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Søgaard R, Holbech H, Nørum U, Bjerregaard P. Investigation of the in vivo estrogenicity of the UV-filters 4-methylbenzylidene camphor and octyl methoxy cinnamate in rainbow trout (Oncorhynchus mykiss). Ecotoxicol Environ Saf 2021; 224:112657. [PMID: 34411820 DOI: 10.1016/j.ecoenv.2021.112657] [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] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
The estrogenic activity of the chemical UV-filters, 4-methylbenzylidene camphor (4-MBC) and octyl methoxy cinnamate (OMC) was investigated in an in vivo rainbow trout (Oncorhynchus mykiss) assay. Plasma vitellogenin concentrations were quantified by means of an Enzyme Linked Immuno Sorbent Assay (ELISA) in juvenile rainbow trout before and after intraperitoneal injection of the test compounds. Injection of 4-MBC on day 0, 3, 6 and 10 in the exposure period caused dose and time dependent increases in the concentration of plasma vitellogenin. Significant elevation of vitellogenin concentrations in plasma was demonstrated from 151 mg 4-MBC kg-1 injection-1. Logistic regression analysis relating the percentage of responding fish to the injected dose of 4-MBC resulted in ED10, ED50 and ED90 values of 37, 115 and 194 mg kg-1 injection-1, respectively, after 14 days of exposure (4 injections). Injections with OMC (up to 202 mg kg-1 injection-1) did not result in a statistically significant response in groups of exposed fish, although some individual fish showed elevated concentrations of vitellogenin in plasma. The results confirm that 4-MBC is estrogenic in fish in vivo.
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Affiliation(s)
- Rasmus Søgaard
- Department of Biology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Henrik Holbech
- Department of Biology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Ulrik Nørum
- Department of Biology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Poul Bjerregaard
- Department of Biology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.
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Lindholt JS, Rasmussen LM, Søgaard R, Lambrechtsen J, Steffensen FH, Frost L, Egstrup K, Urbonaviciene G, Busk M, Olsen MH, Hallas J, Diederichsen AC. Baseline findings of the population-based, randomized, multifaceted Danish cardiovascular screening trial (DANCAVAS) of men aged 65–74 years. Br J Surg 2019; 106:862-871. [DOI: 10.1002/bjs.11135] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background
The challenge of managing age-related diseases is increasing; routine checks by the general practitioner do not reduce cardiovascular mortality. The aim here was to reduce cardiovascular mortality by advanced population-based cardiovascular screening. The present article reports the organization of the study, the acceptability of the screening offer, and the relevance of multifaceted screening for prevention and management of cardiovascular disease.
Methods
Danish men aged 65–74 years were invited randomly (1 : 2) to a cardiovascular screening examination using low-dose non-contrast CT, ankle and brachial BP measurements, and blood tests.
Results
In all, 16 768 of 47 322 men aged 65–74 years were invited and 10 471 attended (uptake 62·4 per cent). Of these, 3481 (33·2 per cent) had a coronary artery calcium score above 400 units. Thoracic aortic aneurysm was diagnosed in the ascending aorta (diameter 45 mm or greater) in 468 men (4·5 per cent), in the arch (at least 40 mm) in 48 (0·5 per cent) and in the descending aorta (35 mm or more) in 233 (2·2 per cent). Abdominal aortic aneurysm (at least 30 mm) and iliac aneurysm (20 mm or greater) were diagnosed in 533 (5·1 per cent) and 239 (2·3 per cent) men respectively. Peripheral artery disease was diagnosed in 1147 men (11·0 per cent), potentially uncontrolled hypertension (at least 160/100 mmHg) in 835 (8·0 per cent), previously unknown atrial fibrillation confirmed by ECG in 50 (0·5 per cent), previously unknown diabetes mellitus in 180 (1·7 per cent) and isolated severe hyperlipidaemia in 48 men (0·5 per cent).
In all, 4387 men (41·9 per cent), excluding those with potentially uncontrolled hypertension, were referred for additional cardiovascular prevention. Of these, 3712 (35·5 per cent of all screened men, but 84·6 per cent of those referred) consented and were started on medication.
Conclusion
Multifaceted cardiovascular screening is feasible and may optimize cardiovascular disease prevention in men aged 65–74 years. Uptake is lower than in aortic aneurysm screening.
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Affiliation(s)
- J S Lindholt
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - L M Rasmussen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - R Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J Lambrechtsen
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - F H Steffensen
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - L Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - K Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - M H Olsen
- CIMA, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - J Hallas
- Institute of Pharmacology, University of Southern Denmark, Odense, Denmark
| | - A C Diederichsen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiology, Odense University Hospital, Odense, Denmark
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Søgaard R, Lindholt JS. Cost-effectiveness of population-based vascular disease screening and intervention in men from the Viborg Vascular (VIVA) trial. Br J Surg 2018; 105:1283-1293. [DOI: 10.1002/bjs.10872] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/22/2018] [Accepted: 03/08/2018] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Population-based screening and intervention for abdominal aortic aneurysm, peripheral artery disease and hypertension was recently reported to reduce the relative risk of mortality among Danish men by 7 per cent. The aim of this study was to investigate the cost-effectiveness of vascular screening versus usual care (ad hoc primary care-based risk assessment) from a national health service perspective.
Methods
A cost-effectiveness evaluation was conducted alongside an RCT involving all men from a region in Denmark (50 156) who were allocated to screening (25 078) or no screening (25 078) and followed for up to 5 years. Mobile nurse teams provided screening locally and, for individuals with positive test results, referrals were made to general practices or hospital-based specialized centres for vascular surgery. Intention-to-treat-based, censoring-adjusted incremental costs (2014 euros), life-years and quality-adjusted life-years (QALYs) were estimated using Lin's average estimator method. Incremental net benefit was estimated using Willan's estimator and sensitivity analyses were conducted.
Results
The cost of screening was estimated at €148 (95 per cent c.i. 126 to 169), and the effectiveness at 0·022 (95 per cent c.i. 0·006 to 0·038) life-years and 0·069 (0·054 to 0·083) QALYs, generating average costs of €6872 per life-year and €2148 per QALY. At a willingness-to-pay threshold of €40 000 per QALY, the probabilities of cost-effectiveness were 98 and 99 per cent respectively. The probability of cost-effectiveness was 71 per cent when all the sensitivity analyses were combined into one conservative scenario.
Conclusion
Vascular screening appears to be cost-effective and compares favourably with current screening programmes.
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Affiliation(s)
- R Søgaard
- Departments of Public Health and Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J S Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, and Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark
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Lindholt J, Søgaard R. Population Screening and Intervention for Vascular Disease in Danish Men (VIVA): A Randomised Controlled Trial. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.10.041] [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: 10/18/2022]
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Kristensen PK, Søgaard R, Thillemann TM, Johnsen SP. ISQUA17-2286IS HIGH QUALITY OF CARE ASSOCIATED WITH HIGHER COSTS? - A NATIONWIDE COHORT STUDY AMONG HIP FRACTURE PATIENTS. Int J Qual Health Care 2017. [DOI: 10.1093/intqhc/mzx125.26] [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: 11/13/2022] Open
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Kvist T, Lindholt J, Rasmussen L, Søgaard R, Lambrechtsen J, Steffensen F, Frost L, Olsen M, Mickley H, Hallas J, Urbonaviciene G, Busk M, Egstrup K, Diederichsen A. The DanCavas Pilot Study of Multifaceted Screening for Subclinical Cardiovascular Disease in Men and Women Aged 65–74 Years. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2016.12.051] [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: 11/15/2022]
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Kvist TV, Lindholt JS, Rasmussen LM, Søgaard R, Lambrechtsen J, Steffensen FH, Frost L, Olsen MH, Mickley H, Hallas J, Urbonaviciene G, Busk M, Egstrup K, Diederichsen ACP. The DanCavas Pilot Study of Multifaceted Screening for Subclinical Cardiovascular Disease in Men and Women Aged 65-74 Years. Eur J Vasc Endovasc Surg 2016; 53:123-131. [PMID: 27890524 DOI: 10.1016/j.ejvs.2016.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 03/17/2016] [Accepted: 10/14/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE/BACKGROUND This pilot study of a large population based randomised screening trial investigated feasibility, acceptability, and relevance (prevalence of clinical and subclinical cardiovascular disease [CVD] and proportion receiving insufficient prevention) of a multifaceted screening for CVD. METHODS In total, 2060 randomly selected Danish men and women aged 65-74 years were offered (i) low dose non-contrast computed tomography to detect coronary artery calcification (CAC) and aortic/iliac aneurysms; (ii) detection of atrial fibrillation (AF); (iii) brachial and ankle blood pressure measurements; and (iv) blood levels of cholesterol and hemoglobin A1c. Web based self booking and data management was used to reduce the administrative burden. RESULTS Attendance rates were 64.9% (n = 678) and 63.0% (n = 640) for men and women, respectively. In total, 39.7% received a recommendation for medical preventive actions. Prevalence of aneurysms was 12.4% (95% confidence interval [CI] 9.9-14.9) in men and 1.1% (95% CI 0.3-1.9) in women, respectively (p < .001). A CAC score > 400 was found in 37.8% of men and 11.3% of women (p < .001), along with a significant increase in median CAC score with age (p = .03). Peripheral arterial disease was more prevalent in men (18.8%, 95% CI 15.8-21.8) than in women (11.2%, 95% CI 8.7-13.6). No significant differences between the sexes were found with regard to newly discovered AF (men 1.3%, women 0.5%), potential hypertension (men 9.7%, women 11.5%), hypercholesterolemia (men 0.9%, women 1.1%) or diabetes mellitus (men 2.1%, women 1.3%). CONCLUSION Owing to the higher prevalence of severe conditions, such as aneurysms and CAC ≥ 400, screening for CVD seemed more prudent in men than women. The attendance rates were acceptable compared with other screening programs and the logistical structure of the screening program proved successful.
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Affiliation(s)
- T V Kvist
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark.
| | - J S Lindholt
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - L M Rasmussen
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - R Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J Lambrechtsen
- Department of Cardiology, University Hospital Odense Svendborg, Svendborg, Denmark
| | - F H Steffensen
- Department of Cardiology, Vejle Hospital, Vejle, Denmark
| | - L Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M H Olsen
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - H Mickley
- Department of Cardiology, Odense University Hospital, Odense C, Denmark
| | - J Hallas
- Institute of Pharmacology, University of Southern Denmark, Odense C, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M Busk
- Department of Cardiology, Vejle Hospital, Vejle, Denmark
| | - K Egstrup
- Department of Cardiology, University Hospital Odense Svendborg, Svendborg, Denmark
| | - A C P Diederichsen
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense C, Denmark
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Kvist T, Lindholt J, Rasmussen L, Søgaard R, Lambrechtsen J, Steffensen F, Frost L, Olsen M, Mickley H, Hallas J, Urbonaviciene G, Busk M, Egstrup K, Diederichsen A. The DANCAVAS Pilot Study of Multifaceted Screening for Subclinical Cardiovascular Disease in Men and Women Aged 65–74. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.07.075] [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: 11/29/2022]
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Villemoes M, Lindholt J, Houlind K, Gottschalksen B, Pedersen C, Rasmussen M, Wedel C, Bramsen M, Søgaard R. Cost Effectiveness Analysis of Heparin- Versus Standard Polytetrafluoroethylene Graft alongside a Randomised Controlled Trial with Five Years Follow-Up. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.07.056] [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: 11/29/2022]
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Hansen TB, Zwisler AD, Berg SK, Sibilitz KL, Thygesen LC, Doherty P, Søgaard R. Exercise-based cardiac rehabilitation after heart valve surgery: cost analysis of healthcare use and sick leave. Open Heart 2015; 2:e000288. [PMID: 26301099 PMCID: PMC4538388 DOI: 10.1136/openhrt-2015-000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 01/05/2023] Open
Abstract
Background Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR on the costs of healthcare use and sick leave among heart valve surgery patients over 12 months post surgery. Methods We conducted a nationwide survey on the CR participation of all patients having undergone valve surgery between 1 January 2011 and 30 June 2011 (n=667). Among the responders (n=500, 75%), the resource use categories of primary and secondary healthcare, prescription medication and sick leave were analysed for CR participants (n=277) and non-participants (n=223) over 12 months. A difference-in-difference analysis was undertaken. All estimates were presented as the means per patient (95% CI) based on non-parametric bootstrapping of SEs. Results Total costs during the 12 months following surgery were €16 065 per patient (95% CI 13 730 to 18 399) in the CR group and €15 182 (12 695 to 17 670) in the non-CR group. CR led to 5.6 (2.9 to 8.3, p<0.01) more outpatient visits per patient. No statistically significant differences in other cost categories or total costs €1330 (−4427 to 7086, p=0.65) were found between the groups. Conclusions CR, as provided in Denmark, can be considered cost neutral. CR is associated with more outpatient visits, but CR participation potentially offsets more expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis.
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Affiliation(s)
- T B Hansen
- Department of Cardiology , Roskilde Hospital , Roskilde , Denmark ; Centre for Applied Health Services Research, University of Southern Denmark , Odense , Denmark ; Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - A D Zwisler
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark . ; National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark ; National Centre of Rehabilitation and Palliation, University of Southern Denmark and University Hospital of Odense , Odense , Denmark
| | - S K Berg
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - K L Sibilitz
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark
| | - P Doherty
- Department of Health Sciences , University of York , York , UK
| | - R Søgaard
- Department of Public Health , Aarhus University , Aarhus , Denmark ; Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
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Grøndal N, Søgaard R, Lindholt JS. Baseline prevalence of abdominal aortic aneurysm, peripheral arterial disease and hypertension in men aged 65–74 years from a population screening study (VIVA trial). Br J Surg 2015; 102:902-6. [DOI: 10.1002/bjs.9825] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/10/2014] [Accepted: 03/09/2015] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Abdominal aortic aneurysm (AAA) screening has been introduced into some health systems and could easily be supplemented with broader vascular screening. The aim of this study was to evaluate the screening set-up and investigate combined screening for AAA, peripheral arterial disease (PAD) and possible hypertension (HT), and detection rates.
Methods
This observational study was based on the intervention arm of a screening trial in 25 083 Danish men aged 65–74 years. A combined screening programme for AAA, PAD and HT was offered at local hospitals. Participants with positive test results were offered secondary prophylaxis and/or referred to their general practitioner. The programme set-up included decentralized screening by three mobile teams at 14 venues. Diagnostic criteria were: aortic diameter at least 30 mm for AAA, ankle : brachial pressure index below 0·9 or above 1·4 for PAD, and BP exceeding 160/100 mmHg for HT.
Results
Overall, 18 749 men (uptake 74·7 per cent) attended the screening. An AAA was diagnosed in 3·3 (95 per cent c.i. 3·0 to 3·6) per cent, PAD in 10·9 (10·5 to 11·4) per cent and HT in 10·5 (10·0 to 10·9) per cent. Lipid-lowering and/or antiplatelet treatment was initiated in 34·8 per cent of the participants.
Conclusion
Preventive actions were started in one-third of the attenders. The long-term effect of this on morbidity and mortality is an important part of future analysis. The trial confirms that the prevalence of AAA in Denmark has decreased only slightly in the past decade, from 4·0 to 3·3 per cent, in contrast to other nations.
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Affiliation(s)
- N Grøndal
- Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark
| | - R Søgaard
- Health Economics, Department for Public Health and Department for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J S Lindholt
- Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark
- Department of Thoracic, Heart and Vascular Surgery, Odense University Hospital, Odense, Denmark
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Søgaard R, Lindholt JS. Screening for abdominal aortic aneurysm in a modern context and issues for the future. Eur J Vasc Endovasc Surg 2014; 48:668. [PMID: 25445727 DOI: 10.1016/j.ejvs.2014.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 12/01/2022]
Affiliation(s)
- R Søgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - J S Lindholt
- Elitary Research Centre of Individualised Medicine in Arterial Diseases (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Sdr Boulevard 20, DK-500, Odense C, Denmark.
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Christensen A, Høy K, Bünger C, Helmig P, Hansen ES, Andersen T, Søgaard R. Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion: cost-utility evaluation along side an RCT with a 2-year follow-up. Eur Spine J 2014; 23:1137-43. [DOI: 10.1007/s00586-014-3238-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
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Phung KTT, Waldorff FB, Buss DV, Eckermann A, Keiding N, Rishøj S, Siersma V, Sørensen J, Søgaard R, Sørensen LV, Vogel A, Waldemar G. A three-year follow-up on the efficacy of psychosocial interventions for patients with mild dementia and their caregivers: the multicentre, rater-blinded, randomised Danish Alzheimer Intervention Study (DAISY). BMJ Open 2013; 3:e003584. [PMID: 24270834 PMCID: PMC3840334 DOI: 10.1136/bmjopen-2013-003584] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To examine the long-term efficacy at the 36-month follow-up of an early psychosocial counselling and support programme lasting 8-12 months for community-dwelling patients with mild Alzheimer's disease and their caregivers. DESIGN Multicentre, randomised, controlled, rater-blinded trial. SETTING Primary care and memory clinics in five Danish districts. PARTICIPANTS 330 home-dwelling patients with mild Alzheimer's disease and their primary caregivers (dyads). INTERVENTIONS Dyads were randomised to receive intervention during the first year after diagnosis. Both intervention and control groups had follow-up visits at 3, 6, 12 and 36 months. MAIN OUTCOME MEASURES Primary outcomes for the patients assessed at 36-month follow-up were changes from baseline in global cognitive function (Mini-Mental State Examination), depressive symptoms (Cornell Depression Scale) and proxy-rated EuroQoL quality of life on visual analogue scale. The primary outcomes for the caregivers were changes from baseline in depressive symptoms (Geriatric Depression Scale) and self-rated EuroQoL quality of life on a visual analogue scale. The secondary outcome measures for the patient were proxy-rated Quality of Life Scale for Alzheimer's disease (QoL-AD), Neuropsychiatric Inventory-Questionnaire, Alzheimer's disease Cooperative Study Activities of Daily Living Scale, all-cause mortality and nursing home placement. RESULTS At a 36-month follow-up, 2 years after the completion of the Danish Alzheimer Intervention Study (DAISY), the unadjusted positive effects previously detected at the 12-month follow-up in one patient primary outcome (Cornell depression score) and one patient secondary outcome (proxy-rated QoL-AD) disappeared (Cornell depression score, p=0.93; proxy-rated QoL-AD, p=0.81). No long-term effect of DAISY intervention on any other primary and secondary outcomes was found at the 36-month follow-up. CONCLUSIONS For patients with very mild Alzheimer's disease and their caregivers, an intensive, multi-component, semitailored psychosocial intervention programme with counselling, education and support during the first year after diagnosis did not show any positive long-term effect on primary and secondary outcomes. TRIAL REGISTRATION The study was registered in the Clinical Trial Database (http://www.controlled-trials.com/ISRCTN74848736).
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Affiliation(s)
- Kieu T T Phung
- Memory Disorders Research Group, Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - F B Waldorff
- Memory Disorders Research Group, Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Research Unit and Department of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - D V Buss
- Memory Disorders Research Group, Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - A Eckermann
- Memory Disorders Research Group, Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - N Keiding
- Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S Rishøj
- Memory Disorders Research Group, Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - V Siersma
- Research Unit and Department of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Sørensen
- Centre for Applied Health Services Research (CAST), University of Southern Denmark, Odense, Denmark
| | - R Søgaard
- Centre for Applied Health Services Research (CAST), University of Southern Denmark, Odense, Denmark
| | - L V Sørensen
- Memory Disorders Research Group, Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - A Vogel
- Memory Disorders Research Group, Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - G Waldemar
- Memory Disorders Research Group, Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Lindholt JS, Sørensen J, Søgaard R, Henneberg EW. Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial. Br J Surg 2010; 97:826-34. [DOI: 10.1002/bjs.7001] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background
The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64–73 years.
Methods
All men aged 64–73 years living in Viborg County were randomized to be controls (n = 6306) or invited for abdominal ultrasonography at a regional hospital (n = 6333). Mortality and AAA-related interventions were recorded in national databases. The cost of initial screening was based on actual costs of the programme. Incremental cost-effectiveness ratios (ICERs) were calculated on gains in life years and Quality Adjusted Life Years (QALY). Discounting (3 per cent) was applied to both costs and effects, and all costs were adjusted to euros at 2007 prices.
Results
The relative risk reduction of the screening programme in AAA-related mortality was 66 per cent (hazard ratio 0·34, 95 per cent confidence interval (c.i.) 0·20 to 0·57). The corresponding risk reduction in all-cause mortality was 2 per cent (hazard ratio 0·98, 95 per cent c.i. 0·93 to 1·03). The ICER was estimated at €157 (−3292 to 4401) per life year gained and €179 (−4083 to 4682) per QALY gained. Screening was found to be cost effective at a probability above 0·97 for a willingness-to-pay threshold of only €5000. One-way sensitivity analysis demonstrated that this result was robust to various alternative assumptions, as the probability did not drop below 0·90 for any scenario.
Conclusion
The mortality benefit of screening for AAA in men aged 64–73 years was maintained in the longer term and screening was cost effective. Registration number: ISRCTN65822028 (http://www.controlled-trials.com).
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Affiliation(s)
- J S Lindholt
- Vascular Research Unit, Viborg Hospital, Viborg, Denmark
| | - J Sørensen
- Centre for Applied Health Service Research and Technology Assessment, University of Southern Denmark, Odense, Denmark
| | - R Søgaard
- Centre for Applied Health Service Research and Technology Assessment, University of Southern Denmark, Odense, Denmark
| | - E W Henneberg
- Vascular Research Unit, Viborg Hospital, Viborg, Denmark
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Lundbaek JA, Birn P, Tape SE, Toombes GES, Søgaard R, Koeppe RE, Gruner SM, Hansen AJ, Andersen OS. Capsaicin regulates voltage-dependent sodium channels by altering lipid bilayer elasticity. Mol Pharmacol 2005; 68:680-9. [PMID: 15967874 DOI: 10.1124/mol.105.013573] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
At submicromolar concentrations, capsaicin specifically activates the TRPV1 receptor involved in nociception. At micro- to millimolar concentrations, commonly used in clinical and in vitro studies, capsaicin also modulates the function of a large number of seemingly unrelated membrane proteins, many of which are similarly modulated by the capsaicin antagonist capsazepine. The mechanism(s) underlying this widespread regulation of protein function are not understood. We investigated whether capsaicin could regulate membrane protein function by changing the elasticity of the host lipid bilayer. This was done by studying capsaicin's effects on lipid bilayer stiffness, measured using gramicidin A (gA) channels as molecular force-transducers, and on voltage-dependent sodium channels (VDSC) known to be regulated by bilayer elasticity. Capsaicin and capsazepine (10-100 microM) increase gA channel appearance rate and lifetime without measurably altering bilayer thickness or channel conductance, meaning that the changes in bilayer elasticity are sufficient to alter the conformation of an embedded protein. Capsaicin and capsazepine promote VDSC inactivation, similar to other amphiphiles that decrease bilayer stiffness, producing use-dependent current inhibition. For capsaicin, the quantitative relation between the decrease in bilayer stiffness and the hyperpolarizing shift in inactivation conforms to that previously found for other amphiphiles. Capsaicin's effects on gA channels and VDSC are similar to those of Triton X-100, although these amphiphiles promote opposite lipid monolayer curvature. We conclude that capsaicin can regulate VDSC function by altering bilayer elasticity. This mechanism may underlie the promiscuous regulation of membrane protein function by capsaicin and capsazepine-and by amphiphilic drugs generally.
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Søgaard R, Ljungstrøm T, Pedersen KA, Olesen SP, Jensen BS. KCNQ4 channels expressed in mammalian cells: functional characteristics and pharmacology. Am J Physiol Cell Physiol 2001; 280:C859-66. [PMID: 11245603 DOI: 10.1152/ajpcell.2001.280.4.c859] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [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: 11/22/2022]
Abstract
Human cloned KCNQ4 channels were stably expressed in HEK-293 cells and characterized with respect to function and pharmacology. Patch-clamp measurements showed that the KCNQ4 channels conducted slowly activating currents at potentials more positive than -60 mV. From the Boltzmann function fitted to the activation curve, a half-activation potential of -32 mV and an equivalent gating charge of 1.4 elementary charges was determined. The instantaneous current-voltage relationship revealed strong inward rectification. The KCNQ4 channels were blocked in a voltage-independent manner by the memory-enhancing M current blockers XE-991 and linopirdine with IC(50) values of 5.5 and 14 microM, respectively. The antiarrhythmic KCNQ1 channel blocker bepridil inhibited KCNQ4 with an IC(50) value of 9.4 microM, whereas clofilium was without significant effect at 100 microM. The KCNQ4-expressing cells exhibited average resting membrane potentials of -56 mV in contrast to -12 mV recorded in the nontransfected cells. In conclusion, the activation and pharmacology of KCNQ4 channels resemble those of M currents, and it is likely that the function of the KCNQ4 channel is to regulate the subthreshold electrical activity of excitable cells.
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Affiliation(s)
- R Søgaard
- Division of Cellular and Molecular Physiology, Department of Medical Physiology, University of Copenhagen, DK-2200 Copenhagen N, Denmark
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