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Winkler LL, Toft U, Glümer C, Bloch P, Buch-Andersen T, Christensen U. Involving supermarkets in health promotion interventions in the Danish Project SoL. A practice-oriented qualitative study on the engagement of supermarket staff and managers. BMC Public Health 2023; 23:706. [PMID: 37072841 PMCID: PMC10111755 DOI: 10.1186/s12889-023-15501-5] [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: 05/09/2022] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Supermarkets have been suggested as relevant settings for environmental and educational initiatives encouraging healthier shopping and eating decisions, but in the literature, limited attention has been paid to the context, perspectives, and everyday practices of supermarket staff. The aim of this study was to examine the engagement of supermarket staff in a health promotion project from a practice-oriented perspective. METHODS The study was based on qualitative data collected in the supermarket setting of Project SoL; a community-based health promotion project in Denmark. We conducted 26 in-depth interviews with store managers and other key staff members in seven participating supermarkets. In addition, we collected data on planning, implementation, and perceptions of supermarket staff of in-store interventions and other project-related activities. These field data included short telephone interviews, observational notes, photos, and audiotapes of meetings. Data were analysed from the perspective of practice theory. RESULTS Although supermarket staff found community-based health promotion meaningful to engage in, the study observed that their engagement was challenged by a business mindset, practical routines and structural requirements favouring sales promotion over health promotion. Nevertheless, there were also examples of how health promotion activities and ways of thinking were successfully incorporated in everyday staff practices during and after Project SoL. CONCLUSIONS Our findings point to both potentials and challenges for using supermarkets as settings for health promotion. The voluntary engagement of supermarket staff in community-based health projects cannot stand alone but should be supplemented by more long-lasting strategies and policies regulating this and other food environments. Context-sensitive and practice-oriented analyses in local food environments could inform such strategies and policies to make sure they target unwanted elements and practices and not just individual behavior.
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Affiliation(s)
- Lise L Winkler
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark.
| | - Ulla Toft
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
| | - Charlotte Glümer
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
- Center for Diabetes, Vesterbrogade 121, 3rd floor, København V, 1620, Denmark
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, 2730, Denmark
| | - Tine Buch-Andersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Gothersgade 160, København K, 1123, Denmark
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Toft U, Buch-Andersen T, Bloch P, Reinbach HC, Jensen BB, Mikkelsen BE, Aagaard-Hansen J, Glümer C. A Community-Based, Participatory, Multi-Component Intervention Increased Sales of Healthy Foods in Local Supermarkets-The Health and Local Community Project (SoL). Int J Environ Res Public Health 2023; 20:2478. [PMID: 36767845 PMCID: PMC9915330 DOI: 10.3390/ijerph20032478] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Project SoL was a 19-month (September 2012 to April 2014) community-based multi-component intervention based on the supersetting approach that was designed to promote healthier eating and physical activity among children and their families. The aim of this study was to examine the effects of a multi-component intervention (level 1) and a mass media intervention alone (level 2) compared to a control area (level 3) on food sales. The design was quasi-experimental. Weekly sales data for all Coop supermarkets in the intervention and control areas were analysed via longitudinal linear mixed-effects analyses. Significant increases in the sales of fish (total) (29%; p = 0.003), canned fish (31%; p = 0.025) and oatmeal (31%; p = 0.003) were found for the level 1 intervention area compared to the control area. In the level 2 intervention area, significant increases in the sales of vegetables (total) (17%; p = 0.038), fresh vegetables (20%; p = 0.01), dried fruit (51%; p = 0.022), oatmeal (19%; p = 0.008) and wholegrain pasta (58%; p = 0.0007) were found compared to the control area. The sales of canned fish increased by 30% in the level 1 area compared to the level 2 area (p = 0.025). This study demonstrated significant increases in the sales of healthy foods, both in the areas with multi-component and mass media interventions alone compared to the control area.
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Affiliation(s)
- Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Tine Buch-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Helene Christine Reinbach
- Department of Food Science, Section for Food Design and Consumer Behaviour, University of Copenhagen, Rolighedsvej 30, Building 2-74, 5th Floor, Room C505, 1958 Frederiksberg C, Denmark
| | - Bjarne Bruun Jensen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Bent Egberg Mikkelsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, 1958 Frederiksberg C, Denmark
| | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- SA MRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Charlotte Glümer
- Center for Diabetes, Copenhagen Municipality, Vesterbrogade 121, 1620 Copenhagen, Denmark
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Thygesen LC, Zinckernagel L, Dalal H, Egstrup K, Glümer C, Grønbæk M, Holmberg T, Køber L, la Cour K, Nakano A, Nielsen CV, Sibilitz KL, Tolstrup JS, Zwisler AD, Taylor RS. Cardiac rehabilitation for patients with heart failure: association with readmission and mortality risk. Eur Heart J Qual Care Clin Outcomes 2022; 8:830-839. [PMID: 34850879 DOI: 10.1093/ehjqcco/qcab086] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
AIMS To examine the temporal trends and factors associated with national cardiac rehabilitation (CR) referral and compare the risk of hospital readmission and mortality in those referred for CR versus no referral. METHODS AND RESULTS This cohort study includes all adult patients alive 120 days from incident heart failure (HF) identified by the Danish Heart Failure Registry (n = 33 257) between 2010 and 2018. Multivariable logistic regression models were used to assess the association between CR referral and patient factors and acute all-cause hospital readmission and mortality at 1 year following HF admission. Overall, 46.7% of HF patients were referred to CR, increasing from 31.7% in 2010 to 52.2% in 2018. Several factors were associated with lower odds of CR referral: male sex [odds ratio (OR): 0.85; 95% confidence interval: 0.80-0.89], older age, unemployment, retirement, living alone, non-Danish ethnic origin, low educational level, New York Heart Association (NYHA) class IV vs. I (OR: 0.75; 0.60-0.95), left ventricular ejection fraction >40%, and comorbidity (stroke, chronic kidney disease, atrial fibrillation/flutter, and diabetes). Myocardial infarction, arthritis, coronary artery bypass grafting, percutaneous coronary intervention, valvular surgery, NYHA class II, and use of angiotensin-converting enzyme inhibitors were associated with higher odds of CR referral. CR referral was associated with lower risk of acute all-cause readmission (OR: 0.92; 0.87-0.97) and all-cause mortality (OR: 0.65; 0.58-0.72). CONCLUSION Although increased over time, only one in two HF patients in Denmark were referred to CR in 2018. Strategies are needed to reduce referral disparities, focusing on subgroups of patients at highest risk of non-referral.
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Affiliation(s)
- Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Line Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Hasnain Dalal
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK.,Primary Care Research Group, University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Kenneth Egstrup
- Department of Cardiovascular Research, Odense University Hospital, Svendborg, Denmark
| | - Charlotte Glümer
- Center for Diabetes in the City of Copenhagen, Copenhagen, Denmark
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen la Cour
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne Nakano
- The Danish Clinical Registries (RKKP), Aarhus. Denmark
| | - Claus Vinther Nielsen
- Institute of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Kirstine Lærum Sibilitz
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark.,Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Bender M, Willaing Tapager I, Brønnum-Hansen H, Andersen I, Glümer C, Vrangbæk K. Equity of referrals to type 2 diabetes rehabilitation in a universal welfare state. SSM Popul Health 2022; 20:101303. [DOI: 10.1016/j.ssmph.2022.101303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
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Thorsen IK, Yang Y, Valentiner LS, Glümer C, Karstoft K, Brønd JC, Nielsen RO, Brøns C, Christensen R, Nielsen JS, Vaag AA, Pedersen BK, Langberg H, Ried-Larsen M. The Effects of a Lifestyle Intervention Supported by the InterWalk Smartphone App on Increasing Physical Activity Among Persons With Type 2 Diabetes: Parallel-Group, Randomized Trial. JMIR Mhealth Uhealth 2022; 10:e30602. [PMID: 36170002 PMCID: PMC9557767 DOI: 10.2196/30602] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 02/08/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Effective and sustainable implementation of physical activity (PA) in type 2 diabetes (T2D) health care has in general not been successful. Efficacious and contemporary approaches to support PA adherence and adoption are required. Objective The primary objective of this study was to investigate the effectiveness of including an app-based (InterWalk) approach in municipality-based rehabilitation to increase moderate-and-vigorous PA (MVPA) across 52 weeks compared with standard care among individuals with T2D. Methods The study was designed as a parallel-group, randomized trial with 52 weeks’ intervention and subsequent follow-up for effectiveness (52 weeks from baseline). Participants were recruited between January 2015 and December 2016 and randomly allocated (2:1) into 12 weeks of (1) standard care + InterWalk app–based interval walking training (IWT; IWT group; n=140), or (2) standard care + the standard exercise program (StC group; n=74). Following 12 weeks, the IWT group was encouraged to maintain InterWalk app–based IWT (3 times per week for 30-60 minutes) and the StC group was encouraged to maintain exercise without structured support. Moreover, half of the IWT group (IWTsupport group, n=54) received additional motivational support following the 12-week program until 52-week follow-up. The primary outcome was change in objectively measured MVPA time (minutes/day) from baseline to 52-week follow-up. Key secondary outcomes included changes in self-rated physical and mental health–related quality of life (HRQoL), physical fitness, weight, and waist circumference. Results Participants had a mean age of 59.6 (SD 10.6) years and 128/214 (59.8%) were men. No changes in MVPA time were observed from baseline to 52-week follow-up in the StC and IWT groups (least squares means [95% CI] 0.6 [–4.6 to 5.8] and –0.2 [–3.8 to 3.3], respectively) and no differences were observed between the groups (mean difference [95% CI] –0.8 [–8.1 to 6.4] minutes/day; P=.82). Physical HRQoL increased by a mean of 4.3 (95% CI 1.8 to 6.9) 12-item Short-Form Health Survey (SF-12) points more in the IWT group compared with the StC group (Benjamini-Hochberg adjusted P=.007) and waist circumference apparently decreased a mean of –2.3 (95% CI –4.1 to –0.4) cm more in the IWT group compared with the StC group but with a Benjamini-Hochberg adjusted P=.06. No between-group differences were observed among the remaining key secondary outcomes. Conclusions Among individuals with T2D referred to municipality-based lifestyle programs, randomization to InterWalk app–based IWT did not increase objectively measured MVPA time over 52 weeks compared with standard health care, although apparent benefits were observed for physical HRQoL. Trial Registration ClinicalTrials.gov NCT02341690; https://clinicaltrials.gov/ct2/show/NCT02341690
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Affiliation(s)
- Ida Kær Thorsen
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Yanxiang Yang
- Chair of Sport and Health Management, Technical University of Munich, Munich, Germany
| | | | - Charlotte Glümer
- Centre for Diabetes, Municipality of Copenhagen, Copenhagen, Denmark
| | - Kristian Karstoft
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rasmus Oestergaard Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Charlotte Brøns
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Jens Steen Nielsen
- Danish Centre for Strategic Research in Type 2 Diabetes, Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | | | - Bente Klarlund Pedersen
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henning Langberg
- CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Frølich A, Nielsen A, Glümer C, Eriksen CU, Maindal HT, Kleist BH, Birke H, Stockmarr A. Patients' assessment of care for type 2 diabetes: Results of the Patient Assessment of Chronic Illness Care scale in a Danish population. BMC Health Serv Res 2021; 21:1069. [PMID: 34627257 PMCID: PMC8501600 DOI: 10.1186/s12913-021-07051-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. We aimed to validate the PACIC questionnaire by (1) assess patients’ perception of the quality of care for Danish patients with type 2 diabetes, (2) identify which factors are most important to the quality of care designated by the five subscales in PACIC, and (3) the validity of the questionnaire. Methods A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results In total, 2,696 individuals with type 2 diabetes completed ≥ 50 % of items. The floor effect for individual items was 8.5–74.5 %; the ceiling effect was 4.1–47.8 %. Cronbach’s alpha was 0.73–0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents, who receive diabetes care primarily at general practice and outpatient clinics had higher scores compared to those receiving care at a private specialist. Receiving rehabilitation was followed by higher scores in all subscales. Those 70 years or older had lower mean total and subscale scores compared to younger patient groups. A higher number of diabetes visits were associated with higher total scores; a higher number of emergency department visits were associated with lower total scores. The effects of healthcare utilisation on subscale scores varied. Conclusions These results provide insight into variations in the quality of provided care and can be used for targeting initiatives towards improving diabetes care. Factors important to the quality of perceived care are having a GP or hospital outpatient clinic as the primary organization. Also having a higher number of visits to the two organizations are perceived as higher quality of care as well as participating in a rehabilitation program. Floor and ceiling effects were comparable to an evaluation of the PACIC questionnaire in a Danish population. Yet, floor effects suggest a need for further evaluation and possible improvement of the PACIC questionnaire in a Danish setting. Total PACIC scores were lower than in other healthcare systems, possible being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07051-6.
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Affiliation(s)
- Anne Frølich
- Section of General Practice, Department of Public Health, University of Copenhagen, 1356 K, Copenhagen, Denmark. .,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, 4200, Slagelse, Denmark.
| | - Ann Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark
| | | | | | | | | | - Hanne Birke
- Center for clinical Research and Prevention, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark
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Garn SD, Glümer C, Villadsen SF, Malling GMH, Christensen U. Understanding the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes: a realist evaluation. Arch Public Health 2021; 79:160. [PMID: 34488884 PMCID: PMC8418966 DOI: 10.1186/s13690-021-00676-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite an increasing use and positive effects of peer support interventions, little is known about how the outcomes are produced. Thus, it is essential not only to measure outcomes, but also to identify the mechanisms by which they are generated. Using a realist evaluation approach, we aimed to identify the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes (peers). By investigating the participating peers' interactions, we furthermore examined how their individual contextual factors either facilitated or hindered the mechanisms in operation. METHODS We used a multi-method case-study design (n = 9). Data included semi-structured interviews with four key groups of informants (peer, peer supporter, project manager, and a diabetes nurse) for each case (n = 25). Furthermore, we collected survey data from peers both before and after participation (n = 9). The interview data were analysed using a systematic text condensation, and the Intervention-context-actor-mechanism-outcome framework was used to structure the analysis. RESULTS We identified 2 groups of mechanisms that improved diabetes self-management and the use of healthcare services (outcomes): 'perceived needs and readiness' and 'encouragement and energy'. However, the mechanisms only generated the intended outcomes among peers with a stable occupation and financial situation, a relatively good health condition, and sufficient energy (all defined as contextual factors). Independent of these contextual factors, 'experience of social and emotional support' was identified as a mechanism within all peers that increased self-care awareness (defined as output). Dependent on whether the contextual factors facilitated or hindered the mechanisms to generate outcomes, we categorised the peers into those who achieved outcomes and those who did not. CONCLUSIONS We identified two groups of mechanisms that improved the peers' diabetes self-management and use of healthcare services. The mechanisms only generated the intended outcomes if peers' individual contextual factors facilitated an active interaction with the elements of the intervention. However, independent of these contextual factors, a third group of mechanisms increased self-care awareness among all peers. We highlight the importance of contextual awareness of the target groups in the design and evaluation of peer support interventions for socially vulnerable people with type 2-diabetes. TRIAL REGISTRATION ClinicalTrials.gov, Retrospective Registration (20 Jan 2021), registration number NCT04722289 .
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Affiliation(s)
- Stine Dandanell Garn
- Center for Diabetes, City of Copenhagen, Copenhagen, Denmark. .,Department of Public Health, Section for Social Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Charlotte Glümer
- Center for Diabetes, City of Copenhagen, Copenhagen, Denmark.,Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Sarah Fredsted Villadsen
- Department of Public Health, Section for Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gritt Marie Hviid Malling
- Department of Public Health, Section for Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Christensen
- Department of Public Health, Section for Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Skovlund SE, Nicolucci A, Balk-Møller N, Berthelsen DB, Glümer C, Perrild H, Kjær P, Nørgaard LM, Troelsen LH, Pietraszek A, Hessler D, Kaplan S, Ejskjær N. Perceived Benefits, Barriers, and Facilitators of a Digital Patient-Reported Outcomes Tool for Routine Diabetes Care: Protocol for a National, Multicenter, Mixed Methods Implementation Study. JMIR Res Protoc 2021; 10:e28391. [PMID: 34477563 PMCID: PMC8449301 DOI: 10.2196/28391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/04/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is growing evidence that digital patient-reported outcome (PRO) questionnaires and PRO-based decision support tools may help improve the active engagement of people with diabetes in self-care, thereby improving the quality of care. However, many barriers still exist for the real-world effectiveness and implementation of such PRO tools in routine care. Furthermore, limited research has evaluated the acceptability, feasibility, and benefits of such tools across different health care settings. OBJECTIVE This study aims to evaluate the acceptability, feasibility, and perceived benefits of the Danish digital PRO diabetes tool in different health care settings in Denmark and to determine the factors affecting its implementation. Furthermore, the study evaluates the psychometric characteristics of the Danish PRO Diabetes Questionnaire and the validity of the scoring algorithms for dialogue support. The objective of this study is to guide the ongoing optimization of the PRO diabetes tool, its implementation, and the design of future randomized controlled effectiveness studies. METHODS We designed a multicenter, mixed methods, single-arm acceptability-feasibility implementation study protocol to contribute to the real-world pilot test of a new digital PRO diabetes tool in routine diabetes care. The use of the tool involves two main steps. First, the people with diabetes will complete a digital PRO Diabetes Questionnaire in the days before a routine diabetes visit. Second, the health care professional (HCP) will use a digital PRO tool to review the PRO results together with the people with diabetes during the visit. The PRO diabetes tool is designed to encourage and support people to take an active role for the people with diabetes in their own care and to expedite the delivery of person-centered, collaborative, and coordinated care. RESULTS A multicenter pilot study protocol and psychometrically designed digital data collection tools for evaluation were developed and deployed as part of a national evaluation of a new digital PRO diabetes intervention. A total of 598 people with diabetes and 34 HCPs completed the study protocol by April 1, 2021. CONCLUSIONS A large-scale, mixed methods, multicenter study for evaluating the use of the nationally developed PRO Diabetes Questionnaire in routine care across all health care sectors in Denmark by using the RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model as a framework has been designed and is ongoing. This study is expected to provide new important and detailed information about the real-world acceptability, perceived relevance, and benefits of the PRO diabetes tool among a large heterogeneous population of people with diabetes in Denmark and HCPs in different care settings. The results will be used to further improve the PRO tool, design implementation facilitation support strategies, and design future controlled effectiveness studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/28391.
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Affiliation(s)
- Søren Eik Skovlund
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Nina Balk-Møller
- PRO Secretariat, National Health Data Authority, Copenhagen, Denmark
| | - Dorthe B Berthelsen
- Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Charlotte Glümer
- Center for Diabetes, Copenhagen Municipality, Copenhagen, Denmark
| | - Hans Perrild
- Department of Endocrinology, Frederiksberg-Bisbebjerg Hospital, Copenhagen, Denmark
| | - Pernille Kjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lise Havbæk Troelsen
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Anna Pietraszek
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Danielle Hessler
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Sherrie Kaplan
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Niels Ejskjær
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
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Buch-Andersen T, Eriksson F, Bloch P, Glümer C, Mikkelsen BE, Toft U. The Danish SoL Project: Effects of a Multi-Component Community-Based Health Promotion Intervention on Prevention of Overweight among 3-8-Year-Old Children. Int J Environ Res Public Health 2021; 18:ijerph18168419. [PMID: 34444168 PMCID: PMC8392184 DOI: 10.3390/ijerph18168419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/14/2021] [Accepted: 07/30/2021] [Indexed: 01/24/2023]
Abstract
The aim of the study was to determine the effects of a multi-component community-based health promotion intervention on body mass index (BMI) z-scores and waist circumference (WC) in three- to eight-year-old children. A quasi-experimental design was adopted to evaluate the effects of the SoL intervention involving three intervention and three control communities. The 19-month intervention was based on the supersetting approach and was designed to promote healthier eating and physical activity among children and their families. BMI z-scores and WC were measured at baseline and follow-up. At baseline, 238 (54%) and 214 (51%) of all eligible children were measured from intervention and control, respectively. The change over time in the BMI z-scores of children from the intervention group was significantly different from that of the control group (p = 0.001). BMI z-scores increased over time in the intervention group in contrast to the control group, whose BMI z-scores decreased (difference in change between groups 0.19 z-scores 95% CI 0.08, 0.30). No significant differences were observed for WC. The results showed no favourable effects of the intervention of Project SoL on BMI z-scores and WC in children. Further studies based on a larger sample size and a longer intervention duration are needed.
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Affiliation(s)
- Tine Buch-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark;
- Correspondence: ; Tel.: +45-3816-3113
| | - Frank Eriksson
- Section of Biostatistics, Department of Public Health, Copenhagen University, Øster Farimagsgade 5, 1014 Copenhagen, Denmark;
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Niels Steensens Vej 2, 2820 Gentofte, Denmark;
| | - Charlotte Glümer
- Center for Diabetes, Copenhagen Municipality, Vesterbrogade 121, 1620 Copenhagen, Denmark;
| | - Bent Egberg Mikkelsen
- Department of Geosciences and Natural Resource Management, Copenhagen University, Rolighedsvej 23, 1958 Frederiksberg, Denmark;
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark;
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10
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Jones A, Bardram JE, Bækgaard P, Cramer-Petersen CL, Skinner T, Vrangbæk K, Starr L, Nørgaard K, Lind N, Bechmann Christensen M, Glümer C, Wang-Sattler R, Laxy M, Brander E, Heinemann L, Heise T, Schliess F, Ladewig K, Kownatka D. Integrated personalized diabetes management goes Europe: A multi-disciplinary approach to innovating type 2 diabetes care in Europe. Prim Care Diabetes 2021; 15:360-364. [PMID: 33184011 DOI: 10.1016/j.pcd.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
Type 2 diabetes mellitus represents a multi-dimensional challenge for European and global societies alike. Building on an iterative six-step disease management process that leverages feedback loops and utilizes commodity digital tools, the PDM-ProValue study program demonstrated that integrated personalized diabetes management, or iPDM, can improve the standard of care for persons living with diabetes in a sustainable way. The novel "iPDM Goes Europe" consortium strives to advance iPDM adoption by (1) implementing the concept in a value-based healthcare setting for the treatment of persons living with type 2 diabetes, (2) providing tools to assess the patient's physical and mental health status, and (3) exploring new avenues to take advantage of emerging big data resources.
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Affiliation(s)
- Allan Jones
- Roche Diabetes Care GmbH, Mannheim, Germany.
| | | | - Per Bækgaard
- Technical University of Denmark, Lyngby, Denmark
| | | | | | | | - Laila Starr
- University of Copenhagen, Copenhagen, Denmark
| | | | - Nanna Lind
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | | | - Rui Wang-Sattler
- German Research Centre for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research, Germany
| | - Michael Laxy
- German Research Centre for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research, Germany
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11
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Thorsen IK, Rossen S, Glümer C, Midtgaard J, Ried-Larsen M, Kayser L. Health Technology Readiness Profiles Among Danish Individuals With Type 2 Diabetes: Cross-Sectional Study. J Med Internet Res 2020; 22:e21195. [PMID: 32930669 PMCID: PMC7525399 DOI: 10.2196/21195] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 01/22/2023] Open
Abstract
Background Information technologies (IT) are increasingly implemented in type 2 diabetes (T2D) treatment as a resource for remotely supported health care. However, possible pitfalls of introducing IT in health care are generally overlooked. Specifically, the effectiveness of IT to improve health care may depend on the user’s readiness for health technology. Objective We aim to investigate readiness for health technology in relation to mental well-being, sociodemographic, and disease-related characteristics among individuals with T2D. Methods Individuals with T2D (aged ≥18 years) who had been referred to self-management education, exercise, diet counseling, smoking cessation, or alcohol counseling completed a questionnaire survey covering (1) background information, (2) the 5-item World Health Organization Well-Being Index (WHO-5), (3) receptiveness to IT use in physical activity, and (4) the Readiness and Enablement Index for Health Technology (READHY), constituted by dimensions related to self-management, social support, and eHealth literacy. Individuals were divided into profiles using cluster analysis based on their READHY scores. Outcomes included differences across profiles in mental well-being, sociodemographic, and disease-related characteristics. Results Participants in the study were 155 individuals with T2D with a mean age of 60.2 (SD 10.7) years, 55.5% (86/155) of which were men and 44.5% (69/155) of which were women. Participants were stratified into 5 health technology readiness profiles based on the cluster analysis: Profile 1, high health technology readiness; Profile 2, medium health technology readiness; Profile 3, medium health technology readiness and high level of emotional distress; Profile 4, medium health technology readiness and low-to-medium eHealth literacy; Profile 5, low health technology readiness. No differences in sociodemographic and disease-related characteristics were observed across profiles; however, we identified 3 vulnerable subgroups of individuals: Profile 3 (21/155, 13.5%), younger individuals (mean age of 53.4 years, SD 8.9 years) with low mental well-being (mean 42.7, SD 14.7) and emotional distress (mean 1.69, SD 0.38); Profile 4 (20/155, 12.9%), older individuals (mean age 66.3 years, SD 9.0 years) with less IT use (50.0% used IT for communication) and low-to-medium eHealth literacy; and Profile 5 (36/155, 23.2%) with low mental well-being (mean 43.4, SD 20.1) and low readiness for health technology. Conclusions Implementation of IT in health care of individuals with T2D should be based on comprehensive consideration of mental well-being, emotional distress, and readiness for health technology rather than sociodemographic and disease-related characteristics to identify the individuals in need of social support, self-management education, and extensive IT support. A one-size-fits-all approach to IT implementation in health care will potentially increase the risk of treatment failure among the most vulnerable individuals.
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Affiliation(s)
- Ida Kær Thorsen
- The Centre for Physical Activity Research, University of Copenhagen, Copenhagen, Denmark
| | - Sine Rossen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Copenhagen, Denmark
| | - Charlotte Glümer
- Center for Diabetes, Municipality of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- The University Hospitals' Centre for Health Research, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- The Centre for Physical Activity Research, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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12
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Juul A, Glümer C, Jervelund SS, Hempler NF. Ethnic differences in participation in diabetes education programmes. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.063] [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: 11/13/2022] Open
Abstract
Abstract
Background
Immigrants from non-Western countries have a higher prevalence of type 2 diabetes. In addition, immigrants have an increased risk of developing diabetes complications, compared with the general population. Diabetes education programmes facilitate essential knowledge and skills that enable people to manage their condition in daily life. However, fewer immigrants attend and complete diabetes education compared with the general population. The aim of this study is to explore what characterises those who decline and accept participation in diabetes education in relation to ethnicity, household composition and diabetes burden in the family.
Methods
The study population consisted of adults with type 2 diabetes referred to a municipal diabetes centre (n = 1819). Individual medical record data was linked to national registry data. Descriptive statistics and logistic regression models were applied.
Results
Preliminary results showed that 23% of individuals from the study population participated in diabetes education. We found no overall differences in participation rates between the general population and non-Western immigrants (24% vs. 18%, P = 0.12). However, when examining the immigrant groups by language (Arabic, Urdu and Turkish), the results indicated a non-significant tendency: Urdu speaking groups’ participation was similar to the general population (24%), whereas Arabic and Turkish speaking groups had lower participation rates (17% and 11%, P = 0.25/0.40).
Conclusions
The results suggest that there are differences in participation between some immigrant groups and the general population. Increased knowledge about which mechanisms affecting participation in diabetes education programme is required to ensure equal access. Further studies and analyses will explore how immigrants’ social relations enable and/or hamper participation in diabetes education and investigate which factors can be changed to improve participation rates.
Key messages
There are differences in participation in diabetes education programmes across different ethnic groups, which suggests a need for in-depth analysis into which mechanisms that affect participation. The results will be used to give input for future practices that can increase immigrant’s participation and retention in diabetes education programmes.
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Affiliation(s)
- A Juul
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Glümer
- Center for Diabetes, Copenhagen Municipality, Copenhagen, Denmark
- Department of Medicine and Health Technology, Aalborg University, Aalborg, Denmark
| | - S S Jervelund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - N F Hempler
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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13
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Hempler NF, Laursen DH, Glümer C. Culturally sensitive diabetes education supporting ethnic minorities with type 2 diabetes. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.027] [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: 11/12/2022] Open
Abstract
Abstract
Background
Ethnic minorities of non-Western origin are at higher risk of type 2 diabetes and diabetes complications, compared to the general population. Diabetes education programmes are essential to support people with diabetes to initiate and sustain behaviours needed to manage their condition throughout their lives. However, shaping diabetes education that provide culturally sensitive education that is acceptable to and supports diabetes self-management among members of ethnic minorities is needed.
Objectives
In this study, we develop and evaluate a culturally sensitive diabetes education programme in a community health setting, focusing on Arabic, Urdu or Turkish languages (n = 100). The programme aims to support ethnic minorities with type 2 diabetes in making health-promoting decisions about their care. Also, it will produce knowledge about methods and tools to improve content and format, and about the skills of those delivering the education. Using design-based research, the development comprised three phases: needs assessment, co-creation and testing. The target groups were actively involved in all phases.
Results
The needs assessment was based on fieldwork, workshops and interviews with the target groups and educators. Data showed that self-blame and learned helplessness undermined health-promoting decisions in the target groups. Also, a lack of clear roles between educators and peer educators, and a limited focus on goal setting in the educational setting was observed. The needs assessment informed the development of a 6 week group-based programme, supported by 11 dialogue tools. Preliminary findings show a high level of programme acceptability and participation as well as engagement in diabetes and care in the target groups.
Conclusions
By actively involving the target groups, health care professionals and as well as health services directly engaged with the target group, the outcomes of the programme are likely to be relevant to individuals and institutions.
Key messages
This study gives voice to ethnic minorities with type 2 diabetes through the co-creation of a diabetes education programme aiming to support health-promoting decisions. Innovative and involving methods are highly relevant to develop acceptable and effective diabetes education programmes targeting ethnic minority groups.
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Affiliation(s)
- N F Hempler
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - D H Laursen
- Center for Diabetes, Copenhagen Municipality, Copenhagen, Denmark
| | - C Glümer
- Center for Diabetes, Copenhagen Municipality, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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14
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Breinholt Larsen F, Hauge Pedersen M, Friis K, Glümer C, Lasgaard M. Patterns of Multimorbidity in the General Danish Population. A Latent Class Analysis. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.062] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - K Friis
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - C Glümer
- Center for Diabetes, Copenhagen Municipality, Copenhagen, Denmark
| | - M Lasgaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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15
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Mikkelsen BE, Bloch P, Reinbach HC, Buch-Andersen T, Lawaetz Winkler L, Toft U, Glümer C, Jensen BB, Aagaard-Hansen J. Project SoL-A Community-Based, Multi-Component Health Promotion Intervention to Improve Healthy Eating and Physical Activity Practices among Danish Families with Young Children Part 2: Evaluation. Int J Environ Res Public Health 2018; 15:E1513. [PMID: 30021938 PMCID: PMC6069463 DOI: 10.3390/ijerph15071513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/30/2018] [Accepted: 07/03/2018] [Indexed: 12/15/2022]
Abstract
Project SoL is implemented over a period of four years with the aim to promote healthy eating and physical activity among children aged 3⁻8 years by targeting the families in a Danish municipality based on the multi-component, supersetting strategy. Interventions are implemented in childcare centres, schools and supermarkets in three local communities as well as in local mass media and social media during a 19 months period in the Municipality of Bornholm. The matching Municipality of Odsherred serves as a control site based on its similarity to Bornholm regarding several socio-demographic and health indicators. The present paper gives an account of the design used for the summative and formative evaluation based on a realistic evaluation and a mixed methods approach combining qualitative and quantitative methods. Summative studies are conducted on changes of health behaviours among the involved families and within the municipalities in general, changes in community awareness of the project, changes in purchase patterns, changes in overweight and obesity among the targeted children and changes in knowledge and preferences among children due to sensory education workshops. The formative research comprises studies on children's perceptions of health, perceptions of staff at supermarkets and media professionals on their roles in supporting the health promotion agenda, and motivations and barriers of community stakeholders to engage in health promotion at community level. The paper discusses operational issues and lessons learnt related to studying complex community interventions, cross-disciplinarily, interfaces between practice and research and research capacity strengthening; and suggests areas for future research. The development and implementation of the intervention and its theoretical foundation is described in a separate paper.
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Affiliation(s)
- Bent Egberg Mikkelsen
- Department of Learning and Philosophy, Aalborg University, Copenhagen DK-2450, Denmark.
| | - Paul Bloch
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens Vej 6, DK-2820 Gentofte, Denmark.
| | | | - Tine Buch-Andersen
- Department of Development and Planning, Aalborg University, Copenhagen DK-2450, Denmark.
| | - Lise Lawaetz Winkler
- Research Centre for Prevention and Health, Capital Region, Glostrup DK-2600, Denmark.
| | - Ulla Toft
- Research Centre for Prevention and Health, Capital Region, Glostrup DK-2600, Denmark.
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region, Glostrup DK-2600, Denmark.
| | - Bjarne Bruun Jensen
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens Vej 6, DK-2820 Gentofte, Denmark.
| | - Jens Aagaard-Hansen
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens Vej 6, DK-2820 Gentofte, Denmark.
- MRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg ZA-2000, South Africa.
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16
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Pisinger C, Koch MBB, Hjortsø E, Jørgensen T, Glümer C. Ups and downs of a peer-based smoking cessation intervention help tailored to hospital-employees with low socioeconomic status: The RESPEKT Study. Tob Prev Cessat 2018; 4:24. [PMID: 32411850 PMCID: PMC7205107 DOI: 10.18332/tpc/91426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking is one of the most important determinants of socioeconomic inequality in mortality. Few studies have tested which interventions are effective in smokers with low socioeconomic status (SES). METHODS All hospitals in the Capital Region of Denmark were included and randomized to intervention or control groups. The target-group was smokers with low SES. Intervention hospitals: smokers in the target-group assisted researchers to tailor a group-based smoking cessation intervention. Further they helped recruiting smoking colleagues and motivating them to stay abstinent. Control hospitals: ‘as usual’. Unforeseen organizational challenges led to a change of study design; the hospital-level assessment was reduced to two cross-sectional surveys. RESULTS Response rates in hospitals’ smoking status survey were very low. Smoking status was reported by 1876 out of 7003 employees at baseline and 2280 out of 7496 employees at 1-year follow-up. Two cross-sectional surveys showed no significant difference in self-reported smoking at 1-year follow-up between intervention and control hospitals (p=0.262). We recruited 100 smokers in the group-based smoking cessation intervention tailored to smokers with low SES (corresponding to approx. 10% of smokers in target-group); 32.4% of these were validated as continuously abstinent at 6 months follow-up. CONCLUSIONS Involving smokers with low SES as partners at an early stage of study design facilitated both recruitment and development of the intervention. Despite high validated long-term abstinence rates in smoking cessation groups in the intervention hospitals we found no apparent effect of the intervention at hospital-level after one year. However, larger involvement of the target-group seems feasible and is recommended.
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Torben Jørgensen
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Research Center for Prevention and Health, Denmark
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17
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Hulman A, Vistisen D, Glümer C, Bergman M, Witte DR, Færch K. Can insulin response patterns predict metabolic disease risk in individuals with normal glucose tolerance? Reply to Crofts CAP, Brookler K, Henderson G [letter]. Diabetologia 2018; 61:1234-1235. [PMID: 29502267 DOI: 10.1007/s00125-018-4589-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Adam Hulman
- Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, DK-8000, Aarhus C, Denmark.
- Danish Diabetes Academy, Odense, Denmark.
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
| | | | - Charlotte Glümer
- Research Center for Prevention and Health, Glostrup Hospital, Glostrup, Denmark
| | - Michael Bergman
- Division of Endocrinology, Diabetes and Metabolism, NYU School of Medicine, NYU Langone Diabetes Prevention Program, New York, NY, USA
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, DK-8000, Aarhus C, Denmark
- Danish Diabetes Academy, Odense, Denmark
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18
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Hulman A, Vistisen D, Glümer C, Bergman M, Witte DR, Færch K. Glucose patterns during an oral glucose tolerance test and associations with future diabetes, cardiovascular disease and all-cause mortality rate. Diabetologia 2018; 61:101-107. [PMID: 28983719 DOI: 10.1007/s00125-017-4468-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 05/24/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
AIMS/HYPOTHESIS In addition to blood glucose concentrations measured in the fasting state and 2 h after an OGTT, intermediate measures during an OGTT may provide additional information regarding a person's risk of future diabetes and cardiovascular disease (CVD). First, we aimed to characterise heterogeneity of glycaemic patterns based on three time points during an OGTT. Second, we compared the incidences of diabetes and CVD and all-cause mortality rates among those with different patterns. METHODS Our cohort study included 5861 participants without diabetes at baseline from the Danish Inter99 study. At baseline, all participants underwent an OGTT with measurements of plasma glucose levels at 0, 30 and 120 min. Latent class mixed-effects models were fitted to identify distinct patterns of glycaemic response during the OGTT. Information regarding incident diabetes, CVD and all-cause mortality rates during a median follow-up time of 11, 12 and 13 years, respectively, was extracted from national registers. Cox proportional hazard models with adjustment for several cardiometabolic risk factors were used to compare the risk of diabetes, CVD and all-cause mortality among individuals in the different latent classes. RESULTS Four distinct glucose patterns during the OGTT were identified. One pattern was characterised by high 30 min but low 2 h glucose values. Participants with this pattern had an increased risk of developing diabetes compared with participants with lower 30 min and 2 h glucose levels (HR 4.1 [95% CI 2.2, 7.6]) and participants with higher 2 h but lower 30 min glucose levels (HR 1.5 [95% CI 1.0, 2.2]). Furthermore, the all-cause mortality rate differed between the groups with significantly higher rates in the two groups with elevated 30 min glucose. Only small non-significant differences in risk of future CVD were observed across latent classes after confounder adjustment. CONCLUSIONS/INTERPRETATION Elevated 30 min glucose is associated with increased risk of diabetes and all-cause mortality rate independent of fasting and 2 h glucose levels. Therefore, subgroups at high risk may not be revealed when considering only fasting and 2 h glucose levels during an OGTT.
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Affiliation(s)
- Adam Hulman
- Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, DK-8000, Aarhus C, Denmark.
- Danish Diabetes Academy, Odense, Denmark.
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
| | | | - Charlotte Glümer
- Research Centre for Prevention and Health, Glostrup Hospital, Glostrup, Denmark
| | - Michael Bergman
- Division of Endocrinology, Diabetes and Metabolism, NYU School of Medicine, NYU Langone Diabetes Prevention Program, New York, NY, USA
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, DK-8000, Aarhus C, Denmark
- Danish Diabetes Academy, Odense, Denmark
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19
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Bernsdorf KA, Lau CJ, Andreasen AH, Toft U, Lykke M, Glümer C. Accessibility of fast food outlets is associated with fast food intake. A study in the Capital Region of Denmark. Health Place 2017; 48:102-110. [PMID: 29031108 DOI: 10.1016/j.healthplace.2017.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 11/29/2016] [Revised: 09/22/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Abstract
Literature suggests that people living in areas with a wealth of unhealthy fast food options may show higher levels of fast food intake. Multilevel logistic regression analyses were applied to examine the association between GIS-located fast food outlets (FFOs) and self-reported fast food intake among adults (+ 16 years) in the Capital Region of Denmark (N = 48,305). Accessibility of FFOs was measured both as proximity (distance to nearest FFO) and density (number of FFOs within a 1km network buffer around home). Odds of fast food intake ≥ 1/week increased significantly with increasing FFO density and decreased significantly with increasing distance to the nearest FFO for distances ≤ 4km. For long distances (>4km), odds increased with increasing distance, although this applied only for car owners. Results suggest that Danish health promotion strategies need to consider the contribution of the built environment to unhealthy eating.
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Affiliation(s)
- Kamille Almer Bernsdorf
- Research Centre for Prevention and Health, Capital Region of Denmark, Rigshospitalet - Glostrup, Nordre Ringvej 57, Section 84/85, 2600 Glostrup, Denmark.
| | - Cathrine Juel Lau
- Research Centre for Prevention and Health, Capital Region of Denmark, Rigshospitalet - Glostrup, Nordre Ringvej 57, Section 84/85, 2600 Glostrup, Denmark.
| | - Anne Helms Andreasen
- Research Centre for Prevention and Health, Capital Region of Denmark, Rigshospitalet - Glostrup, Nordre Ringvej 57, Section 84/85, 2600 Glostrup, Denmark.
| | - Ulla Toft
- Research Centre for Prevention and Health, Capital Region of Denmark, Rigshospitalet - Glostrup, Nordre Ringvej 57, Section 84/85, 2600 Glostrup, Denmark.
| | - Maja Lykke
- Research Centre for Prevention and Health, Capital Region of Denmark, Rigshospitalet - Glostrup, Nordre Ringvej 57, Section 84/85, 2600 Glostrup, Denmark.
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region of Denmark, Rigshospitalet - Glostrup, Nordre Ringvej 57, Section 84/85, 2600 Glostrup, Denmark; Department of Health Sciences and Technology, Aalborg University, Fredrik Bayers vej 7D2, DK-9220 Aalborg, Denmark.
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20
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Veiby N, Drobnjak D, Munch I, Toft U, Glümer C, Faerch K, Kessel L, Larsen M. The effect of caffeine on retinal vessel diameters in the Inter99 eye study. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0f003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - D.N. Drobnjak
- Oslo University Hospital HF, Ophthalmology; Oslo Norway
| | - I.C. Munch
- Zealand University Hospital, Ophthalmology; Roskilde Denmark
| | - U. Toft
- Research Center for Prevention and Health; Glostrup Denmark
| | - C. Glümer
- Research Center for Prevention and Health; Glostrup Denmark
| | - K. Faerch
- Steno Diabetes Center; Gentofte Denmark
| | - L. Kessel
- Rigshospitalet, Ophthalmology; Copenhagen Denmark
| | - M. Larsen
- Rigshospitalet, Ophthalmology; Copenhagen Denmark
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Lund Jensen N, Pedersen HS, Vestergaard M, Mercer SW, Glümer C, Prior A. The impact of socioeconomic status and multimorbidity on mortality: a population-based cohort study. Clin Epidemiol 2017; 9:279-289. [PMID: 28546772 PMCID: PMC5436773 DOI: 10.2147/clep.s129415] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Multimorbidity (MM) is more prevalent among people of lower socioeconomic status (SES), and both MM and SES are associated with higher mortality rates. However, little is known about the relationship between SES, MM, and mortality. This study investigates the association between educational level and mortality, and to what extent MM modifies this association. METHODS We followed 239,547 individuals invited to participate in the Danish National Health Survey 2010 (mean follow-up time: 3.8 years). MM was assessed by using information on drug prescriptions and diagnoses for 39 long-term conditions. Data on educational level were provided by Statistics Denmark. Date of death was obtained from the Civil Registration System. Information on lifestyle factors and quality of life was collected from the survey. The main outcomes were overall and premature mortality (death before the age of 75). RESULTS Of a total of 12,480 deaths, 6,607 (9.5%) were of people with low educational level (LEL) and 1,272 (2.3%) were of people with high educational level (HEL). The mortality rate was higher among people with LEL compared with HEL in groups of people with 0-1 disease (hazard ratio: 2.26, 95% confidence interval: 2.00-2.55) and ≥4 diseases (hazard ratio: 1.14, 95% confidence interval: 1.04-1.24), respectively (adjusted model). The absolute number of deaths was six times higher among people with LEL than those with HEL in those with ≥4 diseases. The 1-year cumulative mortality proportions for overall death in those with ≥4 diseases was 5.59% for people with HEL versus 7.27% for people with LEL, and 1-year cumulative mortality proportions for premature death was 2.93% for people with HEL versus 4.04% for people with LEL. Adjusting for potential mediating factors such as lifestyle and quality of life eliminated the statistical association between educational level and mortality in people with MM. CONCLUSION Our study suggests that LEL is associated with higher overall and premature mortality and that the association is affected by MM, lifestyle factors, and quality of life.
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Affiliation(s)
- Nikoline Lund Jensen
- Research Unit for General Practice.,Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Mogens Vestergaard
- Research Unit for General Practice.,Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Charlotte Glümer
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
| | - Anders Prior
- Research Unit for General Practice.,Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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22
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Schiøtz ML, Stockmarr A, Høst D, Glümer C, Frølich A. Social disparities in the prevalence of multimorbidity - A register-based population study. BMC Public Health 2017; 17:422. [PMID: 28486983 PMCID: PMC5424300 DOI: 10.1186/s12889-017-4314-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/26/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Prevalences of multimorbidity vary between European studies and several methods and definitions are used. In this study we examine the prevalence of multimorbidity in relation to age, gender and educational attainment and the association between physical and mental health conditions and educational attainment in a Danish population. METHODS A cross-sectional design was used to study the prevalence of multimorbidity, defined as two or more chronic conditions, and of comorbid physical and mental health conditions across age groups and educational attainment levels among 1,397,173 individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. After calculating prevalence, odds ratios for multimorbidity and mental health conditions were derived from logistic regression on gender, age, age squared, education and number of physical conditions (only for odds ratios for mental health conditions). Odds ratios for having multimorbidity and mental health conditions for each variable were adjusted for all other variables. RESULTS Multimorbidity prevalence was 21.6%. Half of the population aged 65 and above had multimorbidity, and prevalence was inversely related to educational attainment: 26.9% (95% CI, 26.8-26.9) among those with lower secondary education versus 13.5% (95% CI, 13.5-13.6) among people with postgraduate education. Adjusted odds ratios for multimorbidity were 0.50 (95% CI, 0.49-0.51) for people with postgraduate education, compared to people with lower secondary education. Among all population members, 4.9% (95% CI, 4.9-4.9) had both a physical and a mental health condition, a proportion that increased to 22.6% of people with multimorbidity. Physical and mental health comorbidity was more prevalent in women (6.33%; 95% CI, 6.3-6.4) than men (3.34%; 95% CI, 3.3-3.4) and approximately 50 times more prevalent among older persons than younger ones. Physical and mental health comorbidity was also twice as prevalent among people with lower secondary education than among those with postgraduate education. The presence of a mental health condition was strongly associated with the number of physical conditions; those with five or more physical conditions had an adjusted odds ratio for a mental health condition of 3.93 (95% CI, 3.8-4.1), compared to those with no physical conditions. CONCLUSION Multimorbidity prevalence and patterns in the Danish population are comparable to those of other European populations. The high prevalence of mental and physical health conditions highlights the need to ensure that healthcare systems deliver care that takes physical and mental comorbidity into account. Further, the higher prevalence of multimorbidity among persons with low educational attainment emphasizes the importance of having a health care system providing care that is beneficial to all regardless of socioeconomic status.
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Affiliation(s)
- Michaela L. Schiøtz
- Intersectoral Research Unit for Health Services, The Danish Capital Region, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
- Research Unit for Chronic Conditions, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark Richard Petersens Plads, Building 324, 2800 Kongens Lyngby, Denmark
| | - Dorte Høst
- Research Unit for Chronic Conditions, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, The Capital Region, Rigshospitalet, Copenhagen University, Nordre Ringvej 57 Building 84-85, 2600 Glostrup, DK Denmark
- Department of Health Science and Technology, Aalborg University, Frederik Bajers Vej 5, Aalborg, 9220 Denmark
| | - Anne Frølich
- Research Unit for Chronic Conditions, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
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23
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Drobnjak D, Munch IC, Glümer C, Færch K, Kessel L, Larsen M, Veiby NCBB. Relationship between retinal vessel diameters and retinopathy in the Inter99 Eye Study. J Clin Transl Endocrinol 2017; 8:22-28. [PMID: 29067255 PMCID: PMC5651334 DOI: 10.1016/j.jcte.2017.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 12/28/2016] [Revised: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 01/26/2023]
Abstract
Non-invasive imaging of the eye can throw light on systemic disease processes. Retinopathy and cardiovascular disease share many associated risk factors. Wider retinal vessel diameters are associated with retinopathy.
Purpose To examine the association between retinal vessel diameters and retinopathy in participants with and without type 2 diabetes in a Danish population-based cohort. Methods The study included 878 persons aged 30 to 60 years from the Inter99 Eye Study. Retinopathy was defined as a presence of one or more retinal hemorrhages or one or more microaneurysms. Vessel diameters were expressed as central retinal artery equivalent diameter (CRAE) and central retinal vein equivalent diameter (CRVE). Multiple linear regression analyses were performed. Results Among participants with diabetes, CRAE was 6.3 µm (CI 95%: 1.0 to 11.6, p = 0.020) wider and CRVE was 7.9 µm (CI 95%: 0.7 to 15.2, p = 0.030) wider in those with retinopathy compared to those without retinopathy, after adjusting for age, gender, HbA1c, blood pressure, smoking, serum total and HDL cholesterol. In all participants, CRAE increased with presence of retinopathy (p = 0.005) and with smoking (p = 0.001), and CRAE decreased with hypertension (p < 0.001), high HDL cholesterol (p = 0.016) and age (p < 0.001). Central retinal vein equivalent diameter increased with presence of retinopathy (p = 0.022) and with smoking (p < 0.001), and decreased with higher HDL cholesterol (p < 0.001) and age (p = 0.015). Female gender was associated with wider CRVE (p = 0.029). Conclusions Wider retinal vessel diameters were associated with the presence of retinopathy in participants with diabetes, but not in participants without diabetes. The associations between retinal vessel diameters and known retinopathy risk factors were confirmed. These results suggest that information obtained by non-invasive imaging of the interior of the eye can contribute to a better understanding of systemic disease processes.
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Affiliation(s)
- Dragana Drobnjak
- Center of Eye Research, Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Inger Christine Munch
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Line Kessel
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
| | - Michael Larsen
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
| | - Nina C B B Veiby
- Center of Eye Research, Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway
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24
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Lau CJ, Pisinger C, Husemoen LLN, Jacobsen RK, Linneberg A, Jørgensen T, Glümer C. Reply to "Is diabetes preventable in the general population?". Prev Med 2017; 96:158-159. [PMID: 28043829 DOI: 10.1016/j.ypmed.2016.12.014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/09/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Cathrine J Lau
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark.
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Lise Lotte N Husemoen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark
| | - Rikke Kart Jacobsen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; Department of Clinical Experimental Research, Rigshospitalet, 2600 Glostrup, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; Faculty of Medicine, Aalborg University, 9229 Aalborg East, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark; Faculty of Medicine, Aalborg University, 9229 Aalborg East, Denmark
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25
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Rauh SP, Heymans MW, Koopman ADM, Nijpels G, Stehouwer CD, Thorand B, Rathmann W, Meisinger C, Peters A, de Las Heras Gala T, Glümer C, Pedersen O, Cederberg H, Kuusisto J, Laakso M, Pearson ER, Franks PW, Rutters F, Dekker JM. Predicting glycated hemoglobin levels in the non-diabetic general population: Development and validation of the DIRECT-DETECT prediction model - a DIRECT study. PLoS One 2017; 12:e0171816. [PMID: 28187151 PMCID: PMC5302787 DOI: 10.1371/journal.pone.0171816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022] Open
Abstract
Aims/hypothesis To develop a prediction model that can predict HbA1c levels after six years in the non-diabetic general population, including previously used readily available predictors. Methods Data from 5,762 initially non-diabetic subjects from three population-based cohorts (Hoorn Study, Inter99, KORA S4/F4) were combined to predict HbA1c levels at six year follow-up. Using backward selection, age, BMI, waist circumference, use of anti-hypertensive medication, current smoking and parental history of diabetes remained in sex-specific linear regression models. To minimize overfitting of coefficients, we performed internal validation using bootstrapping techniques. Explained variance, discrimination and calibration were assessed using R2, classification tables (comparing highest/lowest 50% HbA1c levels) and calibration graphs. The model was externally validated in 2,765 non-diabetic subjects of the population-based cohort METSIM. Results At baseline, mean HbA1c level was 5.6% (38 mmol/mol). After a mean follow-up of six years, mean HbA1c level was 5.7% (39 mmol/mol). Calibration graphs showed that predicted HbA1c levels were somewhat underestimated in the Inter99 cohort and overestimated in the Hoorn and KORA cohorts, indicating that the model’s intercept should be adjusted for each cohort to improve predictions. Sensitivity and specificity (95% CI) were 55.7% (53.9, 57.5) and 56.9% (55.1, 58.7) respectively, for women, and 54.6% (52.7, 56.5) and 54.3% (52.4, 56.2) for men. External validation showed similar performance in the METSIM cohort. Conclusions/interpretation In the non-diabetic population, our DIRECT-DETECT prediction model, including readily available predictors, has a relatively low explained variance and moderate discriminative performance, but can help to distinguish between future highest and lowest HbA1c levels. Absolute HbA1c values are cohort-dependent.
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Affiliation(s)
- Simone P Rauh
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anitra D M Koopman
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Giel Nijpels
- Department of General Practice and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Coen D Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Wolfgang Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Tonia de Las Heras Gala
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Glostrup Hospital, Capital Region of Denmark, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henna Cederberg
- Department of Medicine, University of Kuopio and Kuopio University Hospital, Kuopio, Finland
| | - Johanna Kuusisto
- Department of Medicine, University of Kuopio and Kuopio University Hospital, Kuopio, Finland
| | - Markku Laakso
- Department of Medicine, University of Kuopio and Kuopio University Hospital, Kuopio, Finland
| | - Ewan R Pearson
- Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, United Kingdom
| | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skane University Hospital Malmö, Malmö, Sweden.,Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.,Harvard Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Femke Rutters
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jacqueline M Dekker
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Spitters HPEM, Lau CJ, Sandu P, Quanjel M, Dulf D, Glümer C, van Oers HAM, van de Goor IAM. Unravelling networks in local public health policymaking in three European countries - a systems analysis. Health Res Policy Syst 2017; 15:5. [PMID: 28159008 PMCID: PMC5291943 DOI: 10.1186/s12961-016-0168-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Facilitating and enhancing interaction between stakeholders involved in the policymaking process to stimulate collaboration and use of evidence, is important to foster the development of effective Health Enhancing Physical Activity (HEPA) policies. Performing an analysis of real-world policymaking processes will help reveal the complexity of a network of stakeholders. Therefore, the main objectives were to unravel the stakeholder network in the policy process by conducting three systems analyses, and to increase insight into the similarities and differences in the policy processes of these European country cases. METHODS A systems analysis of the local HEPA policymaking process was performed in three European countries involved in the 'REsearch into POlicy to enhance Physical Activity' (REPOPA) project, resulting in three schematic models showing the main stakeholders and their relationships. The models were used to compare the systems, focusing on implications with respect to collaboration and use of evidence in local HEPA policymaking. Policy documents and relevant webpages were examined and main stakeholders were interviewed. RESULTS The systems analysis in each country identified the main stakeholders involved and their position and relations in the policymaking process. The Netherlands and Denmark were the most similar and both differed most from Romania, especially at the level of accountability of the local public authorities for local HEPA policymaking. The categories of driving forces underlying the relations between stakeholders were formal relations, informal interaction and knowledge exchange. CONCLUSIONS A systems analysis providing detailed descriptions of positions and relations in the stakeholder network in local level HEPA policymaking is rather unique in this area. The analyses are useful when a need arises for increased interaction, collaboration and use of knowledge between stakeholders in the local HEPA network, as they provide an overview of the stakeholders involved and their mutual relations. This information can be an important starting point to enhance the uptake of evidence and build more effective public health policies.
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Affiliation(s)
- Hilde P. E. M. Spitters
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Cathrine J. Lau
- Research Centre for Prevention and Health, Capital Region of Denmark, Ndr, Ringvej 57, Afsnit 84/85, 2600 Glostrup, Denmark
| | - Petru Sandu
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, 7 Pandurilor St. Universitas, Room 910, 400376 Cluj-Napoca, Romania
| | - Marcel Quanjel
- Youth Care, Special Needs Education and Research, P.O. Box 6546, 6503 GA, Nijmegen, The Netherlands
| | - Diana Dulf
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, 7 Pandurilor St. Universitas, Room 910, 400376 Cluj-Napoca, Romania
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region of Denmark, Ndr, Ringvej 57, Afsnit 84/85, 2600 Glostrup, Denmark
- Department of Health Sciences and Technology, Aalborg University, Frederik Bayers vej 7D2, DK-9220 Aalborg, Denmark
| | - Hans A. M. van Oers
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
- National Institute of Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Ien A. M. van de Goor
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
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Toft U, Winkler LL, Mikkelsen BE, Bloch P, Glümer C. Discounts on fruit and vegetables combined with a space management intervention increased sales in supermarkets. Eur J Clin Nutr 2017; 71:476-480. [PMID: 28145417 DOI: 10.1038/ejcn.2016.272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 12/08/2016] [Accepted: 12/13/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES To examine the effects of two interventions on consumer purchases of fruits and vegetables (F&V) on the Danish island of Bornholm: a 20% discount on F&V combined with improved shelf-space allocation, and improved shelf-space allocation alone. SUBJECTS/METHODS A space management intervention to promote F&V sales was performed in two large discount supermarkets on Bornholm in Denmark for 3 months (September-November 2012). In addition, a 20% discount on F&V was introduced for 3 months in one of the supermarkets ('space + price'). The effect was evaluated using sales data from the two intervention supermarkets and three control supermarkets from the same supermarket chain but in Odsherred, Denmark (control area). Both the effect on sales of fresh F&V and potential unhealthy substitution effects were evaluated using multi-level regression analyses. RESULTS During the price intervention period, the index number for sales of fresh vegetables increased by 22.2% (P=0.001) in the 'space + price' intervention supermarket compared with the control supermarkets. Furthermore, the index number for the sale of organic fresh fruit and vegetables increased by 12.1% (P=0.04) and the sale of the total amount of fruit and vegetables (fresh, frozen, dried and canned) increased by 15.3% (P=0.01) compared with the control supermarkets. In the 'space only' intervention supermarket no significant increase in the sale of fruit and vegetables was found. No unhealthy substitution effects were found. CONCLUSIONS In conclusion, a 20% price reduction on F&V significantly increased sales of F&V. The effect was most pronounced on vegetables and no negative/unhealthy substitution effects were found.
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Affiliation(s)
- U Toft
- Research Centre for Prevention and Health, The Capital Region Denmark, Glostrup University Hospital, Glostrup, Denmark
| | - L L Winkler
- Research Centre for Prevention and Health, The Capital Region Denmark, Glostrup University Hospital, Glostrup, Denmark
| | - B E Mikkelsen
- Department of Development and Planning, Aalborg University, Copenhagen, Denmark
| | - P Bloch
- Health Promotion Research, Steno Diabetes Center, Gentofte, Denmark
| | - C Glümer
- Research Centre for Prevention and Health, The Capital Region Denmark, Glostrup University Hospital, Glostrup, Denmark.,Department of Development and Planning, Aalborg University, Copenhagen, Denmark
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28
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Larsen FB, Pedersen MH, Friis K, Glümer C, Lasgaard M. A Latent Class Analysis of Multimorbidity and the Relationship to Socio-Demographic Factors and Health-Related Quality of Life. A National Population-Based Study of 162,283 Danish Adults. PLoS One 2017; 12:e0169426. [PMID: 28056050 PMCID: PMC5215832 DOI: 10.1371/journal.pone.0169426] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 12/16/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives To identify patterns of multimorbidity in the general population and examine how these patterns are related to socio-demographic factors and health-related quality of life. Study design and setting We used latent class analysis to identify subgroups with statistically distinct and clinically meaningful disease patterns in a nationally representative sample of Danish adults (N = 162,283) aged 16+ years. The analysis was based on 15 chronic diseases. Results Seven classes with different disease patterns were identified: a class with no or only a single chronic condition (59% of the population) labeled “1) Relatively Healthy” and six classes with a very high prevalence of multimorbidity labeled; “2) Hypertension” (14%); “3) Musculoskeletal Disorders” (10%); “4) Headache-Mental Disorders” (7%); “5) Asthma-Allergy” (6%); “6) Complex Cardiometabolic Disorders” (3%); and “7) Complex Respiratory Disorders” (2%). Female gender was associated with an increased likelihood of belonging to any of the six multimorbidity classes except for class 2 (Hypertension). Low educational attainment predicted membership of all of the multimorbidity classes except for class 5 (Asthma-Allergy). Marked differences in health-related quality of life between the seven latent classes were found. Poor health-related quality of life was highly associated with membership of class 6 (Complex Cardiometabolic Disorders) and class 7 (Complex Respiratory Disorders). Despite different disease patterns, these two classes had nearly identical profiles in relation to health-related quality of life. Conclusion The results clearly support that diseases tend to compound and interact, which suggests that a differentiated public health and treatment approach towards multimorbidity is needed.
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Affiliation(s)
- Finn Breinholt Larsen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
- * E-mail:
| | - Marie Hauge Pedersen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Karina Friis
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Glostrup, Denmark
| | - Mathias Lasgaard
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
- Department of Psychology, Southern University of Denmark, Odense, Denmark
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Lau C, Færch K, Glümer C, Toft U, Tetens I, Borch-Johnsen K, Jørgensen T. Evaluation of dietary intake in a Danish population: the Inter99 study. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/11026480410000931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Cathrine Lau
- Steno Diabetes Centre, Gentofte, Denmark
- Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
| | - Kristine Færch
- Steno Diabetes Centre, Gentofte, Denmark
- Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
| | | | - Ulla Toft
- Steno Diabetes Centre, Gentofte, Denmark
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Li M, Li Y, Weeks O, Mijatovic V, Teumer A, Huffman JE, Tromp G, Fuchsberger C, Gorski M, Lyytikäinen LP, Nutile T, Sedaghat S, Sorice R, Tin A, Yang Q, Ahluwalia TS, Arking DE, Bihlmeyer NA, Böger CA, Carroll RJ, Chasman DI, Cornelis MC, Dehghan A, Faul JD, Feitosa MF, Gambaro G, Gasparini P, Giulianini F, Heid I, Huang J, Imboden M, Jackson AU, Jeff J, Jhun MA, Katz R, Kifley A, Kilpeläinen TO, Kumar A, Laakso M, Li-Gao R, Lohman K, Lu Y, Mägi R, Malerba G, Mihailov E, Mohlke KL, Mook-Kanamori DO, Robino A, Ruderfer D, Salvi E, Schick UM, Schulz CA, Smith AV, Smith JA, Traglia M, Yerges-Armstrong LM, Zhao W, Goodarzi MO, Kraja AT, Liu C, Wessel J, Boerwinkle E, Borecki IB, Bork-Jensen J, Bottinger EP, Braga D, Brandslund I, Brody JA, Campbell A, Carey DJ, Christensen C, Coresh J, Crook E, Curhan GC, Cusi D, de Boer IH, de Vries APJ, Denny JC, Devuyst O, Dreisbach AW, Endlich K, Esko T, Franco OH, Fulop T, Gerhard GS, Glümer C, Gottesman O, Grarup N, Gudnason V, Hansen T, Harris TB, Hayward C, Hocking L, Hofman A, Hu FB, Husemoen LLN, Jackson RD, Jørgensen T, Jørgensen ME, Kähönen M, Kardia SLR, König W, Kooperberg C, Kriebel J, Launer LJ, Lauritzen T, Lehtimäki T, Levy D, Linksted P, Linneberg A, Liu Y, Loos RJF, Lupo A, Meisinger C, Melander O, Metspalu A, Mitchell P, Nauck M, Nürnberg P, Orho-Melander M, Parsa A, Pedersen O, Peters A, Peters U, Polasek O, Porteous D, Probst-Hensch NM, Psaty BM, Qi L, Raitakari OT, Reiner AP, Rettig R, Ridker PM, Rivadeneira F, Rossouw JE, Schmidt F, Siscovick D, Soranzo N, Strauch K, Toniolo D, Turner ST, Uitterlinden AG, Ulivi S, Velayutham D, Völker U, Völzke H, Waldenberger M, Wang JJ, Weir DR, Witte D, Kuivaniemi H, Fox CS, Franceschini N, Goessling W, Köttgen A, Chu AY. SOS2 and ACP1 Loci Identified through Large-Scale Exome Chip Analysis Regulate Kidney Development and Function. J Am Soc Nephrol 2016; 28:981-994. [PMID: 27920155 DOI: 10.1681/asn.2016020131] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 08/22/2016] [Indexed: 01/08/2023] Open
Abstract
Genome-wide association studies have identified >50 common variants associated with kidney function, but these variants do not fully explain the variation in eGFR. We performed a two-stage meta-analysis of associations between genotypes from the Illumina exome array and eGFR on the basis of serum creatinine (eGFRcrea) among participants of European ancestry from the CKDGen Consortium (nStage1: 111,666; nStage2: 48,343). In single-variant analyses, we identified single nucleotide polymorphisms at seven new loci associated with eGFRcrea (PPM1J, EDEM3, ACP1, SPEG, EYA4, CYP1A1, and ATXN2L; PStage1<3.7×10-7), of which most were common and annotated as nonsynonymous variants. Gene-based analysis identified associations of functional rare variants in three genes with eGFRcrea, including a novel association with the SOS Ras/Rho guanine nucleotide exchange factor 2 gene, SOS2 (P=5.4×10-8 by sequence kernel association test). Experimental follow-up in zebrafish embryos revealed changes in glomerular gene expression and renal tubule morphology in the embryonic kidney of acp1- and sos2-knockdowns. These developmental abnormalities associated with altered blood clearance rate and heightened prevalence of edema. This study expands the number of loci associated with kidney function and identifies novel genes with potential roles in kidney formation.
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Affiliation(s)
- Man Li
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.,Division of Nephrology and Department of Human Genetics, University of Utah, Salt Lake City, Utah
| | - Yong Li
- Division of Genetic Epidemiology, Medical Center - University of Freiburg, Freiburg, Germany
| | | | | | | | - Jennifer E Huffman
- National Heart, Lung, and Blood Institute's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts.,Center for Genomic & Experimental Medicine, Institute of Genetics and Molecular Medicine
| | - Gerard Tromp
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania.,Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Christian Fuchsberger
- Center for Biomedicine, European Academy of Bolzano/Bozen, affiliated to the University of Lübeck, Bolzano/Bozen, Italy.,Department of Biostatistics, Center for Statistical Genetics
| | - Mathias Gorski
- Department of Genetic Epidemiology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories and University of Tampere School of Medicine, Tampere, Finland
| | - Teresa Nutile
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", Napoli, Italy
| | | | - Rossella Sorice
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", Napoli, Italy
| | - Adrienne Tin
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Tarunveer S Ahluwalia
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, and.,Steno Diabetes Center, Gentofte, Denmark
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan A Bihlmeyer
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carsten A Böger
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Robert J Carroll
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel I Chasman
- Genetics Division.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.,Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Marilyn C Cornelis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jessica D Faul
- Survey Research Center, Institute for Social Research, and
| | - Mary F Feitosa
- Department of Genetics, School of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Giovanni Gambaro
- Division of Nephrology, Gemelli Foundation University Hospital, Catholic University, Rome, Italy
| | - Paolo Gasparini
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", University of Trieste, Trieste, Italy
| | | | - Iris Heid
- Department of Genetic Epidemiology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Genetic Epidemiology and
| | - Jinyan Huang
- Institute of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,State Key Laboratory of Medical Genomics, Shanghai, China
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Anne U Jackson
- Department of Biostatistics, Center for Statistical Genetics
| | - Janina Jeff
- The Charles Bronfman Institute for Personalized Medicine, and
| | - Min A Jhun
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Annette Kifley
- Center for Vision Research, Department of Ophthalmology and Westmead Millennium Institute for Medical Research, University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Tuomas O Kilpeläinen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, and
| | - Ashish Kumar
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | | | - Kurt Lohman
- Division of Public Health Sciences, Biostatistical Sciences, and
| | - Yingchang Lu
- The Charles Bronfman Institute for Personalized Medicine, and
| | - Reedik Mägi
- Estonian Genome Center of University of Tartu, Tartu, Estonia
| | - Giovanni Malerba
- Section of Biology and Genetics, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Evelin Mihailov
- Estonian Genome Center of University of Tartu, Tartu, Estonia
| | | | - Dennis O Mook-Kanamori
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Epidemiology Section, Department of Biostatistics Epidemiology & Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Antonietta Robino
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Douglas Ruderfer
- Division of Psychiatric Genomics, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erika Salvi
- Department of Health Science, University of Milano, Milano, Italy
| | | | | | - Albert V Smith
- Icelandic Heart Association, Kopavogur, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Laura M Yerges-Armstrong
- Program in Personalized and Genomic Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Mark O Goodarzi
- Department of Medicine and Department of Biomedical Sciences, and.,Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, California
| | - Aldi T Kraja
- Division of Statistical Genomics, Department of Genetics and Center for Genome Sciences and Systems Biology, Washington University, St. Louis, Missouri
| | - Chunyu Liu
- National Heart, Lung, and Blood Institute's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts
| | - Jennifer Wessel
- Department of Epidemiology, Fairbanks School of Public Health, Indianapolis, Indiana.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Eric Boerwinkle
- The Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center, Houston, Texas
| | - Ingrid B Borecki
- Department of Genetics, School of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jette Bork-Jensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, and
| | | | - Daniele Braga
- Department of Health Science, University of Milano, Milano, Italy
| | | | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, and
| | - Archie Campbell
- Center for Genomic & Experimental Medicine, Institute of Genetics and Molecular Medicine
| | - David J Carey
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania
| | - Cramer Christensen
- Department of Internal Medicine and Endocrinology, Vejle Hospital, Vejle, Denmark
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Errol Crook
- Department of Medicine, University of South Alabama College of Medicine, Mobile, Alabama
| | - Gary C Curhan
- Renal Division and Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniele Cusi
- Department of Health Science, University of Milano, Milano, Italy.,Division of Nephrology, San Paolo Hospital, Milan, Italy
| | | | - Aiko P J de Vries
- Division of Nephrology, Department of Medicine, Leiden University Medical Center and Leiden University, The Netherlands
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Olivier Devuyst
- University of Zurich, Institute of Physiology, Zurich Center for Integrative Human Physiology, Mechanisms of Inherited Kidney Disorders Group, Zürich, Switzerland
| | | | | | - Tõnu Esko
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Estonian Genome Center of University of Tartu, Tartu, Estonia.,Division of Endocrinology, Children's Hospital Boston, Boston, Massachusetts.,Department of Genetics, Harvard Medical School, Boston, Massachusetts
| | | | - Tibor Fulop
- Department of Medicine, University of Mississippi, Jackson, Mississippi
| | - Glenn S Gerhard
- Department of Medical Genetics and Molecular Biochemistry, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Charlotte Glümer
- Research Center for Prevention and Health, The Capital Region of Denmark, Glostrup University Hospital, Glostrup, Denmark
| | - Omri Gottesman
- The Charles Bronfman Institute for Personalized Medicine, and
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, and
| | | | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, and.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Caroline Hayward
- Center for Genomic & Experimental Medicine, Institute of Genetics and Molecular Medicine.,Medical Research Council Human Genetics, Institute of Genetics and Molecular Medicine, and
| | - Lynne Hocking
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kindom
| | | | - Frank B Hu
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Lise Lotte N Husemoen
- Research Center for Prevention and Health, The Capital Region of Denmark, Glostrup University Hospital, Glostrup, Denmark
| | - Rebecca D Jackson
- Department of Internal Medicine, The Ohio State University, Columbia, Ohio
| | - Torben Jørgensen
- Research Center for Prevention and Health, The Capital Region of Denmark, Glostrup University Hospital, Glostrup, Denmark
| | | | - Mika Kähönen
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Wolfgang König
- Department of Internal Medicine II, Cardiology, University of Ulm Medical Center, Ulm, Germany.,The German Heart Center Munich, Technical University of Munich, Munich, Germany.,German Center for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | | | - Jennifer Kriebel
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | | | | | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and University of Tampere School of Medicine, Tampere, Finland
| | - Daniel Levy
- National Heart, Lung, and Blood Institute's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts
| | - Pamela Linksted
- Center for Genomic & Experimental Medicine, Institute of Genetics and Molecular Medicine
| | - Allan Linneberg
- Research Center for Prevention and Health, The Capital Region of Denmark, Glostrup University Hospital, Glostrup, Denmark.,Department of Clinical Experimental Research, Rigshospitalet, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yongmei Liu
- Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, and
| | - Antonio Lupo
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Christine Meisinger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Olle Melander
- Department of Clinical Science, Lund University, Malmö, Sweden
| | - Andres Metspalu
- Estonian Genome Center of University of Tartu, Tartu, Estonia
| | - Paul Mitchell
- Center for Vision Research, Department of Ophthalmology and Westmead Millennium Institute for Medical Research, University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine.,German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | | | - Afshin Parsa
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, and
| | - Annette Peters
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Cardiovascular Disease Research, Munich, Germany
| | - Ulrike Peters
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ozren Polasek
- Center for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - David Porteous
- Center for Genomic & Experimental Medicine, Institute of Genetics and Molecular Medicine
| | | | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, and.,Departments of Epidemiology and Health Services, University of Washington, Seattle, Washington.,Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Lu Qi
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Olli T Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, and Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Alex P Reiner
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Paul M Ridker
- Division of Preventive Medicine.,Cardiovascular Medicine Division, and
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Frank Schmidt
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - David Siscovick
- Cardiovascular Health Research Unit, Department of Medicine, and
| | - Nicole Soranzo
- Section of Biology and Genetics, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Konstantin Strauch
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Stephen T Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sheila Ulivi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Uwe Völker
- German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine.,German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,German Center for Diabetes Research, partner site Greifswald, Greifswald, Germany
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Jie Jin Wang
- Center for Vision Research, Department of Ophthalmology and Westmead Millennium Institute for Medical Research, University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - David R Weir
- Survey Research Center, Institute for Social Research, and
| | - Daniel Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Helena Kuivaniemi
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania.,Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Caroline S Fox
- National Heart, Lung, and Blood Institute's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Wolfram Goessling
- Genetics Division.,Steno Diabetes Center, Gentofte, Denmark.,Harvard Stem Cell Institute, Cambridge, Massachusetts; and.,Gastroenterology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Köttgen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland; .,Division of Genetic Epidemiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Audrey Y Chu
- National Heart, Lung, and Blood Institute's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts; .,Division of Preventive Medicine
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Bernsdorf KA, Lau CJ, Robinson K, Toft U, Andreasen AH, Glümer C. Temporal changes in sugar-sweetened soft drink intake and variation across municipalities in the Capital Region of Denmark. Prev Med Rep 2016; 4:364-9. [PMID: 27547718 PMCID: PMC4982919 DOI: 10.1016/j.pmedr.2016.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/02/2016] [Accepted: 08/02/2016] [Indexed: 11/22/2022] Open
Abstract
We aimed to examine the changes in sugar-sweetened soft drink intake across the Capital Region of Denmark from 2007 to 2013 and to examine the association between intake and neighbourhood socioeconomic status. The study included data from three health surveys in 2007 (n = 30,426), 2010 (n = 42,218) and 2013 (n = 34,330) in the Capital Region of Denmark. Frequency of soft drink intake was derived from questionnaires among residents aged 25-79 years and linked with information from central registers. Municipality social groups (MSG) 1-4 of decreasing affluence were defined as a composite measure. Logistic regression analyses were conducted for individuals with an appropriate soft drink intake (< once/week) and for individuals with a frequent soft drink intake (≥ 3 times/week). The proportion of individuals reporting an appropriate soft drink intake increased by 71% during 2007-2013 (p < 0.0001). A corresponding decrease was found in the proportion of individuals reporting a frequent soft drink intake. Compared to MSG 1, odds of an appropriate soft drink intake were significantly lower in MSG 3-4: OR = 0.87 (95%CI 0.83-0.91) and OR = 0.89 (95%CI 0.85-0.92), respectively. Compared to MSG 1, odds of a frequent soft drink intake were significantly higher in MSG 3-4: OR = 1.24 (95%CI 1.63-1.31) and 1.17 (95%CI 1.10-1.25), respectively. A significant interaction between MSG and educational level was found among individuals reporting a frequent soft drink intake (p = 0.02). The results show an encouraging reduction in frequency of soft drink intake among capital residents in the period of 2007-2013. A social gradient was observed in soft drink intake across MSG.
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Affiliation(s)
- Kamille Almer Bernsdorf
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, Section 84-85, DK-2600 Glostrup, Denmark
| | - Cathrine Juel Lau
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, Section 84-85, DK-2600 Glostrup, Denmark
| | - Kirstine Robinson
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, Section 84-85, DK-2600 Glostrup, Denmark
| | - Ulla Toft
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, Section 84-85, DK-2600 Glostrup, Denmark
| | - Anne Helms Andreasen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, Section 84-85, DK-2600 Glostrup, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, Section 84-85, DK-2600 Glostrup, Denmark
- Department of Health Sciences and Technology, Aalborg University, Fredrik Bayers vej 7D2, DK-9220 Aalborg, Denmark
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Winkler LL, Christensen U, Glümer C, Bloch P, Mikkelsen BE, Wansink B, Toft U. Substituting sugar confectionery with fruit and healthy snacks at checkout - a win-win strategy for consumers and food stores? a study on consumer attitudes and sales effects of a healthy supermarket intervention. BMC Public Health 2016; 16:1184. [PMID: 27876025 PMCID: PMC5120526 DOI: 10.1186/s12889-016-3849-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/16/2016] [Indexed: 11/29/2022] Open
Abstract
Background The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL); a Danish participatory community-based health promotion intervention. Methods Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area. Results The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P < 0.05). No significant intervention effect on sales of other intervention items or sugar confectionery was found. Conclusions The present study finds that the healthy checkout intervention was positively evaluated by consumers and provided a ‘responsible’ branding opportunity for supermarkets, thus representing a win-win strategy for store managers and consumers in the short term. However, the intervention was too modest to draw conclusions on long-term sales and health implications of this initiative. More research is needed to assess whether retailer-researcher collaborations on health promotion can be a winning strategy for public health.
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Affiliation(s)
- Lise L Winkler
- Research Centre for Prevention and Health, Centre for Health, Capital Region of Denmark, Rigshospitalet-Glostrup, Ndr. Ringvej 57, Building 84/85, 2600, Glostrup, Denmark.
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Centre for Health, Capital Region of Denmark, Rigshospitalet-Glostrup, Ndr. Ringvej 57, Building 84/85, 2600, Glostrup, Denmark
| | - Paul Bloch
- Steno Health Promotion Research, Steno Diabetes Center, Niels Steensens Vej 8, 2820, Gentofte, Denmark
| | - Bent E Mikkelsen
- Department of Clinical Medicine, Aalborg University, Frederikskaj 10, Building B, B2,, 2450, Copenhagen, SV, Denmark
| | - Brian Wansink
- Marketing in the Department of Applied Economics, Management at Cornell University, 114 Warren Hall, Ithaca, NY, 14853, USA
| | - Ulla Toft
- Research Centre for Prevention and Health, Centre for Health, Capital Region of Denmark, Rigshospitalet-Glostrup, Ndr. Ringvej 57, Building 84/85, 2600, Glostrup, Denmark
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33
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Toft U, Andersen TB, Bloch P, Winkler LL, Glümer C. The quantitative evaluation of the Health and Local Community Project (SoL). Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Abstract
OBJECTIVE This study aimed to examine the association of eczema, asthma and hay fever with mental health in a general child population and to assess the influence of parental socioeconomic position on these associations. METHODS We conducted a cross-sectional health survey of children aged 3, 6, 11 and 15 years in the City of Copenhagen, Denmark. Individual questionnaire data on eczema, asthma, and hay fever and mental health problems assessed using the Strengths and Difficulties Questionnaire (SDQ) was linked to register data on demographics and parental socioeconomic position. 9215 (47.9%) children were included in the analyses. RESULTS Linear regression analyses showed that children with current eczema symptoms had higher SDQ scores (mean difference, 95% CI) of emotional problems (0.26, 0.12 to 0.39), conduct problems (0.19, 0.09 to 0.29) and hyperactivity problems (0.32, 0.16 to 0.48); children with current asthma symptoms had higher SDQ scores of emotional problems (0.45, 0.32 to 0.58), conduct problems (0.28, 0.18 to 0.38) and hyperactivity problems (0.52, 0.35 to 0.69); and children with current hay fever symptoms had higher SDQ scores of emotional problems (0.57, 0.42 to 0.72), conduct problems (0.22, 0.11 to 0.33), hyperactivity problems (0.44, 0.26 to 0.61) and peer problems (0.14, 0.01 to 0.26), compared with children without current symptoms of the relevant disease. For most associations, parental socioeconomic position did not modify the effect. CONCLUSIONS Children with eczema, asthma or hay fever had more emotional, conduct and hyperactivity problems, but not peer problems, compared with children without these diseases. Atopic diseases added equally to the burden of mental health problems independent of socioeconomic position.
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Affiliation(s)
- Lene Hammer-Helmich
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Real World Evidence and Epidemiology, H. Lundbeck A/S, Valby, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Experimental Research, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Obel
- Department of Public Health, Aarhus University, Institute of General Medical Practice, Arhus, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Line Tang Møllehave
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Lau CJ, Pisinger C, Husemoen LLN, Jacobsen RK, Linneberg A, Jørgensen T, Glümer C. Effect of general health screening and lifestyle counselling on incidence of diabetes in general population: Inter99 randomised trial. Prev Med 2016; 91:172-179. [PMID: 27514243 DOI: 10.1016/j.ypmed.2016.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/05/2016] [Accepted: 08/07/2016] [Indexed: 01/19/2023]
Abstract
UNLABELLED We aimed to examine the effect of a large population-based multifactorial screening and lifestyle intervention programme on 10-year incidence of diabetes. In a randomised trial of the general Danish population initiated in 1999-2001 59,616 men and women aged 30-60years were assigned to a five year screening and lifestyle counselling programme (n=11,629) or control group (n=47,987) and followed for ten years in nationwide registers. Intention to treat was applied and risk of diabetes was modeled by Cox regression and expressed as hazard ratios (HRs). We found that 1692 individuals had diabetes at baseline. Among 57,924 individuals without diabetes at baseline, 1267 emigrated, 2593 died and 3369 (Intervention group=684, Control group=2685) developed diabetes. We saw no significant difference in diabetes incidence between the groups after 10-year follow-up (Grey's test: p=0.22). In the first year of follow-up, incidence of diabetes was significantly higher in the intervention group than the control group (HR=1.68, 95%CI 1.29 to 2.29). We observed no difference in incidence of diabetes between the groups in the follow-up intervals from 1 to 6years or after 6-10years (HR=0.94, 0.83 to 1.06; HR=1.03, 0.91 to 1.17). Inviting the general population to participate in a repeated screening and lifestyle counselling programme over five years did not result in lower incidence of diabetes after 10years of follow-up. As expected, significantly more individuals were diagnosed with diabetes in the intervention group during the first year, but this was not followed by a decrease in the following years. TRIALS REGISTRATION Clinical trials NCT00289237.
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Affiliation(s)
- Cathrine J Lau
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark.
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Lise Lotte N Husemoen
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark
| | - Rikke Kart Jacobsen
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; Faculty of Medicine, Aalborg University, 9229 Aalborg East, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600 Glostrup, Denmark; Faculty of Medicine, Aalborg University, 9229 Aalborg East, Denmark
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Hammer-Helmich L, Linneberg A, Thomsen SF, Tang L, Glümer C. Health service use among children with and without eczema, asthma, and hay fever. Clin Epidemiol 2016; 8:341-349. [PMID: 27695364 PMCID: PMC5028076 DOI: 10.2147/clep.s111960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Atopic diseases, for example, eczema, asthma, and hay fever, are among the most common chronic diseases of childhood. Knowledge on health service use among children with atopic disease is limited. This study aimed to investigate the total use and costs of health services for children with and without eczema, asthma, and hay fever in a Danish general population. METHODS We conducted a health survey with four complete birth cohorts from the City of Copenhagen. Individual questionnaire data on eczema, asthma, and hay fever for children aged 3, 6, 11, and 15 years were linked to register information on use and costs of health services and prescribed medication and parental education. In total 9,720 children participated (50.5%). RESULTS We found increased health service use (number of additional consultations per year [95% confidence interval]) among children with current eczema symptoms (1.77 [1.29-2.26]), current asthma symptoms (2.53 [2.08-2.98]), and current hay fever symptoms (1.21 [0.74-1.67]), compared with children without these symptoms. We also found increased use of prescribed medication and most subtypes of health services. Current asthma symptoms and current eczema symptoms, but not current hay fever symptoms, increased the health service costs with at least €300 per year per child. CONCLUSION Children with eczema, asthma, and hay fever used health services and prescribed medication more than children without these diseases.
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Affiliation(s)
- Lene Hammer-Helmich
- Research Center for Prevention and Health, The Capital Region of Denmark, Copenhagen; Department of Real World Evidence and Epidemiology, H. Lundbeck A/S, Valby
| | - Allan Linneberg
- Research Center for Prevention and Health, The Capital Region of Denmark, Copenhagen; Department of Clinical Experimental Research, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Line Tang
- Research Center for Prevention and Health, The Capital Region of Denmark, Copenhagen
| | - Charlotte Glümer
- Research Center for Prevention and Health, The Capital Region of Denmark, Copenhagen; Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Abstract
INTRODUCTION The aim of the current study was to present and discuss a broad range of register-based definitions of chronic conditions for use in register research, as well as the challenges and pitfalls when defining chronic conditions by the use of registers. MATERIALS AND METHODS The definitions were defined based on information from nationwide Danish public healthcare registers. Medical and epidemiological specialists identified and grouped relevant diagnosis codes that covered chronic conditions, using the International Classification System version 10 (ICD-10). Where relevant, prescription and other healthcare data were also used to define the chronic conditions. RESULTS We identified 199 chronic conditions and subgroups, which were divided into four groups according to a medical judgment of the expected duration of the conditions, as follows. Category I: Stationary to progressive conditions (maximum register inclusion time of diagnosis since the start of the register in 1994). Category II: Stationary to diminishing conditions (10 years of register inclusion after time of diagnosis). Category III: Diminishing conditions (5 years of register inclusion after time of diagnosis). Category IV: Borderline conditions (2 years of register inclusion time following diagnosis). The conditions were primarily defined using hospital discharge diagnoses; however, for 35 conditions, including common conditions such as diabetes, chronic obstructive lung disease and allergy, more complex definitions were proposed based on record linkage between multiple registers, including registers of prescribed drugs and use of general practitioners' services. CONCLUSIONS THIS STUDY PROVIDED A CATALOG OF REGISTER-BASED DEFINITIONS FOR CHRONIC CONDITIONS FOR USE IN HEALTHCARE PLANNING AND RESEARCH, WHICH IS, TO THE AUTHORS' KNOWLEDGE, THE LARGEST CURRENTLY COMPILED IN A SINGLE STUDY.
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Affiliation(s)
- Michael F Hvidberg
- Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
| | - Søren P Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Copenhagen, Denmark Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Karin D Petersen
- Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
| | - Anne V Olesen
- Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
| | - Lars Ehlers
- Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
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Jakobsen ML, Larsen JR, Glümer C, Juel K, Ekholm O, Vilsbøll T, Becker U, Fink-Jensen A. Alcohol consumption among patients with diabetes: a survey-based cross-sectional study of Danish adults with diabetes. Scand J Public Health 2016; 44:517-24. [DOI: 10.1177/1403494816645223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Mathilde L. Jakobsen
- Psychiatric Centre Copenhagen, Denmark
- Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark
| | - Julie R. Larsen
- Psychiatric Centre Copenhagen, Denmark
- Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Denmark
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Anders Fink-Jensen
- Psychiatric Centre Copenhagen, Denmark
- Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark
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Vestmar MA, Andersson EA, Christensen CR, Hauge M, Glümer C, Linneberg A, Witte DR, Jørgensen ME, Christensen C, Brandslund I, Lauritzen T, Pedersen O, Holst B, Grarup N, Schwartz TW, Hansen T. Functional and genetic epidemiological characterisation of the FFAR4 (GPR120) p.R270H variant in the Danish population. J Med Genet 2016; 53:616-23. [PMID: 27068006 DOI: 10.1136/jmedgenet-2015-103728] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/17/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND p.R270H (rs116454156) in the long chain fatty acid 7TM receptor FFAR4 (GPR120) which results in impaired Gαq (Gq) coupled signalling, has been associated with obesity. We aimed to extend the functional in vitro analyses of p.R270H and to investigate the association with obesity and glucose-related traits in the Danish population. METHODS Surface expression, Gq and Gi coupled signalling as well as β-arrestin recruitment were examined in vitro. p.R270H was genotyped using the exome chip array in 11 479 Danish adult individuals. Of these 4391 were obese and 4415 were normal weight. Association with quantitative metabolic traits comprised 8720 non-diabetic individuals. RESULTS p.R270H showed reduced surface expression of FFAR4. Ligand-independent activity was eliminated and strongly impaired through the Gq and Gi signalling pathways, respectively. The ligand-induced maximal signalling efficacy of p.R270H was reduced only through the Gq pathway. The p.R270H variant did not affect β-arrestin recruitment. p.R270H was not associated with increased risk of obesity nor increased fasting plasma glucose levels in the Danish study populations. Nor was it associated with these two traits in the European Network for Genetic and Genomic Epidemiology consortium data (N=34 901-71 175; p>0.70). It was also not associated with waist-hip ratio, glucose metabolism during an oral glucose tolerance test, lipid levels or with markers of adiposity (leptin, adiponectin), inflammation (high-sensitive C reactive protein; hs-CRP) and liver function (alanine aminotransferase) in the Danish population (p>0.05). CONCLUSIONS We demonstrate that p.R270H of FFAR4 impairs Gq and Gi signalling of FFAR4 in vitro; however, this impaired signalling for p.R270H does not translate into associations with human metabolic phenotypes in the investigated populations.
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Affiliation(s)
- Marie A Vestmar
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark Section for Metabolic Receptology, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ehm A Andersson
- Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte R Christensen
- Section for Metabolic Receptology, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Hauge
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark Section for Metabolic Receptology, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Glümer
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Daniel R Witte
- Section for General Practice, Department of Public Health, Aarhus University, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center, Gentofte, Denmark Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Cramer Christensen
- Department of Internal Medicine and Endocrinology, SLB, Vejle Hospital, Vejle, Denmark
| | - Ivan Brandslund
- Department of Clinical Biochemistry, Vejle Hospital, Vejle, Denmark Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Torsten Lauritzen
- Section for General Practice, Department of Public Health, Aarhus University, Denmark
| | - Oluf Pedersen
- Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Holst
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark Section for Metabolic Receptology, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Grarup
- Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thue W Schwartz
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark Section for Metabolic Receptology, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Abstract
BACKGROUND High accessibility of unhealthy food stores may contribute to a poor dietary quality. Research on the link between neighbourhood food environment and consumption is limited, especially in a European context. The objective of this study was to examine the relationship between convenience stores (CS) and dietary quality within the Capital Region of Denmark. METHOD Cross-sectional study of the geographic food environment in the Capital Region of Denmark based on 47 623 subjects (age 16+ years) with complete information on retail food environment and dietary quality. A categorization procedure to identify CS from a government list of inspected food stores (the Smiley register) was developed. Using GIS network analyses, density of CS within 0.25 km and 0.5 km network buffers from residency was calculated for participants in metropolitan and non-metropolitan areas, respectively. Information on dietary intake and confounders is derived from a questionnaire survey. Multi-level analyses were performed, adjusting for age, sex, individual socio-economic factors and area socio-economic status. RESULTS In the non-metropolitan population, the odds of having an unhealthy diet increased significantly (P < 0.0001) with increased density of CS. Compared to individuals who did not have a CS within 0.5 km from their home, the odds ratios were 1.20 (95% CI: 1.09-1.33) and 1.37 (95% CI: 1.19-1.57) for individuals having 1 or ≥2 CS, respectively. In the fully adjusted model, the overall association remained significant (P = 0.015) and odds ratios diminished to 1.14 (1.02-1.27) and 1.18 (1.01-1.38). CONCLUSION High accessibility of CS in neighbourhoods is associated with less healthy dietary habits among residents.
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Affiliation(s)
- Pernille L Lind
- 1 Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - Pernille V Jensen
- 1 Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - Charlotte Glümer
- 1 Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - Ulla Toft
- 1 Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
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Almer K, Helms-Andreasen A, Glümer C. The variation and temporal changes of soft drink intake in the Capital Region of Denmark. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv172.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lau CJ, Glümer C, Spitters HPEM, Sandu P, Rus D, Eklund Karlsson L, van de Goor LAM. Impact of policy game on insight and attitude to inter sectoral policy processes - EU country cases. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lau CJ, Glümer C, Spitters HPEM, Sandu P, Rus D, Eklund Karlsson L, van de Goor LAM. Impact of the policy game In2action on insight and attitude towards intersectoral policy processes in real life policy making: questionnaire results from game participants in three EU country cases. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv167.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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44
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Hammer-Helmich L, Linneberg A, Thomsen SF, Obel C, Glümer C. Association between Allergic Diseases and Mental Distress in Danish Adolescents. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
| | - Ola Ekholm
- National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences UnitUniversity of Glasgow, Glasgow, UK and Department of Epidemiology, Columbia UniversityNew YorkNYUSA
| | - Charlotte Glümer
- Research Centre for Prevention and HealthThe Capital Region of DenmarkGlostrupDenmark
| | - Knud Juel
- National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
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Christensen AI, Ekholm O, Gray L, Glümer C, Juel K. What is wrong with non-respondents? Alcohol-, drug- and smoking-related mortality and morbidity in a 12-year follow-up study of respondents and non-respondents in the Danish Health and Morbidity Survey. Addiction 2015; 110:1505-12. [PMID: 25845815 PMCID: PMC4538793 DOI: 10.1111/add.12939] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/10/2014] [Accepted: 03/31/2015] [Indexed: 12/04/2022]
Abstract
AIM Response rates in health surveys have diminished over the last two decades, making it difficult to obtain reliable information on health and health-related risk factors in different population groups. This study compared cause-specific mortality and morbidity among survey respondents and different types of non-respondents to estimate alcohol-, drug- and smoking-related mortality and morbidity among non-respondents. DESIGN Prospective follow-up study of respondents and non-respondents in two cross-sectional health surveys. SETTING Denmark. PARTICIPANTS A total sample of 39 540 Danish citizens aged 16 years or older. MEASUREMENTS Register-based information on cause-specific mortality and morbidity at the individual level was obtained for respondents (n = 28 072) and different types of non-respondents (refusals n = 8954; illness/disabled n = 731, uncontactable n = 1593). Cox proportional hazards models were used to examine differences in alcohol-, drug- and smoking-related mortality and morbidity, respectively, in a 12-year follow-up period. FINDINGS Overall, non-response was associated with a significantly increased hazard ratio (HR) of 1.56 [95% confidence interval (CI) = 1.36-1.78] for alcohol-related morbidity, 1.88 (95% CI = 1.38-2.57) for alcohol-related mortality, 1.55 (95% CI = 1.27-1.88) for drug-related morbidity, 3.04 (95% CI = 1.57-5.89) for drug-related mortality and 1.15 (95% CI = 1.03-1.29) for smoking-related morbidity. The hazard ratio for smoking-related mortality also tended to be higher among non-respondents compared with respondents, although no significant association was evident (HR = 1.14; 95% CI = 0.95-1.36). Uncontactable and ill/disabled non-respondents generally had a higher hazard ratio of alcohol-, drug- and smoking-related mortality and morbidity compared with refusal non-respondents. CONCLUSION Health survey non-respondents in Denmark have an increased hazard ratio of alcohol-, drug- and smoking-related mortality and morbidity compared with respondents, which may indicate more unfavourable health behaviours among non-respondents.
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Affiliation(s)
| | - Ola Ekholm
- National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK,Department of EpidemiologyColumbia UniversityNew YorkNY
| | - Charlotte Glümer
- Research Centre for Prevention and HealthThe Capital Region of DenmarkGlostrupDenmark
| | - Knud Juel
- National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
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Westergaard ML, Hansen EH, Glümer C, Jensen RH. Prescription pain medications and chronic headache in Denmark: implications for preventing medication overuse. Eur J Clin Pharmacol 2015; 71:851-60. [PMID: 25967539 DOI: 10.1007/s00228-015-1858-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/29/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of the present paper is to study which prescription pain medications are most commonly dispensed to people with chronic headache (CH), particularly those with medication-overuse headache (MOH). METHODS This cross-sectional study analysed prescription pain medications dispensed within 1 year to 68,518 respondents of a national health survey. Participants with headache ≥ 15 days per month for 3 months were classified as having CH. Those with CH and over-the-counter analgesic use ≥ 15 days per month or purchase of ≥ 20 or ≥ 30 defined daily doses (DDDs) of prescription pain medication per month (depending on the drug) were classified as having MOH. Associations between CH and other chronic pain conditions were analysed by logistic regression. RESULTS Among those with CH (adjusted prevalence 3.3%, CI 3.2-3.5%), pain medications most commonly dispensed were paracetamol, tramadol, ibuprofen and codeine. CH was associated with osteoarthritis, back pain, and rheumatoid arthritis. Among those with MOH, 32.4% were dispensed an opioid at least once within 1 year. Only 5.1% of people with CH were dispensed triptans. CONCLUSIONS High prevalence of opioid use among people with CH may be due to inappropriate headache treatment or development of MOH among those treated for other pain conditions. While there were cases of triptan overuse, triptans remain underutilized among those with CH, suggesting that migraine may be under-recognized and inappropriately treated, leading to overuse of other medications. Education of physicians on appropriate headache management is essential for MOH prevention. There is a need to increase universal awareness about MOH as an adverse effect of long-term analgesic use.
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Affiliation(s)
- Maria Lurenda Westergaard
- Danish Headache Center, Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 69, Område Nord Bolig 16, Glostrup, 2600, Denmark,
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Westergaard ML, Glümer C, Hansen EH, Jensen RH. Medication overuse, healthy lifestyle behaviour and stress in chronic headache: Results from a population-based representative survey. Cephalalgia 2015; 36:15-28. [DOI: 10.1177/0333102415578430] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/25/2015] [Indexed: 01/03/2023]
Abstract
Aim This cross-sectional study investigated associations between chronic headache (CH) with and without medication overuse, healthy lifestyle behaviour, and stress. Methods Questionnaires were sent to 129,150 adults. Those with headache ≥15 days per month for three months were classified as having CH then further described as having medication-overuse headache (MOH) or CH without medication overuse. Associations between headache and daily smoking, physical inactivity, obesity, excessive drinking, illicit drug use, and high stress were analysed by logistic regression. Results CH with and without medication overuse (prevalence 1.8% and 1.6%, respectively) had strong, graded associations with stress. Associations with daily smoking, physical inactivity, and obesity were significant only for MOH. Odds for MOH were highest among people who had all three factors compared to those who had none (OR 2.8 in women and 5.1 in men). High stress plus any of these three factors had synergistic effects in MOH but not clearly in those who had CH without overuse. Associations between CH subtypes and excessive drinking or illicit drug use were not statistically significant. Conclusion Results suggest strong links between healthy lifestyle behaviour and stress in MOH. Stress reduction and promoting healthy behaviour are highly relevant in MOH management.
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Affiliation(s)
- Maria Lurenda Westergaard
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - Charlotte Glümer
- Research Center for Prevention and Health, Capital Region of Denmark, Denmark
- Department of Health Science and Technology, University of Aalborg, Denmark
| | | | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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Westergaard M, Glümer C, Hansen EH, Jensen RJ. EHMTI-0145. Health risk behaviours in medication-overuse headache: results of a population-based study. J Headache Pain 2014. [PMCID: PMC4181490 DOI: 10.1186/1129-2377-15-s1-b38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Westergaard M, Glümer C, Hansen EH, Jensen RH. EHMTI-0144. Physical and mental health status of people with medication-overuse headache across socioeconomic strata: results of a population-based study. J Headache Pain 2014. [PMCID: PMC4180171 DOI: 10.1186/1129-2377-15-s1-b39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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