Publications by authors named "Charlotte Overgaard"

43 Publications

How do reminder systems in follow-up screening for women with previous gestational diabetes work? - a realist review.

BMC Health Serv Res 2021 Jun 1;21(1):535. Epub 2021 Jun 1.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej, 14, 9220, Aalborg Øst, Denmark.

Background: Women with previous gestational diabetes have an increased risk of developing type 2 diabetes later in life. Recommendations therefore urge these women to participate in follow-up screening, 4-12 weeks postpartum and every 1-3 years thereafter. We sought to theorize how reminder interventions to support early detection of diabetes work, for whom, and in what circumstances.

Methods: We used a method informed by realist review and synthesis. A systematic, iterative search in six electronic databases (PubMed, MEDLINE Ovid, The Cochrane Library, CINAHL, EMBASE) had a primary focus on experimental intervention studies and included additional information in relation to identified intervention studies. Analysis inductively identified context-mechanism-outcome configurations present in the evidence.

Results: We located 16 articles eligible for inclusion. A cross-case comparison identified seven grouped context-mechanism-outcome configurations leading to intervention mechanisms relating to changes in women's reasoning and behavior. Configurations were thematically ordered in relation to Systems Resources, Women's Circumstances, and Continuity of Care. These were mapped onto a socio-ecological model and discussed according to identified middle-range theories.

Conclusion: Our findings adds to the body of evidence, that reminders have the potential to be effective in increasing participation in the recommended follow-up screening. Our study may assist researchers and policy and decision makers to analyze and judge if reminders are feasible and/or likely to succeed in their specific context. Further research into the perspective of socially disadvantaged and overweight women is needed to avoid unintended consequences such as social inequality in service use and stigmatization in future programs.
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http://dx.doi.org/10.1186/s12913-021-06569-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167960PMC
June 2021

Interventions to reduce preterm birth in pregnant women with psychosocial vulnerability factors-A systematic review.

Midwifery 2021 Apr 20;100:103018. Epub 2021 Apr 20.

Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg Øst, Denmark.

Objective: Pregnant women with psychosocial vulnerability factors face a higher risk of preterm birth, a heavier burden of perinatal morbidity and mortality and less social health equity. Prevention of preterm birth in this group has proved difficult, and more knowledge is needed to ensure evidence-based care and improve prevention. This study aimed to determine the effectiveness of preventive interventions to reduce preterm birth among pregnant women with psychosocial vulnerability factors.

Design: A systematic review of preventive interventions was conducted, searching the databases Cinahl, Cochrane Library, Embase, ProQuest, PsycInfo, PubMed and Scopus to identify RCT's. The search was completed on October 14, 2019. Using the Cochrane Collaboration tools, quality assessments were made, and independent single-data extraction was conducted. Due to heterogeneity in, e.g., participant characteristics, intervention content and duration, the data were synthesised qualitatively. Included studies were ranked in evidence-based hierarchical order, elucidating the risk of bias of each individual study, all of which were ranked as having a medium or low level of evidence.

Findings: We identified 1,562 articles, of which five focused on prevention of preterm birth, met our predefined criteria for inclusion and quality assessment, and were therefore included. Interventions consisted of home visits in two studies, group meetings in one study, phone calls in one study, and physical massage in the last study. Four transverse themes arose: intervention intensity, initiation, continuity of care, and the healthcare professionals' educational background.

Key Conclusions: The evidence base for interventions aiming to prevent preterm birth among pregnant women with psychosocial vulnerabilities is limited. Interventions based on ten antenatal group meetings initiated during the second trimester and facilitated by the same midwife have the greatest likelihood of being effective. Continuity in intervention delivery and healthcare professional's educational background may positively impact the efficiency of the intervention. Further research is needed to address questions about the impact of intervention initiation and intensity and its degree of continuity and mode of delivery.
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http://dx.doi.org/10.1016/j.midw.2021.103018DOI Listing
April 2021

Improving oral health in nursing home residents: A cluster randomized trial of a shared oral care intervention.

Community Dent Oral Epidemiol 2021 Apr 25. Epub 2021 Apr 25.

Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Aalborg Øst, Denmark.

Objectives: To compare a designated shared oral care intervention in a group of public nursing home residents with a standard oral care programme, focusing on levels of oral plaque and oral inflammation.

Methods: A cluster randomized field trial was undertaken in 14 Danish public nursing homes. There were 145 participants included in the intervention group and 98 in the control group. We undertook a six-month intervention based on the principle of situated interprofessional learning. The primary outcomes were plaque and inflammation levels measured with the mucosal plaque index (MPS); this was assessed at baseline, after three and six months (end of intervention), and at follow-up (six months postintervention). The odds ratios (OR) and 95% confidence intervals (CI) were estimated with ordinal regression.

Results: Socio-demographic characteristics and oral health status at baseline were comparable between the two groups, with the exception of age: the intervention group were significantly younger than controls (median 82 vs 87 years). After three and six months, those receiving the shared oral care intervention had significantly lower plaque and inflammation than the control group. The adjusted ORs for a reduction in MPS were 11.8 (CI: 6.5-21.3) and 11.0 (CI: 5.8-20.9), respectively. At follow-up, plaque levels and oral inflammation had approached the pre-intervention level, with no remaining statistically significant group differences.

Conclusions: The shared oral care intervention based on a situated learning perspective was effective in improving oral health among care home residents. However, after termination of the intervention, the effect quickly decreased. This confirms the challenges of achieving long-term improvement in oral health in nursing home residents. An implementation strategy focusing on achieving changes at both organizational and individual levels with persistent attention to oral health care seem required for long-term improvement.
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http://dx.doi.org/10.1111/cdoe.12638DOI Listing
April 2021

Supportive encounters during pregnancy and the postnatal period: An ethnographic study of care experiences of parents in a vulnerable position.

J Clin Nurs 2021 Apr 19. Epub 2021 Apr 19.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

Background: Pregnant women and partners with psychological and/or social challenges are exposed to adverse health outcomes. It is therefore recommended that they receive targeted maternity care services. The relationship between parents and professionals is key to help parents engage with services and experience them as supportive. However, more knowledge is needed on parents' care experiences during encounters with professionals to further understand when and how these are experienced as supportive.

Objectives: This study aimed at identifying the key elements of supportive care practices by exploring how parents in vulnerable positions experience their relationship and encounters with the professionals involved in their pregnancy and postnatal care.

Design: Ethnographic fieldwork was conducted in a Danish municipality, including 50 semi-structured interviews with parents and 51 field visits during parent-professional encounters, including informal interviews and participant observation. Using a purposive recruitment strategy, 26 women and 13 men were recruited, who varied in age, socioeconomic background and vulnerability factors. COREQ reporting guidelines were used.

Results: The analysis identified five themes: (a) Having a voice: Feeling listened to, (b) Being met with empathy: Feeling understood, (c) Worthy of attention: Feeling taken seriously, (d) On equal terms: Feeling like a normal family and (e) Moving in the right direction: Feeling reassured.

Conclusion: Positive care experiences facilitate engagement with services and professionals as this contribute to parents feeling included, respected and safe. Conversely, negative care experiences leave parents feeling excluded, judged and anxious, potentially reinforcing and adding to existing feelings of anxiety and stigma. This requires that professionals have good communication skills and are able to approach parents in an open and non-judgmental way.

Relevance To Clinical Practice: Understanding the significance of supportive care practices is paramount for health visitors, midwives and other professionals involved in providing for parents in vulnerable positions during pregnancy and the postnatal period.
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http://dx.doi.org/10.1111/jocn.15778DOI Listing
April 2021

Early-life childhood obesity risk prediction: A Danish register-based cohort study exploring the predictive value of infancy weight gain.

Pediatr Obes 2021 Mar 29:e12790. Epub 2021 Mar 29.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark.

Background: Information on postnatal weight gain is important for predicting later overweight and obesity, but it is unclear whether inclusion of this postnatal predictor improves the predictive performance of a comprehensive model based on prenatal and birth-related predictors.

Objectives: To compare performance of prediction models based on predictors available at birth, with and without information on infancy weight gain during the first year when predicting childhood obesity risk.

Methods: A Danish register-based cohort study including 55.041 term children born between January 2004 and July 2011 with birthweight >2500 g registered in The Children's Database was used to compare model discrimination, reclassification, sensitivity and specificity of two models predicting risk of childhood obesity at school age. Each model consisted of eight predictors available at birth, one additionally including information on weight gain during the first 12 months of life.

Results: The area under the receiving operating characteristic curve increased from 0.785 (95% confidence interval (CI) [0.773-0.798]) to 0.812 (95% CI [0.801-0.824]) after adding weight gain information when predicting childhood obesity. Adding this information correctly classified 30% more children without obesity and 21% with obesity and improved sensitivity from 0.42 to 0.48. Specificity remained unchanged at 0.91.

Conclusion: Adding infancy weight gain information improves discrimination, reclassification and sensitivity of a comprehensive prediction model based on predictors available at birth.
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http://dx.doi.org/10.1111/ijpo.12790DOI Listing
March 2021

Parental mental health conditions and use of healthcare services in children the first year of life- a register-based, nationwide study.

BMC Public Health 2021 03 21;21(1):557. Epub 2021 Mar 21.

Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.

Background: Parental mental health conditions have been associated with increased morbidity and use of healthcare services in offspring. Existing studies have not examined different severities of parental mental health conditions, and the impact of paternal mental health has been overlooked. We examined the association between two severities of parental mental health conditions and use of healthcare services for children during the first year of life and explored the impact of both maternal and paternal mental health conditions.

Methods: This register-based cohort study included all live-born children born in Denmark from 2000 to 2016. Information on socioeconomics, diagnoses, drug prescriptions, and healthcare contacts was extracted from nationwide public registries. Parents were grouped according to severity of mental condition based on the place of treatment of the mental health condition. Negative binominal regression analyses were performed to estimate the incidence rate ratio (IRR) of contacts to general practice (GP), out-of-hour medical service, emergency room (ER), and out- and inpatient hospital contacts during the first 12 months of the child's life.

Results: The analyses included 964,395 children. Twenty percent of the mothers and 12 % of the fathers were identified with mental health conditions. Paternal mental health conditions were independently associated with increased risk of infant healthcare contacts (GP IRR 1.05 (CI95% 1.04-1.06) and out-of-hour IRR 1.20 (CI95% 1.18-1.22)). Risks were higher for maternal mental health conditions (GP IRR 1.18 (CI95% 1.17-1.19) and out-of-hour IRR 1.39 (CI95% 1.37-1.41)). The risks were even higher if both parents were classified with a mental health condition (GP IRR 1.25 (CI95% 1.23-1.27) and out-of-hour contacts IRR 1.49 (CI95% 1.45-1.54)), including minor mental health condition (GP IRR 1.22 (CI95% 1.21-1.24) and out-of-hour IRR 1.37 (CI95% 1.34-1.41)). This pattern was the same for all types of healthcare contacts.

Conclusions: Both maternal and paternal mental health conditions, including minor mental health conditions, were associated with increased utilization of healthcare services. Focus on both parents' mental health conditions (even if minor) may be warranted in service planning.
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http://dx.doi.org/10.1186/s12889-021-10625-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981963PMC
March 2021

Living With Fear: Experiences of Danish Parents in Vulnerable Positions During Pregnancy and in the Postnatal Period.

Qual Health Res 2021 02;31(3):564-577

Aalborg University, Aalborg Øst, Denmark.

Targeted services are recommended to pregnant women/parents in vulnerable positions to support their well-being and improve health outcomes; however, being offered extra services is associated with feelings of fear and anxiety. Adopting an ethnographic approach, we explore what parents fear, how and why they experience fear, and how this shapes their childbearing experience and engagement with Danish maternity care services. We made field observations and conducted interviews with 39 parents in vulnerable positions, who shared multiple, ambiguous, and interrelated fears. Four main themes were constructed: fear of going back to a dark place, of having a negative impact on the baby, of being labeled, and of the consequences of service engagement and being open. We conclude that what parents fear, the intensity of these fears, and what potentially triggers it are contingent on their life story, their care pathways, and the maternity care system.
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http://dx.doi.org/10.1177/1049732320978206DOI Listing
February 2021

Recruiting residents from disadvantaged neighbourhoods for community-based health promotion and disease prevention services in Denmark-How, why and under what circumstances does an active door-to-door recruitment approach work?

Health Soc Care Community 2021 Jan 6. Epub 2021 Jan 6.

Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark.

Residents living in disadvantaged neighbourhoods have higher mortality and morbidity and participate less in health services than people living in more prosperous areas. Studies on how and why different approaches work for recruiting residents from disadvantaged neighbourhoods to health services are needed. Conducting face-to-face meetings with obliging health professionals (HPs) as part of an active recruitment strategy increases interest in service use, particularly among the most vulnerable residents. The services offered must be free, flexible and easily accessible for residents from disadvantaged neighbourhoods to consider their use. Residents immediately consider and 'translate' the relevance and acceptability of health services presented to them in light of their current situation, which affects their response. Individual contextual circumstances such as current health issues or difficult life circumstances, either promote or dampen their interest in using the services. This study is a realist evaluation of active face-to-face recruitment where HPs go from door-to-door to visit residents in disadvantaged neighbourhoods and offer them community-based health promotion and disease prevention services. A programme theory explicating the assumptions behind this recruitment approach was tested empirically in the present study. Eight direct observations of the active recruitment process in three different neighbourhoods and 17 realist interviews with residents were conducted. Sampling of residents was purposeful and opportunistic. Data were collected between March and August 2018. The findings support the use of active face-to-face recruitment in disadvantaged neighbourhoods to increase participation in health interventions. A broad range of health services should be presented to residents to accommodate their different needs and interests. Refusal to have services presented during active recruitment was rare, but more knowledge about these reasons for declining services is needed.
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http://dx.doi.org/10.1111/hsc.13246DOI Listing
January 2021

The role of social technologies in community care - A realist evaluation of a Danish web-based citizen-to-citizen platform adopted in community care to promote belonging and mental health.

Health Soc Care Community 2020 Nov 13. Epub 2020 Nov 13.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

As social technologies increase in popularity, there is a growing interest in incorporating them into mental health interventions. Research shows that the use of social technologies may support belonging and mental health. Findings, however, are contradictory and highlight the need to clarify the processes and mechanisms by which this technology may have positive effects. This study conducted a realist evaluation of a web-based citizen-to-citizen platform adopted within community care in a Danish Municipality. It focused on how, for whom and under what circumstances the web-based platform worked to promote belonging and mental health. The evaluation was structured in subsequent phases of development, testing, and refinement of programme theories. A purposeful sampling frame was developed based on the programme theories, and 27 interviews were conducted. With variations, the platform was found to support its users in meeting their social needs by (a) expanding their access to social networks; (b) allowing them to overcome barriers related to reaching out to new people in real life and (c) providing them with an improved starting point for identification of a relational match. Whether this resulted in improved belongingness and mental health was strongly affected by individual and relational circumstances. Findings suggest that web-based platforms that aim to enable citizens to locate friends and activity partners can serve as helpful tools in interventions striving to promote mental health in the community, as they may support people to fulfil a need for belongingness. However, the impact of such tools is highly dependent on the individual's abilities to use the initiatives to form relationships of sufficient quality to accommodate these needs. People with previous relational difficulties, and who have struggled to achieve feelings of belonging and citizens with limited digital literacy, may need support to realise the social opportunities provided by these technologies.
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http://dx.doi.org/10.1111/hsc.13222DOI Listing
November 2020

Assessing mental health literacy among Danish adolescents - development and validation of a multifaceted assessment tool (the Danish MeHLA questionnaire).

Psychiatry Res 2020 11 14;293:113373. Epub 2020 Aug 14.

Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

It is recognized that mental health literacy is vital in both the prevention of mental health problems and in mental health promotion and empowerment of adolescents. In spite of this, only a limited number of tools assessing mental health literacy among adolescents have been developed and most of these have not been adequately tested. In this study, a questionnaire assessing mental health literacy was developed and tested using a three-step approach: 1) item generation in which the principles of public patient involvement were essential, 2) item testing and 3) exploration of psychometric properties. Internal consistency of the questionnaire was determined through Cronbach's alpha and confirmatory factor analysis was conducted in order to determine the construct validity of the questionnaire. The results demonstrated partly skewed data, good internal consistency, good Kaiser-Meyer-Olkin and acceptable results in the goodness of fit index. The initial results suggest that the questionnaire developed and validated in this study is valuable in assessing mental health literacy and could provide useful, essential information on the topic. It thus appears to be a promising tool in the promotion and improvement of mental health and early intervention of mental health problems among adolescents.
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http://dx.doi.org/10.1016/j.psychres.2020.113373DOI Listing
November 2020

Improving oral health in nursing home residents: A process evaluation of a shared oral care intervention.

J Clin Nurs 2020 Sep 24;29(17-18):3392-3402. Epub 2020 Jun 24.

Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Aalborg Øst, Denmark.

Aims And Objectives: To evaluate the process of implementing an oral care intervention in nursing homes in a Danish municipality.

Background: Older people with aged natural dentition require preventive and curative oral health care. An intervention based on principles of situated learning was implemented to establish closer cooperation between dental and nursing staff in nursing homes, leading to improved oral hygiene in nursing home residents.

Design: An embedded multiple-case study combined with principles of realist evaluation unfolded in three phases: Formulation of initial programme theory, Testing and Refining the programme theory. The COREQ checklist is followed in reporting.

Methods: Observations, six group interviews and 22 face-to-face interviews with dentists, dental practitioners, nursing home managers, care professionals and residents were conducted in three nursing homes (n = 41).

Results: Three main outcomes of a programme theory were identified, relating to (a) residents, in the form of new oral care routines; (b) interdisciplinary working, in the form of professional pride in performing sufficient oral care; (c) organisational level changes, in the form of increased interdisciplinary knowledge sharing. The overarching supportive mechanisms were the creation of relationships between residents, dental practitioners and care professionals as well as nursing home management taking responsibility for structure, planning and knowledge sharing.

Conclusion: The situated learning perspective supported residents and care professionals' competencies in performing sufficient oral care. The shared oral care intervention supports an individual and multidisciplinary assessment of nursing home residents' ability to self-care concerning oral care. Contextual factors, supportive and restraining mechanisms influence the intervention's success.

Relevance To Clinical Practice: Understanding the complexity within interdisciplinary cooperation in primary nursing and unravelling the necessary properties to enhance nursing home residents' oral health care are areas of improvement for care service in nursing homes.
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http://dx.doi.org/10.1111/jocn.15373DOI Listing
September 2020

Healing architecture and Snoezelen in delivery room design: a qualitative study of women's birth experiences and patient-centeredness of care.

BMC Pregnancy Childbirth 2020 May 11;20(1):283. Epub 2020 May 11.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej, 14, 9220, Aalborg Øst, Denmark.

Background: The physical place and environment has a profound influence on experiences, health and wellbeing of birthing women. An alternatively designed delivery room, inspired by the principles of healing architecture and Snoezelen, was established in a Danish regional hospital. These principles provided knowledge of how building and interior design affects the senses, including users' pain experience and stress levels. The aim of the study was to explore women's experience of the environment and its ability to support the concept of patient-centeredness in the care of birthing women.

Methods: Applying a hermeneutical-phenomenological methodology, fourteen semi-structured interviews with low-risk women giving birth in an alternative delivery room at an obstetric unit in Denmark were undertaken 3-7 weeks after birth.

Results: Overall, women's experiences of given birth in the alternative delivery room were positive. Our analysis suggests that the environment was well adapted to the women's needs, as it offered a stress- and anxiety-reducing transition to the hospital setting, at the same time as it helped them obtain physical comfort. The environment also signaled respect for the family's needs as it supported physical and emotional interaction between the woman and her partner and helped relieve her concern for the partner's well-being. The psychosocial support provided by the midwives appeared inseparable from the alternative delivery room, as both affected, amplified, and occasionally restricted the women's experience of the physical environment.

Conclusion: Our findings support the use of principles of healing architecture and Snoezelen in birth environments and add to the evidence on how the physical design of hospital environments influence on both social and physical aspects of the well-being of patients. The environment appeared to encompass several dimensions of the concept of patient-centered care.
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http://dx.doi.org/10.1186/s12884-020-02983-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216688PMC
May 2020

Infancy weight gain, parental socioeconomic position, and childhood overweight and obesity: a Danish register-based cohort study.

BMC Public Health 2019 Sep 2;19(1):1209. Epub 2019 Sep 2.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg East, Denmark.

Background: Rapid infant weight gain (RIWG) is a very strong predictor of childhood overweight and obesity (COO). Socioeconomic position (SEP) is also related to the risk of COO and parents of different SEP may differ in their reaction to accelerated infant weight gain. Together this could lead to differences in how weight gain and COO risk relate across SEP. This study aimed to analyse possible interaction of SEP and RIWG on COO risk.

Methods: A register-based longitudinal cohort study followed 19,894 healthy, term infants, born in Denmark between December 2011 and May 2015. Logistic regression models were used to estimate odds ratios (OR) of COO risk at 2 years (22-26 months) of age with 95% confidence intervals (95% CI) for categories of infancy weight gain based on changes in weight-for-age z-scores between 0 and 8-10 months of age (slow (<- 0.67), mean (- 0.67-0.67), rapid (> 0.67-1.34) and very rapid (> 1.34)). Possible multiplicative and additive interaction of SEP (based on household income and maternal education) on the relationship between infancy weight gain and COO were analysed.

Results: In total, 19.1 and 15.1% experienced rapid or very rapid weight gain, respectively, and 1497 (7.5%) children were classified with COO at follow-up. These prevalences were higher in those with lower levels of SEP. Adjusted OR for COO were 3.09 (95% CI [2.66-3.59]) and 7.58 (95% CI [6.51-8.83]) for rapid and very rapid weight gain, respectively, when household income was included in the model. Results were similar in the model including maternal education. No signs of interactions were detected on a multiplicative scale. Weak signs of additive interaction were present, but these values did not reach significance.

Conclusion: Both rapid and very rapid weight gain were associated with substantially higher risks of COO but these associations were not modified by SEP. This indicates that promotion of healthy weight gain should take place in all population groups irrespective of their SEP.
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http://dx.doi.org/10.1186/s12889-019-7537-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6720844PMC
September 2019

Understanding rapid infant weight gain prevention: a systematic review of quantitative and qualitative evidence.

Eur J Public Health 2020 08;30(4):703-712

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

Background: Rapid infant weight gain (RIWG) is strongly related to childhood overweight and obesity, and prevention of RIWG is an approach to early years obesity prevention. This systematic review aimed to explore effectiveness, deliverers' and recipients' experiences of involvement, and key intervention components and processes of such prevention activities.

Methods: Key databases and websites were searched systematically for quantitative and qualitative studies covering intervention effectiveness, experiences with intervention involvement or process outcomes. After duplicate screening and quality assessment, papers were analyzed through narrative synthesis, thematic synthesis and intervention component analysis.

Results: Seven quantitative and seven qualitative studies were eligible for inclusion. Most intervention studies reported small, but significant results on infant weight gain. More significant results were measured on weight gain during the first compared with the second year of life. A weak evidence base made elaboration of the relationship between intervention effectiveness and content challenging. Home-delivered interventions may be more relevant for parents. Contextual factors, such as social norms, beliefs and professional identity should be considered during intervention development. Stakeholder involvement can be key to increase intervention acceptability and feasibility.

Conclusions: The field of RIWG prevention is new and evolving, but more research is needed before further conclusions about intervention effectiveness and intervention content can be drawn. Future interventions should take parents, health professionals and other contextual needs into account to improve chances of success. More research on long-term effects on overweight and obesity is needed.
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http://dx.doi.org/10.1093/eurpub/ckz140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445039PMC
August 2020

An explorative evaluation study of the mechanisms underlying a community-based fitness centre in Denmark - Why do residents participate and keep up the healthy activities?

Health Soc Care Community 2018 11 26;26(6):898-907. Epub 2018 Jul 26.

Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark.

Health-risk behaviour like physical inactivity is more evident in deprived neighbourhoods than in nondeprived neighbourhoods, and in the former knowledge is lacking as to what causes effects in interventions on physical activity. A possible contribution to physical activity interventions is community engagement, which has been shown to be effective for changing health-risk behaviour, but more knowledge is needed on "the active ingredients" or mechanisms that make interventions work. The aim of this study was to give more insight into the possible mechanisms within an intervention on physical activity using community engagement. The study applied a theory-based evaluation approach using theory of change to uncover the underlying mechanisms of a community-based fitness centre in a deprived Danish neighbourhood. Data were gathered from documents about the intervention, semistructured interviews with three front-line workers on the intervention and ten residents participating in the centre as either volunteer instructors or members. The following mechanisms of the intervention to improve participation and health were anticipated by the front-line workers; the creation of meaningful communities through social interaction, the presence of relatable role models, residents taking responsibility and feeling co-ownership and the experience of being of value as an instructor. Interviews with members and volunteer instructors showed that the anticipated mechanisms did facilitate participation and improved health; however, with some individual variations and with the physical and mental benefits of the particular activities also functioning as mechanisms for participation and engagement. Furthermore, the study found potential unintended consequences related to engagement, such as difficulties in balancing the needs of others with own needs. Findings indicate that both the social aspect and the activities should be prioritised, as should a continued focus on the inclusion of different residents in the area. Furthermore, unintended consequences should be considered and prevented through support for volunteering residents.
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http://dx.doi.org/10.1111/hsc.12614DOI Listing
November 2018

'They'll be judging us' a qualitative study of pregnant women's experience of being offered participation in a supportive intervention.

Midwifery 2018 Jun 21;61:81-87. Epub 2018 Feb 21.

Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg Øst, Denmark. Electronic address:

Objective: to explore pregnant women's experience of being offered participation in a supportive intervention and how their experience influenced the outcome of the intervention.

Design And Setting: a qualitative, phenomenological hermeneutic study based on semi-structured interviews with eight Danish first-time mothers.

Findings: the study revealed a divergence between the professional's and the women's perception of their vulnerability. The women typically felt the offer of participation as a stigma, which they met with anxiety and confusion. Insufficient information led to uncertainty and a feeling of being evaluated as inadequate mothers or parents. The information offered failed to provide the basis of informed choice. However, the development of a trusting, supportive and non-judgemental relationship with the health professionals ensured most women a positive outcome of the intervention.

Key Conclusion: being invited to participate in an intervention targeting vulnerable women may induce unintended feelings in relation to stigmatization and judgement, leading to doubt about own ability to cope with motherhood. Inadequate information and explication about aims and contents of the intervention are likely to cause confusion and anxiety and a feeling of being judged as parents. Information combined with establishing a trusting and non-judgemental relationship between women and professionals appears to have significant impact on outcomes.

Implications For Practice: care providers should be aware of the induced negative feelings and sense of judgement and stigmatization as a result of being categorized as vulnerable and perceived in need of help to cope with motherhood, and that they may play a key role in helping women cope with this. Furthermore, detailed information about the intervention and the background of the offer should be ensured as well as an informed choice of participation.
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http://dx.doi.org/10.1016/j.midw.2018.02.017DOI Listing
June 2018

Social capital and frequent attenders in general practice: a register-based cohort study.

BMC Public Health 2018 03 2;18(1):310. Epub 2018 Mar 2.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, DK-9220, Aalborg East, Denmark.

Background: Frequent attendance to primary care constitutes a large use of resources for the health care system. The association between frequent attendance and illness-related factors has been examined in several studies, but little is known about the association between frequent attendance and individual social capital. The aim of this study is to explore this association.

Methods: The analysis is conducted on responders to the North Denmark Region Health Profile 2010 (n = 23,384), individually linked with information from administrative registers. Social capital is operationalized at the individual level, and includes cognitive (interpersonal trust and norms of reciprocity) as well as structural (social network and civic engagement) dimensions. Frequent attendance is defined as the upper-quartile of the total number of measured consultations with a general practitioner over a period of 148 weeks.

Results: Using multiple logistic regression, we found that frequent attendance was associated with a lower score in interpersonal trust [OR 0.86 (0.79-0.94)] and social network [OR 0.88 (0.79-0.98)] for women, when adjusted for age, education, income and SF12 health scores. Norms of reciprocity and civic engagement were not significantly associated with frequent attendance for women [OR 1.05 (0.99-1.11) and OR 1.01 (0.92-1.11) respectively]. None of the associations were statistically significant for men.

Conclusion: This study suggests that for women, some aspects of social capital are associated with frequent attendance in general practice, and the statistically significant dimensions belonged to both cognitive and structural aspects of social capital. This association was not seen for men. This indicates a multifaceted and heterogeneous relationship between social capital and frequent attendance among genders.
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http://dx.doi.org/10.1186/s12889-018-5230-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834840PMC
March 2018

Postpartum computed tomography angiography of the fetoplacental macrovasculature in normal pregnancies and in those complicated by fetal growth restriction.

Acta Obstet Gynecol Scand 2018 Mar;97(3):322-329

Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.

Introduction: Current knowledge of the fetoplacental vasculature in fetal growth restriction (FGR) due to placental dysfunction focuses on the microvasculature rather than the macrovasculature. The aim of this study was to investigate the feasibility of computed tomography angiography to analyze the fetoplacental macrovasculature in normal and FGR pregnancies.

Material And Methods: We included 29 placentas (22-42 weeks of gestation) from normal birthweight pregnancies and eight placentas (26-37 weeks of gestation) from FGR pregnancies (birthweight < -15% and abnormal umbilical Doppler flow). We performed postpartum placental computed tomography angiography followed by semi-automatic three-dimensional image segmentation.

Results: A median of nine (range seven to eleven) vessel generations was identified. In normal birthweight placentas, gestational age was positively linearly correlated with macrovascular volume (p = 0.002), vascular surface area (p < 0.0005) and number of vessel junctions (p = 0.012), but not with vessel diameter and inter-branch length. The FGR placentas had a lower weight (p = 0.004) and smaller convex volume (p = 0.022) (smallest convex volume containing the macrovasculature); however, macrovascular volume was not significantly reduced. Hence, macrovascular density given as macrovascular outcomes per placental volume was increased in FGR placentas: macrovascular volume per convex volume (p = 0.004), vascular surface area per convex volume (p = 0.004) and number of vessel junctions per convex volume (p = 0.037).

Conclusions: Evaluation of the fetoplacental macrovasculature is feasible with computed tomography angiography. In normal birthweight placentas, macrovascular volume and surface area increase as pregnancy advances by vessel branching rather than increased vessel diameter and elongation. The FGR placenta was smaller; however, the macrovascular volume was within normal range because of an increased macrovascular density.
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http://dx.doi.org/10.1111/aogs.13289DOI Listing
March 2018

Associations between the structural and functional aspects of social relations and poor mental health: a cross-sectional register study.

BMC Public Health 2017 Nov 3;17(1):860. Epub 2017 Nov 3.

Public Health and Epidemiology Group, Department of Health and Science and Technology, Aalborg University, Niels Jernes vej 12, -9220, Aalborg, DK, Denmark.

Background: Social relations influence mental health through different pathways. To capture the complexity of social relations, it is beneficial to consider both the structural (e.g., reachability of social network and social integration) and functional (e.g., instrumental and emotional support) aspects of the concept. Both aspects are rarely investigated simultaneously. This study aimed to examine the association between the structural and functional aspects of social relations and poor mental health.

Methods: The study was designed as a cross-sectional register study. We used data on mental health and social relations from 15,839 individuals aged 16-92 years with a mean age of 49.0 years (SD 17.9) who responded to The North Denmark Region Health Survey 2013 among residents in Northern Jutland, Denmark. The 12-Item Short-Form Health Survey measured mental health; a cut-off point of 44.5 was used to dichotomize participants into poor and good mental health. The categorization of social relations was inspired by Berkman et al.'s conceptual model of social relations and health. The analyses were performed with survey logistic regression.

Results: We found that 21.6% (n = 3422) of participants reported poor mental health, and 59% (n = 2020) of these were women. Being in contact with family and friends less than once a month statistically significantly increased the risk for poor mental health (Family OR = 1.78, 95% CI = 1.51-2.10 and Friends OR = 2.65, 95% CI = 2.30-3.06). The individuals who were not in contact with their network as often as they liked had a significantly higher risk for poor mental health (OR = 2.40, 95% CI = 2.20-2.62). Lack of instrumental support was associated with a higher risk for poor mental health (OR = 2.81, 95% CI = 2.26-3.48). We found an interaction between age and emotional support; the youngest population had the highest risk for poor mental health when they did not have access to emotional support (Young OR = 5.26, 95% CI = 3.91-7.09; Adult OR = 3.69, 95% CI = 3.17-4.30; and Elderly OR = 2.73, 95% CI = 2.23-3.34).

Conclusions: Both structural and functional aspects of social relations were associated with poor mental health in our study. Rarely being in contact with friends and a lack of network reachability were associated with poor mental health. Likewise, low levels of emotional and instrumental support were associated with poor mental health.
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http://dx.doi.org/10.1186/s12889-017-4871-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5670730PMC
November 2017

The long-term financial consequences of breast cancer: a Danish registry-based cohort study.

BMC Public Health 2017 10 30;17(1):853. Epub 2017 Oct 30.

Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 2. Sal, 9000, Aalborg, Denmark.

Background: A breast cancer diagnosis affects an individual's affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined. The present study investigated whether breast cancer affected future income among Danish women that participated in the work force. We also examined the roles of sociodemographic factors and prior psychiatric medical treatment.

Methods: This registry-based cohort study was based on information retrieved from linked Danish nationwide registries. We compared the incomes of 13,101 women (aged 30-59 years) diagnosed with breast cancer (exposed) to those of 60,819 women without breast cancer (unexposed). Changes in income were examined during a 10-year follow-up; for each follow-up year, we calculated the mean annual income and the relative change compared to the income earned one year prior to diagnosis. Expected changes in Danish female income, according to calendar year and age, were estimated based on information from Statistics Denmark. For exposed and unexposed groups, the observed income changes were dichotomized to those above and those below the expected change in income in the Danish female population. We examined the impact of breast cancer on income each year of follow-up with logistic regression models. Analyses were stratified according to educational level, marital status, and prior psychiatric medical treatment.

Results: Breast cancer had a temporary negative effect on income. The effect was largest during the first three years after diagnosis; thereafter, the gap narrowed between exposed and unexposed cohorts. The odds ratio for an increase in income in the cancer cohort compared to the cancer-free cohort was 0.81 (95% CI 0.77-0.84) after three years. After seven years, no significant difference was observed between cohorts. Stratified analyses demonstrated that the negative effect of breast cancer on income lasted longest among women with high educational levels. Being single or having received psychiatric medical treatment increased the chance to experience an increase in income among women with breast cancer.

Conclusion: A breast cancer diagnosis led to negative effects on income, which ameliorated over the following seven years. Sociodemographic factors and prior psychiatric medical treatment might influence long-term consequences of breast cancer on income.
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http://dx.doi.org/10.1186/s12889-017-4839-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661907PMC
October 2017

Association of Previous Cesarean Delivery With Surgical Complications After a Hysterectomy Later in Life.

JAMA Surg 2017 Dec;152(12):1148-1155

Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.

Importance: In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied.

Objective: To investigate whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life.

Design, Setting, And Participants: This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016.

Exposure: Cesarean delivery.

Main Outcomes And Measures: Reoperation, perioperative and postoperative complications, and blood transfusion within 30 days of a hysterectomy.

Results: Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714 (48.3%) had an abdominal hysterectomy, 2513 (32.7%) had a vaginal hysterectomy, and 1458 (19.0%) had a laparoscopic hysterectomy. In total, 388 women (5.0%) had a reoperation within 30 days after a hysterectomy. Compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted odds ratio of reoperation for women having 1 previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted odds ratio was 1.35 (95% CI, 0.96-1.91) for women having 2 or more cesarean deliveries. Perioperative and postoperative complications were reported in 934 women (12.2%) and were more frequent in women with previous cesarean deliveries, with adjusted odds ratios of 1.16 (95% CI, 0.98-1.37) for 1 cesarean delivery and 1.30 (95% CI, 1.02-1.65) for 2 or more cesarean deliveries. Blood transfusion was administered to 195 women (2.5%). Women having 2 or more cesarean deliveries had an adjusted odds ratio for receiving blood transfusion of 1.93 (95% CI, 1.21-3.07) compared with women having no previous cesarean delivery.

Conclusions And Relevance: Women with at least 1 previous cesarean delivery face an increased risk of complications when undergoing a hysterectomy later in life. The results support policies and clinical efforts to prevent cesarean deliveries that are not medically indicated.
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http://dx.doi.org/10.1001/jamasurg.2017.2825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831435PMC
December 2017

The impact of prior psychiatric medical treatment on return to work after a diagnosis of breast cancer: A registry based study.

Scand J Public Health 2019 Jul 8;47(5):519-527. Epub 2017 Aug 8.

1 Department of Social Medicine, Aalborg University Hospital, Denmark.

Breast cancer and psychiatric disorders negatively impact work life, both positively associated with unemployment and early retirement. Our purpose was to assess whether being prescribed psychiatric medication, 2-4 yrs prior to a diagnosis of breast cancer, could impact the likelihood of returning to work after cancer therapy. 16,868 self-supporting women, diagnosed with breast cancer in Denmark from 2000 to 2012, were identified from a population-based clinical database, then cross-referenced to data held for psychiatric medication usage, sociodemographics, and labour-market participation. The association between historic psychiatric medication and return to work was estimated using a modified Poisson regression model. 'Return to work' was defined as being self-supporting one year after diagnosis of breast cancer. 16% of our cohort had used psychiatric medical treatment 2-4 years before their diagnosis. Sixty-three per cent of these individuals had returned to work one year later, compared to 69% of the patient group with no prior history of using psychiatric medication treatments. In the fully adjusted model, prior use of psychiatric medication diminished the likelihood of returning to work one year after cancer diagnosis (RR = 0.91 (0.87-0.94)). High income and older age were positively associated with returning to work; negative correlates included those related to disease severity. Although historic use of psychiatric medication may incur a minor effect on working life, further research is needed on the long-term social consequences for sub-groups.
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http://dx.doi.org/10.1177/1403494817722291DOI Listing
July 2019

Nutrient deficiency and obstetrical outcomes in pregnant women following Roux-en-Y gastric bypass: A retrospective Danish cohort study with a matched comparison group.

Eur J Obstet Gynecol Reprod Biol 2017 Sep 12;216:56-60. Epub 2017 Jul 12.

Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.

Objective: Roux-en-Y gastric bypass surgery and small-for-gestational-age births are known to be associated although the etiology is not fully understood. This study aimed to investigate pregnancy outcomes and maternal nutritional status among pregnant women with a history of Roux-en-Y gastric bypass using maternal anemia and gestational weight gain as indicators of micronutrient and macronutrient deficiency in pregnancy.

Study Design: The study was designed as a retrospective matched cohort study. All Roux-en-Y-gastric-bypass-operated pregnant women (n=151) who were followed in the outpatient obstetric clinic at Aalborg University Hospital in Denmark and gave birth between 1 January 2010 and 31 December 2013 were included. Each Roux-en-Y-gastric-bypass-operated woman was closely matched with a non-Roux-en-Y-gastric-bypass-operated woman. Primary outcomes were small-for-gestational-age birth, maternal anemia and gestational weight gain. The two groups (matched 1:1) were compared by paired tests on all measures, conditional logistic regression for paired binary data and the paired t-test or Wilcoxon signed-rank test for paired continuous data.

Results: The risk of small-for-gestational-age birth (odds ratio (OR)=2.67, 95% confidence interval (CI); 1.04-6.82) and maternal anemia (OR=3.0, 95% CI; 1.09-8.25) were significantly increased for the Roux-en-Y gastric bypass group compared to the non-Roux-en-Y gastric bypass group. No significant difference was found in gestational weight gain (p=0.169) between women with a history of Roux-en-Y gastric bypass (11.51kg±8.97 standard deviation (SD)) and non- Roux-en-Y-gastric-bypass-operated women (12.18kg±6.28 SD).

Conclusion: A history of Roux-en-Y gastric bypass surgery increases the risk of small-for-gestational-age birth and anemia, while a finding of differences in gestational weight gain is uncorroborated. Our findings suggest a role of micronutrient deficiency rather than reduced gestational weight gain in the etiology of small-for-gestational-age birth among women with a history of Roux-en-Y gastric bypass surgery.
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http://dx.doi.org/10.1016/j.ejogrb.2017.07.016DOI Listing
September 2017

Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty - A register-based cohort study.

PLoS One 2017 17;12(3):e0173083. Epub 2017 Mar 17.

Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

Objective: To investigate the implications of low and moderate preoperative alcohol consumption on postoperative mortality and morbidity after primary hip and knee arthroplasty.

Methods: A total of 30,799 patients who underwent primary hip or knee arthroplasty between January 1st, 2005 and October 8th, 2011 with information on preoperative alcohol consumption (0 grams of pure alcohol/week, >0-168 g/week, >168-252 g/week, and >252 g/week) were identified through the Danish Anesthesia Database. The 90-day and 1-year risks of mortality (primary outcomes), 1-year risk of prosthetic infection, and 30-day risks of cardiovascular disease and deep venous thrombosis (secondary outcomes) were estimated by Cox regression analysis.

Results: We identified 285 (0.9%) deaths within the first 90 days and 694 (2.3%) within the first year. Within the first 30 days, 209 (0.7%) and 270 (0.9%) patients had acquired cardiovascular disease and deep venous thrombosis, respectively, and 514 (1.7%) patients developed prosthetic infection within the first year. The adjusted mortality models yielded hazard ratios of 0.55 (95% confidence interval [CI] 0.41 to 0.74) at 90 days and 0.61 (95% CI 0.51 to 0.73) at 1 year for the group consuming >0-168 g/week when compared to abstainers. Adjusted hazard ratios showed that the group consuming >0-168 g/week had a 0.91 (95% CI 0.75 to 1.11) risk of prosthetic infection, 0.68 (95% CI 0.50 to 0.92) risk of cardiovascular disease and 0.88 (95% CI 0.67 to 1.15) risk of deep venous thrombosis when compared to abstainers.

Conclusions: This study demonstrates that low-to-moderate alcohol consumption prior to primary hip or knee arthroplasty is associated with lower risks of mortality at both 90 days and 1 year after surgery and of cardiovascular disease after 30 days. More research from longitudinal studies is needed to identify specific causal relations and explanations.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173083PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357001PMC
September 2017

Are freestanding midwifery units a safe alternative to obstetric units for low-risk, primiparous childbirth? An analysis of effect differences by parity in a matched cohort study.

BMC Pregnancy Childbirth 2017 01 9;17(1):14. Epub 2017 Jan 9.

Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.

Background: Intrapartum complications and the use of obstetric interventions are more common in primiparous childbirth than in multiparous childbirth, leading to concern about out of hospital birth for primiparous women. The purpose of this study was to determine whether the effect of birthplace on perinatal and maternal morbidity and the use of obstetric interventions differed by parity among low-risk women intending to give birth in a freestanding midwifery unit or in an obstetric unit in the North Denmark Region.

Methods: The study is a secondary analysis of data from a matched cohort study including 839 low-risk women intending birth in a freestanding midwifery unit (primary participants) and 839 low-risk women intending birth in an obstetric unit (individually matched control group). Analysis was by intention-to-treat. Conditional logistic regression analysis was applied to compute odds ratios and effect ratios with 95% confidence intervals for matched pairs stratified by parity.

Results: On no outcome did the effect of birthplace differ significantly between primiparous and multiparous women. Compared with their counterparts intending birth in an obstetric unit, both primiparous and multiparous women intending birth in a freestanding midwifery unit were significantly more likely to have an uncomplicated, spontaneous birth with good outcomes for mother and infant and less likely to require caesarean section, instrumental delivery, augmented labour or epidural analgesia (although for caesarean section this trend did not attain statistical significance for multiparous women). Perinatal outcomes were comparable between the two birth settings irrespective of parity. Compared to multiparas, transfer rates were substantially higher for primiparas, but fell over time while rates for multiparas remained stable.

Conclusions: Freestanding midwifery units appear to confer significant advantages over obstetric units to both primiparous and multiparous mothers, while their infants are equally safe in both settings. Our findings thus support the provision of care in freestanding midwifery units as an alternative to care in obstetric units for all low-risk women regardless of parity. In view of the global rise in caesarean section rates, we consider it an important finding that freestanding midwifery units show potential for reducing first-birth caesarean.
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http://dx.doi.org/10.1186/s12884-016-1208-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223304PMC
January 2017

Alcohol consumption and mortality in patients undergoing coronary artery bypass graft (CABG)-a register-based cohort study.

BMC Cardiovasc Disord 2016 11 11;16(1):219. Epub 2016 Nov 11.

Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg Øst, Denmark.

Background: Previous studies have shown that compared with abstinence and heavy drinking, moderate alcohol consumption is associated with a reduced risk of mortality among the general population and patients with heart failure and myocardial infarction. We examined the association between alcohol consumption and mortality in coronary artery bypass graft (CABG) patients.

Method: We studied 1,919 first-time CABG patients using data on alcohol consumption and mortality obtained from Danish national registers from March 2006 to October 2011. Alcohol consumption was divided into the following groups: abstainers (0 units/week), moderate consumers (1-14 units/week), moderate-heavy drinkers (15-21 units/week) and heavy drinkers (>21 units/week). Hazard ratios (HR) of all-cause mortality were calculated using Cox proportional hazard regression analysis.

Results: The median follow-up was 2.2 years [IQR 2.0]. There were 112 deaths, of which 96 (86 %) were classified as cardiovascular. Adjustments for age and sex showed no increased risk of all-cause mortality for the abstainers (HR 1.61, 95 % CI, 1.00-2.58) and moderate-heavy drinkers (HR 1.40, 95 % CI, 0.73-2.67) compared with moderate consumers. However, heavy drinkers had a high risk of all-cause mortality compared with moderate consumers (HR 2.44, 95 % CI, 1.47-4.04). A full adjustment showed no increase in mortality for the abstainers (HR 1.59, 95 % CI, 0.98-2.57) and moderate-heavy drinkers (HR 1.68, 95 % CI, 0.86-3.29), while heavy drinkers were associated with an increased mortality rate (HR 1.88, 95 % CI, 1.10-3.21). There was no increased risk of 30-day mortality for the abstainers (HR 0.74, 95 % CI, 0.23-2.32), moderate-heavy drinkers (HR 0.36, 95 % CI, 0.07-1.93) and heavy drinkers (HR 2.20, 95 % CI, 0.65-7.36).

Conclusion: There was no increased risk of mortality for abstainers (0 units/week) or moderate-heavy drinkers (15-21 units/week) following a CABG. Only heavy drinking (>21 units/week) were significantly associated with an increased mortality rate. These results suggest that only heavy drinking present a risk factor among CABG patients.
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http://dx.doi.org/10.1186/s12872-016-0403-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5105266PMC
November 2016

Mental health and school dropout across educational levels and genders: a 4.8-year follow-up study.

BMC Public Health 2016 09 15;16:976. Epub 2016 Sep 15.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 12, DK-9220, Aalborg East, Denmark.

Background: Education is a key determinant of future employment and income prospects of young people. Poor mental health is common among young people and is related to risk of dropping out of school (dropout). Educational level and gender might play a role in the association, which remains to be studied.

Methods: Mental health was measured in 3146 Danish inhabitants aged 16-29 years using the 12-Item Short-Form Health Survey and examined across genders and educational levels. For students, educational level at baseline was used; for young people who were not enrolled in school at baseline (non-students), the highest achieved educational level was used. The risk of dropout in students was investigated in administrative registers over a 4.8-year period (1(st) March 2010-31(th) December 2014). Odds ratios (OR) and 95 % confidence intervals (CI) were calculated for mental health and in relation to dropout in logistic regression models, adjusting for age, gender, educational level, parental education, parental income and ethnicity.

Results: Poor mental health was present in 24 % (n = 753) of the participants, 29 % (n = 468) in females and 19 % (n = 285) in males (p < 0.0001). The prevalence differed from 19 to 39 % across educational levels (p < 0.0001). Females had a statistically significantly higher adjusted risk of poor mental health than males (OR = 1.8, CI = 1.5-2.2). Among the students the lowest risk was found at the elementary level (OR = 1.3, CI = 0.8-2.3), while students in higher education had a statistically significantly higher risk (OR = 1.9, CI = 1.2-2.9). The lowest-educated non-students had the highest OR of poor mental health (OR = 3.3, CI = 2.1-5.4). Dropout occurred in 8 % (n = 124) of the students. Poor mental health was associated to dropout in vocational (OR = 1.8, CI = 1.0-3.2) and higher education (OR = 2.0, CI = 1.0-4.2). For males in higher education, poor mental health was a predictor of dropout (OR = 5.2, CI = 1.6-17.3), which was not seen females in higher education (OR = 1.2, CI = 0.5-3.1).

Conclusions: Poor mental health was significantly associated to dropout among students in vocational and higher education. Males in higher education had five times the risk of dropout when reporting poor mental health, while no such association was found for females.
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http://dx.doi.org/10.1186/s12889-016-3622-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024430PMC
September 2016

Can registry data be used as a proxy for perceived stress? A cross-sectional study.

Ann Epidemiol 2016 07 31;26(7):493-499. Epub 2016 May 31.

Department of Social Medicine, Aalborg University Hospital, Denmark; Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Denmark.

Purpose: This study explores the applicability of registry data as a proxy for perceived stress by examining the association between perceived stress measured in health surveys and registry data.

Methods: Of 35,700 randomly invited participants from the 2010 Health Survey in the North Denmark Region (age 16-99 years), 21,842 answered 10 items from Cohen's Perceived Stress Scale. Respondents were divided into quartiles based on their stress score. Survey information was individually linked to national registries containing information on prescribed psychiatric medication and consultations with psychologists or psychiatrists from 2009 to 2011.

Results: The percentage of persons with prescriptions or consultations was higher (37.6%) in the highest stress score group, compared with the lowest stress score group (7.7%). Odds ratio (95% confidence interval) for the highest score compared with the lowest score was 7.3 (6.5-8.1). Different combinations of treatment showed low sensitivity (8.7%-37.6%), positive predictive value (49.4%-56.8%), and positive agreement (16.2%-42.7%) were found, whereas specificity (88.5%-98.0%) and negative agreement (85.5%-87.2%) were higher. Kappa measure showed slight to fair agreement (0.104-0.285).

Conclusions: Participants reporting high perceived stress were more often prescribed medications and referred for consultations with psychologists or psychiatrists. However, due to low predictive values, registry data may not be suitable as a proxy for perceived stress.
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http://dx.doi.org/10.1016/j.annepidem.2016.05.008DOI Listing
July 2016

The relationship between self-reported mental health and redeemed prescriptions of antidepressants: a register-based cohort study.

BMC Psychiatry 2016 06 7;16:189. Epub 2016 Jun 7.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, DK-9220, Aalborg, Denmark.

Background: Poor mental health is a major problem in most western societies, especially predominant among young adults. However, associations of self-reported poor mental health with subsequent psychiatric or medical treatment are unknown. We examined the relation between self-reported mental health and redeeming prescriptions of antidepressants among three age groups.

Methods: We analyzed data from 16,233 individuals aged 16 years and over randomly selected to participate in the 2010 North Denmark Region Health Survey completed in February 2010. Mental health was defined according to the Short-Form 12 instrument (SF-12) and dichotomized into poor and good. Outcome data were retrieved from administrative information on redeemed prescriptions of antidepressants between February 2010 and December 2012. Crude cumulative incidence curves were produced to illustrate the probability of redeeming new prescriptions of antidepressants over time. Cox regression analysis was used to estimate risk of redeeming prescriptions of antidepressants when having poor mental health, adjusted for preselected explanatory covariates.

Results: Among the young (16-29 years-old), 620 (23 %) participants suffered from poor mental health. Among the adults (30-59 years-old) and elderly (60 years-old or over), 1592 (18 %) participants and 723 (15 %) reported poor mental health, respectively. Overall, women were more likely than men to rate their mental health as poor. For all age groups, there was an increased probability for redeeming prescriptions of antidepressants when having poor mental health. The hazard ratio [HR] for redeeming prescriptions of antidepressants for those reporting poor versus good mental health, adjusted for sex, ethnicity, marital status, education level, occupational status, smoking and physical activity was 3.1 (95 % confidence interval [CI] 2.20-4.29) for young participants. For adults, the HR was 2.3 (95 % CI 1.86-2.78) and for elderly, it was 3.5 (95 % CI 2.66-4.57).

Conclusion: Self-reported poor mental health was more frequent among younger than older participants. Overall, antidepressants were the most often used treatment. An increased probability of redeeming antidepressant prescriptions when having self-reported poor mental health was observed in all age groups. These findings suggest that frequent reporting of poor mental health is a common issue for all age groups that needs more attention.
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http://dx.doi.org/10.1186/s12888-016-0893-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897872PMC
June 2016

Leisure-Time Physical Activity and the Risk of Suspected Bacterial Infections.

Med Sci Sports Exerc 2016 09;48(9):1737-44

1Public Health Epidemiology Group, Department of Health Science Technology, Aalborg University, Aalborg, DENMARK; and 2Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, DENMARK.

Introduction: The risk of upper respiratory tract viral infections is reduced with increased physical activity, but little information is available regarding bacterial infections. We examined the relationship between leisure-time physical activity and suspected bacterial infections.

Methods: Information on leisure-time physical activity was obtained from the 2007 and 2010 North Denmark Region Health Surveys of 18,874 Danes and linked to data from nationwide administrative registries. Suspected bacterial infections were determined based on filled prescriptions for antibiotics. Adjusted estimates were calculated using logistic regression models.

Results: During a 1-yr follow-up, 5368 participants filled at least one antibiotic prescription. There was a statistically significant difference between physical activity level and filling any antibiotic prescriptions among women (P = 0.003) but not among men (P = 0.191). Logistic regression analysis showed that compared with sedentary behavior, all levels of leisure-time physical activities lowered the likelihood of filling an antibiotic prescription. However, after multivariable adjustments, only estimates of low physical activity were significant (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.82; 0.99). Multivariable adjusted subgroup analyses of suspected cystitis showed a decreased likelihood of engaging in low (OR = 0.79, 95% CI = 0.65-0.95) and moderate (OR = 0.68, 95% CI = 0.54-0.87) physical activity.

Conclusion: Low leisure-time physical activity is associated with a statistically significant 10% lower risk of suspected bacterial infections during a 1-yr follow-up compared with sedentary behavior. Further, low and moderate levels of physical activity were associated with the statistically significant reduction of suspected cystitis. No reduction in suspected respiratory tract infections was statistically significant and associated with physical activity compared with sedentary behavior.
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http://dx.doi.org/10.1249/MSS.0000000000000953DOI Listing
September 2016