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Harkko J, Pietiläinen O, Jousilahti P, Rahkonen O, Kouvonen A, Lallukka T. Trajectories of CVD medication after statutory retirement: contributions of pre-retirement sociodemographic, work and health-related factors: a register study in Finland. BMC Geriatr 2023; 23:570. [PMID: 37723432 PMCID: PMC10506324 DOI: 10.1186/s12877-023-04272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/01/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are prevalent in older people, but few studies focus on developmental patterns in CVD medication directly after transition to statutory retirement. We thus aimed to identify trajectories of CVD medication after retirement, and their sociodemographic, work and health-related determinants. METHODS We used complete register data of former employees of the City of Helsinki, Finland. All who reached their statutory retirement in 2000-2013, with five-year follow-up data (n = 6,505, 73% women), were included. Trajectories of CVD medication were identified with group-based trajectory modelling using data from Finnish Social Insurance Institution's reimbursement register. Sociodemographic, work and health-related determinants of trajectory group membership were analysed using multinomial logistic regression. RESULTS Six trajectories of CVD medication were distinguished: "constant low" (35%), "late increase" (6%), "early increase" (5%), "constant high" (39%), "high and decreasing " (8%), and "low and decreasing" (7%). The majority (74%) of the retirees fell into the "constant low" and "constant high" categories. Lower occupational class and increased pre-retirement sickness absence were associated with the "constant high" trajectory. Further, those with lower educational attainment were more prone to be in the "early increase" trajectory. CONCLUSIONS Individuals in lower socioeconomic positions or with a higher number of pre-retirement sickness absence may be considered at higher risk and might benefit from early interventions, e.g. lifestyle interventions and interventions targeting working conditions, or more frequent monitoring.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
- University of Helsinki, P.O. Box 20 (Tukholmankatu 8 B), N00014, Helsinki, Finland.
| | - Olli Pietiläinen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Tea Lallukka
- University of Helsinki, P.O. Box 20 (Tukholmankatu 8 B), N00014, Helsinki, Finland.
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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Mrdakovic Popic J, Haanes H, Di Carlo C, Nuccetelli C, Venoso G, Leonardi F, Trevisi R, Trotti F, Ugolini R, Dvorzhak A, Escribano A, Perez Sanchez D, Real A, Michalik B, Pannecoucke L, Blanchart P, Kallio A, Pereira R, Lourenço J, Skipperud L, Jerome S, Fevrier L. Tools for harmonized data collection at exposure situations with naturally occurring radioactive materials (NORM). Environ Int 2023; 175:107954. [PMID: 37187003 DOI: 10.1016/j.envint.2023.107954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
Naturally occurring radioactive materials (NORM) contribute to the dose arising from radiation exposure for workers, public and non-human biota in different working and environmental conditions. Within the EURATOM Horizon 2020 RadoNorm project, work is ongoing to identify NORM exposure situations and scenarios in European countries and to collect qualitative and quantitative data of relevance for radiation protection. The data obtained will contribute to improved understanding of the extent of activities involving NORM, radionuclide behaviours and the associated radiation exposure, and will provide an insight into related scientific, practical and regulatory challenges. The development of a tiered methodology for identification of NORM exposure situations and complementary tools to support uniform data collection were the first activities in the mentioned project NORM work. While NORM identification methodology is given in Michalik et al., 2023, in this paper, the main details of tools for NORM data collection are presented and they are made publicly available. The tools are a series of NORM registers in Microsoft Excel form, that have been comprehensively designed to help (a) identify the main NORM issues of radiation protection concern at given exposure situations, (b) gain an overview of materials involved (i.e., raw materials, products, by-products, residues, effluents), c) collect qualitative and quantitative data on NORM, and (d) characterise multiple hazards exposure scenarios and make further steps towards development of an integrated risk and exposure dose assessment for workers, public and non-human biota. Furthermore, the NORM registers ensure standardised and unified characterisation of NORM situations in a manner that supports and complements the effective management and regulatory control of NORM processes, products and wastes, and related exposures to natural radiation worldwide.
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Affiliation(s)
- Jelena Mrdakovic Popic
- Norwegian Radiation and Nuclear Safety Authority (DSA), Grini Næringspark, 13, Østerås, Norway.
| | - Hallvard Haanes
- Norwegian Radiation and Nuclear Safety Authority (DSA), Grini Næringspark, 13, Østerås, Norway
| | - Christian Di Carlo
- National Institute of Health (ISS), National Centre for Radiation Protection and Computational Physics, Rome, Italy
| | - Cristina Nuccetelli
- National Institute of Health (ISS), National Centre for Radiation Protection and Computational Physics, Rome, Italy
| | - Gennaro Venoso
- National Institute of Health (ISS), National Centre for Radiation Protection and Computational Physics, Rome, Italy
| | - Federica Leonardi
- National Institute for Insurance Against Accidents at Work (INAIL), DiMEILA, Monteporzio Catone, Rome, Italy
| | - Rosabianca Trevisi
- National Institute for Insurance Against Accidents at Work (INAIL), DiMEILA, Monteporzio Catone, Rome, Italy
| | - Flavio Trotti
- Environmental Protection Agency of Veneto (ARPAV), Verona, Italy
| | | | - Alla Dvorzhak
- Research Centre on Energy, Environment and Technology (CIEMAT), Av. Complutense 40, Madrid 28040, Spain
| | - Alicia Escribano
- Research Centre on Energy, Environment and Technology (CIEMAT), Av. Complutense 40, Madrid 28040, Spain
| | - Danyl Perez Sanchez
- Research Centre on Energy, Environment and Technology (CIEMAT), Av. Complutense 40, Madrid 28040, Spain
| | - Almudena Real
- Research Centre on Energy, Environment and Technology (CIEMAT), Av. Complutense 40, Madrid 28040, Spain
| | - Boguslaw Michalik
- Central Mining Institute, Silesian Centre for Environmental Radioactivity (GIG), Plac Gwarków, 1, 40-166 Katowice, Poland
| | - Lea Pannecoucke
- Institute for Radiological Protection and Nuclear Safety, IRSN/PSE-ENV/SEDRE, 92260 Fontenay-aux-Roses, France
| | - Pascale Blanchart
- Institute for Radiological Protection and Nuclear Safety, IRSN/PSE-ENV/SEDRE, 92260 Fontenay-aux-Roses, France
| | - Antti Kallio
- Radiation and Nuclear Safety Authority, (STUK), Lähteentie 2, 96400 Rovaniemi, Finland
| | - Ruth Pereira
- GreenUPorto - Sustainable Agrifood Production Research Centre/Inov4Agro, Department of Biology, Faculty of Sciences of the University of Porto, Campus de Vairão, Rua de Agrária, 747, Vila do Conde, Portugal
| | - Joana Lourenço
- Department of Biology and CESAM, University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal
| | - Lindis Skipperud
- Norwegian University of Life Sciences (NMBU), Environmental Chemistry Section, P. O. Box 5003, 1432 Aas, Norway
| | - Simon Jerome
- Norwegian University of Life Sciences (NMBU), Environmental Chemistry Section, P. O. Box 5003, 1432 Aas, Norway
| | - Laureline Fevrier
- Institute for Radiological Protection and Nuclear Safety, IRSN/PSE-ENV/SRTE, 13115 Saint Paul-lez-Durance Cedex, France
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Yang L, Huang C, Zhao M, Lee PMY, Zhang C, Yu Y, Xi B, Li J. Maternal hypertensive disorders during pregnancy and the risk of offspring diabetes mellitus in childhood, adolescence, and early adulthood: a nationwide population-based cohort study. BMC Med 2023; 21:59. [PMID: 36797785 PMCID: PMC9933265 DOI: 10.1186/s12916-023-02762-5] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Maternal hypertensive disorders during pregnancy (HDP) have been suggested to contribute to the development of offspring cardiovascular disease later in life, but empirical evidence remains inconsistent. This study was aimed to assess the association of maternal overall and type-specific HDPs with diabetes in offspring from childhood to early adulthood. METHODS Using Danish national health registers, a total of 2,448,753 individuals born in Denmark from 1978 to 2018 were included in this study. Maternal HDP included chronic hypertension, gestational hypertension, and preeclampsia. The outcome of interest was diabetes in offspring (including type 1, type 2, and gestational diabetes). The follow-up of offspring started at birth and ended at the first diagnosis of diabetes, emigration from Denmark, death, or time end on 31 December 2018, whichever came first. Cox proportional hazards regression was used to evaluate the hazard ratios (HRs) with 95% confidence intervals (CIs) of the association between maternal HDP and diabetes (including type 1, type 2, and gestational diabetes) in offspring from birth to young adulthood (up to 41 years), with the offspring's age as the time scale. RESULTS During a follow-up of up to 41 (median: 19.3) years, 1247 offspring born to mothers with HDP and 23,645 offspring born to mothers without HDP were diagnosed with diabetes. Compared with offspring born to mothers without HDP, those born to mothers with HDP had an increased risk for overall diabetes (HR=1.27, 95% CI=1.20-1.34), as well as for type 2 diabetes (HR=1.57, 95% CI=1.38-1.78) and gestational diabetes (HR=1.37, 95% CI=1.25-1.49). We did not observe obvious increased risk for type 1 diabetes (HR=1.08, 95% CI=0.98-1.18). Offspring of mothers with gestational hypertension (HR=1.37, 95% CI=1.00-1.88) or preeclampsia (HR=1.62, 95% CI=1.41-1.87) had higher risks of type 2 diabetes. The strongest association was observed for severe preeclampsia, with a 2-fold risk of type 2 diabetes (HR=2.00, 95% CI=1.42-2.82). The association between maternal HDP and type 1 diabetes did not reach statistical significance, except for maternal gestational hypertension (HR=1.41, 95%CI=1.17-1.71). In addition, we found that offspring born to mothers with any subtypes of maternal HDP had higher risk of gestational diabetes, and the corresponding HRs (95%CIs) for chronic hypertension, gestational hypertension, and preeclampsia were 1.60 (1.06-2.41), 1.29 (1.04-1.59), and 1.38 (1.24-1.53), respectively. We also observed stronger associations among offspring of mothers with HDP and comorbid diabetes (HR=4.64, 95%CI=3.85-5.60) than offspring of mothers with HDP or diabetes alone. CONCLUSIONS Offspring of mothers with HDP, especially mothers with comorbid diabetes, had an increased risk of diabetes later in their life. Our findings suggest that timely and effective prevention of HDP in women of childbearing age should be taken into consideration as diabetes prevention and control strategies for their generations.
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Affiliation(s)
- Liu Yang
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chen Huang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Priscilla M Y Lee
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Cheng Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China. .,Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China.
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Jiong Li
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
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García-Velázquez R, Kieseppä V, Lilja E, Koponen P, Skogberg N, Kuusio H. A multisource approach to health care use: concordance between register and self-reported physician visits in the foreign-born population in Finland. BMC Med Res Methodol 2022; 22:309. [PMID: 36460964 PMCID: PMC9717412 DOI: 10.1186/s12874-022-01780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Reliable information on the use of health services is important for health care planning, monitoring and policy. It is critical to assess the validity of the sources used for this purpose, including register and survey-based data. Studies on foreign-born populations' health care use have usually implemented either survey or register data. The concordance of such data among groups of different cultural background remains largely unknown. In this study, we presented an approach to examine routinely how survey and register-related characteristics may explain disagreement found between the two information sources. METHODS We linked register- and survey-based data pertaining to the Finnish Register of Primary Health Care general physician visits and the Survey on Well-Being among Foreign Born Population (FinMonik, 2018-2019), a nationally representative survey. The sample comprised n = 5,800 informants for whom registered general physician visits were tracked in the 12-month period preceding their participation in the survey. Cohen's kappa was used as measure of multisource concordance, hierarchical loglinear models for the association between single predictors and multisource discrepancy, and a logistic regression model for examining source-related predictors of source discrepancy. Survey weights were used in all sample analyses. RESULTS Source concordance was poor. When dichotomizing general physician visits (zero vs one or more), 35% of informants had reported one or more visits while none were found from register. Both register- and informant-related predictors were associated to this discrepancy (i.e. catchment area, private health care use, inability to work, region of origin and reason for migration). CONCLUSIONS We found high discrepancy between the reported and the registered physician visits among the foreign-born population in Finland, with a particularly high number of reported physician visits when none were found in the register. There was a strong association between the specific catchment area and mismatch, indicating that both register under-coverage and survey over-report are plausible and may coexist behind the discrepancy. However, associations of informant's characteristics and mismatch were less pronounced. Implications on the validity of medical information sources are discussed.
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Affiliation(s)
- Regina García-Velázquez
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Valentina Kieseppä
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Eero Lilja
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Päivikki Koponen
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Natalia Skogberg
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Hannamaria Kuusio
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
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Almquist YB, Miething A. The impact of an unemployment insurance reform on incidence rates of hospitalisation due to alcohol-related disorders: a quasi-experimental study of heterogeneous effects across ethnic background, educational level, employment status, and sex in Sweden. BMC Public Health 2022; 22:1847. [PMID: 36192708 DOI: 10.1186/s12889-022-14209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Many Western countries have scaled back social and health expenditure, including decreases in the generosity and coverage of unemployment insurance, resulting in negative effects on general health and well-being at the aggregate level. Yet, research has not sufficiently looked into heterogeneity of such effects across different subgroups of the population. In Sweden, the 2006 unemployment insurance reform, implemented on the 1st of January 2007, encompassed a drastic increase of insurance fund membership fees, reduced benefit levels, and stricter eligibility requirements. As this particularly affected already socioeconomically disadvantaged groups in society, such as foreign-born and low-educated individuals, the current study hypothesise that the reform would also have a greater impact on health outcomes in these groups. Methods Based on register data for the total population, we utilise a quasi-experimental approach to investigate heterogeneous health effects of the reform across ethnic background, educational level, employment status, and sex. Due to behaviourally caused diseases having a relatively shorter lag time from exposure, hospitalisation due to alcohol-related disorders serves as the health outcome. A series of regression discontinuity models are used to analyse monthly incidence rates of hospitalisation due to alcohol-related disorders among individuals aged 30–60 during the study period (2001–2012), with the threshold set to the 1st of January 2007. Results The results suggest that, in general, there was no adverse effect of the reform on incidence rates of hospitalisation due to alcohol-related disorders. A significant increase is nonetheless detected among the unemployed, largely driven by Swedish-born individuals with Swedish-born or foreign-born parents, low-educated individuals, and men. Conclusions We conclude that the Swedish 2006 unemployment insurance reform generally resulted in increasing incidence rates of hospitalisation due to alcohol-related disorders among unemployed population subgroups known to have higher levels of alcohol consumption. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14209-2.
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Abstract
BACKGROUND Prospective registration aims to reduce bias in the conduct and reporting of research and to increase transparency. In addition, prospective registration of systematic reviews is argued to help preventing unintended duplication, thereby reducing research waste. PROSPERO was launched in 2011 as the first prospective register for systematic reviews. While it has long been the only option to prospectively register systematic reviews, recently there have been new developments. Our aim was to identify and characterize current options to prospectively register a systematic review to assist review authors in choosing a suitable register. METHODS To identify systematic review registers, we independently performed internet searches in January 2021 using keywords related to systematic reviews and prospective registration. "Registration" was defined as the process of entering information about a planned systematic review into a database before starting the systematic review process. We collected data on the characteristics of the identified registries and contacted the responsible party of each register for verification of the data related to their registry. RESULTS Overall, we identified five options to prospectively register a systematic review: PROSPERO, the Registry of Systematic Reviews/Meta-Analyses in Research Registry, and INPLASY, which are specific to systematic reviews, and the Open Science Framework Registries and protocols.io, which represent generic registers open to any study type. Detailed information on each register is presented in tables in the main text. Regarding the systematic-review-specific registries, authors have to trade-off between the costs of registration and the processing time of their registration record. All registers provide an option to search for systematic reviews already registered in the register. However, it is unclear how useful these search functions are. CONCLUSION Authors can prospectively register their systematic review in five registries, which come with different characteristics and features. The research community should discuss fair and sustainable financing models for registers that are not operated by for-profit organizations.
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Wodschow K, Villanueva CM, Larsen ML, Gislason G, Schullehner J, Hansen B, Ersbøll AK. Association between magnesium in drinking water and atrial fibrillation incidence: a nationwide population-based cohort study, 2002-2015. Environ Health 2021; 20:126. [PMID: 34906160 PMCID: PMC8672465 DOI: 10.1186/s12940-021-00813-z] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common heart rhythm disorder and a risk factor of adverse cardiovascular diseases. Established causes do not fully explain the risk of AF and unexplained risk factors might be related to the environment, e.g. magnesium in drinking water. Low magnesium levels in drinking water might be associated with higher risk of cardiovascular diseases including AF. With detailed individual data from nationwide registries and long-term magnesium exposure time series, we had a unique opportunity to investigate the association between magnesium in drinking water and AF. OBJECTIVE We evaluated the association between magnesium concentration in drinking water and AF risk. METHODS A nationwide register-based cohort study (2002-2015) was used including individuals aged ≥30 years. Addresses were linked with water supply areas (n = 2418) to obtain time-varying drinking water magnesium exposure at each address. Five exposure groups were defined based on a 5-year rolling time-weighted average magnesium concentration. AF incidence rate ratios (IRRs) between exposure groups were calculated using a Poisson regression of incidence rates, adjusted for sex, age, and socioeconomic position. Robustness of results was investigated with different exposure definitions. RESULTS The study included 4,264,809 individuals (44,731,694 person-years) whereof 222,998 experienced an incident AF. Magnesium exposure ranged from 0.5 to 62.0 mg/L (mean = 13.9 mg/L). Estimated IRR (95% CI) compared to the referent exposure group (< 5 mg/L) was 0.98 (0.97-1.00) for the second lowest exposure group (5-10 mg/L), and 1.07 (1.05-1.08) for the two highest exposure groups (15-62 mg/L). Strongest positive associations were observed among those aged ≥80 years and with lowest education group. An inverse association was found among individuals with highest education group. CONCLUSION There might be a small beneficial effect on AF of an increase in magnesium level in drinking water up to 10 mg/L, though an overall positive association was observed. The unexpected positive association and different associations observed for subgroups suggest a potential influence of unaccounted factors, particularly in vulnerable populations. Future research on magnesium in drinking water and cardiovascular diseases needs to focus on contextual risk factors, especially those potentially correlating with magnesium in drinking water.
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Affiliation(s)
- Kirstine Wodschow
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen C, Denmark
| | - Cristina M. Villanueva
- ISGlobal, Campus Mar, Dr. Aiguader, 88, 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
- Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Dr. Aiguader, 88, 08003 Barcelona, Spain
| | - Mogens Lytken Larsen
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej15, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 3. sal, 1120 Copenhagen C, Denmark
| | - Jörg Schullehner
- Geological Survey of Denmark and Greenland, GEUS Department of Groundwater and Quaternary Geology Mapping, C.F. Moellers Allé 8, Bygning 1110, 8000 Aarhus C, Denmark
- Department of Public Health –Research Unit for Environment, Work and Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Birgitte Hansen
- Geological Survey of Denmark and Greenland, GEUS Department of Groundwater and Quaternary Geology Mapping, C.F. Moellers Allé 8, Bygning 1110, 8000 Aarhus C, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen C, Denmark
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Du J, Li J, Liu X, Liu H, Obel C, Shen H, Hu Z, Yu Y. Association of maternal diabetes during pregnancy with high refractive error in offspring: a nationwide population-based cohort study. Diabetologia 2021; 64:2466-2477. [PMID: 34401952 DOI: 10.1007/s00125-021-05526-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS We aimed to investigate the associations between maternal diabetes before or during pregnancy and the risk of high refractive error (RE) in offspring until the age of 25 years. METHODS This nationwide register-based cohort study comprised 2,470,580 individuals born in 1977-2016. The exposure was maternal diabetes during or before pregnancy (type 1 diabetes, type 2 diabetes and gestational diabetes). Cox regression was used to examine the association between maternal diabetes and the risk of high RE in offspring from birth until the age of 25 years, adjusting for multiple potential confounders. RESULTS During up to 25 years of follow-up, 553 offspring of mothers with diabetes and 19,695 offspring of mothers without diabetes were diagnosed with high RE. Prenatal exposure to maternal diabetes was associated with a 39% increased risk of high RE: HR 1.39 (95% CI 1.28, 1.51), p < 0.001; standardised cumulative incidence in unexposed offspring at 25 years of age 1.18% (95% CI 1.16%, 1.19%); cumulative incidence difference 0.72% (95% CI 0.51%, 0.94%). The elevated risks were observed for hypermetropia (HR 1.37 [95% CI 1.24, 1.51], p < 0.001), myopia (HR 1.34 [95% CI 1.08, 1.66], p = 0.007) and astigmatism (HR 1.58 [95% CI 1.29, 1.92], p < 0.001). The increased risks were more pronounced among offspring of mothers with diabetic complications (HR 2.05 [95% CI 1.60, 2.64], p < 0.001), compared with those of mothers with diabetes but no diabetic complications (HR 1.18 [95% CI 1.02, 1.37], p = 0.030). CONCLUSIONS/INTERPRETATION Our findings suggest that maternal diabetes during pregnancy is associated with an increased risk of high RE in offspring, in particular among those of mothers with diabetic complications. Early ophthalmological screening should be recommended in offspring of mothers with diabetes diagnosed before or during pregnancy.
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Affiliation(s)
- Jiangbo Du
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Xiaoqin Liu
- NCRR-National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Hu Liu
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Carsten Obel
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hongbing Shen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhibin Hu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.
- The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Siyam A, Ir P, York D, Antwi J, Amponsah F, Rambique O, Funzamo C, Azeez A, Mboera L, Kumalija CJ, Rumisha SF, Mremi I, Boerma T, O'Neill K. The burden of recording and reporting health data in primary health care facilities in five low- and lower-middle income countries. BMC Health Serv Res 2021; 21:691. [PMID: 34511083 PMCID: PMC8436492 DOI: 10.1186/s12913-021-06652-5] [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: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/05/2022] Open
Abstract
Background Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands. Methods In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services. Result Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker. Conclusions PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06652-5.
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Affiliation(s)
- Amani Siyam
- Health Workforce Department, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland.
| | - Por Ir
- National Institute of Public Health, No. 80, Samdach Penn Nouth Blvd (289), Sangkat Boeungkak 2, Tuol Kork District, Phnom Penh, Cambodia
| | - Dararith York
- Department of Planning and Health Information, Ministry of Health, No. 80, Samdach Penn Nouth Blvd (289), Sangkat Boeungkak 2, Tuol Kork District, Phnom Penh, Cambodia
| | - James Antwi
- Centre for Health and Social Policy Research, West End University College, Ngleshie Amanfro, Accra, Ghana
| | - Freddie Amponsah
- Ghana Health Service, Private Mail Bag, Ministries, Accra, Ghana
| | - Ofelia Rambique
- National Institute of Health, Vila de Marracuene, National Road, 3943, Maputo, Mozambique
| | - Carlos Funzamo
- World Health Organization Country Office, Rua Joseph Ki-zerbo 227, P.O. Box 377, Maputo, Mozambique
| | - Aderemi Azeez
- Federal Ministry of Health, Federal Secretariat, Phase III, Shehu Shagari Way, Central Business District, Abuja, FCT, Nigeria
| | - Leonard Mboera
- SACIDS Foundation for One Health (SACIDS), Sokoine University of Agriculture (SUA), P.O. Box 3297, Chuo Kikuu, SUA, Morogoro, Tanzania
| | - Claud John Kumalija
- Health Management Information System (HMIS), Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Susan Fred Rumisha
- The National Institute for Medical Research, 3 Barack Obama Drive, P.O.Box 9653, 11101, Dar es Salaam, Tanzania
| | - Irene Mremi
- The National Institute for Medical Research, 3 Barack Obama Drive, P.O.Box 9653, 11101, Dar es Salaam, Tanzania
| | - Ties Boerma
- Department of Community Health Sciences, Max Rady College of Medicine-University of Manitoba, Room S113 - 750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada
| | - Kathryn O'Neill
- Integrated Health Services Department, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
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10
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Mikkola TM, Kautiainen H, Mänty M, von Bonsdorff MB, Koponen H, Kröger T, Eriksson JG. Use of antidepressants among Finnish family caregivers: a nationwide register-based study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2209-2216. [PMID: 33646320 PMCID: PMC8558159 DOI: 10.1007/s00127-021-02049-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to compare the use of antidepressants over 6 years between family caregivers providing high-intensity care and a matched control population using register-based data. METHODS The study includes all individuals, who received family caregiver's allowance in Finland in 2012 (n = 29,846 females, mean age 66 years; n = 12,410 males, mean age 71 years) and a control population matched for age, sex, and municipality of residence (n = 59,141 females; n = 24,477 males). Information on purchases of antidepressants, including the number of defined daily doses (DDD) purchased, between 2012 and 2017 was obtained from the national drugs reimbursement register. RESULTS During the follow-up, 28.5% of female caregivers and 23.5% of the female controls used antidepressants, while the numbers for males were 21.1% and 16.4%, respectively. Adjusted for socioeconomic status, female caregivers used 43.7 (95% confidence interval 42.4-45.0) and their controls used 36.2 (35.3-37.2) DDDs of antidepressants per person-year. Male caregivers used 29.6 (27.6-31.6) and their controls used 21.6 (20.2-23.0) DDDs of antidepressants per person-year. Among female caregivers, the relative risk for use of antidepressants was similar (about 1.3) from 20 to 70 years, after which the relative risk declined. In male caregivers, the relative risk was highest (about 1.4-1.5) between 45 and 65 years. CONCLUSIONS Family caregivers providing high-intensity care use more antidepressants and hence, are likely to have poorer mental health than the age-matched general population in virtually all age groups. However, the magnitude of the higher use varies as a function of age and gender.
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Affiliation(s)
- Tuija M. Mikkola
- Folkhälsan Research Center, PO Box 211, 00251 Helsinki, Finland ,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, PO Box 211, 00251 Helsinki, Finland ,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Minna Mänty
- Unit of Strategy and Research, City of Vantaa, Vantaa, Finland ,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Mikaela B. von Bonsdorff
- Folkhälsan Research Center, PO Box 211, 00251 Helsinki, Finland ,Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Koponen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teppo Kröger
- Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland
| | - Johan G. Eriksson
- Folkhälsan Research Center, PO Box 211, 00251 Helsinki, Finland ,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore ,Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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11
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Hayes L, Adams J, McCallum I, Forrest L, Hidajat M, White M, Sharp L. Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis. J Epidemiol Community Health 2021; 75:1-9. [PMID: 33055178 DOI: 10.1136/jech-2020-214232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/11/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Poorer colorectal cancer survival in the UK than in similar countries may be partly due to delays in the care pathway. To address this, cancer waiting time targets were established. We investigated if socio-demographic inequalities exist in meeting cancer waiting times for colorectal cancer. METHODS We identified primary colorectal cancers (International Classification of Diseases, Tenth Revision C18-C20; n=35 142) diagnosed in the period 2001-2010 in the Northern and Yorkshire Cancer Registry area. Using multivariable logistic regression, we calculated likelihood of referral and treatment within target by age group and deprivation quintile. RESULTS 48% of the patients were referred to hospital within target (≤14 days from general practitioner (GP) referral to first hospital appointment); 52% started treatment within 31 days of diagnosis; and 44% started treatment within 62 days of GP referral. Individuals aged 60-69, 70-79 and 80+ years were significantly more likely to attend a first hospital appointment within 14 days than those aged <60 years (adjusted OR=1.23, 95% CI 1.12 to 1.34; adjusted OR=1.19, 95% CI 1.09 to 1.29; adjusted OR=1.30, 95% CI 1.18 to 1.42, respectively). Older age was significantly associated with lower likelihood of starting treatment within 31 days of diagnosis and 62 days of referral. Deprivation was not related to referral within target but was associated with lower likelihood of starting treatment within 31 days of diagnosis or 62 days of referral (most vs least: adjusted OR=0.82, 95% CI 0.74 to 0.91). CONCLUSIONS Older patients with colorectal cancer were less likely to experience referral delays but more likely to experience treatment delays. More deprived patients were more likely to experience treatment delays. Investigation of patient pathways, treatment decision-making and treatment planning would improve understanding of these inequalities.
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Affiliation(s)
- Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Iain McCallum
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lynne Forrest
- University of Edinburgh School of GeoSciences, Edinburgh, UK
| | - Mira Hidajat
- University of Bristol School of Social and Community Medicine, Bristol, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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12
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Choi BCK. BIG DATA … small story. J Epidemiol Community Health 2020; 75:309-310. [PMID: 33115887 PMCID: PMC7892384 DOI: 10.1136/jech-2020-215752] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Bernard C K Choi
- Public Health Agency of Canada, Ottawa, Canada .,University of Toronto, Toronto, Canada.,University of Ottawa, Ottawa, Canada
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13
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Day LT, Gore-Langton GR, Rahman AE, Basnet O, Shabani J, Tahsina T, Poudel A, Shirima K, Ameen S, K.C. A, Salim N, Zaman SB, Shamba D, Blencowe H, Ruysen H, El Arifeen S, Boggs D, Gordeev VS, Rahman QSU, Hossain T, Joshi E, Thapa S, Poudel RP, Poudel D, Chaudhary P, Karki R, Chitrakar B, Mkopi N, Wisiko A, Kitende AP, Shirati MR, Chingalo C, Semhando AO, Mtei C, Mwenisongole V, Bakuza JM, Kombo J, Mbaruku G, Lawn JE. Labour and delivery ward register data availability, quality, and utility - Every Newborn - birth indicators research tracking in hospitals (EN-BIRTH) study baseline analysis in three countries. BMC Health Serv Res 2020; 20:737. [PMID: 32787852 PMCID: PMC7422224 DOI: 10.1186/s12913-020-5028-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 07/12/2019] [Accepted: 02/24/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Countries with the highest burden of maternal and newborn deaths and stillbirths often have little information on these deaths. Since over 81% of births worldwide now occur in facilities, using routine facility data could reduce this data gap. We assessed the availability, quality, and utility of routine labour and delivery ward register data in five hospitals in Bangladesh, Nepal, and Tanzania. This paper forms the baseline register assessment for the Every Newborn-Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. METHODS We extracted 21 data elements from routine hospital labour ward registers, useful to calculate selected maternal and newborn health (MNH) indicators. The study sites were five public hospitals during a one-year period (2016-17). We measured 1) availability: completeness of data elements by register design, 2) data quality: implausibility, internal consistency, and heaping of birthweight and explored 3) utility by calculating selected MNH indicators using the available data. RESULTS Data were extracted for 20,075 births. Register design was different between the five hospitals with 10-17 of the 21 selected MNH data elements available. More data were available for health outcomes than interventions. Nearly all available data elements were > 95% complete in four of the five hospitals and implausible values were rare. Data elements captured in specific columns were 85.2% highly complete compared to 25.0% captured in non-specific columns. Birthweight data were less complete for stillbirths than live births at two hospitals, and significant heaping was found in all sites, especially at 2500g and 3000g. All five hospitals recorded count data required to calculate impact indicators including; stillbirth rate, low birthweight rate, Caesarean section rate, and mortality rates. CONCLUSIONS Data needed to calculate MNH indicators are mostly available and highly complete in EN-BIRTH study hospital routine labour ward registers in Bangladesh, Nepal and Tanzania. Register designs need to include interventions for coverage measurement. There is potential to improve data quality if Health Management Information Systems utilization with feedback loops can be strengthened. Routine health facility data could contribute to reduce the coverage and impact data gap around the time of birth.
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Affiliation(s)
- Louise Tina Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Georgia R. Gore-Langton
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashish K.C.
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Vladimir S. Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Population Health Sciences, Queen Mary University of London, Mile End Road, London, E1 4NS UK
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | | | | | | | | | - Namala Mkopi
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Anna Wisiko
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Alodear Patrick Kitende
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Christostomus Chingalo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Cleopatra Mtei
- Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | | | - John Mathias Bakuza
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Japhet Kombo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Godfrey Mbaruku
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
BACKGROUND All adults over 17 years of age have access to the Public Dental Service after the Finnish Dental Care Reform in 2001-2002. This study aimed to survey the treatment needs and treatment measures provided for adult patients and changes in these during the period 2001-2013. METHODS Sing each person's unique identifier, demographic data on dental visits during the period 2001-2013 were collected from municipal databases in five PDS-units covering 320,000 inhabitants. The numbers of visitors, those in need of basic periodontal or caries treatment (CPI > 2 and D + d > 0) were calculated for three age groups. Treatment provided was also calculated in 13 treatment categories. Trend analyses were performed to study changes during the study period. RESULTS Restorative treatments (968,772; 23.6%), examinations (658,394; 16.1%), radiographs taken (529,875; 12.9%) anaesthesia used (521,169; 12.7%) and emergency treatments (348,229; 8.5%) made up 73.8% of all treatment measures during the entire study period. Periodontal treatment (7.8%) and caries prevention (3.9%) made up a small part of the care provided and prosthetics and treatment of TMJ disorders were extremely uncommon (fewer than 1%). Treatments related to caries (restorative treatment, examinations, endodontics, emergencies, anaesthesia and radiographs) made up 60.4% of the dental personnel's treatment time. During the study period, statistically significant increasing trends were found for radiographs (p < 0.001***), anaesthesia (p = 0.003**) and total number of treatments (p = 0.009**). There was a slight decreasing trend in treatment need among the youngest adults (18-39 years; p = 0.033*). CONCLUSION Compared with the results of national epidemiological studies, insufficient periodontal treatment is provided and prosthetic treatment is almost totally neglected in the PDS. Rather, adults' dental treatment concentrates on treatment of caries. The unmet needs may be due to tradition, inadequate treatment processes or a lack of resources or failed salary incentives.
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Affiliation(s)
- J Linden
- Public Dental Service Lohja, Lohja, Finland.
| | - E Widström
- Institute of Clinical Dentistry, Arctic University of Norway, Tromso, Norway.,National Institute for Health and Welfare (THL), Helsinki, Finland
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15
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Rúa-Figueroa Fernández de Larrinoa I, Pego-Reigosa JM. Contributions of the lupus register of the Spanish Society of Rheumatology (RELESSER) to the knowledge of systemic lupus erythematosus in Spain. ACTA ACUST UNITED AC 2020; 17:245-249. [PMID: 32205082 DOI: 10.1016/j.reuma.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/16/2020] [Indexed: 11/19/2022]
Abstract
The lupus register of the Spanish Society of Rheumatology (RELESSER) is a multicentre register of patients with systemic lupus erythematosus (SLE) under follow-up by Spanish Rheumatology Services. It contains data on a total of 4024 patients with SLE. So far, 14 studies have been published from the transversal phase of RELESSER. Here we report the more relevant contributions of those studies, according to the authors' perspective, concerning cumulative clinical characteristics, level of activity, treatments, refractory disease, damage and mortality. We also review the main results of the analysis regarding incomplete SLE, lupus nephritis, respiratory manifestations, cardiovascular disease, serious infection, malignancies, fibromyalgia, SLE in males, SLE in Hispanics and juvenile-onset SLE, comparing the main characteristics of each subgroup to the global cohort. RELESSER has become one of the most important clinical SLE registers around the world, with a high yield in terms of knowledge generation about the disease in Spain, also useful for the entire scientific community.
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Hadziabdic E, Hjelm K. Register-based study concerning the problematic situation of using interpreting service in a region in Sweden. BMC Health Serv Res 2019; 19:727. [PMID: 31640714 PMCID: PMC6805506 DOI: 10.1186/s12913-019-4619-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to increasing international migration, Sweden has become a multicultural and multilingual society, with about 19% of the population born abroad, which imposes high demands on the healthcare sector and interpreting services. The aim was to investigate problems in the use of interpreters as recorded by healthcare staff and the interpreter service in a region in Sweden. METHODS Cross-sectional register-based study. The study focused on a geographically well-defined region in Sweden including (a) specialized care at three hospitals; (b) local healthcare, including out-patient clinics at hospital and emergency healthcare and primary healthcare; and (c) dental care. The study was based on 726 existing incident reports on the interpreting service and information from the interpreter agency from 2012 and the first quarter of 2016 during a period of a massive influx of refugees. RESULTS The highest number of adverse advents was reported in local healthcare and mainly concerned the absence of an interpreter at the appointed time. Non-authorized in-person interpreters performed most interpretation assignments and Arabic was the most requested language. CONCLUSIONS This study highlights the significance of good cooperation between healthcare and the interpreter service in order to guarantee safe and high-quality healthcare for patients in need of interpreters to be able to communicate in healthcare.
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Affiliation(s)
- Emina Hadziabdic
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, SE-351 95, Växjö, Sweden.
| | - Katarina Hjelm
- Department of Public Health and Caring Sciences, Uppsala University, SE- 751 22, Uppsala, Sweden
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17
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Linden J, Widström E, Sinkkonen J. Children and adolescents´ dental treatment in 2001-2013 in the Finnish public dental service. BMC Oral Health 2019; 19:131. [PMID: 31262298 PMCID: PMC6604139 DOI: 10.1186/s12903-019-0828-z] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022] Open
Abstract
Background The Public Dental Service (PDS) in Finland has catered for the overwhelming majority of the young for more than 50 years. They have had examinations, preventive measures and all other necessary treatment free of charge. This study aimed to survey the treatment needs and treatment measures provided for children and adolescents and changes in these during the period 2001–2013. Methods Using each person’s unique identifier, data on patients (< 18 years), their oral health (CPI > 2, D + d > 0) and treatment received in the period 2001–2013 were collected retrospectively from municipal databases in five PDS-units covering 320,000 inhabitants. The National Institute for Health and Welfare gave ethical approval. Permission to use local data was received from the Directors in the PDS units. Treatment measures were grouped into 14 categories and patients into three age categories (0–6 years, 7–13 years and 14–17 years). Trend analysis was used to test changes over time. Results About 40,000 children and adolescents visited the PDS each year and 2,488,805 treatment measures were provided for them during the entire study period. The proportion of those in need of treatment decreased from 44.4 to 33.2% during the study period. The most common treatment categories were examinations (613,753, 24.7%), orthodontics (499,033, 20.1%), preventive measures (372,473, 15.0%) and restorative treatment (355,325, 14.3%); these made up 74% of all treatment measures. During the study period, statistically highly significant (p < 0.001***) increasing trends were found for examinations, anaesthesia and the total number of treatment measures, and a significant (p < 0.001***) decreasing trend in restorative treatment were found for all the young. More preventive treatment measures were provided for those not in need of treatment compared with those in need of treatment. Conclusion Although children’s oral health had improved and restorative treatment provided had decreased, the total number of treatment measures increased. Healthy children received frequent examinations and high numbers of preventive treatment measures. Targeting treatment according to needs was not satisfactory.
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Affiliation(s)
- J Linden
- Public Dental Service Lohja, Lohja, Finland.
| | - E Widström
- Institute of Clinical Dentistry, Arctic University of Norway, Tromsø, Norway.,National Institute for Health and Welfare (THL), Helsinki, Finland
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McConkey R, Craig S, Kelly C. The prevalence of intellectual disability: A comparison of national census and register records. Res Dev Disabil 2019; 89:69-75. [PMID: 30947106 DOI: 10.1016/j.ridd.2019.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND International prevalence rates for intellectual disability vary widely with estimates often based on samples. In Ireland people with an intellectual disability are identified in the national census. Moreover, a national register of people receiving or requiring intellectual disability services is maintained and updated annually. AIMS The prevalence rates from the census were contrasted with those from the register along with variations in prevalence across the 26 counties of Ireland. METHODS 2011 and 2016 Census of Population prevalence per 1000 for children (aged 5-19 years) and adults (20 years and over) stratified by the 26 countries were contrasted with similar prevalence in the national register. Publically available data from the 2011 census in Northern Ireland and Scotland were obtained. RESULTS The Irish census identified nearly twice as many children and adults than were on the national register. Prevalence rates also varied across the 26 counties; more so on the register than the census. The Irish census had lower prevalence rates than Northern Ireland but higher than Scotland. CONCLUSIONS Determining the prevalence of intellectual disability is challenging due to variations in terminology. A national register has advantages over reliance on census data for service planning.
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Affiliation(s)
- Roy McConkey
- Institute of Nursing and Health Research, Ulster University, N. Ireland, United Kingdom.
| | - Sarah Craig
- National Health Information Systems, Health Research Board, Dublin, Ireland
| | - Caraíosa Kelly
- National Health Information Systems, Health Research Board, Dublin, Ireland
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Santaeugènia Gonzàlez SJ, Roqué I Figuls M, Sánchez Ferrín P, Salvà Casanovas A. [Complexity and prevalence of geriatric syndromes in patients treated in intermediate care units in Catalonia: A multicentre study of XARESS project]. Rev Esp Geriatr Gerontol 2019; 54:75-80. [PMID: 30782487 DOI: 10.1016/j.regg.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 09/25/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Descriptive study is presented on the complexity and prevalence of geriatric syndromes (GS) in Intermediate Care Units in Catalonia. METHODS A retrospective study was conducted on 6471 stays completed during the year 2014 in the participating centres of the XARESS network. Data was obtained by extracting the information routinely collected on the CMBD-RSS registry (Minimum Basic Dataset for the Intermediate Care Resources). The prevalence and associations between geriatric síndromes (resource group) RG category, length of stay, and destination at discharge is described. Results were stratified by type of unit (convalescence or long stay). RESULTS Participants presented a median of 3 GS at admission in long stay units, and 2 GS at admission in convalescence units. The number of GS varied with RG category, although in all RG categories, there were patients without complexity (no SG), and patients with extreme complexity (up to 9 GS). Patients with geriatric syndromes had a longer mean length of stay and greater dependence than patients without syndromes, although with great variability across GS. However, the presence of geriatric syndromes had no impact on the destination at discharge. CONCLUSIONS The population cared for in intermediate care units have high complexity and a high prevalence of geriatric syndromes at admission. The CMBD-RSS registry allows the characterisation of complexity of the population admitted to the Catalan convalescence and long term intermediate care units.
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Affiliation(s)
| | | | - Pau Sánchez Ferrín
- Pla Director Sociosanitari, Departament de Salut, Generalitat de Catalunya, Barcelona, España
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Dalsgaard EM, Witte DR, Charles M, Jørgensen ME, Lauritzen T, Sandbæk A. Validity of Danish register diagnoses of myocardial infarction and stroke against experts in people with screen-detected diabetes. BMC Public Health 2019; 19:228. [PMID: 30795763 PMCID: PMC6387546 DOI: 10.1186/s12889-019-6549-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/09/2018] [Accepted: 02/15/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Administrative patient registers are often used to estimate morbidity in epidemiological studies. The validity of register data is thus important. This study aims to assess the positive predictive value of myocardial infarction and stroke registered in the Danish National Patient Register, and to examine the association between cardiovascular risk factors and cardiovascular disease based on register data or validated diagnoses in a well-defined diabetes population. METHODS We included 1533 individuals found with screen-detected type 2 diabetes in the ADDITION-Denmark study in 2001-2006. All individuals were followed for cardiovascular outcomes until the end of 2014. Hospital discharge codes for myocardial infarction and stroke were identified in the Danish National Patient Register. Hospital medical records and other clinically relevant information were collected and an independent adjudication committee evaluated all possible events. The positive predictive value for myocardial infarction and stroke were calculated as the proportion of cases recorded in the Danish National Patient Register confirmed by the adjudication committee. RESULTS The positive predictive value was 75% (95% CI: 64;84) for MI and 70% (95% CI: 54;80) for stroke. The association between cardiovascular risk factors and incident cardiovascular disease did not depend on using register-based or verified diagnoses. However, a tendency was seen towards stronger associations when using verified diagnoses. CONCLUSIONS Our results show that studies using only register-based diagnoses are likely to misclassify cardiovascular outcomes. Moreover, the results suggest that the magnitude of associations between cardiovascular risk factors and cardiovascular outcomes may be underestimated when using register-based diagnoses.
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Affiliation(s)
- Else-Marie Dalsgaard
- Department of Public Health, Aarhus University, Bartholins allé 2, DK-8000, Aarhus C, Denmark.
| | - Daniel Rinse Witte
- Department of Public Health, Aarhus University and Danish Diabetes Academy, Odense, Denmark
| | - Morten Charles
- Department of Public Health, Aarhus University, Bartholins allé 2, DK-8000, Aarhus C, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Copenhagen, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Aarhus University, Bartholins allé 2, DK-8000, Aarhus C, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University and Steno Diabetes Center, Aarhus, Denmark
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Vajda FJE, Graham JE, Hitchcock AA, Lander CM, O'Brien TJ, Eadie MJ. Antiepileptic drugs and foetal malformation: analysis of 20 years of data in a pregnancy register. Seizure 2018; 65:6-11. [PMID: 30593875 DOI: 10.1016/j.seizure.2018.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 01/27/2023] Open
Abstract
PURPOSE This paper reports additional data supplementing earlier publications based on Australian Pregnancy Register (APR) data. METHOD Over 20 years, the APR has collected Information on pregnancies in Australian women with epilepsy (WWE), untreated WWE and those taking AEDs for other indications. Contact is by telephone, at set intervals. Treatment is not interfered with. Data are analysed using conventional statistical techniques, confidence interval methods, and logistic regression. RESULTS By 2018, the APR contained details of 2148 pregnancies. AEDs were taken throughout 1972 of the pregnancies (91.8%). The remaining 176 (8.2%) did not receive AEDs, at least early in pregnancy. There were (i) dose-related increased incidences of pregnancies carrying foetal malformations associated with maternal intake of valproate and topiramate when topiramate was a component of AED polytherapy (P < .05), (ii) a similar dose-related trend in relation to carbamazepine intake, (iii) no evidence that levetiracetam and lamotrigine were unsafe from the foetal standpoint, (iv) insufficient data to permit conclusions regarding teratogenicity in relation to other AEDs, and (v) no evidence that pre-conception folate supplementation reduced the hazard of AED-associated foetal malformation. AED polytherapy did not increase foetal hazard unless valproate or topiramate was involved in the AED combination. Genetic factors probably contributed to the malformation hazard. Seizures occurring in earlier pregnancy probably did not contribute to the malformation hazard. CONCLUSIONS If it were not for the importance of maintaining seizure control, the above findings suggest that it would be better to avoid using certain AEDs, particularly valproate and topiramate, during pregnancy.
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Affiliation(s)
- F J E Vajda
- Department of Medicine and Neurosciences, Royal Melbourne Hospital University of Melbourne, Parkville, 3050 Victoria, Australia.
| | - J E Graham
- Department of Medicine and Neurosciences, Royal Melbourne Hospital University of Melbourne, Parkville, 3050 Victoria, Australia
| | - A A Hitchcock
- Department of Medicine and Neurosciences, Royal Melbourne Hospital University of Melbourne, Parkville, 3050 Victoria, Australia
| | - C M Lander
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, Queensland, 4027 Australia
| | - T J O'Brien
- Department of Medicine and Neurosciences, Alfred Hospital and Monash University, Melbourne 3004, Australia
| | - M J Eadie
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, Queensland, 4027 Australia
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Frisk G, Ekberg S, Lidbrink E, Eloranta S, Sund M, Fredriksson I, Lambe M, Smedby KE. No association between low-dose aspirin use and breast cancer outcomes overall: a Swedish population-based study. Breast Cancer Res 2018; 20:142. [PMID: 30458873 PMCID: PMC6247765 DOI: 10.1186/s13058-018-1065-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/19/2018] [Indexed: 01/05/2023] Open
Abstract
Background Results from previous studies indicate that use of low-dose aspirin may improve breast cancer prognosis. We evaluated aspirin use and breast cancer outcomes in relation to clinical characteristics as well as dose and duration of aspirin use. Methods We used information from the Regional Breast Cancer Quality-of-Care Registries in three Swedish regions to identify 21,414 women diagnosed with a first stage I–III breast cancer between 1 April 2006 and 31 December 2012. The cohort was further linked to nationwide registers to retrieve information about dispensing low-dose aspirin before and after breast cancer diagnosis, comorbidity and causes of death. In a separate analysis, we investigated time to breast cancer death among 621 women with stage IV disease at diagnosis. Associations were evaluated using a multivariable Cox proportional hazards model. Results Among women with stage I–III breast cancer, 2660 (12.4%) used low-dose aspirin shortly before breast cancer diagnosis and 4091 (19.1%) were users during follow-up. Women were followed for a median of 3.8 years after diagnosis. There was no association between aspirin use and breast cancer-specific death in multivariable analyses (use before diagnosis: hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.77–1.12; use after diagnosis: HR 1.00, 95% CI 0.74–1.37). Similarly, aspirin use was not associated with risk of first recurrence/metastases in a subgroup of stage I–III breast cancer patients (HR 0.97, 95% CI 0.86–1.10). However, in analyses stratified by stage, an inverse association between low-dose aspirin use after diagnosis and breast cancer death was found for women with stage I tumors (HR 0.53, 95% CI 0.29–0.96). Among women with stage IV disease at diagnosis, aspirin use was not associated with time to breast cancer death (HR 0.91, 95% CI 0.67–1.23). Conclusion In this large population-based cohort study there was no evidence that low-dose aspirin use before or after breast cancer diagnosis is associated with a reduced risk of adverse outcomes overall in breast cancer. However, a potential benefit was noted among women with stage I tumors, warranting further investigation. Electronic supplementary material The online version of this article (10.1186/s13058-018-1065-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gabriella Frisk
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
| | - Sara Ekberg
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Elisabet Lidbrink
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Irma Fredriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
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Qvist I, Søgaard R, Lindholt JS, Lorentzen V, Hallas J, Frost L. Adherence to Prescribed Drugs Among 65-74 Year Old Men Diagnosed with Abdominal Aortic Aneurysm or Peripheral Arterial Disease in a Screening Trial: A VIVA Substudy. Eur J Vasc Endovasc Surg 2018; 57:442-450. [PMID: 30393062 DOI: 10.1016/j.ejvs.2018.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 06/06/2018] [Accepted: 09/22/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Adherence to antiplatelet and statin therapy in participants diagnosed with abdominal aortic aneurysm (AAA) or peripheral arterial disease (PAD) was examined in a vascular screening trial. METHODS This was a population based cohort study. The study population consisted of 65-74 year old men diagnosed with AAA or PAD in the Viborg Vascular (VIVA) multifaceted screening trial for CVD. Data from the VIVA screening cohort were linked to data from Danish registers from 2007 to 2016. Initiation of antiplatelet and statin treatment was measured within 120 days after screening. Persistence was defined as no treatment gap >100 days between two prescription renewals after screening. A proportion of days covered ≥80% over five years of follow up was used as a categorical cut off for adherence. RESULTS Among the 18,748 screened participants, 618 with AAA and 2051 with PAD were identified. Among non-users at baseline, 65% and 62% initiated antiplatelet and statin treatment, 57% and 59% persisted with antiplatelet and statin use, and 60% and 57% were adherent, respectively. Among users at baseline, 73% and 69% had filled an antiplatelet or statin prescription, respectively, within 120 days after screening. Further, 79% and 73% persisted with their antiplatelet and statin treatment, and 89% and 83% were adherent, respectively. CONCLUSION In a vascular screening trial, six of every 10 non-users initiated preventive treatment; among these, the adherence rate was 57-60%. Among users at baseline, the five year adherence to antiplatelet and statin treatment exceeded 80%. The effectiveness of screening initiatives might be improved by measures to improve the fulfilment of preventive medication.
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Affiliation(s)
- Ina Qvist
- Department of Cardiology, Diagnostic Centre, Regional Hospital Central Jutland, Silkeborg, Denmark; Centre for Research in Clinical Nursing, Regional Hospital Viborg, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Rikke Søgaard
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jes S Lindholt
- Department of Vascular Surgery, Regional Hospital Central Jutland, Viborg, Denmark; Centre of Individualised Medicine in Arterial Diseases, Department of Cardiothoracic and Vascular Department T, Odense University Hospital, Odense, Denmark
| | - Vibeke Lorentzen
- Centre for Research in Clinical Nursing, Regional Hospital Viborg, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Jesper Hallas
- Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Central Jutland, Silkeborg, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Östergren O, Martikainen P, Lundberg O. The contribution of alcohol consumption and smoking to educational inequalities in life expectancy among Swedish men and women during 1991-2008. Int J Public Health 2017; 63:41-48. [PMID: 28835983 PMCID: PMC5766714 DOI: 10.1007/s00038-017-1029-7] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 08/06/2017] [Accepted: 08/14/2017] [Indexed: 01/12/2023] Open
Abstract
Objectives To assess the level and changes in contribution of smoking and alcohol-related mortality to educational differences in life expectancy in Sweden. Methods We used register data on the Swedish population at ages 30–74 during 1991–2008. Cause of death was used to identify alcohol-related deaths, while smoking-related mortality was estimated using lung cancer mortality to indirectly assess the impact of smoking on all-cause mortality. Results Alcohol consumption and smoking contributed to educational differences in life expectancy. Alcohol-related mortality was higher among men and contributed substantially to inequalities among men and made a small (but increasing) contribution to inequalities among women. Smoking-related mortality decreased among men but increased among women, primarily among the low educated. At the end of the follow-up, smoking-related mortality were at similar levels among men and women. The widening gap in life expectancy among women could largely be attributed to smoking. Conclusions Smoking and alcohol consumption contribute to educational differences in life expectancy among men and women. The majority of the widening in the educational gap in mortality among women can be attributed to alcohol and smoking-related mortality.
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Affiliation(s)
- Olof Östergren
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Sveavägen 160, 106 91, Stockholm, Sweden.
| | - Pekka Martikainen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Olle Lundberg
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Sveavägen 160, 106 91, Stockholm, Sweden
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Muñoz-Pascual A, Sáez-López P, Jiménez-Mola S, Sánchez-Hernández N, Alonso-García N, Andrés-Sainz AI, Macias-Montero MC, Vázquez-Pedrezuela C, Pereira de Castro Juez N, Del Pozo-Tagarro P, Pablos-Hernández C, Cervera-Díaz C, Cerón-Fernández A, Vuelta-Calzada E, Perez-Jara Carrera J, González-Ramírez A, Collado-Díaz T, Idoate-Gil J, Guerrero-Díaz MT, Gutierrez-Bejarano D, Martín-Perez E. [Orthogeriatrics: The First multicentre regional register of hip fractures in Castilla y León (Spain)]. Rev Esp Geriatr Gerontol 2017; 52:242-248. [PMID: 28522074 DOI: 10.1016/j.regg.2017.03.001] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 02/12/2017] [Accepted: 03/13/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study is to describe the characteristics of the patients with hip fracture admitted to the Public Hospitals of Castilla y León during three monthly periods (November 2014, and October and November 2015). MATERIAL AND METHOD The Castilla y León orthogeriatrics work group created a common register to collect data on hip fractures. The study included patients 75 years-old and over hospitalised with hip fractures in the 13 public hospitals in the community during November 2014, and October and November 2015. A multicentre, prospective, and observational study was conducted, in which clinical, functional, and social variables, as well as in-hospital mortality, were collected. RESULTS The analysis included data from a total of 776 patients with a mean age of 86 (±6) years. The surgical delay was 4±2.8 days, and the mean hospital stay was 10±4.7 days. The anaesthesia risk was ASA 3±0.6. Around two-thirds (66.5%) of the patients had medical complications while in hospital, and 55.5% required a transfusion. In-hospital mortality was 4.6%. The mean pre-surgical stay was related to the overall stay: P<.001. CONCLUSIONS Hip fracture registers are an essential tool for evaluating the process and for improving the treatment quality of these patients. This is the first multicentre register of hip fracture in the elderly created in a Spanish region, and could be a good precedent reference for a future national register.
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Affiliation(s)
| | - Pilar Sáez-López
- Unidad de Geriatría, Complejo Asistencial de Ávila, Ávila, España; Instituto de Investigación Hospital Universitario La Paz, Fundación Idi Paz, Ávila, España.
| | - Sonia Jiménez-Mola
- Unidad de Geriatría, Complejo Asistencial Universitario de León, León, España
| | | | | | | | | | | | | | | | | | - Carmen Cervera-Díaz
- Unidad de Geriatría, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | | | | | | | | | - Javier Idoate-Gil
- Unidad de Geriatría, Complejo Asistencial Universitario de León, León, España
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Jacob J, Arranz M, Sancho Ramoneda M, Lopez À, Navarro Sáez MC, Cousiño Chao JR, López Altimiras X, López I Vengut F, García Trallero O, Zorrilla J, German A, Farré Cerdà J, Lista E. [Noninvasive mechanical ventilation in emergency services in Catalonia: the VNICat registry cohort study]. Emergencias 2017; 29:33-38. [PMID: 28825266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To study how noninvasive ventilation (NIV) is used in prehospital emergency services and hospital emergency departments. To explore associations between NIV use and hospital mortality. MATERIAL AND METHODS Prospective analysis of a consecutive multicenter cohort of patients who were treated with NIV between February and March 2015. The study was undertaken in emergency medical services in Catalonia and 8 Catalan hospital emergency departments. We collected information during the acute episode and on discharge, as well as data describing the patients' condition when stable. The dependent variable was all-cause hospital mortality. RESULTS We studied 184 acute episodes requiring NIV, in the prehospital setting in 25 cases (13.6%) and in the hospital in 159 (86.4%). The most common scenario was acute heart failure (AHF) (38.0%). The second most common was chronic obstructive pulmonary disease (COPD) (34.2%). In most cases, NIV was discontinued in the emergency department. Mortality was 7.5% during prehospital care and 21.4% in the hospital. Hospital mortality was associated with limiting the use of life support. We detected no significant differences in mortality between the groups of patients with AHF vs COPD. CONCLUSION The use of NIV in prehospital and hospital emergency care follows current evidence-based recommendations and is required more often for AHF than for exacerbated COPD. Hospital mortality is high in this context and is associated with frequent limiting of life support.
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Affiliation(s)
- Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - María Arranz
- Servicio de Urgencias, Hospital de Viladecans, Barcelona, España
| | | | | | | | | | | | - Francesc López I Vengut
- Servicio de Urgencias, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España
| | | | - José Zorrilla
- Servicio de Urgencias, Xarxa Assistencial de Manresa, Fundació Althaia, Barcelona, España
| | - Antonio German
- Servicio de Urgencias, Hospital Universitari Mútua de Terrassa, Barcelona, España
| | - Jaume Farré Cerdà
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, España
| | - Eva Lista
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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Borsari L, Malagoli C, Ballotari P, De Girolamo G, Bonora K, Violi F, Capelli O, Rodolfi R, Nicolini F, Vinceti M. Validity of hospital discharge records to identify pregestational diabetes in an Italian population. Diabetes Res Clin Pract 2017; 123:106-111. [PMID: 28002751 DOI: 10.1016/j.diabres.2016.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/10/2016] [Revised: 09/20/2016] [Accepted: 11/29/2016] [Indexed: 12/30/2022]
Abstract
AIMS In recent years, the prevalence of pregestational diabetes (PGDM) and the concern about the possibility of adverse pregnancy outcomes in affected women have been increasing. Routinely collected health data represent a timely and cost-efficient approach in PGDM epidemiological research. This study aims to evaluate the reliability of hospital discharge (HD) coding to identify a population-based cohort of pregnant women with PGDM and to assess trends in prevalence in two provinces of Northern Italy. METHODS We selected all deliveries occurred in the period 1997-2010 with ICD-9-CM codes for PGDM in HD record and we matched up to 5 controls from mothers without diabetes. We used Diabetes Registers (DRs) as the gold standard for validation analysis. RESULTS We selected 3800 women, 653 with diabetes and 3147 without diabetes. The agreement between HD records and DRs was 90.7%, with K=0.58. We detected 350 false positives and only 1 false negative. Sensitivity was 99.3%, specificity 90.0%, positive predictive value 46.4% and negative predictive value 99.9%. Of the false positives, 48.6% had gestational diabetes and 2.3% impaired glucose tolerance. After the validation process, PGDM prevalence decreased from 4.4 to 2.0 per 1000 deliveries. CONCLUSIONS Our results show that HD facilitate detection of almost all PGDM cases, but they also include a large number of false positives, mainly due to gestational diabetes. This misclassification causes a large overestimation of PGMD prevalence. Our findings require accuracy evaluation of ICD-9-CM codes, before they can be widely applied to epidemiological research and public health surveillance related to PGDM.
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Affiliation(s)
- Lucia Borsari
- Sezione di Sanità Pubblica, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Carlotta Malagoli
- Sezione di Sanità Pubblica, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Paola Ballotari
- Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | | | - Karin Bonora
- Azienda Unità Sanitaria Locale di Modena, Modena, Italy
| | - Federica Violi
- Sezione di Sanità Pubblica, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | | | - Rossella Rodolfi
- Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
| | - Fausto Nicolini
- Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Vinceti
- Sezione di Sanità Pubblica, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy.
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Holst S, Wohlfahrt J, Kjær SK, Kamper-Jørgensen M, Kern P, Andersson M, Koch A. Cervical cancer screening in Greenland, 1997-2011: Screening coverage and trends in the incidence of high-grade cervical lesions. Gynecol Oncol 2016; 143:307-312. [PMID: 27018418 DOI: 10.1016/j.ygyno.2016.03.029] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In spite of the high incidence of cervical cancer in Greenland, no assessment has been made of the impact of organized cervical screening, introduced in 1998, in relation to occurrence of high-grade cervical lesions. The objectives of the present study were to estimate coverage of the screening program and to examine possible changes in cervical intraepithelial neoplasia (CIN3) incidence in Greenland during 1997-2011 according to calendar period and age. METHODS Using nationwide registries, we calculated age-standardized incidence rates for all women born and living in Greenland. To investigate whether possible variation in the incidence of CIN3 were related to differences in screening coverage, we further estimated relative risks of CIN3 within two years of screening among women who participated in the screening program using log-linear binomial regression. RESULTS Coverage of the screening program was low during 1997-2011 with the highest level of 54% observed in 2011. Peaks in CIN3 incidence of around 300 per 100,000 person-years were observed in 1999 and between 2009 and 2011, while the incidence was lower of approximately 100 per 100,000 person-years between 2000 and 2008. During 2009-2011, the highest incidence was found among women aged 25-34 years. Similar patterns of CIN3 risk according to calendar period and age groups were observed among screened women. CONCLUSIONS The great variations in CIN3 incidence and low screening coverage observed during 1997-2011 suggest that improvements in the Greenlandic screening program are warranted.
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Affiliation(s)
- Signe Holst
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark.
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, The Danish Cancer Society, Strandboulevarden 49, DK-2100, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Mads Kamper-Jørgensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Denmark
| | - Peder Kern
- Department of Gynecology and Obstetrics, Queen Ingrid's Hospital, Nuuk, Greenland
| | - Mikael Andersson
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark
| | - Anders Koch
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark
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Jacobsen R, Thorsen SU, Cohen AS, Lundqvist M, Frederiksen P, Pipper CB, Pociot F, Thygesen LC, Ascherio A, Svensson J, Heitmann BL. Neonatal vitamin D status is not associated with later risk of type 1 diabetes: results from two large Danish population-based studies. Diabetologia 2016; 59:1871-81. [PMID: 27241183 DOI: 10.1007/s00125-016-4002-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/05/2016] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to assess whether neonatal levels of 25-hydroxyvitamin D (25(OH)D) are associated with risk of developing type 1 diabetes before the age of 18 years. METHODS Two large-scale studies with different designs-a case-cohort and a case-control-were conducted using Danish national register data and biobank material. Weighted Cox regression and conditional logistic regression were used to calculate HRs and ORs, respectively. The concentration of 25(OH)D was assessed from neonatal dried blood spots using highly sensitive liquid chromatography-tandem mass spectrometry. Quintiles of 25(OH)D3 were used in the main analyses. RESULTS The case-cohort study included 912 type 1 diabetes cases and 2866 individuals without type 1 diabetes born in Denmark between 1981 and 2002 and followed up until the end of 2012. The case-control study included 527 matched case-control pairs born between 1981 and 1999 and followed up until May 2004. Both studies found no association between 25(OH)D3 levels and later risk of developing type 1 diabetes. The neonatal total 25(OH)D levels in the studies were low: 46% (case-cohort study) and 51% (case-control study) of individuals had 25(OH)D levels <25 nmol/l. CONCLUSIONS/INTERPRETATION Our two large-scale national studies showed that 25(OH)D3 levels around the time of birth were not associated with later type 1 diabetes risk. Whether higher levels of 25(OH)D3 during pregnancy, acquired by higher doses of supplementation than are recommended today in most countries, could protect the offspring against type 1 diabetes cannot be ruled out by the present studies.
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Affiliation(s)
- Ramune Jacobsen
- Research Unit for Dietary Studies at The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, Hovedvejen, Entrance 5, Ground Floor, 2000, Frederiksberg, Denmark.
- The Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark.
| | - Steffen U Thorsen
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Paediatrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arieh S Cohen
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - Marika Lundqvist
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - Peder Frederiksen
- Research Unit for Dietary Studies at The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, Hovedvejen, Entrance 5, Ground Floor, 2000, Frederiksberg, Denmark
| | - Christian B Pipper
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Pociot
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Paediatrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Alberto Ascherio
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jannet Svensson
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Paediatrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Berit L Heitmann
- Research Unit for Dietary Studies at The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, Hovedvejen, Entrance 5, Ground Floor, 2000, Frederiksberg, Denmark
- The Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Boden Institute of Obesity, Nutrition Exercise and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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de La Forest Divonne M, Gottenberg JE, Salliot C. Safety of biologic DMARDs in RA patients in real life: A systematic literature review and meta-analyses of biologic registers. Joint Bone Spine 2017; 84:133-40. [PMID: 27341745 DOI: 10.1016/j.jbspin.2016.02.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/03/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In daily practice, safety in rheumatoid arthritis (RA) patients receiving biological treatment is an important issue. Unlike randomized controlled trials, biologic registers provide long-term real life safety data. To identify all biologic registers worldwide, to extract and analyze data regarding safety in RA patients under biologics. METHOD Systematic review was performed independently by 2 rheumatologists using PUBMED, COCHRANE Library and EMBASE databases, up to December 2014. Worldwide biologic registers and related publications were identified. Data on safety issues in RA patients were extracted for meta-analyses. Random-effect meta-analyses were performed to estimate risk ratios (RRs) of mortality, cardiovascular events, cancer, including lymphoma and melanoma and serious infections between (1) biological and non-biological DMARD (cDMARD), (2) between biologics when data were available. RESULTS Forty-three biological registers were identified worldwide and 27 publications were included for safety meta-analyses on anti-TNFs. Compared to cDMARD, mortality and cardiovascular events were significantly decreased in patients treated with anti-TNFs: RR=0.60 [95% CI 0.38-0.94] and RR=0.62 [0.44-0.88], respectively. Anti-TNFs did not increase the risk of solid cancer in patients without or with prior malignancy (RR=0.84 [0.60-1.18] and RR=0.77 [0.29-2.03], respectively), lymphoma (RR=0.90 [0.62-1.31]) and melanoma (RR=1.17 [0.86-1.59]). As expected, serious infections were significantly increased during anti-TNF treatment (RR=1.48 [1.18-1.85]) compared to cDMARD. No significant difference was found between soluble receptor to TNF and monoclonal antibodies (RR=0.55 [0.22-1.35]). CONCLUSIONS By reducing dramatically chronic inflammation in RA patients, anti-TNFs decrease mortality, cardiovascular events without increase significantly the risk of cancer, compared to cDMARDs.
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Kjærulff TM, Ersbøll AK, Gislason G, Schipperijn J. Geographical clustering of incident acute myocardial infarction in Denmark: A spatial analysis approach. Spat Spatiotemporal Epidemiol 2016; 19:46-59. [PMID: 27839580 DOI: 10.1016/j.sste.2016.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To examine the geographical patterns in AMI and characterize individual and neighborhood sociodemographic factors for persons living inside versus outside AMI clusters. METHODS The study population comprised 3,515,670 adults out of whom 74,126 persons experienced an incident AMI (2005-2011). Kernel density estimation and global and local clustering methods were used to examine the geographical patterns in AMI. Median differences and frequency distributions of sociodemographic factors were calculated for persons living inside versus outside AMI clusters. RESULTS Global clustering of AMI occurred in Denmark. Throughout the country, 112 significant clusters with high risk of incident AMI were identified. The relative risk of AMI in significant clusters ranged from 1.45 to 47.43 (median=4.84). Individual and neighborhood socioeconomic position was markedly lower for persons living inside versus outside AMI clusters. CONCLUSIONS AMI is geographically unequally distributed throughout Denmark and determinants of these geographical patterns might include individual- and neighborhood-level sociodemographic factors.
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Affiliation(s)
- Thora Majlund Kjærulff
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, DK-1353 Copenhagen K, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, DK-1353 Copenhagen K, Denmark.
| | - Gunnar Gislason
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, DK-1353 Copenhagen K, Denmark; Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark; Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, DK-2900 Hellerup, Denmark; The Danish Heart Foundation, Hauser Plads 10, DK-1127 Copenhagen K, Denmark.
| | - Jasper Schipperijn
- Department of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark .
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Conde Barreiro S, Rodríguez Rigual M, Bueno Lozano G, López Siguero JP, González Pelegrín B, Rodrigo Val MP, Compés Dea ML. [Epidemiology of type 1 diabetes mellitus in children in Spain]. An Pediatr (Barc) 2014; 81:189.e1-189.e12. [PMID: 24467823 DOI: 10.1016/j.anpedi.2013.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 10/28/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Epidemiological studies in many regions and countries have contributed to determining the epidemiology of type 1 diabetes (T1DM) in children less than 15 years old. Studies in many regions of Spain have been published, but the national incidence is not really known. MATERIAL AND METHODS A review was made of the publications on the epidemiology of T1DM in Spain, selecting the references on patients less than 15 years old. RESULTS Many epidemiological studies on T1DM in almost all regions in Spain have been published. The methodology of these studies is heterogeneous, with variations in geographical definition, duration, period of study, limit of age, and data collection. The incidence rates are variable, from 11.5 cases per 100,000/year in Asturias to 27.6 in Castilla-La Mancha. Some studies report the percentage of diabetic ketoacidosis at the time of diagnosis, which is usually in the range of 25-40%. CONCLUSIONS Although there have been various epidemiological studies on T1DM in almost all regions in Spain, the methodology is heterogeneous. The mean incidence of T1DM in children less than 15 years old in Spain, stimated from the selected studies is 17,69 cases per 100,000/year. T1DM registers need to be created and updated, using standardized methodology, to get more reliable data of the epidemiology of T1DM in Spain in the near future.
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Affiliation(s)
| | - M Rodríguez Rigual
- Unidad de diabetes infantil, Hospital Universitario Miguel Servet, Zaragoza, España
| | - G Bueno Lozano
- Servicio de Pediatría, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J P López Siguero
- Servicio de Endocrinología Pediátrica, Hospital Maternoinfantil Carlos Haya, Málaga, España
| | | | - M P Rodrigo Val
- Dirección General de Salud Pública del Gobierno de Aragón, Zaragoza, España
| | - M L Compés Dea
- Dirección General de Salud Pública del Gobierno de Aragón, Zaragoza, España
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