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Thinggaard BS, Frederiksen K, Subhi Y, Möller S, Sørensen TL, Kawasaki R, Grauslund J, Stokholm L. VEGF Inhibition Associates With Decreased Risk of Mortality in Patients With Neovascular Age-related Macular Degeneration. Ophthalmol Sci 2024; 4:100446. [PMID: 38313400 PMCID: PMC10837639 DOI: 10.1016/j.xops.2023.100446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
Purpose Controversy exists regarding the systemic safety of intravitreal VEGF inhibitors in the treatment of neovascular age-related macular degeneration (nAMD). We aimed to investigate the potential impact of VEGF inhibitor treatment on the risk of all-cause mortality and cardiovascular disease (CVD) among patients with nAMD. Design A nationwide register-based cohort study with 16 years follow-up. Participants Patients with nAMD exposed with VEGF inhibitors (n = 37 733) and unexposed individuals without nAMD (n = 1 897 073) aged ≥ 65 years residing in Denmark between January 1, 2007, and December 31, 2022. Methods Cox proportional hazards analysis was conducted to assess the effect of intravitreal VEGF inhibitor treatment on all-cause mortality and incident CVD. Main Outcome Measures In a predefined analysis plan we defined primary outcomes as hazard ratios (HRs) of all-cause mortality and a composite CVD endpoint in patients with nAMD treated with VEGF inhibitors compared with individuals without nAMD. The secondary outcomes encompassed analyses that explored the impact of the number of doses and the association between exposure and outcome over a specific time period. Results Overall, 63.7% of patients with nAMD were women with an average age of 69.9 years (interquartile range 65.0-76.0 years). Patients exposed to VEGF inhibitors demonstrated a reduced risk of all-cause mortality compared with individuals without nAMD (HR, 0.79; 95% confidence interval [CI], 0.78-0.81), and an increased risk of composite CVD (HR, 1.04; 95% CI, 1.01-1.07). The decreased risk of all-cause mortality persisted, but there was no significant association between VEGF inhibitor treatment and CVD when patients with nAMD were grouped by the number of doses or considered exposed within 60 days postinjection. Conclusions Our study revealed a decreased risk of all-cause mortality and a 4% increased risk of CVD among patients with nAMD exposed with VEGF inhibitors. The decreased risk of mortality is unlikely to be directly pathophysiologically related to VEGF inhibitor treatment. Instead, we speculate that patients undergoing VEGF inhibitor treatment are, on average, individuals in good health with adequate personal resources. Therefore, they also have a higher likelihood of overall survival. These findings strongly support the safety of VEGF inhibitor treatment in terms of all-cause mortality and CVD among patients with nAMD. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Benjamin Sommer Thinggaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Katrine Frederiksen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Yousif Subhi
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Torben Lykke Sørensen
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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Bay LT, Nielsen DS, Flurey C, Giraldi A, Möller S, Graugaard C, Ellingsen T. Associations of gender with sexual functioning, loneliness, depression, fatigue and physical function amongst patients suffering from rheumatoid arthritis with a particular focus on methotrexate usage. Rheumatol Int 2024; 44:919-931. [PMID: 38483561 PMCID: PMC10980642 DOI: 10.1007/s00296-024-05555-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/31/2024] [Indexed: 04/01/2024]
Abstract
There is a lack of knowledge regarding methotrexate (MTX) usage in patients with rheumatoid arthritis (RA) and its possible links with gender, disease characterization and sexual functioning, loneliness, fatigue and depression. We, therefore, investigated the associations of gender with physical function, fatigue, depression, loneliness and sexual functioning with a particular focus on MTX usage. A cross-sectional study design was used. Inclusion criteria were RA diagnosis, age above 18 years and available data on MTX treatment 1 year after diagnosis. Data consisted of responses from validated questionnaires regarding physical function, fatigue, depression, loneliness and sexual functioning combined with evaluations from medical records. Data were analysed with linear regression models comparing numerical outcome measures between male and female patients and between MTX users and MTX non-users. Amongst 286 patients with RA (69 men and 217 women), 67.8% were MTX users 1 year after diagnosis. Comparing women and men, both overall and within subgroups of MTX usage, we found significantly more adverse outcomes for women than men in physical functioning at diagnosis and in sexual function, depression, fatigue and physical functioning at enrolment in the study. Gender differences were also present when comparing MTX users with MTX non-users divided by gender. There were only significant differences in the HAQ and loneliness scores when comparing MTX users with MTX non-users. Women with RA had more negative outcomes measured by the selected PROMs compared to men with RA, both overall and in subgroups of users and non-users of MTX. These findings call for sharpened attention to the importance of gender in the treatment and care of patients with RA, as well as in future clinical research.
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Affiliation(s)
- Laila T Bay
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital, 5000, Odense, Denmark.
- Department of Gynecology, University of Southern Denmark, 5000, Odense, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Dorthe S Nielsen
- Department of Geriatrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Flurey
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sören Möller
- OPEN, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Christian Graugaard
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital, 5000, Odense, Denmark
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Bang LL, Tornby DR, Pham STD, Assing K, Möller S, Palarasah Y, Madsen LW, Thomsen KG, Johansen IS, Pedersen RM, Andersen TE. Culturing of SARS-CoV-2 from patient samples: Protocol for optimal virus recovery and assessment of infectious viral load. J Virol Methods 2024; 326:114912. [PMID: 38447645 DOI: 10.1016/j.jviromet.2024.114912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/16/2024] [Accepted: 03/02/2024] [Indexed: 03/08/2024]
Abstract
Optimal sampling, preservation, and culturing of SARS-CoV-2 from COVID-19 patients are critical for successful recovery of virus isolates and to accurately estimate contagiousness of the patient. In this study, we investigated the influence of the type of sampling media, storage time, freezing conditions, sterile filtration, and combinations of these to determine the optimal pre-analytic conditions for virus recovery and estimation of infectious viral load in COVID-19 patients. Further, we investigated the viral shedding kinetics and mucosal antibody response in 38 COVID-19 hospitalized patients. We found Universal Transport Medium (Copan) to be the most optimal medium for preservation of SARS-CoV-2 infectivity. Our data showed that the probability of a positive viral culture was strongly correlated to Ct values, however some samples did not follow the general trend. We found a significant correlation between plaque forming units and levels of mucosal antibodies and found that high levels of mucosal antibodies correlated with reduced chance of isolating the virus. Our data reveals essential parameters to consider from specimen collection over storage to culturing technique for optimal chance of isolating SARS-CoV-2 and accurately estimating patient contagiousness.
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Affiliation(s)
- Line L Bang
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ditte R Tornby
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stephanie T D Pham
- Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Kristian Assing
- Department of Clinical Immunology, Odense University Hospital and Research Unit for Clinical Immunology, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense 5000, Denmark
| | - Yaseelan Palarasah
- Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Lone W Madsen
- Department of Infectious Diseases, Odense University Hospital and Research Unit for Infectious Diseases, University of Southern Denmark, Odense, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark; Unit for Infectious Diseases, Department of medicine, Sygehus Lillebælt, Kolding, Denmark
| | - Karina G Thomsen
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital and Research Unit for Infectious Diseases, University of Southern Denmark, Odense, Denmark
| | - Rune M Pedersen
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas E Andersen
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Gehrt L, Englund H, Laake I, Nieminen H, Möller S, Feiring B, Lahdenkari M, Trogstad L, Benn CS, Sørup S. Is vaccination against measles, mumps, and rubella associated with reduced rates of antibiotic treatments among children below the age of 2 years? Nationwide register-based study from Denmark, Finland, Norway, and Sweden. Vaccine 2024; 42:2955-2965. [PMID: 38508926 DOI: 10.1016/j.vaccine.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 02/06/2024] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Previous studies have shown that vaccination against measles, mumps, and rubella (MMR) may have beneficial non-specific effects, reducing the risk of infections not targeted by the vaccine. We investigated if MMR vaccine given after the third dose of diphtheria-tetanus-acellular pertussis vaccine (DTaP3), was associated with reduced rates of antibiotic treatments. METHODS Register-based cohort study following children from the age of recommended MMR vaccination until age 2 years. We included 831,287 children born in Denmark, Finland, Norway, and Sweden who had received DTaP3 but not yet MMR vaccine. Cox proportional hazards regression with age as the underlying timescale and vaccination status as a time-varying exposure was used to estimate covariate-adjusted Hazard Ratios (aHRs) and inverse probability of treatment weighted (IPTW) HRs of antibiotic treatments. Summary estimates were calculated using random-effects meta-analysis. RESULTS Compared with only having received DTaP3, receipt of MMR vaccine after DTaP3 was associated with reduced rates of antibiotic treatments in all countries: the aHR was 0.92 (0.91-0.93) in Denmark, 0.92 (0.90-0.94) in Finland, 0.84 (0.82-0.85) in Norway, and 0.87 (0.85-0.90) in Sweden, yielding a summary estimate of 0.89 (0.85-0.93). A stronger beneficial association was seen in a negative control exposure analysis comparing children vaccinated with DTaP3 vs two doses of DTaP. CONCLUSIONS Across the Nordic countries, receipt of MMR vaccine after DTaP3 was associated with an 11% lower rate of antibiotic treatments. The negative control analysis suggests that the findings are affected by residual confounding. Findings suggest that potential non-specific effects of MMR vaccine are of limited clinical and public health importance for the milder infections treated out-of-hospital in the Nordic setting.
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Affiliation(s)
- Lise Gehrt
- Bandim Health Project, Research Unit OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense C, Denmark; Danish Institute for Advanced Study, University of Southern Denmark, Odense C, Denmark.
| | - Hélène Englund
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health Oslo, Norway
| | - Heta Nieminen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense C, Denmark
| | - Berit Feiring
- Division of Infection Control, Norwegian Institute of Public Health Oslo, Norway
| | - Mika Lahdenkari
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lill Trogstad
- Division of Infection Control, Norwegian Institute of Public Health Oslo, Norway
| | - Christine Stabell Benn
- Bandim Health Project, Research Unit OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense C, Denmark; Danish Institute for Advanced Study, University of Southern Denmark, Odense C, Denmark
| | - Signe Sørup
- Bandim Health Project, Research Unit OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense C, Denmark; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Clausen A, Möller S, Skjødt MK, Lynggaard RB, Vinholt PJ, Lindberg-Larsen M, Søndergaard J, Abrahamsen B, Rubin KH. Validity of Major Osteoporotic Fracture Diagnoses in the Danish National Patient Registry. Clin Epidemiol 2024; 16:257-266. [PMID: 38633218 PMCID: PMC11022871 DOI: 10.2147/clep.s444447] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
Objective To evaluate the validity of diagnosis codes for Major Osteoporotic Fracture (MOF) in the Danish National Patient Registry (NPR) and secondly to evaluate whether the fracture was incident/acute using register-based definitions including date criteria and procedural codes. Methods We identified a random sample of 2400 records with a diagnosis code for a MOF in the NPR with dates in the year of 2018. Diagnoses were coded with the 10th revision of the International Classification of Diseases (ICD-10). The sample included 2375 unique fracture patients from the Region of Southern Denmark. Medical records were retrieved for the study population and reviewed by an algorithmic search function and medical doctors to verify the MOF diagnoses. Register-based definitions of incident/acute MOF was evaluated in NPR data by applying date criteria and procedural codes. Results The PPV for MOF diagnoses overall was 0.99 (95% CI: 0.98;0.99) and PPV=0.99 for the four individual fracture sites, respectively. Further, analyses of incident/acute fractures applying date criteria, procedural codes and using patients' first contact in the NPR resulted in PPV=0.88 (95% CI: 0.84;0.91) for hip fractures, PPV=0.78 (95% CI: 0.74;0.83) for humerus fractures, PPV=0.78 (95% CI: 0.73;0.83) for clinical vertebral fractures and PPV=0.87 (95% CI: 0.83;0.90) for wrist fractures. Conclusion ICD-10 coded MOF diagnoses are valid in the NPR. Furthermore, a set of register-based criteria can be applied to qualify if the MOF fracture was incident/acute. Thus, the NPR is a valuable and reliable data source for epidemiological research on osteoporotic fractures.
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Affiliation(s)
- Anne Clausen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Michael Kriegbaum Skjødt
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Herlev Hospital, Copenhagen, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | | | - Pernille Just Vinholt
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Lindberg-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Jens Søndergaard
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Katrine Hass Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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Simonsen MB, Kappel SS, Aunsholt L, Möller S, Sangild PT, Zachariassen G. Mineral supplementation for very preterm infants fed fortified human milk. J Pediatr Gastroenterol Nutr 2024. [PMID: 38587119 DOI: 10.1002/jpn3.12190] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES The safety and feasibility of human milk fortification with bovine colostrum (BC) were investigated in very preterm infants (FortiColos trial, NCT03537365). The BC product contained lower calcium, phosphate, and iron levels compared to the conventional fortifier (CF). We tested whether fortification with BC plus extra phosphate was sufficient to support the infants' mineral status assessed by blood biochemistry. METHODS In a randomised controlled trial (FortiColos, NCT03537365), mineral status was compared after fortification with BC versus CF. Blood calcium, phosphate, and haemoglobin were determined before and up to 3 weeks after the start of fortification (at the mean age of 8-9 days). The maximum supplemental doses of calcium, phosphate, and iron given were retrieved from patient medical records. Results were adjusted for gestational age, birth weight, and enteral nutrition with the mother's own milk and/or donor human milk. RESULTS Blood values of calcium, phosphate, and haemoglobin were similar between groups. Infants in both groups required supplementation with calcium and phosphate, but infants fed BC required higher maximum doses of phosphate and calcium (p < 0.05) to maintain acceptable blood values. Regardless of fortification groups, the most immature (<29 weeks of gestation) and small for gestational age infants showed a higher risk for requiring additional phosphate (OR: 3.9, p < 0.001; OR: 2.14, p = 0.07, respectively). CONCLUSIONS The use of BC as a fortifier for human milk requires additional phosphate and calcium relative to a CF. Regardless of the fortification product, the most immature and small infants require additional mineral supplementation.
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Affiliation(s)
- Marie Bendix Simonsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Susanne Soendergaard Kappel
- Section of Comparative Paediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lise Aunsholt
- Section of Comparative Paediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Per Torp Sangild
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Section of Comparative Paediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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Baeksgaard Jensen L, Yilmaz M, Nordsmark M, Möller S, Elle IC, Ladekarl M, Qvortrup C, Pfeiffer P. TRIFLURIDINE/TIPIRACIL (FTD/TPI) with or without bevacizumab in previously treated patients with esophago-gastric adenocarcinoma, a randomised phase III trial. EClinicalMedicine 2024; 70:102521. [PMID: 38495525 PMCID: PMC10940909 DOI: 10.1016/j.eclinm.2024.102521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/03/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Background Trifluridine-tipiracil has shown a survival benefit compared with placebo in patients with chemorefractory metastatic esophago-gastric adenocarcinoma. We aimed to compare the efficacy of trifluridine-tipiracil plus bevacizumab vs trifluridine-tipiracil monotherapy in pre-treated patients with metastatic esophago-gastric adenocarcinoma. Methods This investigator-initiated, open-label, randomized trial enrolled patients with metastatic esophago-gastric adenocarcinoma. The main inclusion criteria were patients with pre-treated metastatic esophago-gastric adenocarcinoma, and WHO performance status 0 or 1. Participants were randomly assigned (1:1) to receive oral trifluridine-tipiracil (35 mg/m2 twice daily on days 1-5 and 8-12 every 28 days) alone or combined with bevacizumab (5 mg/kg on days 1 and 15) until progression, unacceptable toxicity, or patient decision to withdraw. Randomisation was stratified by sex and treatment line. The primary endpoint was investigator-evaluated progression-free survival. All analyses were based on intention to treat. This trial is registered with EudraCT, 2018-004845-18. Findings From Oct 1, 2019, to Sept 30, 2021, 103 patients were enrolled and randomly assigned to trifluridine-tipiracil (n = 53) or trifluridine-tipiracil plus bevacizumab (n = 50). The clinical cut-off date was March 1st, 2023, after a median follow-up of 36.6 months. Median progression-free survival was 3.1 months (95% CI 2.0-4.3) in the trifluridine-tipiracil group vs 3.9 months (3.0-6.3) in the trifluridine-tipiracil plus bevacizumab group (hazard ratio 0.68, 95% CI 0.46-1.02; p = 0.058). The most frequent grade 3 or worse adverse event was neutropenia, observed in 26 (49%) patients in the trifluridine-tipiracil group vs 23 patients (46%) in the trifluridine-tipiracil plus bevacizumab group. At least one hospitalization was observed in 21 patients (40%) in the trifluridine-tipiracil group and 22 patients (44%) in the trifluridine-tipiracil plus bevacizumab group. No deaths were deemed treatment related. Interpretation In patients with pre-treated metastatic esophago-gastric cancer, trifluridine-tipiracil plus bevacizumab, compared to trifluridine-tipiracil monotherapy, did not significantly prolong progression-free survival. The combination of trifluridine-tipiracil with bevacizumab was well tolerated without increase in severe neutropenia and no new safety signals. Funding Servier, Roche.
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Affiliation(s)
| | - Mette Yilmaz
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sören Möller
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Denmark
| | | | - Morten Ladekarl
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Denmark
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Pedersen FN, Stokholm L, Andersen N, Andresen J, Bek T, Hajari J, Heegaard S, Højlund K, Kawasaki R, Laugesen CS, Möller S, Schielke K, Nielsen JS, Stidsen JV, Thomsen RW, Thinggaard B, Grauslund J. Risk of diabetic retinopathy according to subtype of type 2 diabetes. Diabetes 2024:db240016. [PMID: 38498373 DOI: 10.2337/db24-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
Type 2 diabetes is a heterogeneous disease that can be subdivided based on beta-cell function and insulin sensitivity. We aimed to investigate the presence, incidence and progression of diabetic retinopathy (DR) according to subtypes of type 2 diabetes. In a national cohort, we identified three subtypes of type 2 diabetes which included classical, hyperinsulinemic and insulinopenic type 2 diabetes based on HOMA2 measurements. From the Danish Registry of Diabetic Retinopathy (DiaBase) we extracted information on level of DR. We used several national health registries to link information on comorbidity, medications and laboratory tests. We found individuals with hyperinsulinemic type 2 diabetes were less likely to have DR at entry date compared to classical type 2 diabetes, whereas individuals with insulinopenic type 2 diabetes were more likely to have DR. In multivariable Cox regression analysis, individuals with hyperinsulinemic type 2 diabetes had a decreased risk of both incidence and progression of DR compared to classical type 2 diabetes. We did not find any clear difference in risk of incident or progression of DR in individuals with insulinopenic compared to classical type 2 diabetes. These findings indicate that subcategorization of type 2 diabetes is important in evaluating the future risk of DR.
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Affiliation(s)
- Frederik N Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN - Open Patient data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Javad Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Ryo Kawasaki
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Japan
| | - Caroline S Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN - Open Patient data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Katja Schielke
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Steen Nielsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Jacob V Stidsen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Benjamin Thinggaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN - Open Patient data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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9
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Petersen LLK, Dursun MD, Madsen G, Le DQS, Möller S, Qvist N, Ellebæk MB. Poly-ϵ-caprolactone scaffold as staple-line reinforcement of rectal anastomosis: an experimental piglet study. BMC Gastroenterol 2024; 24:112. [PMID: 38491416 PMCID: PMC10943786 DOI: 10.1186/s12876-024-03202-1] [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: 11/21/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
PURPOSE Rectal anastomoses have a persisting high incidence of anastomotic leakage. This study aimed to assess whether the use of a poly-ϵ-caprolactone (PCL) scaffold as reinforcement of a circular stapled rectal anastomosis could increase tensile strength and improve healing compared to a control in a piglet model. METHOD Twenty weaned female piglets received a stapled rectal anastomosis and were randomised to either reinforcement with PCL scaffold (intervention) or no reinforcement (control). On postoperative day five the anastomosis was subjected to a tensile strength test followed by a histological examination to evaluate the wound healing according to the Verhofstad scoring. RESULTS The tensile strength test showed no significant difference between the two groups, but histological evaluation revealed significant impaired wound healing in the intervention group. CONCLUSION The incorporation of a PCL scaffold into a circular stapled rectal anastomosis did not increase anastomotic tensile strength in piglets and indicated an impaired histologically assessed wound healing.
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Affiliation(s)
- Laura Lovisa Køtlum Petersen
- Research Unit of Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Martin Dennis Dursun
- Research Unit of Surgery, Odense University Hospital, Odense, Denmark.
- University of Southern Denmark, Odense, Denmark.
| | - Gunvor Madsen
- Research Unit of Pathology, Odense University Hospital, Odense, Denmark
| | | | - Sören Möller
- Open Patient data Explorative Network, Department of Clinical Research, Odense University Hospital and Research unit OPEN, University of Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Research Unit of Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit of Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
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10
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Cuk P, Tiskus M, Möller S, Lambertsen KL, Backer Mogensen C, Festersen Nielsen M, Helligsø P, Gögenur I, Bremholm Ellebæk M. Surgical stress response in robot-assisted versus laparoscopic surgery for colon cancer (SIRIRALS): randomized clinical trial. Br J Surg 2024; 111:znae049. [PMID: 38445434 DOI: 10.1093/bjs/znae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Evidence for the routine use of robotic technology and its impact on short-term outcomes in colon cancer surgery is lacking. The aim of this study was to compare the surgically induced systemic stress response and clinical and patient-reported outcomes for patients undergoing robot-assisted or laparoscopic colon cancer surgery. METHODS In this double-blinded superiority RCT completed between August 2021 and March 2023, patients with stage 1-3 colon cancer were randomized in a 1 : 1 ratio to undergo either robot-assisted or laparoscopic colon cancer surgery. The primary outcome was changes in the systemic stress response, characterized by C-reactive protein expression in the first three postoperative days. Secondary outcomes were intraoperative and postoperative complications and patient-reported outcomes. The latter included quality of recovery-15 and pain intensity using a visual analogue scale. RESULTS In total, 128 patients were screened for potential inclusion in this study; 50 patients (25 in the robot-assisted group and 25 in the laparoscopic group) were included in the final follow-up and analysis. The postoperative C-reactive protein response was higher on the first postoperative day in the laparoscopic group (mean difference = 19.88 mg/l, 95% c.i. 3.89-35.86; P = 0.045). No statistically significant differences were noted for C-reactive protein expression on the second and third postoperative days. CONCLUSION Adopting robot-assisted surgery for stage 1-3 colon cancer is associated with a reduction in the surgical stress response. REGISTRATION NUMBER NCT04687384 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Pedja Cuk
- Department of General and Colorectal Surgery, University Hospital of Southern Jutland, Aabenraa, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Mindaugas Tiskus
- Department of General and Colorectal Surgery, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kate Lykke Lambertsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, BRIDGE, Brain Research-Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Hospital Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Michael Festersen Nielsen
- Department of General and Colorectal Surgery, University Hospital of Southern Jutland, Aabenraa, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Per Helligsø
- Department of General and Colorectal Surgery, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Ismail Gögenur
- Surgical Department, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - Mark Bremholm Ellebæk
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit of Surgery, Odense University Hospital, Odense, Denmark
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11
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Christensen MH, Bistrup C, Rubin KH, Nohr EA, Vinter CA, Andersen MS, Möller S, Jensen DM. Kidney Disease in Women With Previous Gestational Diabetes Mellitus: A Nationwide Register-Based Cohort Study. Diabetes Care 2024; 47:401-408. [PMID: 38100751 DOI: 10.2337/dc23-1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE The association between gestational diabetes mellitus (GDM) and incident kidney disease, the mediating effects of diabetes and hypertension, and the impact of severity of metabolic dysfunction during pregnancy on the risk of incident kidney disease were investigated in this study. RESEARCH DESIGN AND METHODS This Danish, nationwide, register-based cohort study included all women giving birth between 1997 and 2018. Outcomes included chronic kidney disease (CKD) and acute kidney disease, based on diagnosis codes. Cox regression analyses explored the association between GDM and kidney disease. A proxy for severity of metabolic dysfunction during pregnancy was based on GDM diagnosis and insulin treatment during GDM in pregnancy and was included in the models as an interaction term. The mediating effects of subsequent diabetes and hypertension prior to kidney disease were quantified using mediation analyses. RESULTS Data from 697,622 women were used. Median follow-up was 11.9 years. GDM was associated with higher risk of CKD (adjusted hazard ratio [aHR] 1.92; 95% CI 1.67-2.21), whereas acute kidney disease was unrelated to GDM. The proportions of indirect effects of diabetes and hypertension on the association between GDM and CKD were 75.7% (95% CI 61.8-89.6) and 30.3% (95% CI 25.2-35.4), respectively, as assessed by mediation analyses. The CKD risk was significantly increased in women with insulin-treated GDM and no subsequent diabetes compared with women without GDM (aHR 2.35; 95% CI 1.39-3.97). CONCLUSIONS The risk of CKD was significantly elevated after GDM irrespective of subsequent development of diabetes and hypertension. Furthermore, women with severe metabolic dysfunction during pregnancy had the highest CKD risk.
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Affiliation(s)
- Maria Hornstrup Christensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Claus Bistrup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Katrine Hass Rubin
- Research Unit Open Patient data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense University Hospital, Odense, Denmark
| | - Ellen Aagaard Nohr
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christina Anne Vinter
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Skovsager Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Sören Möller
- Research Unit Open Patient data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense University Hospital, Odense, Denmark
| | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Hansen DL, Maquet J, Lafaurie M, Möller S, Berentsen S, Frederiksen H, Moulis G, Gaist D. Primary autoimmune haemolytic anaemia is associated with increased risk of ischaemic stroke: A binational cohort study from Denmark and France. Br J Haematol 2024; 204:1072-1081. [PMID: 38098244 DOI: 10.1111/bjh.19242] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 03/14/2024]
Abstract
Primary autoimmune haemolytic anaemia (AIHA) causes the destruction of red blood cells and a subsequent pro-thrombotic state, potentially increasing the risk of ischaemic stroke. We investigated the risk of ischaemic stroke in patients with AIHA in a binational study. We used prospectively collected data from nationwide registers in Denmark and France to identify cohorts of patients with primary AIHA and age- and sex-matched general population comparators. We followed the patient and comparison cohorts for up to 5 years, with the first hospitalization of a stroke during follow-up as the main outcome. We estimated cumulative incidence, cause-specific hazard ratios (csHR) and adjusted for comorbidity and exposure to selected medications. The combined AIHA cohorts from both countries comprised 5994 patients and the 81 525 comparators. There were 130 ischaemic strokes in the AIHA cohort and 1821 among the comparators. Country-specific estimates were comparable, and the overall adjusted csHR was 1.36 [95% CI: 1.13-1.65], p = 0.001; the higher rate was limited to the first year after AIHA diagnosis (csHR 2.29 [95% CI: 1.77-2.97], p < 10-9 ) and decreased thereafter (csHR 0.89 [95% CI: 0.66-1.20], p = 0.45) (p-interaction < 10-5 ). The findings indicate that patients diagnosed with primary AIHA are at higher risk of ischaemic stroke in the first year after diagnosis.
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Affiliation(s)
- Dennis Lund Hansen
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Julien Maquet
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France
| | - Margaux Lafaurie
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense University Hospital, Odense, Denmark
| | - Sigbjørn Berentsen
- Department of Research and Innovation, Haugesund Hospital, Haugesund, Norway
| | - Henrik Frederiksen
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France
| | - David Gaist
- Research Unit for Neurology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
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13
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Liposits G, Winther SB, Ryg J, Skuladottir H, Möller S, Hofsli E, Shah CH, Poulsen LØ, Berglund Å, Qvortrup C, Osterlund P, Glimelius B, Sorbye H, Pfeiffer P. The effect of BRAF V600E mutation on survival and treatment efficacy in vulnerable older patients with metastatic colorectal cancer - A post-hoc exploratory analysis of the randomized NORDIC9-study. J Geriatr Oncol 2024; 15:101632. [PMID: 37730481 DOI: 10.1016/j.jgo.2023.101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Gabor Liposits
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense, Denmark.
| | - Stine B Winther
- Department of Oncology, Odense University Hospital, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense, Denmark; Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Halla Skuladottir
- Department of Oncology, Regional Hospital Gødstrup, Herning, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Eva Hofsli
- Department of Oncology, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Åke Berglund
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Pia Osterlund
- Department of Oncology, Tampere University Hospital and Tampere University, Tampere, Finland; Department of Oncology, Helsinki University Hospital, Helsinki, Finland; Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Halfdan Sorbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense, Denmark
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14
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Unger P, Schmidt J, Dorow M, Möller S, Palm HW. Reaching the steady state: 30 years of Anguillicola crassus infection of European eel, Anguilla anguilla L., in Northern Germany. Parasitology 2024; 151:300-308. [PMID: 38212980 PMCID: PMC11007276 DOI: 10.1017/s0031182024000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
A 30 years long data series on the infection dynamics of European eel (Anguilla anguilla L.) with the non-native invasive nematode Anguillicola crassus Kuwahara, Niimi & Hagaki, 1974 is presented. Parasite burden was evaluated for 30 years in inland and coastal waters in Mecklenburg-Western Pomerania from 1991 to 2020. The total prevalence, mean intensity and damage status of the swim bladders were very high during the first decade (1991–2000), and significantly decreased in both marine and freshwater eel populations in the following decades (2001–2010, 2011–2020). The parasite intensity of eels in coastal waters was significantly lower compared with the freshwater systems (61.3% vs 79.5% in the first decade), indicating the vulnerability of the parasites to brackish water conditions and the fact that the life cycle of A. crassus cannot be completed under high saline conditions. Eel caught in the western part of the Baltic Sea (west of Darss sill) had the lowest mean infection (51.8% in first decade) compared to the eastern part with 63.8%. Thus, besides different infection patterns caused by the environmental conditions, a temporal trend towards a reduced parasite intensity and a more balanced parasite–host relationship developed in the 30 years of interaction after the first invasion. Possible reasons and mechanisms for the observed trends in parasite–host interactions are discussed.
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Affiliation(s)
- Patrick Unger
- Aquaculture and Sea-Ranching, Faculty of Agricultural and Environmental Sciences, University of Rostock, Justus-von-Liebig-Weg 6, 18059 Rostock, Germany
| | - Johanna Schmidt
- General and Specific Zoology, Institute of Biological Sciences, University of Rostock, Universitätsplatz 2, 18055 Rostock, Germany
- Faculty of Biology and Psychology, Georg-August-University Göttingen, Wilhelmsplatz 1, 37073 Göttingen, Germany
| | - Malte Dorow
- Mecklenburg-Vorpommern Research Centre for Agriculture and Fisheries (LFA-MV), Fischerweg 408, Rostock 18069, Germany
| | - Sören Möller
- General and Specific Zoology, Institute of Biological Sciences, University of Rostock, Universitätsplatz 2, 18055 Rostock, Germany
| | - Harry Wilhelm Palm
- Aquaculture and Sea-Ranching, Faculty of Agricultural and Environmental Sciences, University of Rostock, Justus-von-Liebig-Weg 6, 18059 Rostock, Germany
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15
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Ahrenfeldt LJ, Stripp TA, Möller S, Viftrup DT, Nissen RD, Hvidt NC. Cognitive function among religious and non-religious Europeans: a cross-national cohort study. Aging Ment Health 2024; 28:502-510. [PMID: 37771160 DOI: 10.1080/13607863.2023.2260766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES To examine the associations between several measures and categories of religiosity and cognitive function across sex and European regions. METHODS We conducted a longitudinal study including 17,756 Europeans aged 50 and older who participated in the Survey of Health, Ageing and Retirement in Europe wave 1. Participants were followed for up to 15 years. Associations were analyzed using linear mixed effects models adjusted for several potential confounders. RESULTS Religious service attendance was consistently associated with better cognitive function (coefficient: 1.04, 95% CI 0.71; 1.37) across sex and European regions. Praying was also associated with better cognitive function but only among men (coefficient: 0.55, 95% CI 0.15; 0.96). However, individuals who received religious education from their parents had poorer cognitive function (coefficient: -0.59, 95% CI -0.93; -0.25). The association persisted in women and among both sexes in Western Europe. Comparing different religious categories to the non-religious, participants who were religious in childhood showed an inverse association with cognitive function, while persistently religious men exhibited better cognitive function. CONCLUSIONS Our findings indicate that religious service attendance and, to a certain extent, prayer is associated with better cognitive function. However, receiving religious education in childhood may be linked to lower cognitive function.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tobias Anker Stripp
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Human Flourishing Program, Institute for Quantitative Social Sciences, Harvard University, Cambridge, MA, USA
| | - Sören Möller
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorte Toudal Viftrup
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ricko Damberg Nissen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (Age Care), Odense University Hospital, Odense, Denmark
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16
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Dalaei F, de Vries CEE, Poulsen L, Möller S, Kaur MN, Dijkhorst PJ, Thomsen JB, Hoogbergen M, Makarawung DJS, Mink van der Molen AB, Repo JP, Paul MA, Busch KH, Cogliandro A, Opyrchal J, Rose M, Juhl CB, Andries AM, Printzlau A, Støving RK, Klassen AF, Pusic AL, Sørensen JA. Body Contouring Surgery after Bariatric Surgery Improves Long-term Health-related Quality of Life and Satisfaction with Appearance: An International Longitudinal Cohort Study Using the BODY-Q. Ann Surg 2024:00000658-990000000-00783. [PMID: 38375665 DOI: 10.1097/sla.0000000000006244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To examine health-related quality of life (HRQL) and satisfaction with appearance in patients who have undergone bariatric surgery (BS) with or without subsequent body contouring surgery (BCS) in relation to the general population normative for the BODY-Q. BACKGROUND The long-term impact of BS with or without BCS has not been established using rigorously developed and validated patient-reported outcome measures (PROM). The BODY-Q is a PROM developed to measure changes in HRQL and satisfaction with appearance in patients with BS and BCS. METHODS Prospective BODY-Q data were collected from six European countries (Denmark, Netherlands, Finland, Germany, Italy, and Poland) from June 2015 to February 2022 in a cohort of patients who underwent BS. Mixed effects regression models were used to analyze changes in HRQL and appearance over time between patients who did and did not receive BCS and to examine the impact of patient-level covariates on outcomes. RESULTS This study included 24,604 assessments from 5,620 patients. BS initially led to improved HRQL and appearance scores throughout the first post-bariatric year, followed by a gradual decrease. Patients who underwent subsequent BCS after BS experienced a sustained improvement in HRQL and appearance or remained relatively stable for up to 10-years postoperatively. CONCLUSION Patients who underwent BCS maintained the improvement in HRQL and satisfaction with appearance in contrast to patients who only underwent BS, who reported a decline in scores 1-2 years postoperatively. Our results emphasize the pivotal role that BCS plays in the completion of the weight loss trajectory.
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Affiliation(s)
- Farima Dalaei
- Research Unit of Plastic Surgery, Odense University Hospital, Denmark
- Clinical Institute, University of Southern Denmark, Odense Denmark
- OPEN, Odense Explorative Patient Network, Odense, Denmark
| | - Claire E E de Vries
- Department of Surgery, OLVG West Hospital, Amsterdam, Netherlands
- Department of Surgery. Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, United States
| | - Lotte Poulsen
- Research Unit of Plastic Surgery, Odense University Hospital, Denmark
- Clinical Institute, University of Southern Denmark, Odense Denmark
| | - Sören Möller
- OPEN - Odense Patient data Explorative Network, Odense, University Hospital and University of Southern Denmark, Odense, Denmark
| | - Manraj N Kaur
- Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, United States
| | - Phillip J Dijkhorst
- Department of Surgery OLVG West Hospital & Dutch Obesity Clinic (NOK), Amsterdam, the Netherlands
| | - Jørn Bo Thomsen
- Research Unit of Plastic Surgery, Odense University Hospital, Denmark
- Clinical Institute, University of Southern Denmark, Odense Denmark
| | | | - Dennis J S Makarawung
- Department of Plastic and Reconstructive Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Aebele B Mink van der Molen
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht and St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jussi P Repo
- Tampere University Hospital and University of Tampere, Tampere, Finland
| | | | - Kay-Hendrik Busch
- Department of Plastic Surgery, Johanniter-Krankenhaus und Waldkrankenahaus Bonn, Germany
| | - Annalisa Cogliandro
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Jakub Opyrchal
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie Memorial National Cancer Center, Gliwice, Poland
| | - Michael Rose
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Science in Malmö, Lund University, Sweden
| | - Claus B Juhl
- University Hospital of Southwest Jutland, Institute for Regional Health Research, University of Southern Denmark and Steno Diabetes Center Odense, Denmark
| | - Alin M Andries
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | | | - René K Støving
- Center for Eating Disorders, Odense University Hospital, Denmark. Research Unit for Medical Endocrinology, Odense University Hospital, Denmark
- Mental Health Services in the Region of Southern Denmark, Odense. Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea L Pusic
- Department of Surgery. Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, United States
| | - Jens A Sørensen
- Research Unit of Plastic Surgery, Odense University Hospital, Denmark
- Clinical Institute, University of Southern Denmark, Odense Denmark
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Birkeland S, Bismark M, Barry MJ, Möller S. Complaint behaviour among healthcare users: self-reported complaint experience and complaint proneness in adult men. BMJ Open Qual 2024; 13:e002581. [PMID: 38365433 PMCID: PMC10875482 DOI: 10.1136/bmjoq-2023-002581] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
AIMS When patients are harmed by, or dissatisfied with, healthcare, only a minority will lodge a complaint or file a claim for compensation. This survey aimed to investigate complaint behaviour and inequalities in complaints using self-reports and hypothetical case vignettes. METHODS Cross-sectional, web-based survey among 6755 Danish men aged 45-70 years (response rate=30%). Participants reported their lifetime complaint experience and the likelihood that they would complain in response to hypothetical case vignettes. RESULTS Overall, 4.8% of participants had complained about healthcare. Predictors were younger age (OR 2.08, 95% CI 1.32 to 3.27, p=0.002 45-50 years compared with 65-70 years), chronic illness (OR 1.49, 95% CI 1.12 to 1.98, p=0.006), rural residence (OR 2.11, 95% CI 1.20 to 3.73, p=0.010 comparing least and most populated areas), high healthcare utilisation (OR 1.55, 95% CI 1.18 to 2.03, p=0.002 primary care, and OR 1.97, 95% CI 1.52 to 2.55, p=0.000 hospital care) and decreased agreeableness on the 10-item Big Five personality inventory (OR 0.91, 95% CI 0.83 to 0.99, p=0.034). Complaint experience was associated with increased wish to complain about the treatment in the hypothetical vignettes (p=0.006). CONCLUSIONS Roughly 1 in 20 men reported having complained about healthcare. Complaints were more common among men who were younger, living in rural areas, diagnosed with chronic illness and high users of healthcare services. Prior complaint experience may be associated with a higher proclivity for complaining about future healthcare. Findings suggest differences in the way healthcare users respond to care experiences, pointing to the importance of aligning expectations and providing clear information about treatment options.
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Affiliation(s)
- Søren Birkeland
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Marie Bismark
- Public Health Law, University of Melbourne, Parkville, Victoria, Australia
| | | | - Sören Möller
- Open Patient data Exploratory Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Gosvig K, Jensen SS, Sjölander H, Hansen NH, Möller S, Qvist N, Ellebæk MB. Translation and validation of the Hirschsprung and anorectal malformation quality of life (HAQL) questionnaire in a Danish Hirschsprung population. Pediatr Surg Int 2024; 40:52. [PMID: 38334791 PMCID: PMC10857969 DOI: 10.1007/s00383-024-05634-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Hirschsprung's disease (HD) may result in an impaired quality of life (QoL) due to bowel problems, postoperative complications and other health-related issues. The Hirschsprung and Anorectal Malformation Quality of Life (HAQL) questionnaire is a disease-specific instrument developed in the Netherlands to measure the QoL in patients with HD and anorectal malformations. The aim of this study was to translate, culturally adapt and validate HAQL in a Danish Hirschsprung population. MATERIAL AND METHODS Translation and cultural adaptation were performed according to international guidelines. Invitations to participate in the validation were sent to 401 patients operated for HD during the period from 1985 to 2012. A total of 156 patients completed the translated and culturally adapted Danish versions of HAQL and 35 parents of children and adolescents completed the corresponding parent questionnaire. Reliability was evaluated in terms of internal consistency using Cronbach's α and test-retest reliability using Intraclass Correlation Coefficient for the retest step. Known groups comparison was performed with comparison of mild HD (defined as recto-sigmoidal HD) and serious HD (defined as more proximal disease). RESULTS The internal consistency of the dimensions was overall satisfactory for adults and adolescents but more problematic for children, where Cronbach's α was less than 0.7 in 60% of the dimensions. For both children and adolescents, the α-value was unsatisfactory for social functioning, emotional functioning, and body image. The test-retest reliability was overall good. The known groups comparison was only able to demonstrate a significant difference between mild and severe HD within one dimension. CONCLUSIONS The translated version of the HAQL questionnaires provides an overall reliable instrument for evaluating disease-specific QoL in a Danish HD population, but it is important to acknowledge the limitations of the questionnaire, especially in children and adolescents.
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Affiliation(s)
- Kristina Gosvig
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Signe Steenstrup Jensen
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Hannes Sjölander
- University of Southern Denmark, Odense, Denmark
- Research Unit for Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Nina Højer Hansen
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark.
- University of Southern Denmark, Odense, Denmark.
- Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, Odense, Denmark.
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, Odense, Denmark
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Nielsen LK, Schjesvold F, Möller S, Guldbrandsen N, Hansson M, Remes K, Peceliunas V, Abildgaard N, Gregersen H, King MT. Health-related quality of life and quality-adjusted progression free survival for carfilzomib and dexamethasone maintenance following salvage autologous stem-cell transplantation in patients with multiple myeloma: a randomized phase 2 trial by the Nordic Myeloma Study Group. J Patient Rep Outcomes 2024; 8:15. [PMID: 38315268 PMCID: PMC10844184 DOI: 10.1186/s41687-024-00691-2] [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] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Decisions regarding maintenance therapy in patients with multiple myeloma should be based on both treatment efficacy and health-related quality of life (HRQL) consequences. In the CARFI trial, patients with first relapse of multiple myeloma underwent salvage autologous stem cell transplantation (salvage ASCT) before randomization to carfilzomib-dexamethasone maintenance therapy (Kd) or observation. The primary clinical endpoint was time to progression, which was extended by 8 months by Kd. The aim of this paper is to present the all HRQL endpoints of the CARFI trial including the HRQL effect of Kd maintenance therapy relative to observation. The primary HRQL endpoint was assessed by EORTC QLQ-C30 Summary score (QLQ-C30-sum) at 8 months follow-up. A key secondary HRQL endpoint was quality-adjusted progression-free-survival (QAPFS). METHODS HRQL was assessed with EORTC QLQ-C30, EORTC QLQ-MY20 and FACT/GOG-Ntx at randomization and every second month during follow-up. HRQL data were analyzed with linear mixed effect models until 8 months follow-up. QAPFS per individual was calculated by multiplying progression-free survival (PFS) by two quality-adjustment metrics, the QLQ-C30-sum and EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D). The QAPFS per treatment group was estimated with the Kaplan-Meier method. P < 0.05 was used for statistical significance, and a between-group minimal important difference of 10 points was interpreted as clinically relevant for the QLQ-C30-sum. RESULTS 168 patients were randomized. HRQL questionnaire compliance was 93%. For the QLQ-C30-sum, the difference of 4.62 points (95% confidence interval (CI) -8.9: -0.4, p = 0.032) was not clinically relevant. PFS was 19.3 months for the Kd maintenance group and 16.8 months for the observation group; difference = 2.5 months (95% CI 0.5; 4.5). QAPFS based on the QLQ-C30-sum for the Kd maintenance group was 18.0 months (95% CI 16.4; 19.6) and for the observation group 15.0 months (95% CI 13.5; 16.5); difference = 3.0 months (95% CI 0.8-5.3). QAPFS based on the QLU-C10D for the Kd maintenance group was 17.5 months (95% CI 15.9; 19.2) and 14.0 months (95% CI 12.4; 15.5) for the observation group; difference = 3.5 months (95% CI 1.1-5.9). CONCLUSIONS Kd maintenance therapy after salvage ASCT did not adversely affect overall HRQL, but adjustment for HRQL reduced the PFS compared to unadjusted PFS. PFS of maintenance therapy should be quality-adjusted to balance the benefits and HRQL impact.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of life Research Center, Department of Hematology, Odense University Hospital, DK-5000, Odense, Denmark.
- Department of Hematology, Gødstrup Hospital, Herning, Denmark.
- Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark.
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Center for B cell malignancies, University of Oslo, Oslo, Norway
| | - Sören Möller
- Open Patient data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nina Guldbrandsen
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital, Lund, Sweden
| | - Kari Remes
- Department of Hematology, Turku University Hospital, Turku, Finland
| | - Valdas Peceliunas
- Department of Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Niels Abildgaard
- Quality of life Research Center, Department of Hematology, Odense University Hospital, DK-5000, Odense, Denmark
- Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark
| | - Henrik Gregersen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Madeleine T King
- Quality of life Research Center, Department of Hematology, Odense University Hospital, DK-5000, Odense, Denmark
- School of Psychology, University of Sydney, Sydney, Australia
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Möller S, Seif Amir Hosseini A, Emami A, Langheinrich A, Sehmisch S, Hoffmann R, Schweigkofler U. [Comparison of planimetric CT‑based volumetry with simplified models for determining the size of intrapelvic hematomas due to pelvic fractures in emergency room diagnostics]. Unfallchirurgie (Heidelb) 2024; 127:126-134. [PMID: 37306758 DOI: 10.1007/s00113-023-01324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Bleeding in the pelvis can lead to a circulatory problem. The widely used whole-body computed tomography (WBCT) scan in the context of treatment in the trauma resuscitation unit (TRU) can give an idea of the source of bleeding (arterial vs. venous/osseous); however, the volume determination of an intrapelvic hematoma by volumetric planimetry cannot be used for a quick estimation of the blood loss. Simplified measurement techniques using geometric models should be used to estimate the extent of bleeding complications. OBJECTIVE To determine whether simplified geometric models can be used to quickly and reliably determine intrapelvic hematoma volume in fractures type Tile B/C during emergency room diagnostics or whether the time-consuming planimetric method must always be used. MATERIAL AND METHODS Retrospectively, 42 intrapelvic hemorrhages after pelvic fractures Tile B + C (n = 8:B, 34:C) at two trauma centers in Germany were selected (66% men, 33% women; mean age 42 ± 20 years) and the CT scans obtained during the initial trauma scan were analyzed in more detail. The CT datasets of the included patients with 1-5 mm slice thickness were available for analysis. By area labelling (ROIs) of the hemorrhage areas in the individual slice images, the volume was calculated by CT volumetrically. Comparatively, volumes were calculated using simplified geometric figures (cuboid, ellipsoid, Kothari). A correction factor was determined by calculating the deviation of the volumes of the geometric models from the planimetrically determined hematoma size. RESULTS AND DISCUSSION The median planimetric bleeding volume in the total collective was 1710 ml (10-7152 ml). Relevant pelvic bleeding with a total volume > 100 ml existed in 25 patients. In 42.86% the volume was overestimated in the cuboid model and in 13 cases (30.95%) there was a significant underestimation to the planimetrically measured volume. Thus, we excluded this volume model. In the models ellipsoid and measuring method according to Kothari, an approximation to the planimetrically determined volume could be achieved with a correction factor calculated via a multiple linear regression analysis. The time-saving and approximate quantification of the hematoma volume using a modified ellipsoidal calculation according to Kothari makes it possible to assess the extent of bleeding in the pelvis after trauma if there are signs of a C-problem. This measurement method, as a simple reproducible metric, could be embedded in trauma resuscitation units (TRU) in the future.
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Affiliation(s)
- S Möller
- , In den Weingärten 5, 65719, Hofheim am Taunus, Deutschland.
- BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland.
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Sigvaldsen A, Højsager FD, Paarup HM, Beck IH, Timmermann CAG, Boye H, Nielsen F, Halldorsson TI, Nielsen C, Möller S, Barington T, Grandjean P, Jensen TK. Early-life exposure to perfluoroalkyl substances and serum antibody concentrations towards common childhood vaccines in 18-month-old children in the Odense Child Cohort. Environ Res 2024; 242:117814. [PMID: 38042520 DOI: 10.1016/j.envres.2023.117814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
Exposure to per- and polyfluoroalkyl substances (PFAS) has been associated with reduced antibody response to childhood vaccinations. Previous studies have mostly focused on antibodies against diphtheria or tetanus, while fewer studies have assessed antibodies toward attenuated viruses, such as measles, mumps or rubella (MMR). Therefore, we set out to determine associations between prenatal and early postnatal PFAS exposure and vaccine-specific Immunoglobulin G (IgG) in the background-exposed Odense Child Cohort. Blood samples were drawn in pregnancy at gestation weeks 8-16 and from the offspring at age 18 months. In the maternal serum samples we quantified perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA). In the offspring serum samples we quantified the same five PFAS compounds and IgG towards diphtheria, tetanus and MMR. A total of 880 and 841 children were included in the analyses of diphtheria and tetanus or MMR, respectively. Multiple linear regression models were used for estimation of difference in virus-specific IgG per doubling of PFAS concentrations. Maternal PFAS concentrations were non-significantly inversely associated with most vaccine-specific antibody concentrations. Likewise, child PFAS concentrations were associated with non-significant reductions of antibodies towards tetanus and MMR. A significant reduction in the percent difference in mumps antibody concentration per doubling of child PFNA (-9.2% (95% confidence interval: -17.4;-0.2)), PFHxS (-8.3% (-15.0;-1.0) and PFOS (-7.9% (-14.8;-0.4) was found. These findings are of public health concern, as inadequate response towards childhood vaccines may represent a more general immune dysfunction.
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Affiliation(s)
- Annika Sigvaldsen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
| | - Frederik Damsgaard Højsager
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Iben Have Beck
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Henriette Boye
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Odense Child Cohort, Odense University Hospital, Odense, Denmark
| | - Flemming Nielsen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000, Odense, Denmark
| | | | - Christel Nielsen
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Sören Möller
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Torben Barington
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Philippe Grandjean
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000, Odense, Denmark; Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA
| | - Tina Kold Jensen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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Kuo LY, Roitzheim C, Valencia H, Mayer J, Möller S, Myung ST, Finsterbusch M, Guillon O, Fattakhova-Rohlfing D, Kaghazchi P. Doping-Induced Surface and Grain Boundary Effects in Ni-Rich Layered Cathode Materials. Small 2024:e2307678. [PMID: 38258588 DOI: 10.1002/smll.202307678] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/21/2023] [Indexed: 01/24/2024]
Abstract
In this work, the effects of dopant size and oxidation state on the structure and electrochemical performance of LiNi0.8 Co0.1 Mn0.1 O2 (NCM811) are investigated. It is shown that doping with boron (B) which has a small ionic radius and an oxidation state of 3+, leads to the formation of a boron oxide-containing surface coating (probably Li3 BO3 ), mainly on the outer surface of the secondary particles. Due to this effect, boron only slightly affects the size of the primary particle and the initial capacity, but significantly improves the capacity retention. On the other hand, the dopant ruthenium (Ru) with a larger ionic radius and a higher oxidation state of 5+ can be stabilized within the secondary particles and does not experience a segregation to the outer agglomerate surface. However, the Ru dopant preferentially occupies incoherent grain boundary sites, resulting in smaller primary particle size and initial capacity than for the B-doped and pristine NCM811. This work demonstrates that a small percentage of dopant (2 mol%) cannot significantly affect bulk properties, but it can strongly influence the surface and/or grain boundary properties of microstructure and thus the overall performance of cathode materials.
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Affiliation(s)
- Liang-Yin Kuo
- Department of Chemical Engineering, Ming Chi University of Technology, No. 84, Gongzhuan Rd., New Taipei City, 243303, Taiwan
| | - Christoph Roitzheim
- Institute of Energy and Climate Research, Materials Synthesis and Processing (IEK-1), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Helen Valencia
- Central Facility for Electron Microscopy (GFE), RWTH Aachen University, 52074, Aachen, Germany
- Ernst Ruska-Centre (ER-C 2), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Joachim Mayer
- Central Facility for Electron Microscopy (GFE), RWTH Aachen University, 52074, Aachen, Germany
- Ernst Ruska-Centre (ER-C 2), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Sören Möller
- Institute of Energy and Climate Research, Materials Synthesis and Processing (IEK-1), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Seung-Taek Myung
- Department of Nanotechnology and Advanced Materials Engineering, Sejong University, 98 Gunja-dong, Gwangjin-gu, Seoul, 05006, South Korea
| | - Martin Finsterbusch
- Institute of Energy and Climate Research, Materials Synthesis and Processing (IEK-1), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Olivier Guillon
- Institute of Energy and Climate Research, Materials Synthesis and Processing (IEK-1), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Dina Fattakhova-Rohlfing
- Institute of Energy and Climate Research, Materials Synthesis and Processing (IEK-1), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
- Faculty of Engineering and Center for Nanointegration Duisburg-Essen CENIDE, University Duisburg-Essen, Lotharstraße 1, 47057, Duisburg, Germany
| | - Payam Kaghazchi
- Institute of Energy and Climate Research, Materials Synthesis and Processing (IEK-1), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
- MESA+ Institute for Nanotechnology, University of Twente, P. O. Box 217, Enschede, 7500AE, The Netherlands
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Rattenborg S, Frøstrup Hansen T, Möller S, Frostberg E, Rahr HB. Non-Curative Treatment Choices in Colorectal Cancer: Predictors and Between-Hospital Variations in Denmark: A Population-Based Register Study. Cancers (Basel) 2024; 16:366. [PMID: 38254854 PMCID: PMC10814909 DOI: 10.3390/cancers16020366] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Variations in treatment choices have been reported in colorectal cancer (CRC). In the context of national recommendations, we aimed to elucidate predictors and between-hospital variations in refraining from curatively intended surgery and adjuvant chemotherapy in potentially curable colorectal cancer. METHODS A total of 34,116 patients diagnosed with CRC from 2009 to 2018 were included for analyses on non-curative treatment in this register-based study. Subsequently 8006 patients were included in analyses on adjuvant treatment. Possible predictors included patient-, disease-, socioeconomic- and perioperative-related factors. Logistic regressions were utilized to examine the predictors of a non-curative aim of treatment and no adjuvant chemotherapy. RESULTS The predictors of non-curative treatment were high age, poor performance, distant metastases and being underweight. Predictors for no adjuvant treatment were high age, poor performance, kidney disease, postoperative complications and living alone. For both outcomes we found between-hospital variations to be present. CONCLUSIONS Non-curative overall treatment and refraining from adjuvant chemotherapy were associated with well-known risk factors, but the former was also associated with being underweight and the latter was also associated with living alone. Marked between-hospital variations were found and should be examined further.
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Affiliation(s)
- Søren Rattenborg
- Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; (E.F.); (H.B.R.)
- Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark;
- Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Torben Frøstrup Hansen
- Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark;
- Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Sören Möller
- Open Patient Data Exploratory Network, Odense University Hospital, J. B. Winsløws Vej 9A, 3. Sal, 5000 Odense C, Denmark;
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Erik Frostberg
- Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; (E.F.); (H.B.R.)
- Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Hans Bjarke Rahr
- Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; (E.F.); (H.B.R.)
- Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark;
- Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
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Jespersen E, Soo WK, Minet LR, Eshoj HR, King MT, Pfeiffer P, Möller S. External validation and diagnostic value of the Elderly Functional Index version 2.0 for assessing functional status and frailty in older Danish patients with gastrointestinal cancer receiving chemotherapy: A prospective, clinical study. J Geriatr Oncol 2024; 15:101675. [PMID: 38070322 DOI: 10.1016/j.jgo.2023.101675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/04/2023] [Accepted: 11/15/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Patient perspectives on functioning are often overlooked in oncology practice. This study externally validates the ELderly Functional Index (ELFI), a patient-reported measure for assessing multidimensional functioning, in older patients with gastrointestinal cancer receiving chemotherapy. The study compares ELFI scoring methods, evaluates its diagnostic value with geriatric oncology tools, and proposes a cut-off point for clinical use. MATERIALS AND METHODS Danish patients aged ≥70 years with gastrointestinal cancer undergoing chemotherapy from a prospective, observational study were included. Two ELFI scoring methods, item-based and domain-based, were compared. Internal consistency reliability, validity, and correlations between ELFI, its component scales, and measures of functioning/frailty (including Eastern Cooperative Oncology Group Performance Status [ECOG-PS], Geriatric-8 [G8], Vulnerable Elders Survey-13 [VES-13], Timed-Up-and-Go [TUG], and 30-s chair stand test [30CST]) were investigated. Sensitivity and specificity analyses evaluated the ability of ELFI to predict frailty outcomes and identified frailty thresholds. Receiver operating characteristic analyses assessed the diagnostic ability of ELFI, alongside other measures, for oncological outcomes and frailty differentiation. Equipercentile equating methods enabled ECOG-PS, ELFI, and G8 mapping. RESULTS One hundred fifty-four patients (median age 73.5 years, range 70-85) undergoing curative- or palliative-intent chemotherapy (49%) were included. ELFI demonstrated good internal consistency (Cronbach's alpha = 0.82) and acceptable convergent, structural, and discriminant validity. ELFI showed moderate to very strong correlations with its component scales (r = 0.40-0.93), and weaker correlations with frailty measures (r = 0.02-0.60). ELFI score < 80 indicated frailty risk, with almost fivefold risk of ECOG-PS 2 at follow-up (odds ratio[OR] = 4.8, 95% confidence interval [CI] 1.4-15.9), and predicted G8, VES-13, TUG, and 30CST frailty at follow-up, not completing planned chemotherapy (OR = 3.1; 95%CI 1.5-6.2), mono-therapy (OR = 3.5; 95%CI 1.5-8.1), initial dose reduction (OR = 4.9; 95%CI 2.0-12.1), and shorter overall survival (hazard ratio = 2.0, 95%CI 1.4-3.0). A preliminary crosswalk between ECOG-PS, ELFI, and G8 was established. DISCUSSION ELFI was validated as a concise patient-reported measure of functional status in older patients with cancer and its relationship to frailty. ELFI demonstrated comparable predictive ability to other tools for oncological outcomes. Both scoring methods yielded similar results, with the domain-based method (ELFI v2.0) endorsed for consistency. ELFI v2.0 score of 80 was suggested as the frailty threshold in this population, supporting its clinical utility.
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Affiliation(s)
- Eva Jespersen
- Department of Oncology, Academy of Geriatric Cancer Research, AgeCare, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Wee Kheng Soo
- Eastern Health Clinical School, Monash University, Melbourne, VIC 3128, Australia; Aged Medicine Program, Eastern Health, Melbourne, VIC, Australia; Cancer Services, Eastern Health, Melbourne, VIC, Australia
| | - Lisbeth R Minet
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik R Eshoj
- Department of Hematology, Quality of Life Research Center, Odense University Hospital, Odense, Denmark
| | | | - Per Pfeiffer
- Department of Oncology, Academy of Geriatric Cancer Research, AgeCare, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN - Open Patient Data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Brintow MB, Prinds C, O'Connor M, Möller S, Henriksen TB, Mørk S, Hvidtjørn D. Continuing bonds in parents after a loss in pregnancy, or a death at or shortly after birth: A population-based study. Death Stud 2023:1-13. [PMID: 38145415 DOI: 10.1080/07481187.2023.2297059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
In this study, we describe continuing bonds and grief reactions and assess their association in 980 parents bereaved in pregnancy, at or shortly after birth. We found that most parents experienced continuing bonds. However, they differed by type of loss. Parents losing their child due to termination of pregnancy or miscarriage experienced bonds less frequently and had the least intense grief reaction. Parents losing their child postpartum experienced bonds most frequently and had the most intense grief reaction. Continuing bonds were associated with intensified grief in parents losing their child after termination or miscarriage, while this relationship was less obvious after stillbirth or postpartum death.
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Affiliation(s)
| | - Christina Prinds
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Maja O'Connor
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Tine Brink Henriksen
- Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sofie Mørk
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorte Hvidtjørn
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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Andersen TR, Drevsfeldt A, Möller S, Møller M. Injuries in male youth football: a one season prospective cohort study of 223 Danish elite players. Front Sports Act Living 2023; 5:1250223. [PMID: 38164442 PMCID: PMC10757927 DOI: 10.3389/fspor.2023.1250223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives This study prospectively investigated injury prevalence, incidence, and burden in male elite under-17 football players (N = 223) during a full season. Methods The players weekly completed a standardized web-based injury survey (OSTRC-H2) and a physical exposure report throughout the study. Results Average weekly response rate was 89.5%. Football exposure accounted for 52.4% of total physical exposure. On average (±SD), the players participated in individual football, strength, and rehabilitation practices for 1.2 ± 1.5, 3.0 ± .2.1, and 1.9 ± 3.4 h/week, respectively. In total, 742 health problems were reported. Mean weekly prevalence of health problems, injuries and illnesses were 20.1%, 16.5% and 3.8%, respectively. The injury incidence per 1,000 h of football exposure, match play and team practice were 8.28 (95% CI: 7.54-9.08), 16.77 (95% CI: 13.65-20.4), and 7.24 (95% CI: 6.5-8.04), respectively. Sudden-onset and gradual-onset injuries accounted for 36.7% and 43.4% of the total proportion of health problems. Hip/groin injuries had the highest incidence (1.58/1,000 h), whereas knee injuries had the highest burden (20.86 days lost/1,000 h). On average, the players experienced 3.33 health problems (average duration: 7.8 days). On average pr. player, 2.7 (95% CI: 2.2-3.3) wks of football exposure were lost. Conclusion Sudden and gradual-onset injuries influenced player availability during the season. Health problem prevalence fluctuated markedly, and injury incidence was higher during match play than training. The players had substantial volumes of training beyond football-specific training and matches. Our findings could assist medical and sports science practitioneers in enhancing training and recovery processes to maximize player availability.
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Affiliation(s)
- Thomas Rostgaard Andersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Football Association, Brondby, Denmark
| | - Andreas Drevsfeldt
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Merete Møller
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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Mørk S, Hvidtjørn D, Möller S, Henriksen TB, O'Connor M, Bonanno GA. Grief trajectories after loss in pregnancy and during the neonatal period. J Psychiatr Res 2023; 168:293-299. [PMID: 37931510 DOI: 10.1016/j.jpsychires.2023.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023]
Abstract
Distinguishing patterns of grief over time in parents with a loss in pregnancy or during the neonatal period is important for identification of parents with severe grief symptoms, who may need additional support. Our aim was to describe grief in this population and to examine variations by type of loss in a large prospective cohort. We used questionnaire data from the Danish longitudinal cohort, Life After the Loss, which contains information on parents with a loss in pregnancy (from 14 weeks) or during the neonatal period. Parents completed the Prolonged Grief-13 scale at 1, 7, and 13 months after their loss. We applied Latent Growth Mixture Modelling to identify prolonged grief trajectories and used multinomial regression models to assess factors associated with class membership. Three distinct trajectories were identified in 676 parents: resilience (73.1%), recovery (16.9%), and chronic (10%). The distribution varied by type of loss, and the chronic group were overrepresented by parents with stillbirths (16.2%) and neonatal deaths (16.1%) in contrast to parents with spontaneous abortions (8.2%) and termination of pregnancy due to fetal anomalies (6.2%). Furthermore, not having a living child or being a woman was associated with following the chronic trajectory. These results underline that, while most bereaved parents are resilient, 10% experience consistently high levels of grief symptoms during the first year after the loss. Information on type of loss, gender, and whether the parent has living children are meaningful indicators of grief class membership.
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Affiliation(s)
- Sofie Mørk
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
| | - Dorte Hvidtjørn
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Tine Brink Henriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Maja O'Connor
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - George A Bonanno
- Department of Clinical Psychology, Teachers College, Columbia University, New York, USA
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Samadzadeh S, Olesen MN, Wirenfeldt M, Möller S, Misu T, Soelberg K, Frederiksen JL, Heegaard S, Mariotto S, Fujihara K, Ruprecht K, Andersen TL, Marignier R, Lillevang ST, Flanagan EP, Pittock SJ, Kim HJ, Bennett JL, Paul F, Sorensen GL, Weinshenker BG, Lassmann H, Asgari N. Microfibrillar-associated protein 4 as a potential marker of acute relapse in inflammatory demyelinating diseases of the central nervous system: Pathological and clinical aspects. Mult Scler 2023; 29:1721-1735. [PMID: 37830484 PMCID: PMC10880047 DOI: 10.1177/13524585231200720] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Microfibrillar-associated protein 4 (MFAP4) is an extracellular matrix protein not previously described in the human central nervous system (CNS). OBJECTIVES We determined MFAP4 CNS expression and measured cerebrospinal fluid (CSF) and serum levels. METHODS Tissue was sampled at autopsy from patients with acute multiple sclerosis (MS) (n = 3), progressive MS (n = 3), neuromyelitis optica spectrum disorder (NMOSD) (n = 2), and controls (n = 9), including 6 healthy controls (HC). MFAP4 levels were measured in 152 patients: 49 MS, 62 NMOSD, 22 myelin oligodendrocyte glycoprotein-associated disease (MOGAD), and 19 isolated optic neuritis (ION). RESULTS MFAP4 localized to meninges and vascular/perivascular spaces, intense in the optic nerve. At sites of active inflammation, MFAP4 reactivity was reduced in NMOSD and acute MS and less in progressive MS. CSF MFAP4 levels were reduced during relapse and at the onset of diseases (mean U/mL: MS 14.3, MOGAD 9.7, and ION 14.6 relative to HC 17.9. (p = 0.013, p = 0.000, and p = 0.019, respectively). Patients with acute ON (n = 68) had reduced CSF MFAP4 (mean U/mL: 14.5, p = 0.006). CSF MFAP4 levels correlated negatively with relapse severity (rho = -0.41, p = 0.017). CONCLUSION MFAP4 immunoreactivity was reduced at sites of active inflammation. CSF levels of MFAP4 were reduced following relapse and may reflect disease activity.
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Affiliation(s)
- Sara Samadzadeh
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mads Nikolaj Olesen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Martin Wirenfeldt
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Pathological Anatomy and Molecular Biology, Hospital South West Jutland, Esbjerg, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kerstin Soelberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jette Lautrup Frederiksen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
| | - Steffen Heegaard
- Departments of Ophthalmology and Pathology, Rigshospitalet, Glostrup, Denmark
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan
- Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Levin Andersen
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | | | - Eoin P Flanagan
- Department Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sean J Pittock
- Department Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Jeffrey L Bennett
- Department of Neurology & Ophthalmology, Programs in Neuroscience & Immunology University of Colorado, Anschutz, CO, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Grith Lykke Sorensen
- Cancer and Inflammation, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Nasrin Asgari
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark Department of Neurology, Slagelse Hospital, Slagelse, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Larsen UL, Zachariassen G, Möller S, Førre WU, Grøsle I, Halken S, Herskind AM, Strøm T, Toft P, Ellebæk M, Qvist N. Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia. Eur J Pediatr Surg 2023; 33:469-476. [PMID: 36929125 DOI: 10.1055/s-0043-1767829] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Nutritional support during the neonatal and postoperative period in congenital diaphragmatic hernia (CDH) is challenging and controversial. We aimed to report on early enteral nutritional support in symptomatic CDH patients during the pre- and postoperative period, including feasibility, associated factors with established full enteral nutrition, and weight at birth, discharge, and 18 months. METHODS We retrospectively collected data on nutrition: type and volume of enteral nutrition and parental support. Enteral feeding was introduced preoperatively from day 1 after birth, increased step-wised (breastmilk preferred), and resumed after CDH repair on the first postoperative day. Baseline data were available from our CDH database. RESULTS From 2011 to 2020, we identified 45 CDH infants. Twenty-two were girls (51.1%), 35 left sided (77.8%), and 40 underwent CDH repair (88.9%). Median (interquartile range) length of stay in the pediatric intensive care unit was 14.6 days (6.0-26.5), and 1-year mortality was 17.8%.Postoperatively, 120 and 160 mL/kg/d of enteral nutrition was achieved after a median of 6.5 (3.6-12.6) and 10.6 (7.6-21.7) days, respectively. In total, 31 (68.9%) needed supplemental parenteral nutrition in a median period of 8 days (5-18), and of those 11 had parenteral nutrition initiated before CDH repair. No complications to enteral feeding were reported. CONCLUSION Early enteral nutrition in CDH infants is feasible and may have the potential to reduce the need for parental nutrition and reduce time to full enteral nutrition in the postoperative period.
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Affiliation(s)
- Ulla Lei Larsen
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gitte Zachariassen
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- H.C. Andersen Children's Hospital, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Wilhelmine Ursin Førre
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Ingvild Grøsle
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Susanne Halken
- H.C. Andersen Children's Hospital, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Maria Herskind
- H.C. Andersen Children's Hospital, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Strøm
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Hospital Sønderjylland, University of Southern Denmark, Odense, Denmark
| | - Palle Toft
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mark Ellebæk
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Surgery, and Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Surgery, and Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Hecker K, Banszerus L, Schäpers A, Möller S, Peters A, Icking E, Watanabe K, Taniguchi T, Volk C, Stampfer C. Coherent charge oscillations in a bilayer graphene double quantum dot. Nat Commun 2023; 14:7911. [PMID: 38036517 PMCID: PMC10689829 DOI: 10.1038/s41467-023-43541-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
The coherent dynamics of a quantum mechanical two-level system passing through an anti-crossing of two energy levels can give rise to Landau-Zener-Stückelberg-Majorana (LZSM) interference. LZSM interference spectroscopy has proven to be a fruitful tool to investigate charge noise and charge decoherence in semiconductor quantum dots (QDs). Recently, bilayer graphene has developed as a promising platform to host highly tunable QDs potentially useful for hosting spin and valley qubits. So far, in this system no coherent oscillations have been observed and little is known about charge noise in this material. Here, we report coherent charge oscillations and [Formula: see text] charge decoherence times in a bilayer graphene double QD. The charge decoherence times are measured independently using LZSM interference and photon assisted tunneling. Both techniques yield [Formula: see text] average values in the range of 400-500 ps. The observation of charge coherence allows to study the origin and spectral distribution of charge noise in future experiments.
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Affiliation(s)
- K Hecker
- JARA-FIT and 2nd Institute of Physics, RWTH Aachen University, 52074, Aachen, Germany.
- Peter Grünberg Institute (PGI-9), Forschungszentrum Jülich, 52425, Jülich, Germany.
| | - L Banszerus
- JARA-FIT and 2nd Institute of Physics, RWTH Aachen University, 52074, Aachen, Germany
- Peter Grünberg Institute (PGI-9), Forschungszentrum Jülich, 52425, Jülich, Germany
| | - A Schäpers
- JARA-FIT and 2nd Institute of Physics, RWTH Aachen University, 52074, Aachen, Germany
| | - S Möller
- JARA-FIT and 2nd Institute of Physics, RWTH Aachen University, 52074, Aachen, Germany
- Peter Grünberg Institute (PGI-9), Forschungszentrum Jülich, 52425, Jülich, Germany
| | - A Peters
- JARA-FIT and 2nd Institute of Physics, RWTH Aachen University, 52074, Aachen, Germany
| | - E Icking
- JARA-FIT and 2nd Institute of Physics, RWTH Aachen University, 52074, Aachen, Germany
- Peter Grünberg Institute (PGI-9), Forschungszentrum Jülich, 52425, Jülich, Germany
| | - K Watanabe
- Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, 305-0044, Japan
| | - T Taniguchi
- International Center for Materials Nanoarchitectonics, National Institute for Materials Science, 1-1 Namiki, Tsukuba, 305-0044, Japan
| | - C Volk
- JARA-FIT and 2nd Institute of Physics, RWTH Aachen University, 52074, Aachen, Germany
- Peter Grünberg Institute (PGI-9), Forschungszentrum Jülich, 52425, Jülich, Germany
| | - C Stampfer
- JARA-FIT and 2nd Institute of Physics, RWTH Aachen University, 52074, Aachen, Germany
- Peter Grünberg Institute (PGI-9), Forschungszentrum Jülich, 52425, Jülich, Germany
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Christensen ER, Clausen A, Petersen TG, Skjødt MK, Abrahamsen B, Möller S, Rubin KH. Excess mortality following a first and subsequent osteoporotic fracture: a Danish nationwide register-based cohort study on the mediating effects of comorbidities. RMD Open 2023; 9:e003524. [PMID: 38030232 PMCID: PMC10689412 DOI: 10.1136/rmdopen-2023-003524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES This study aimed to examine the risk of mortality following incident and subsequent osteoporotic fractures, the effect of different fracture type combinations, and the mediating role of postfracture morbidity in a Danish population. METHODS We used the National Patient Registry to identify patients ≥60 years with incident major osteoporotic fracture of the hip, vertebrae, wrist or humerus between 2013 and 2018, and controls matched 1:10 on age and sex. Possible mediators were identified using International Classification of Diseases, 10th Revision codes registered in the 6 months following index fracture. HRs were estimated using Cox regression analyses with 95% CIs. The effect of possible mediators was estimated using mediation analyses. RESULTS The study included 106 303 patients and 1 062 988 controls. Mortality following index fracture was highest in the month following hip fractures (HR 10.98 (95% CI 10.23 to 11.79) in women and HR 16.40 (95% CI 15.00 to 17.93) in men). Subsequent hip fractures resulted in the highest HRs for all fracture type combinations. In women, the highest HR was observed in patients with index wrist/subsequent hip fractures (HR 2.43 (95% CI 2.12 to 2.78)). In men, the highest HR was observed in patients with index humerus/subsequent hip fractures (HR 2.69 (95% CI 2.04 to 3.54)). Pneumonia mediated the largest proportion of mortality, but dehydration, urinary tract infection and sepsis were also important factors. CONCLUSIONS The highest mortality risk was found in the month immediately following both index and subsequent fracture. The combination of index and subsequent fractures at different skeletal sites had a substantial impact on the risk of mortality. Postfracture morbidities were found mediate the association.
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Affiliation(s)
| | - Anne Clausen
- 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
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Kriegbaum Skjødt
- Department of Medicine, Holbæk Hospital, Holbæk, Region Zealand, Denmark
- Department of Medicine, Gentofte Hospital, Hellerup, Copenhagen, Denmark
| | - Bo Abrahamsen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Region Zealand, Denmark
| | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Katrine Hass Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Højsager FD, Andersen M, Juul A, Nielsen F, Möller S, Christensen HT, Grøntved A, Grandjean P, Jensen TK. Retraction notice to "Prenatal and early postnatal exposure to perfluoroalkyl substances and bone mineral content and density in the odense child cohort" [Environ. Int. 167 (2022) 107417]. Environ Int 2023; 181:108275. [PMID: 37903696 DOI: 10.1016/j.envint.2023.108275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Affiliation(s)
- F D Højsager
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark.
| | - M Andersen
- Department of Endocrinology and Metabolism, Odense University, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - A Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Denmark
| | - F Nielsen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark
| | - S Möller
- Odense Patient data Explorative Network (OPEN), Odense, Denmark
| | - H T Christensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - A Grøntved
- Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - P Grandjean
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Depertment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - T K Jensen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Odense Patient data Explorative Network (OPEN), Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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Højsager FD, Sigvaldsen A, Andersen MS, Juul A, Nielsen F, Möller S, Christesen HBT, Grøntved A, Grandjean P, Jensen TK. Prenatal and early postnatal exposure to perfluoroalkyl substances and bone mineral content and density in the Odense Child Cohort. Environ Int 2023; 181:108264. [PMID: 37864903 DOI: 10.1016/j.envint.2023.108264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION Exposure to perfluoroalkyl substances (PFAS) has been associated with lower bone mineral density (BMD) in animal and human studies, but prospective data from children are limited. OBJECTIVES To determine associations between prenatal and early postnatal PFAS exposure and BMD at age 7 years. METHODS In the Odense Child Cohort, Denmark, pregnant women were recruited in 2010-2012, and their children were invited for subsequent health examinations. At 12 weeks of gestation the pregnant women delivered a serum sample, and at age 18 months serum was obtained from the child to measure perfluorooctane sulfonic acid(PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA) by LC-MS/MS. At age 7 years DXA scans were performed to measure bone mineral content (BMC) and BMD Z-score. PFAS in pregnancy (n = 881) and/or at age 18 months (n = 668) were regressed against DXA measurements, adjusted for maternal education, child height Z-score, sex (for BMC) and for postnatal exposure, additionally duration of total breastfeeding. We additionally performed structural equation models determining combined effects of pre-and postnatal PFAS exposures. RESULTS Higher prenatal and early postnatal serum concentrations of all measured PFAS were associated with lower BMC and BMD Z-scores at age 7 years, all estimates were negative although not all significant. For each doubling of 18-month exposure to PFNA or PFOS, BMD Z-scores were lowered by -0.10 (95 % CI -0.19;-0.00) and -0.08 (-0.17;-0.00), respectively after adjustment. Pre- and postnatal PFAS were correlated, but structural equation models suggested that associations with BMD were stronger for 18-month than prenatal PFAS exposure. DISCUSSION Bone density is established in childhood, and a reduction in BMD during early childhood may have long-term implication for peak bone mass and lifelong bone health. Future studies of the impact of PFAS exposure on fracture incidence will help elucidate the clinical relevance.
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Affiliation(s)
- Frederik Damsgaard Højsager
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark
| | - Annika Sigvaldsen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark.
| | - Marianne Skovsager Andersen
- Department of Endocrinology and Metabolism, Odense University, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Denmark
| | - Flemming Nielsen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark
| | - Sören Möller
- Odense Patient Data Explorative Network (OPEN), Odense, Denmark
| | | | - Anders Grøntved
- Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Philippe Grandjean
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Depertment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Tina Kold Jensen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Odense Patient Data Explorative Network (OPEN), Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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Thykjaer AS, Andresen J, Andersen N, Bek T, Heegaard S, Hajari J, Schmidt Laugesen C, Möller S, Pedersen FN, Kawasaki R, Højlund K, Rubin KH, Stokholm L, Peto T, Grauslund J. Inter-grader reliability in the Danish screening programme for diabetic retinopathy. Acta Ophthalmol 2023; 101:783-788. [PMID: 37066883 DOI: 10.1111/aos.15667] [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] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/18/2022] [Accepted: 03/27/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE The Danish Registry of Diabetic Retinopathy includes information from >200 000 patients who attends diabetic retinopathy (DR) screening in Denmark. Screening of patients with uncomplicated type 2 diabetes is often performed by practicing ophthalmologists, while patients with type 1 and complicated type 2 diabetes attends screening at hospitals. We performed a clinical reliability study of retinal images from Danish screening facilities to explore the inter-grader agreement between the primary screening ophthalmologist and a blinded, certified grader. METHODS Invitations to participate were sent to screening facilities across Denmark. The primary grader uploaded fundus photographs with information on estimated level of DR (International Clinical Diabetic Retinopathy scale as 0 [no DR], 1-3 [mild, moderate or severe nonproliferative DR {NPDR}], or 4 [proliferative DR {PDR}]), region of screening, image style, and screening facility. Images were then regraded by a blinded, certified, secondary grader. Weighted kappa analysis was performed to evaluate agreement. RESULTS Fundus photographs from 230 patients (458 eyes) were received from practicing ophthalmologists (52.6%) and hospital-based grading centres (47.4%) from all Danish regions. Reported levels of DR by the primary graders were 66.8%, 12.2%, 13.1%, 1.3% and 5.5% for DR levels 0-4. The overall agreement between primary and secondary graders was 93% (κ = 0.83). Based on screening facility agreement was 96% (κ = 0.89) and 90% (κ = 0.76) for practicing ophthalmologists and hospital-based graders. CONCLUSION In this nationwide study, we observed a high overall inter-grader agreement and based on this, it is reasonable to assume that reported DR gradings in the screening programme in Denmark, accurately reflect the truth.
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Affiliation(s)
- Anne Suhr Thykjaer
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Javad Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | | | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Frederik Nørregaard Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Katrine Hass Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Thykjær AS, Rosengaard L, Andersen N, Andresen J, Bek T, Hajari J, Heegaard S, Højlund K, Kawasaki R, Laugesen CS, Möller S, Pedersen FN, Schielke KC, Stokholm L, Grauslund J. Bariatric surgery in individuals with type 2 diabetes is not associated with short or long-term risk of diabetic retinopathy progression: results from a nationwide cohort study. Acta Diabetol 2023; 60:1531-1539. [PMID: 37421439 PMCID: PMC10520211 DOI: 10.1007/s00592-023-02140-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/15/2023] [Indexed: 07/10/2023]
Abstract
AIMS Bariatric surgery is used to induce weight loss and glycemic stability in type 2 diabetes (T2D). It has been a concern that this may lead to early worsening of diabetic retinopathy (DR) due to a rapid decline in HbA1c. In this study, we evaluated the risk of short and long-term DR development and need for ocular intervention in an entire nation of individuals with T2D undergoing bariatric surgery. METHODS The study comprised a national, register-based cohort of individuals with T2D screened for DR. Cases were matched by age, sex and DR level at the date of surgery (index date) with non-bariatric controls. We extracted information on DR levels, in- and outpatient treatments, pharmaceutical prescriptions and laboratory values. We evaluated worsening of DR (incident and progressive DR) at follow-up (6 and 36 months). RESULTS Amongst 238,967 individuals with T2D, who attended diabetic eye screening, we identified 553 that underwent bariatric surgery (0.2%) and 2677 non-bariatric controls. Median age was 49 years, and 63% were female. Cases had more comorbidities, lower HbA1c as well as more frequent use of glucose-lowering and antihypertensive medication than controls at index date. In a fully adjusted logistic regression model, the risk of DR worsening for cases was not significantly different compared to controls, neither short-term (OR 0.41 [CI 95% 0.13; 1.33], p = 0.14) nor long-term (OR 0.64 [CI 95% 0.33; 1.24], p = 0.18). CONCLUSIONS In this nationwide study, bariatric surgery did not associate with increased risk of short- or long-term DR worsening.
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Affiliation(s)
- Anne S Thykjær
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.
- Steno Diabetes Center Odense, Odense University Hospital, Odense C, Denmark.
| | - Louise Rosengaard
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Javad Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense C, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Caroline S Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Frederik N Pedersen
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Katja C Schielke
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense C, Denmark
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Gaist D, García Rodríguez LA, Hallas J, Hald SM, Möller S, Høyer BB, Selim M, Goldstein LB. Association of Statin Use With Risk of Stroke Recurrence After Intracerebral Hemorrhage. Neurology 2023; 101:e1793-e1806. [PMID: 37648526 PMCID: PMC10634647 DOI: 10.1212/wnl.0000000000207792] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/12/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Survivors of spontaneous intracerebral hemorrhage (ICH) may have indications for statin therapy. The effect of statins on the risk of subsequent hemorrhagic and ischemic stroke (IS) in this setting is uncertain. We sought to determine the risk of any stroke (ischemic stroke, IS or recurrent ICH), IS, and recurrent ICH associated with statin use among ICH survivors. METHODS Using the Danish Stroke Registry, we identified all patients admitted to a hospital in Denmark (population 5.8 million) with a first-ever ICH between January 2003 and December 2021 who were aged 50 years or older and survived >30 days. Patients were followed up until August 2022. Within this cohort, we conducted 3 nested case-control analyses for any stroke, IS, and recurrent ICH. We matched controls for age, sex, time since first-ever ICH, and history of prior IS. The primary exposure was statin use before or on the date of subsequent stroke or the equivalent date in matched controls. Using conditional logistic regression, we calculated adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) for any stroke, IS, and recurrent ICH associated with statin exposure. RESULTS We identified 1,959 patients with any stroke (women 45.3%; mean [SD] age, 72.6 [9.7] years) who were matched to 7,400 controls; 1,073 patients with IS (women 42.0%; mean [SD] age, 72.4 [10.0] years) who were matched to 4,035 controls and 984 patients with recurrent ICH (women 48.7%; mean [SD] age, 72.7 [9.2] years) who were matched to 3,755 controls. Statin exposure was associated with a lower risk of both any stroke (cases 38.6%, controls 41.1%; aOR 0.88; 95% CI 0.78-0.99) and IS (cases 39.8%, controls 41.8%, aOR 0.79; 95% CI 0.67-0.92), but was not associated with recurrent ICH risk (cases 39.1%, controls 40.8%, aOR 1.05; 95% CI 0.88-1.24). DISCUSSION Exposure to statins was not associated with an increased risk of recurrent ICH but was associated with a lower risk of any stroke, largely due to a lower risk of IS. Confirmation of these findings in randomized trials is needed. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that statin use in patients with ICH is associated with a lower risk of any stroke and IS and not with increased risk of recurrent ICH.
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Affiliation(s)
- David Gaist
- From the Research Unit for Neurology (D.G., S.M.H.), Odense University Hospital; University of Southern Denmark, Odense, Denmark; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Department of Clinical Pharmacology (J.H.), Pharmacy and Environmental Medicine, University of Southern Denmark; Open Patient Data Explorative Network (OPEN) (S.M.), Odense University Hospital; Odense Patient Data Explorative Network (OPEN) (B.B.H.), Odense University Hospital, Denmark; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington.
| | - Luis Alberto García Rodríguez
- From the Research Unit for Neurology (D.G., S.M.H.), Odense University Hospital; University of Southern Denmark, Odense, Denmark; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Department of Clinical Pharmacology (J.H.), Pharmacy and Environmental Medicine, University of Southern Denmark; Open Patient Data Explorative Network (OPEN) (S.M.), Odense University Hospital; Odense Patient Data Explorative Network (OPEN) (B.B.H.), Odense University Hospital, Denmark; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Jesper Hallas
- From the Research Unit for Neurology (D.G., S.M.H.), Odense University Hospital; University of Southern Denmark, Odense, Denmark; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Department of Clinical Pharmacology (J.H.), Pharmacy and Environmental Medicine, University of Southern Denmark; Open Patient Data Explorative Network (OPEN) (S.M.), Odense University Hospital; Odense Patient Data Explorative Network (OPEN) (B.B.H.), Odense University Hospital, Denmark; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Stine Munk Hald
- From the Research Unit for Neurology (D.G., S.M.H.), Odense University Hospital; University of Southern Denmark, Odense, Denmark; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Department of Clinical Pharmacology (J.H.), Pharmacy and Environmental Medicine, University of Southern Denmark; Open Patient Data Explorative Network (OPEN) (S.M.), Odense University Hospital; Odense Patient Data Explorative Network (OPEN) (B.B.H.), Odense University Hospital, Denmark; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Sören Möller
- From the Research Unit for Neurology (D.G., S.M.H.), Odense University Hospital; University of Southern Denmark, Odense, Denmark; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Department of Clinical Pharmacology (J.H.), Pharmacy and Environmental Medicine, University of Southern Denmark; Open Patient Data Explorative Network (OPEN) (S.M.), Odense University Hospital; Odense Patient Data Explorative Network (OPEN) (B.B.H.), Odense University Hospital, Denmark; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Birgit Bjerre Høyer
- From the Research Unit for Neurology (D.G., S.M.H.), Odense University Hospital; University of Southern Denmark, Odense, Denmark; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Department of Clinical Pharmacology (J.H.), Pharmacy and Environmental Medicine, University of Southern Denmark; Open Patient Data Explorative Network (OPEN) (S.M.), Odense University Hospital; Odense Patient Data Explorative Network (OPEN) (B.B.H.), Odense University Hospital, Denmark; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Magdy Selim
- From the Research Unit for Neurology (D.G., S.M.H.), Odense University Hospital; University of Southern Denmark, Odense, Denmark; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Department of Clinical Pharmacology (J.H.), Pharmacy and Environmental Medicine, University of Southern Denmark; Open Patient Data Explorative Network (OPEN) (S.M.), Odense University Hospital; Odense Patient Data Explorative Network (OPEN) (B.B.H.), Odense University Hospital, Denmark; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Larry B Goldstein
- From the Research Unit for Neurology (D.G., S.M.H.), Odense University Hospital; University of Southern Denmark, Odense, Denmark; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Department of Clinical Pharmacology (J.H.), Pharmacy and Environmental Medicine, University of Southern Denmark; Open Patient Data Explorative Network (OPEN) (S.M.), Odense University Hospital; Odense Patient Data Explorative Network (OPEN) (B.B.H.), Odense University Hospital, Denmark; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
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Svendsen MT, Andersen KE, Feldman SR, Mejldal A, Möller S, Kongstad LP. An effective patient-supporting intervention for topical treatment of psoriasis is also cost-effective. Clin Exp Dermatol 2023; 48:1247-1254. [PMID: 37585448 DOI: 10.1093/ced/llad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/18/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND A randomized controlled trial (RCT) of topical treatment combined with regular patient support provided by dermatological nurses in structured consultations of 20-min duration every fourth week improved psoriasis severity, quality of life and treatment adherence compared with topical treatment combined with standard patient support, which is seeing a dermatologist every third month. OBJECTIVES To examine the economic impact of the patient support from a healthcare-sector perspective in the RCT. METHODS Costs for primary care, secondary healthcare services and costs of prescription medication were compared for the intervention and nonintervention groups over 48 weeks. Health benefits were expressed in terms of quality-adjusted life-years (QALYs) measured by the EuroQoL five-dimension three-level questionnaire. Regression analyses were used to estimate incremental cost and QALYs. RESULTS The incremental cost was estimated at £462, with an average increase of 0.08 QALYs per patients for participants receiving the intervention compared with those receiving standard care. The incremental cost-effectiveness ratio for patients was £5999/QALY. The intervention had an almost 100% probability of being cost-effective at a willingness-to-pay threshold of £30 000 per QALY. CONCLUSIONS Addressing adherence issues is critical to improving outcomes for patients with psoriasis who use topical treatment. The personal support intervention was effective with an acceptable increase in costs.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Klaus Ejner Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Steven R Feldman
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anna Mejldal
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Line Planck Kongstad
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
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Clausen AR, Stokholm L, Frederiksen KH, Möller S, Blaabjerg M, Pedersen FN, Grauslund J. Retinal vein occlusion as an age-dependent marker of incident dementia in a long-term Danish national cohort. Acta Ophthalmol 2023. [PMID: 37874264 DOI: 10.1111/aos.15797] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The aim of this study was to investigate retinal vein occlusion (RVO) as an independent marker of incident dementia. METHODS In a prospective nationwide cohort study, we identified 2 225 568 individuals through the Danish national health registers. Individuals older than 65 years, without unspecified retinal vascular occlusion or dementia were included from 1998 to 2020 and followed until 2022. We calculated the incidence rate (IR) and performed a Cox regression analysis with a hazard ratio (HR) and 95% confidence interval (CI) for RVO (exposure) as a marker of all-cause dementia adjusted for systemic comorbidity. RESULTS We identified 19 669 individuals with RVO who had a higher prevalence of systemic comorbidity at inclusion compared to those without RVO (n = 2 185 483). We performed a Cox regression analysis for age-dependent exposure due to non-proportional hazards in the pre-planned analysis. Exposed individuals younger than 75 years had an increased risk of all-cause dementia (adjusted HR 1.09, 95% CI 1.01-1.18), whereas individuals older than 75 years had a decreased risk of all-cause dementia (adjusted HR 0.92, 95% CI 0.86-0.98). CONCLUSION Individuals with RVO had an age-dependent risk of dementia, with a 9% increased risk in individuals with RVO younger than 75 years and an 8% decreased risk in individuals older than 75 years at the time of exposure.
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Affiliation(s)
- Anna Rebien Clausen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN-Open Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | | | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN-Open Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Morten Blaabjerg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Frederik Nørregaard Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Møller JJK, la Cour K, Pilegaard MS, Dalton SO, Bidstrup P, Möller S, Jarlbaek L. The use and timing of rehabilitation and palliative care to cancer patients, and the influence of social vulnerability - a population-based study. BMJ Support Palliat Care 2023:spcare-2023-004487. [PMID: 37816594 DOI: 10.1136/spcare-2023-004487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES To identify and investigate different cohorts of cancer patients' use of physical rehabilitation and specialised palliative care (SPC) services, focusing on patients with incurable cancer and the impact of social vulnerability. METHODS The sample originated from patients diagnosed during 2013-2018 and alive 1 January 2015. Use of physical rehabilitation and/or SPC units were identified from contacts registered in population-based administrative databases. Competing-risks regression models were applied to investigate disparities with regard to social vulnerability, disease duration, gender and age. RESULTS A total of 101 268 patients with cancer were included and 60 125 survived longer than 3 years after their diagnosis. Among the 41 143 patients, who died from cancer, 66%, survived less than 1 year, 23% survived from 1 to 2 years and 11% survived from 2 to 3 years. Contacts regarding physical rehabilitation services appeared in the entire cancer trajectory, whereas contacts regarding SPC showed a steep increase as time drew closer to death. The largest disparity was related to disease duration. Socially vulnerable patients had less contact with SPC, while a larger proportion of the socially vulnerable cancer survivors used rehabilitation, compared with the non-vulnerable patients. CONCLUSIONS This study provides a previously unseen detailed overview of the use of physical rehabilitation and/or SPC among patients with incurable cancer. The services appeared to overlap at a group level in the cancer trajectory, emphasising the importance of awareness with regard to coordination and combination of the services. Disparities between socially vulnerable or non-vulnerable patients were identified.
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Affiliation(s)
- Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- DEFACTUM, Central Region Denmark, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Pernille Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sören Möller
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Kristensen SB, Clausen A, Skjødt MK, Søndergaard J, Abrahamsen B, Möller S, Rubin KH. An enhanced version of FREM (Fracture Risk Evaluation Model) using national administrative health data: analysis protocol for development and validation of a multivariable prediction model. Diagn Progn Res 2023; 7:19. [PMID: 37784165 PMCID: PMC10546772 DOI: 10.1186/s41512-023-00158-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Osteoporosis poses a growing healthcare challenge owing to its rising prevalence and a significant treatment gap, as patients are widely underdiagnosed and consequently undertreated, leaving them at high risk of osteoporotic fracture. Several tools aim to improve case-finding in osteoporosis. One such tool is the Fracture Risk Evaluation Model (FREM), which in contrast to other tools focuses on imminent fracture risk and holds potential for automation as it relies solely on data that is routinely collected via the Danish healthcare registers. The present article is an analysis protocol for a prediction model that is to be used as a modified version of FREM, with the intention of improving the identification of subjects at high imminent risk of fracture by including pharmacological exposures and using more advanced statistical methods compared to the original FREM. Its main purposes are to document and motivate various aspects and choices of data management and statistical analyses. METHODS The model will be developed by employing logistic regression with grouped LASSO regularization as the primary statistical approach and gradient-boosted classification trees as a secondary statistical modality. Hyperparameter choices as well as computational considerations on these two approaches are investigated by an unsupervised data review (i.e., blinded to the outcome), which also investigates and handles multicollinarity among the included exposures. Further, we present an unsupervised review of the data and testing of analysis code with respect to speed and robustness on a remote analysis environment. The data review and code tests are used to adjust the analysis plans in a blinded manner, so as not to increase the risk of overfitting in the proposed methods. DISCUSSION This protocol specifies the planned tool development to ensure transparency in the modeling approach, hence improving the validity of the enhanced tool to be developed. Through an unsupervised data review, it is further documented that the planned statistical approaches are feasible and compatible with the data employed.
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Affiliation(s)
- Simon Bang Kristensen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anne Clausen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Michael Kriegbaum Skjødt
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Katrine Hass Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark.
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
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Alawi S, Dieperink KB, Agerskov H, Marcussen J, Möller S, Voltelen B, Hyldig N. Translation and Cross-Cultural Validation of the Danish Version of the Family Health Scale-Long Form: A Psychometric Study. Semin Oncol Nurs 2023; 39:151480. [PMID: 37550098 DOI: 10.1016/j.soncn.2023.151480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The Family Health Scale is a new instrument for evaluating family health. The instrument is reported as valid and reliable in investigating family health among different types of adult family members. This study aimed to translate the Family Health Scale into Danish and investigate its validity and reliability in families with a family member affected by chronic or serious illness. DATA SOURCES Translation was performed through forward and backward bilingual practice consisting of 10 steps. A cross-sectional study included 406 participants, of whom 94 also participated in a follow-up study within 3 weeks for the test-retest. Content validity was examined by conducting cognitive interviews with nine family members. Internal consistency reliability was assessed using Cronbach α. The test-retest reliability was evaluated using intraclass correlation coefficients. Model fit was assessed using confirmatory factor analysis. CONCLUSION The Family Health Scale demonstrated good content validity and a moderate model fit. Both Internal consistency reliability and test-retest reliability were satisfying. Cronbach α ranged from 0.73 to 0.89, while the intraclass correlation coefficient value was 0.88. The confirmatory factor analysis estimated a satisfying model fit, with an acceptable root-mean-square error of 0.076 and a moderate comparative fit index of 0.794. IMPLICATION FOR NURSING PRACTICE The Family Health Scale instrument has the potential to identify vulnerable families or families affected by chronic or serious illnesses, such as cancer. The assessment tool can consequently be used to target interventions to promote family health and improve the health of both the individual and his/her family.
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Affiliation(s)
- Sharifa Alawi
- Department of Oncology, Research Unit of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark.
| | - Karin B Dieperink
- Department of Oncology, Research Unit of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Jette Marcussen
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Health Sciences, University College Lillebaelt, Vejle, Denmark; Department of Nature and Health, University of Greenland
| | - Sören Möller
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Barbara Voltelen
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; Department of Nursing Education and Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Nana Hyldig
- Department of Haematology, Research Unit of Haematology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Fonvig CE, Troelsen J, Brønd JC, Möller S, Holsgaard-Larsen A. Predictors of Physical Activity Levels in Ambulant/Semiambulant Children and Adolescents With Cerebral Palsy: A Clinical Cohort Study. Adapt Phys Activ Q 2023; 40:664-686. [PMID: 36963406 DOI: 10.1123/apaq.2022-0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 03/26/2023] Open
Abstract
Children and adolescents with cerebral palsy (CP) show a reduced physical activity (PA) level compared with their typically developed peers. This study aimed to identify potential predictors of objectively evaluated habitual PA using data from a national clinical registry-the Cerebral Palsy Follow-Up Program (CPFP)-and proxy-reported questionnaires. Data from the CPFP database showed that female sex was associated with a lower PA level. Additional questionnaire data revealed age, popliteal angle limitation, Pediatric Outcomes Data Collection Instrument-Sports and Physical Functioning Scale score, screen time, Functional Mobility Scale score at 50 m, and fatigue as predictors. The proposed models can be used for the prediction and early detection of the PA level and consequently for the potential improvement among ambulant/semiambulant individuals with CP. Further research should investigate the predictive impact of personal, social, and environmental factors on the PA level and the gap in PA levels between girls and boys.
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Affiliation(s)
- Christina Esmann Fonvig
- Orthopedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense,Denmark
- Department of Orthopedics and Traumatology, Odense University Hospital, Odense,Denmark
| | - Jens Troelsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense,Denmark
| | - Jan Christian Brønd
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense,Denmark
| | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, Odense,Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense,Denmark
| | - Anders Holsgaard-Larsen
- Orthopedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense,Denmark
- Department of Orthopedics and Traumatology, Odense University Hospital, Odense,Denmark
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Pedersen FN, Stokholm L, Andersen N, Andresen J, Bek T, Hajari JN, Heegaard S, Højlund K, Kawasaki R, Möller S, Laugesen CS, Schielke KC, Thykjær AS, Peto T, Pouwer F, Grauslund J. Longitudinal bidirectional associations between diabetic retinopathy and diagnosed depression: Results from a Danish nationwide registry-based cohort study. J Diabetes Complications 2023; 37:108589. [PMID: 37657405 DOI: 10.1016/j.jdiacomp.2023.108589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/31/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Diabetic retinopathy (DR) is a feared complication and a leading course of visual impairment, but the connection between DR and depression including the direction has never been studied in a nationwide cohort. We aimed to assess, whether the associations between DR and diagnosed depression are bidirectional. METHODS We performed a national register-based cohort study of individuals with type 2 diabetes, who attended diabetic eye screening between January 2013 and June 2022. Level of DR was extracted from the Danish Registry of Diabetic Retinopathy. The severity of DR was assessed according to the International Clinical Diabetic Retinopathy severity scale. Diagnosed depression was ascertained by physician diagnostic codes of unipolar depression (F32), recurrent depression (F33) or dysthymia (F34.1) from the Danish National Patient Register. We estimated presence of diagnosed depression according to DR level at index date and risk of diagnosed depression during follow-up using multivariable logistic and Cox regression, respectively. Secondly, we assessed whether diagnosed depression at index date could predict incident DR. RESULTS We included 240,893 individuals with type 2 diabetes with baseline rates of diagnosed depression ranging from 5.2 to 6.0 % for DR level 1-4. At index date, individuals with type 2 diabetes and DR were less likely to have a history of diagnosed depression (multivariable adjusted OR, 0.77 [95 % CI 0.73-0.82]). In 226,523 individuals with type 2 diabetes followed for 1,159,755 person-years, 1.7 % developed at least one episode of diagnosed depression. In a model adjusted for age and sex, individuals with DR at index date had an increased risk of incident diagnosed depression compared to those without DR (HR 1.25 [95 % CI 1.16-1.36]). Adjusting for marital status, use of glucose-, lipid- and blood pressure lowering medication, HbA1c, diabetic neuropathy and Charlson comorbidity index waived the above risk (multivariable adjusted HR 1.02 [95 % CI 0.93-1.12]). Furthermore a previous history of diagnosed depression was not associated with increased risk of incident DR (multivariable adjusted HR 0.89 [95 % CI 0.77-1.03]). CONCLUSION In this nationwide cohort study, individuals with DR at first screening were 23 % less likely to have a history of depression, but our data did not support a bidirectional association between DR and depression. Selection bias may have occurred as diagnosed depression is a known barrier for attending DR-screening.
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Affiliation(s)
- Frederik N Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN - Open Patient data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Javad N Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN - Open Patient data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Caroline S Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Katja C Schielke
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne S Thykjær
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland, United Kingdom
| | - Frans Pouwer
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Svenstrup L, Möller S, Fedder J, Pedersen DE, Erb K, Andersen CY, Humaidan P. Investigation of luteal HCG supplementation in GnRH-agonist-triggered fresh embryo transfer cycles: a randomized controlled trial. Reprod Biomed Online 2023; 48:103415. [PMID: 38452605 DOI: 10.1016/j.rbmo.2023.103415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 03/09/2024]
Abstract
RESEARCH QUESTION Does splitting the human chorionic gonadotrophin (HCG) support in IVF cycles triggered by a gonadotrophin-releasing hormone agonist result in a better progesterone profile? DESIGN Randomized controlled three-arm study, performed at the Fertility Clinic, Odense University Hospital, Denmark. Patients with 12-25 follicles ≥12 mm were randomized into three groups: Group 1 - ovulation triggered with 6500 IU HCG; Group 2 - ovulation triggered with 0.5 mg GnRH agonist, followed by 1500 IU HCG on the day of oocyte retrieval (OCR); and Group 3 - ovulation triggered with 0.5 mg GnRH agonist, followed by 1000 IU HCG on the day of OCR and 500 IU HCG on OCR + 5. All groups received 180 mg vaginal progesterone. Progesterone concentrations were analysed in eight blood samples from each patient. RESULTS Sixty-nine patients completed the study. Baseline and laboratory data were comparable. Progesterone concentration peaked on OCR + 4 in Groups 1 and 2, and peaked on OCR + 6 in Group 3. On OCR + 6, the progesterone concentration in Group 2 was significantly lower compared with Groups 1 and 3 (P = 0.003 and P < 0.001, respectively). On OCR + 8, the progesterone concentration in Group 3 was significantly higher compared with the other groups (both P<0.001). Progesterone concentrations were significantly higher in Group 3 from OCR + 6 until OCR + 14 compared with the other groups (all P ≤ 0.003). Four patients developed ovarian hyperstimulation syndrome in Group 3. CONCLUSION Sequential HCG support after a GnRH agonist trigger provides a better progesterone concentration in the luteal phase.
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Affiliation(s)
- Louise Svenstrup
- Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Research Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark; Fertility Clinic, Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.
| | - Sören Möller
- Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Jens Fedder
- Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Research Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark; Fertility Clinic, Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Dorrit Elschner Pedersen
- Fertility Clinic, Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Karin Erb
- Fertility Clinic, Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Humaidan
- Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Fertility Clinic, Skive Regional Hospital, Skive, Denmark; Faculty of Health, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Rajabaleyan P, Jensen RO, Möller S, Qvist N, Ellebaek MB. Primary anastomosis and suturing combined with vacuum-assisted abdominal closure in patients with secondary peritonitis due to perforation of the small intestine: a retrospective study. BMC Surg 2023; 23:280. [PMID: 37715227 PMCID: PMC10503050 DOI: 10.1186/s12893-023-02179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Intestinal resection and a proximal stoma is the preferred surgical approach in patients with severe secondary peritonitis due to perforation of the small intestine. However, proximal stomas may result in significant nutritional problems and long-term parenteral nutrition. This study aimed to assess whether primary anastomosis or suturing of small intestine perforation is feasible and safe using the open abdomen principle with vacuum-assisted abdominal closure (VAC). METHODS Between January 2005 and June 2018, we performed a retrospective chart review of 20 patients (> 18 years) with diffuse faecal peritonitis caused by small intestinal perforation and treated with primary anastomosis/suturing and subsequent open abdomen with VAC. RESULTS The median age was 65 years (range: 23-90 years). Twelve patients were female (60%). Simple suturing of the small intestinal perforation was performed in three cases and intestinal resection with primary anastomosis in 17 cases. Four patients (20%) died within 90-days postoperatively. Leakage occurred in five cases (25%), and three patients developed an enteroatmospheric fistula (15%). Thirteen of 16 patients (83%) who survived were discharged without a stoma. The rest had a permanent stoma. CONCLUSIONS Primary suturing or resection with anastomosis and open abdomen with VAC in small intestinal perforation with severe faecal peritonitis is associated with a high rate of leakage and enteroatmospheric fistula formation. TRIAL REGISTRATION The study was approved by the Danish Patient Safety Authority (case number 3-3013-1555/1) and the Danish Data Protection Agency (file number 18/28,404). No funding was received.
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Affiliation(s)
- Pooya Rajabaleyan
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
| | - Rie Overgaard Jensen
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mark Bremholm Ellebaek
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Dinesen S, Stokholm L, Subhi Y, Peto T, Savarimuthu TR, Andersen N, Andresen J, Bek T, Hajari J, Heegaard S, Højlund K, Laugesen CS, Kawasaki R, Möller S, Schielke K, Thykjær AS, Pedersen F, Grauslund J. Five-Year Incidence of Proliferative Diabetic Retinopathy and Associated Risk Factors in a Nationwide Cohort of 201 945 Danish Patients with Diabetes. Ophthalmology Science 2023; 3:100291. [PMID: 37025947 PMCID: PMC10070897 DOI: 10.1016/j.xops.2023.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
Purpose To evaluate the proliferative diabetic retinopathy (PDR) progression rates and identify the demographic and clinical characteristics of patients who later developed PDR compared with patients who did not progress to that state. Design A national 5-year register-based cohort study including 201 945 patients with diabetes. Subjects Patients with diabetes who had attended the Danish national screening program (2013-2018) for diabetic retinopathy (DR). Methods We used the first screening episode as the index date and included both eyes of patients with and without subsequent progression of PDR. Data were linked with various national health registries to investigate relevant clinical and demographic parameters. The International Clinical Retinopathy Disease Scale was used to classify DR, with no DR as level 0, mild DR as level 1, moderate DR as level 2, severe DR as level 3, and PDR as level 4. Main Outcome Measures Hazard ratios (HRs) for incident PDR for all relevant demographic and clinical parameters and 1-, 3-, and 5-year incidence rates of PDR according to baseline DR level. Results Progression to PDR within 5 years was identified in 2384 eyes of 1780 patients. Proliferative diabetic retinopathy progression rates from baseline DR level 3 at 1, 3 and 5 years were 3.6%, 10.9%, and 14.7%, respectively. The median number of visits was 3 (interquartile range, 1-4). Progression to PDR was predicted in a multivariable model by duration of diabetes (HR, 4.66 per 10 years; 95% confidence interval [CI], 4.05-5.37), type 1 diabetes (HR, 9.61; 95% CI, 8.01-11.53), a Charlson Comorbidity Index score of > 0 (score 1: HR, 4.62; 95% CI, 4.14-5.15; score 2: HR, 2.28; 95% CI, 1.90-2.74; score ≥ 3: HR, 4.28; 95% CI, 3.54-5.17), use of insulin (HR, 5.33; 95% CI, 4.49-6.33), and use of antihypertensive medications (HR, 2.23; 95% CI, 1.90-2.61). Conclusions In a 5-year longitudinal study of an entire screening nation, we found increased risk of PDR with increasing baseline DR levels, longer duration of diabetes, type 1 diabetes, systemic comorbidity, use of insulin, and blood pressure-lowering medications. Most interestingly, we found lower risk of progression from DR level 3 to PDR compared with that in previous studies. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Frederiksen KH, Stokholm L, Frederiksen PH, Jørgensen CM, Möller S, Kawasaki R, Peto T, Grauslund J. Cardiovascular morbidity and all-cause mortality in patients with retinal vein occlusion: a Danish nationwide cohort study. Br J Ophthalmol 2023; 107:1324-1330. [PMID: 35537802 PMCID: PMC10447393 DOI: 10.1136/bjophthalmol-2022-321225] [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] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/24/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Associations between retinal vein occlusion (RVO) and subsequent cardiovascular disease (CVD) or mortality have not been evaluated in a recent cohort, after novel therapeutic options have increased referrals for treatment of the condition. We aimed to evaluate overall and subtype-stratified risk of CVD and all-cause mortality following RVO and assess any alterations after the introduction of angiostatic therapy in Denmark in 2011. METHODS This nationwide, registry-based cohort study from 1998 to 2018 evaluated 4 194 781 individuals. Hazard ratios (HRs) were reported for RVO as an overall measure and subclassified as branch and central RVO. RESULTS Patients with RVO (n=15 665) were median 71.8 years old at the time of exposure and 50.7% were women. RVO associated with incident CVD (adjusted HR 1.13, 95% CI 1.09 to 1.17) but not mortality (adjusted HR 1.00, 95% CI 0.97 to 1.03). Almost similar risks of CVD were found for patients with branch and central RVO (adjusted HRs 1.14, 95% CI 1.03 to 1.25, and 1.12, 95% CI 1.00 to 1.25, respectively), but only patients with central RVO exhibited increased mortality (adjusted HR 1.12, 95% CI 1.04 to 1.21). Risk of CVD, especially non-ischaemic, was higher for patients diagnosed after 2011 (adjusted HRs 1.24, 95% CI 1.15 to 1.33 vs 1.06, 95% CI 1.01 to 1.12). CONCLUSION In a cohort of the Danish population aged 40 years or more, patients with RVO had a 13% increased risk of incident CVD compared with unexposed individuals. Risk of CVD was increased after 2011, when intravitreal angiostatic treatment was introduced and referral practices altered.
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Affiliation(s)
- Katrine Hartmund Frederiksen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Peter Hartmund Frederiksen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Sören Möller
- Open Patient data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Vision Informatics, Osaka University School of Medicine, Osaka, Japan
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Beck IH, Bilenberg N, Möller S, Nielsen F, Grandjean P, Højsager FD, Halldorsson TI, Nielsen C, Jensen TK. Association Between Prenatal and Early Postnatal Exposure to Perfluoroalkyl Substances and IQ Score in 7-Year-Old Children From the Odense Child Cohort. Am J Epidemiol 2023; 192:1522-1535. [PMID: 37119029 DOI: 10.1093/aje/kwad110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/13/2023] [Accepted: 04/26/2023] [Indexed: 04/30/2023] Open
Abstract
Perfluoroalkyl substances (PFAS) are persistent chemicals capable of crossing the placenta and passing into breast milk. Evidence suggests that PFAS exposure may affect brain development. We investigated whether prenatal or early postnatal PFAS exposure was associated with intelligence quotient (IQ) scores in schoolchildren from the Odense Child Cohort (Denmark, 2010-2020). We assessed concentrations of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) in maternal serum collected during the first trimester of pregnancy and in child serum at age 18 months. At 7 years of age, children completed an abbreviated version of the Wechsler Intelligence Scale for Children, Fifth Edition, from which Full Scale Intelligence Quotient (FSIQ) and Verbal Comprehension Index scores were estimated. In multiple linear regression analyses conducted among 967 mother-child pairs, a doubling in maternal PFOS and PFNA concentrations was associated with a lower FSIQ score, while no significant associations were observed for PFOA, PFHxS, or PFDA. PFAS concentrations at age 18 months and duration of breastfeeding were strongly correlated, and even in structural equation models it was not possible to differentiate between the opposite effects of PFAS exposure and duration of breastfeeding on FSIQ. PFAS exposure is ubiquitous; therefore, an association with even a small reduction in IQ is of public health concern.
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Rattenborg S, Möller S, Frostberg E, Rahr HB. Uneven Between-Hospital Distribution of Patient-Related Risk Factors for Adverse Outcomes of Colorectal Cancer Treatment: A Population-Based Register Study. Clin Epidemiol 2023; 15:867-880. [PMID: 37502790 PMCID: PMC10370415 DOI: 10.2147/clep.s411392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Purpose The purpose of this study was to elucidate between-hospital variation in the prevalence at the time of diagnosis of patient-related risk factors for adverse outcomes of colorectal cancer (CRC) treatment. Patients and Methods A register-based national cohort of 44,471 patients diagnosed with CRC and registered in the Danish Colorectal Cancer Group database in 2009-2018 was included in the study. Patient-related risk factors present at diagnosis were collected from national Danish registers within the areas of demography, lifestyle factors, comorbidity, participation in screening, disease-related factors and socioeconomic factors. Prediction models of short-term postoperative outcomes and mortality were modelled to examine the potential aggregated impact of patient-related risk factors on outcomes, and variations between hospitals were examined. Results The most conspicuous variations found were for old age (75+ years), ranging from 31% (95% confidence interval (95% CI): 29-33%) to 46% (95% CI: 43-48%), Union for International Cancer Control Stage I ranging from 12% (95% CI: 10-14%) to 21% (95% CI: 19-22%), Stage IV ranging from 23% (95% CI: 21-25%) to 35% (95% CI: 34-37%) and American Society of Anesthesiologists score ≥III ranging from 18% (95% CI: 16-19%) to 40% (95% CI: 37-43%). Clinically significant variations were found in predicted probability of 30-day surgical complications which varied from 17% (95% CI: 16-17%) to 23% (95% CI: 22-23%) and 90-day postoperative mortality which varied between 3.2% (95% CI: 3-3.4%) and 5.5% (95% CI: 4.9-6%). Conclusion Marked variation in the prevalence of patient-related risk factors for adverse outcomes of colorectal cancer treatment exists between hospitals in Denmark. It seems reasonable to take these differences into account when comparing outcomes between hospitals.
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Affiliation(s)
- Søren Rattenborg
- Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Colorectal Cancer Center South, Vejle, Denmark
| | - Sören Möller
- Open Patient Data Exploratory Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erik Frostberg
- Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Colorectal Cancer Center South, Vejle, Denmark
| | - Hans B Rahr
- Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Colorectal Cancer Center South, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Møller JJK, la Cour K, Pilegaard MS, Dalton SO, Bidstrup PE, Möller S, Jarlbaek L. Social vulnerability among cancer patients and changes in vulnerability during their trajectories - A longitudinal population-based study. Cancer Epidemiol 2023; 85:102401. [PMID: 37392489 DOI: 10.1016/j.canep.2023.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Identification of socially vulnerable cancer patients in the health care system is difficult. Only little is known concerning changes in the patients' social circumstances during the trajectory. Such knowledge is valuable regarding the identification of socially vulnerable patients in the health care system. The objective of this study was to use administrative data to identify population-based characteristics of socially vulnerable cancer patients and investigate how social vulnerability changed during the cancer trajectory. METHODOLOGY A registry-based social vulnerability index (rSVI) was applied to each cancer patient prior to their diagnosis, and used to assess changes in social vulnerability after the diagnosis. RESULTS A total of 32,497 cancer patients were included. Short-term survivors (n = 13,994) died from cancer from one to three years after the diagnosis, and long-term survivors (n = 18,555) survived at least three years after the diagnosis. 2452 (18 %) short-term survivors and 2563 (14 %) long-term survivors were categorized as socially vulnerable at diagnosis, of these 22 % and 33 % changed category to not socially vulnerable during the first two years after the diagnosis, respectively. For patients changing status of social vulnerability, several social and health-related indicators changed, which is in line with the complexity of the multifactorial social vulnerability. Less than 6 % of the patients categorized as not vulnerable at diagnosis, changed to become vulnerable during the following two years. CONCLUSION During the cancer trajectory, social vulnerability may change in both directions. Surprisingly, more patients, who were categorized as socially vulnerable when their cancer was diagnosed, changed status to not socially vulnerable during follow-up. Future research should attempt to increase knowledge on identifying cancer patients, who experience deterioration after the diagnosis.
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Affiliation(s)
- Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Danish Research Centre for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark.
| | - Karen la Cour
- Danish Research Centre for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark; Research Unit for User Perspectives and Community-Based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- Research Unit for User Perspectives and Community-Based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sören Möller
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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