were high in all samples as measured by the NorVold Abuse Questionnaire (NorAQ), and 1/10-1/5 women in the study suffered currently from abusive experiences. In multivariate analyses prevalence of abuse was consistently associated with sociodemographic but not to sample variables.
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Affiliation(s)
- Katarina Swahnberg
- Division of Women's Health, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Sweden.
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25
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Hilden M, Sidenius K, Langhoff-Roos J, Wijma B, Schei B. Women's experiences of the gynecologic examination: factors associated with discomfort. Acta Obstet Gynecol Scand 2003; 82:1030-6. [PMID: 14616277 DOI: 10.1034/j.1600-0412.2003.00253.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate how women experience the gynecologic examination and to assess possible factors associated with experiencing discomfort during the gynecologic examination. METHODS Consecutive patients visiting the Department of Obstetrics and Gynecology at Glostrup County Hospital, Denmark, were invited to participate in the study, and received a postal questionnaire that included questions about the index visit, obstetric and gynecologic history and sexual abuse history. The response rate was 80% (n = 798). The degree of discomfort during the gynecologic examination was indicated on a scale from 0 to 10. Experiencing discomfort was defined as a score of 6 or more, based on the 75th percentile. RESULTS Discomfort during the gynecologic examination was strongly associated with a negative emotional contact with the examiner and young age. Additionally, dissatisfaction with present sexual life, a history of sexual abuse and mental health problems such as depression, anxiety and insomnia were significantly associated with discomfort. CONCLUSION The emotional contact between patient and examiner seemed to have great importance when focusing on discomfort during the gynecologic examination. Furthermore, we found that discomfort was associated with a number of factors that are seldom known to the gynecologists, such as sexual abuse history, mental health problems and patients' sexual life. Gynecologists need to focus on the emotional contact and to reevaluate issues for communication before the examination.
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Affiliation(s)
- Malene Hilden
- Department of Obstetrics and Gynecology, Glostrup University Hospital, Copenhagen/Center for Victims of Sexual Assault, H:S Rigshospitalet, Copenhagen, Denmark.
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Wijma B, Schei B, Swahnberg K, Hilden M, Offerdal K, Pikarinen U, Sidenius K, Steingrimsdottir T, Stoum H, Halmesmäki E. Emotional, physical, and sexual abuse in patients visiting gynaecology clinics: a Nordic cross-sectional study. Lancet 2003; 361:2107-13. [PMID: 12826432 DOI: 10.1016/s0140-6736(03)13719-1] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Abuse against women causes much suffering for individuals and is a major concern for society. We aimed to estimate the prevalence of three types of abuse in patients visiting gynaecology clinics in five Nordic countries, and to assess the frequency with which gynaecologists identify abuse victims. METHODS We did a cross-sectional, multicentre study of women attending five departments of gynaecology in Denmark, Finland, Iceland, Norway, and Sweden. We recruited 4729 patients; 3641 (77%) responded and were included in the study. Participants completed a postal questionnaire (norvold abuse questionnaire) confidentially. Primary outcome measures were prevalences of emotional, physical, and sexual abuse, and whether abused patients had told their gynaecologist about these experiences. We assessed differences between countries with Pearson's chi(2) test. FINDINGS The ranges across the five countries of lifetime prevalence were 38-66% for physical abuse, 19-37% for emotional abuse, and 17-33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92-98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit. INTERPRETATION Despite prevalences of emotional, physical, and sexual abuse being high in patients visiting gynaecology clinics in the Nordic countries, most victims of abuse are not identified by their gynaecologists. This lack of discussion might increase the risk of abused patients not being treated according to their needs. Gynaecologists should always consider asking their patients about abuse.
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Affiliation(s)
- B Wijma
- Division of Women's Health, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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27
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Worm AM, Sidenius K, Hilden M. [Sexually transmitted infections and sexual violence against women. Guidelines for examination, prophylactic treatment and follow-up]. Ugeskr Laeger 2002; 164:4768-73. [PMID: 12407878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Based upon a literature search, but also considering the situation in Denmark, guidelines for examination, prophylactic treatment and follow-up of female victims of sexual assault have been prepared. A pragmatic attitude, looking upon the victim's situation and fear of having acquired a sexually transmitted infection, has been prevailing in order to avoid unnecessary examinations and treatments. The guidelines are directed towards female victims in whom the assault has included vaginal, oral, and/or anal penetration or attempt of penetration. It is concluded that all victims should be screened for and offered prophylactic treatment for chlamydia. Screening for gonorrhea initially and at follow-up is recommended but treatment only if an infection has been established. All victims should be screened for hepatitis B initially and again after three months and vaccination offered if any information indicates that the assailant has an increased risk of hepatitis B. All victims should be screened for HIV initially and again after one and three months. In single cases antiviral HIV prophylaxis must be considered.
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Affiliation(s)
- Anne-Marie Worm
- Center for Voldtaegtsofre, afsnit 4073, H:S Rigshospitalet, DK-2100 København ø
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28
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Hilden M, Sidenius K. [Sexual dysfunction after rape]. Ugeskr Laeger 2002; 164:4801-3. [PMID: 12407888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- Malene Hilden
- Center for Voldtaegtsofre, JMC, afsnit 5032, H:S Rigshospitalet, Blegdamsvejn 9, DK-2100 København ø
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29
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Schei B, Wijma B, Svahnberg K, Sidenius K, Hilden M, Pikarinen U, Halmesmäki E, Steingrimsdottir T, Offerdal K, Stoum H. History of abuse among gynaecological patients - A five country nordic study. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)86260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Hilden M. History of sexual abuse and gynecological examination in Danish patients visiting gynecological in-and out-patient clinic. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)81884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Luurila OJ, Härkönen R, Hilden M, Icen R, Kohvakka A, Linna M, Sillanpää J, Vänskä O, Lukkala K. Carvedilol and atenolol once daily in the treatment of hypertension. J Hypertens Suppl 1989; 7:S264-5. [PMID: 2576666 DOI: 10.1097/00004872-198900076-00128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fifty milligrams of carvedilol and 100 mg atenolol were administered in a random order once a day for 2 months to 43 patients with mild to moderate hypertension, in a double-blind crossover study. Blood pressure, heart rate and peripheral blood flow parameters (n = 11) were recorded 2 and 24 h after the drug administration. Supine blood pressure was the same 2 h after both carvedilol and atenolol administration, but carvedilol caused a greater decrease in standing systolic blood pressure 2 h after the administration (P less than 0.05). The heart rate decreased less with carvedilol (P less than 0.01). There was no difference in the effects exerted by the two therapies on systolic blood pressure and the heart rate 24 h after drug administration, but the diastolic blood pressure was higher in patients given carvedilol (92 versus 88 mmHg; P less than 0.05). Forearm blood flow, forearm vascular resistance and calf blood flow did not change significantly with either of the therapies. In conclusion, 50 mg carvedilol once a day is an effective antihypertensive therapy, though its duration of action did not reach that of 100 mg atenolol once a day. Peripheral vasodilation was similar with both therapies.
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Affiliation(s)
- O J Luurila
- Orion Pharmaceutica, Research Centre, Espoo, Finland
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32
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Madsen JK, Pedersen F, Amtoft A, Deding A, Grande P, Hansen JN, Hilden M, Hornum I, Jensen T, Lindskov J. [Reduction of mortality in acute myocardial infarction with streptokinase and aspirin therapy. Results of ISIS-2]. Ugeskr Laeger 1989; 151:2565-9. [PMID: 2683281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This investigation includes 17,187 patients in 417 hospitals in 16 countries admitted within 24 hours of the commencement of symptoms of acute myocardial infarction (AMI). The patients were allotted at random to the following treatments 1) intravenous infusion of 1.5 million International Units streptokinase (SK) during one hour, 2) 160 mg acetyl salicylic acid (ASA) daily for 30 days, 3) both SK and ASA and 4) placebo treatment only. The five-week cardiovascular mortality was reduced by 25% following infusion of streptokinase from 12.0% to 9.2% and by 23% during ASA treatment from 11.8% to 9.4%. The combination of SK and ASA resulted in 42% reduction in the cardiovascular mortality after five weeks compared with the placebo. The effect of SK was greatest if treatment was instituted within six hours but effects were obtained after all of the first 24 hours. The preliminary results show that the reduction in mortality obtained by both SK and ASA appears to continue during the subsequent one to two years. SK treatment resulted in haemorrhage requiring treatment in 0.5% as compared with 0.2% in the placebo group, more cases of proved cerebral haemorrhage, 0.1% as compared with 0.0%, but fewer cases of cerebral apoplexy, 0.7% as compared with 0.8%. It is concluded that thrombolysis with SK combined with prophylaxis of repeated thrombosis with ASA is the indicated treatment in cases of AMI and less than 6-24 hours duration.
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Abstract
This study provides clear documentation of in vivo biogenesis of erythropoietin (Epo) by a human renal carcinoma. A middle-aged woman with a clear cell renal carcinoma of the left kidney developed severe polycythemia. This polycythemia was accompanied by markedly elevated levels of immunoreactive erythropoietin both in the peripheral venous blood, and in blood derived from the left renal vein during nephrectomy. Exstirpation of the non-invasive renal carcinoma was followed by complete restoration of both hematocrit and erythropoietin plasma concentration to normal levels. The fall in plasma erythropietin concentration immediately after nephrectomy (T/2 less than or equal to 3 hours) was probably a valid representation of plasma erythropoietin metabolism in this patient. Direct evidence of erythropoietin production in individual renal carcinoma cells was provided by immunoperoxidase studies demonstrating focal cytoplasmatic accumulation of immunoreactive erythropoietin in the tumor cells.
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Affiliation(s)
- O J Nielsen
- Dept. of Internal Medicine & Hematology, Gentofte University Hospital, Hellerup, Denmark
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34
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Bellens J, Halver B, Hilden M, Jakobsen G, Nilsson PT, Petersen I, Stürup H. [Analgesic treatment with levomepromazine (Nozinan) and methadone in patients with acute myocardial infarction: a double-blind randomized study]. Ugeskr Laeger 1981; 143:1313-6. [PMID: 6170148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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35
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Hilden M, Christoffersen P, Juhl E, Dalgaard JB. Liver histology in a 'normal' population--examinations of 503 consecutive fatal traffic casualties. Scand J Gastroenterol 1977; 12:593-7. [PMID: 918553 DOI: 10.3109/00365527709181339] [Citation(s) in RCA: 166] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The liver histology of 503 consecutive victims of fatal (within 24 hours) traffic accidents submitted to medico-legal autopsy are used as a standard of reference. In 370 persons (74%) no pathological changes in the liver biopsies were observed. Fatty liver was found in 120 persons (24%), non-specific portal inflammation in 7 persons, alcoholic hepatitis in 6, and portal fibrosis in 5. No cases of cirrhosis, chronic aggressive hepatitis, changes compatible with chronic persistent hepatitis, viral hepatitis, or other internationally accepted morphological diagnoses were found. A significant positive correlation between the frequency of steatosis and age groups was demonstrable. Fatty liver was found in 1% of persons below 20 years, in 18% between 20--40 years, and in 39% of persons more than 60 years in this normal material. The persons with fatty liver had a higher body weight, but the overweight was not correlated to age. It is concluded that fatty infiltration in the liver is a normal observation in aged persons.
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Abstract
In a medical department, specialized in liver diseases, 45 patients (33 men and 12 women) suffering from steatosis of the liver have been examined with reference to serum lipid abnormalities. Twenty-eight of the patients were chronic alcoholics. Annual check-ups, including biopsy of the liver, were made to evaluate the development of the steatosis. The patients did not receive treatment with drugs or diet. Thirteen patients showed hypercholesterolemia, 16 increased serum triglyceride and 8 increased serum phosphorus lipid. Two showed a type I lipoprotein anomaly and 33 a type II-like pattern, defined as increased beta-lipoprotein associated with increase of serum cholesterol, was found in four cases. Three had a type III and three a type IV abnormal pattern, with increased pre-beta-lipoprotein and serum triglyceride levels. Correlation analysis revealed correlations between pre-beta-lipoprotein and serum triglyceride as well as between serum triglyceride and serum free fatty acid levels.
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37
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38
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Olsen F, Hilden M, Jessen K, Loft B. Arterial hypertension, unilateral contracted kidney and subclavian steal syndrome. Acta Med Scand 1974; 196:137-9. [PMID: 4423781 DOI: 10.1111/j.0954-6820.1974.tb00983.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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39
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40
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Hilden M, Juhl E, Thomsen AC, Christoffersen P. Fatty liver persisting for up to 33 years. A follow-up of the inversen-roholm liver biopsy material. Acta Med Scand 1973; 194:485-9. [PMID: 4773448 DOI: 10.1111/j.0954-6820.1973.tb19478.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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41
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Olsen F, Hilden M, Ibsen H. Raised levels of immunoglobulins in serum of hypertensive patients. Acta Pathol Microbiol Scand B Microbiol Immunol 1973; 81:775-8. [PMID: 4521972 DOI: 10.1111/j.1699-0463.1973.tb02275.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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42
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Rehfeld JF, Juhl E, Hilden M. Carbohydrate metabolism in alcohol-induced fatty liver. Evidence for an abnormal insulin response to glucagon in alcoholic liver disease. Gastroenterology 1973; 64:445-51. [PMID: 4691595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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43
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Prytz H, Björneboe M, Orskov F, Hilden M. Antibodies to Escherichia coli in alcoholic and non-alcoholic patients with cirrhosis of the liver or fatty liver. Scand J Gastroenterol 1973; 8:433-8. [PMID: 4584759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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44
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Brandt NJ, Hilden M. [Homocystinuria]. Ugeskr Laeger 1972; 134:494-7. [PMID: 4552175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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45
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Hilden M, Brandt NJ, Schonheyder F, Quaade F. [A case of homocystinuria]. Ugeskr Laeger 1972; 134:498-502. [PMID: 5013687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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46
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Hilden M, Lauritsen O. The fibrinolytic system of plasma after electroshock. Scand J Clin Lab Invest 1971; 28:435-7. [PMID: 4258036 DOI: 10.3109/00365517109095720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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47
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48
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Iversen Hansen R, Hilden M, Amris CJ. [Hemophiliac patient operated on for hyperparathyroidism and duodenal ulcer]. Ugeskr Laeger 1969; 131:273-4. [PMID: 5771028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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49
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Amris CJ, Hilden M. Treatment of factor XIII deficiency with cryoprecipitate. Thromb Diath Haemorrh 1968; 20:528-33. [PMID: 5710469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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50
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Hilden M, Leth A, Hilden T. [High hemoglobin values during medical treatment of hypertension]. Ugeskr Laeger 1968; 130:1815-20. [PMID: 5728002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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