Publications by authors named "Volkert Dirk Siersma"

31 Publications

Short and long-term psychosocial consequences of participating in a colorectal cancer screening programme: a matched longitudinal study.

BMJ Evid Based Med 2021 Jun 3. Epub 2021 Jun 3.

The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark.

Objectives: To investigate the psychosocial consequences of receiving a false-positive (no abnormalities) result or being diagnosed with polyps compared with receiving a negative result in a colorectal cancer (CRC) screening programme.

Design And Setting: This was a longitudinal study nested in the roll-out of the Danish CRC screening programme that targets all individuals aged 50-74 years.

Participants: In the inclusion period (April-September 2017), all positive screenees (n=1854) were consecutively enrolled and matched 2:1:1 on sex, age (±2 years), municipality and screening date with negative screenees (n=933) and individuals not yet invited to screening (n=933).Questionnaires were sent by mail to all eligible participants in Region Zealand, Denmark, after the screening result, 2 months and 12 months after the final result.Positive screenees who did not receive the follow-up procedure were excluded.

Main Outcome Measures: The primary outcomes were psychosocial consequences. Outcomes were measured with the CRC screening-specific questionnaire Consequences of screening in CRC with 11 outcomes after the screening result and with 21 outcomes at the two later assessments.

Results: After receiving the screening result, individuals with no abnormalities, low-risk and medium-risk and high-risk polyps scored significantly worse on 8 of 11 outcomes compared with the negative screenee group. At the 12-month follow-up, the differences were still significant in 8 of 21 outcomes (no abnormalities), 4 of 21 outcomes (low-risk polyps) and 10 of 21 outcomes (medium-risk and high-risk polyps). The negative screenee group and the group not yet invited to screening differed psychosocially on 5 of 11 outcomes after the screening result, but on none of the 21 outcomes at the 2 months and 12 months follow-up.

Conclusions: The study showed that there are both short-term and long-term psychosocial consequences associated with receiving a no abnormalities result or being diagnosed with polyps. The consequences were worst for individuals diagnosed with medium-risk and high-risk polyps.
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http://dx.doi.org/10.1136/bmjebm-2020-111576DOI Listing
June 2021

Clinical management of hip fractures in elderly patients with dementia and postoperative 30-day mortality: A population-based cohort study.

Brain Behav 2020 11 6;10(11):e01823. Epub 2020 Sep 6.

Research Unit for General Practice, Department of Public Heath, University of Southern Denmark, Odense, Denmark.

Objectives: Patients with dementia have an increased 30-day mortality after hip fracture. We investigated clinical management including time to surgery, out-of-hours admission and surgery, surgery on weekends, surgery volume per ward, and anesthesia technique for this excess mortality risk.

Method: This register- and population-based study comprised 12,309 older adults (age 70+) admitted to hospital for a first-time hip fracture in 2013-2014, of whom 11,318 underwent hip fracture surgery. Cox proportional hazards regression models were applied for the analysis.

Results: The overall postoperative 30-day mortality was 11.4%. Patients with dementia had a 1.5 times increased mortality risk than those without (HR = 1.50 [95% CI 1.31-1.72]). We observed no time-to-surgery difference by patient dementia status; additionally, the excess mortality risk in patients with dementia could not be explained by the clinical management factors we examined.

Conclusions: Increased mortality in patients with dementia could not be explained by the measured preoperative clinical management. Suboptimal handling of postoperative complication and rehabilitation are to be investigated for their role in the witnessed increased mortality for patients with dementia.
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http://dx.doi.org/10.1002/brb3.1823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667308PMC
November 2020

Reconstruction of the anterior cruciate- and anterolateral ligament deficient knee with a modified iliotibial graft reduces instability more than with an intra-articular hamstring graft.

Knee Surg Sports Traumatol Arthrosc 2020 Aug 10;28(8):2526-2534. Epub 2020 Feb 10.

University of Copenhagen, Copenhagen, Denmark.

Purpose: To compare knee kinematics before and after anterior cruciate ligament ACL reconstruction (ACL-R) using hamstring graft (HG) and a double-stranded iliotibial tract graft attached to Gerdy's tubercle (providing an extra-articular anterolateral tenodesis) (named the modified iliotibial tract graft = MIT).

Method: Eighteen cadaveric knees were tested in a 6 degree of freedom kinematics rig. An optical tracking system recorded kinematics of the knee from 0 to 80 degrees of flexion applying no load, internal/external rotation (IR/ER), valgus/varus rotation (VGR/VRR), simulated pivot shift (SPS), anterior translation (AT) and posterior translation loads. The knee was tested before and after resection of the ACL and the anterolateral ligament (ALL), respectively; then after HG-ACL-R and MIT-ACL-R. Grafts were fixed at 20° of flexion. Results were compared to the intact knee.

Results: ACL resection resulted in a significant increase in AT (p < 0.05) over the entire range of motion, peaking at 20° of flexion, mean difference 6.6 ± 2.25 mm (p = 0.0007). ACL-R with HG-ACL and MIT-ACL restored AT. Resection of the ALL increased IR in the fully extended knee, mean difference 2.4 ± 2.1° (p = 0.024). When compared to the intact knee and the knee after HG-ACL-R, MIT-ACL-R knee reduced IR/SPS significantly (p < 0.05) in deep flexion angles (60°-80°), peaking at 80° of flexion. The MIT-ACL-R caused significantly less VRR at 80° flexion (p = 0.02).

Conclusion: MIT-ACL-R restored AT equally to the HG-ACL-R. The MIT-ACL-R reduced IR and SPS in deep flexion, resulting in overconstraint. MIT-ACL-R can be used as an alternative to standard reconstruction methods.
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http://dx.doi.org/10.1007/s00167-020-05850-8DOI Listing
August 2020

Conjunctival intraepithelial neoplasia and carcinoma: distinct clinical and histological features in relation to human papilloma virus status.

Br J Ophthalmol 2021 06 24;105(6):878-883. Epub 2019 Oct 24.

Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

Aims: Human papillomavirus (HPV) is considered a causative agent for the development of a broad range of human carcinomas. The role of HPV in the development of conjunctival intraepithelial neoplasia (CIN) and carcinoma (cSCC) remains unclear. The purpose of the present study was to investigate the HPV prevalence in a nationwide cohort and to describe clinical and histopathological features in relation to HPV status.

Methods: All cases of CIN and cSCC in Denmark from 1980 to 2016 were included. We combined p16 immunohistochemistry (IHC), RNA in situ hybridisation (RNA ISH) and HPV DNA PCR to detect HPV. The results were correlated to clinical and histopathological parameters.

Results: One hundred twelve primary tumours and 33 recurrent tumours were included for HPV analysis. Twenty-four (21%) of the primary tumours were HPV positive by PCR. Eighteen of out 19 HPV-positive tumours were positive by RNA ISH. HPV16 was the most prevalent genotype (n=18, 75%). The patients with HPV-positive tumours were significantly younger (mean difference 11.5 years, 95% CI 5.2 to 17.9, p=0.0005) and had a higher recurrence compared with patients with HPV-negative tumours (HR 2.30, 95% CI 1.02 to 5.21, p=0.046). The HPV-positive tumours were associated with a positive p16 IHC and a non-keratinising morphology.

Conclusion: We describe distinct clinical and histopathological features associated with HPV status in cSCC. The finding of transcriptionally active HPV in this material lends support to a causal role of HPV in a subset of cSCC.
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http://dx.doi.org/10.1136/bjophthalmol-2019-315011DOI Listing
June 2021

The risk of fall accidents for home dwellers with dementia-A register- and population-based case-control study.

Alzheimers Dement (Amst) 2018 30;10:421-428. Epub 2018 May 30.

Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.

Introduction: Institutionalized people with dementia have an increased risk of fall accidents, but little is known about whether this increased risk holds for home dwellers.

Methods: This register- and population-based study comprised 115,584 cases and 394,679 controls. Cases were individuals with any fall between 2009 and 2014, and matched with up to six controls on age, sex, and geographic location. Individuals were excluded if they (1) had any fall in 2008, or (2) lived in a nursing home on the date of the fall. Dementia, other chronic diseases, and sedative medicines were assessed from Danish national registers.

Results: After adjusting for potential confounders, older people with dementia living at home had a 1.89-fold higher risk of fall (odds ratio = 1.89, 95% confidence interval [1.84-1.94],  < .001).

Discussion: Dementia almost doubles the risk of fall for older Danish people living at home. This highlights the need for effective fall preventions that target people with dementia.
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http://dx.doi.org/10.1016/j.dadm.2018.05.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107894PMC
May 2018

Dementia and road traffic accidents among non-institutionalized older people in Denmark: A Danish register-based nested case-control study.

Scand J Public Health 2019 Mar 18;47(2):221-228. Epub 2018 Jun 18.

1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.

Aim: We used register-based data to estimate the effect of all-type dementia on road traffic accidents (RTAs) risk, combined with comorbidities or sedative medicines, among non-institutionalized older people in Denmark.

Methods: The source population was all residents in Denmark aged 65 years and older, alive as of January 1, 2008 ( n = 853,228). Cases were those who had any type of RTA in 2009-2014. Each case was matched for age, sex and geographic location to 4-6 controls. All-type dementia was ascertained using the International Classification of Diseases version 10 (ICD-10) diagnosis supplemented with prescribed medicine records. Eight chronic diseases were selected to assess comorbidities. Four types of medicines were categorized as sedative medicines for analysis. Conditional logistic regression with adjustment for education and marital status as well as either the number of comorbidities or sedative medications use was performed using STATA software.

Results: Older people with dementia had lower RTAs risk compared to their controls (odds ratio = 0.43, 95% confidence interval (0.32-0.60), p < 0.001). Significant interaction was observed between dementia and the number of comorbidities for RTAs estimation.

Conclusions: The significantly lower RTAs risk for older individuals with dementia observed in our study may be due to people with dementia living at home having a lower frequency of outdoor activities; that is, less exposure to traffic. However, this, together with the interaction between dementia and comorbidities as well as sedative medications, should be investigated further.
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http://dx.doi.org/10.1177/1403494818782094DOI Listing
March 2019

Interplay between financial assets and social relations on decline in physical function and mortality among older people.

Eur J Ageing 2018 Jun 4;15(2):133-142. Epub 2017 Jul 4.

1Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen, Denmark.

It is well established that socioeconomic position (SEP) and social relations impact physical function and mortality in old age. Due to differential vulnerability, few social relations may lead to greater decline in physical function and mortality among older people with low compared to high SEP. The aim was to investigate whether older people with few social relations experience greater decline in physical function and mortality when also subject to low financial assets? The study population included 4060 older people aged 75 or 80 years at baseline in 1998-1999. Social relations at baseline and physical function at baseline and after 1.5, 3.0 and 4.5 years were obtained from questionnaires. Financial assets at baseline and mortality during 10 years of follow-up were obtained from registers. Analyses of the associations between financial assets combined with social relations and decline in physical function and mortality, respectively, were conducted. Among males, but not females, low financial assets and few social relations were associated with the greatest decline in physical function. Yet, interaction only reached significance between financial assets and visits. Among males and females, low financial assets and few social relations were associated with the highest mortality. Interactions only reached significance between financial assets and visits for females and social activity for males. In conclusion, few social relations implied greater decline in physical function among older males and higher mortality among older males and females with low financial assets; however, the study only supports the presence of differential vulnerability for visits and social activity.
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http://dx.doi.org/10.1007/s10433-017-0437-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971023PMC
June 2018

Measuring bothersome menopausal symptoms: development and validation of the MenoScores questionnaire.

Health Qual Life Outcomes 2018 May 16;16(1):97. Epub 2018 May 16.

Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Q, P.O. Box 2099, 1014, Copenhagen K, Denmark.

Background: The experience of menopausal symptoms is common and an adequate patient-reported outcome measure is crucial in studies where women are treated for these symptoms. The aims of this study were to identify a patient-reported outcome measure for bothersome menopausal symptoms and, in the absence of an adequate tool, to develop a new measure with high content validity, and to validate it using modern psychometric methods.

Methods: The literature was reviewed for existing questionnaires and checklists for bothersome menopausal symptoms. Relevant items were extracted and subsequently tested in group interviews, single interviews, and pilot tests. A patient-reported outcome measure was drafted and completed by 1504 women. Data was collected and psychometrically validated using item-response theory Rasch Models.

Results: All questionnaires identified in the literature lacked content validity regarding bothersome menopausal symptoms and none were validated using item-response theory. Our content validation resulted in a draft measurement encompassing 122 items across eight domains. Following psychometrical validation, the final version of our patient-reported outcome measure, named the MenoScores Questionnaire, encompassed 51 items, including one single item, covering 11 scales.

Conclusion: Menopausal symptoms are multidimensional with some symptoms unquestionably related to the menopausal transition. We identified four constructs of importance: hot flushes, day-and-night sweats, general sweating, and menopausal-specific sleeping problems. The MenoScores Questionnaire is condition-specific with high content validity and adequate psychometrical properties. It is designed to measure bothersome menopausal symptoms and all scales are developed and psychometrically validated using item-response theory Rasch Models.

Trial Registration: Approved by the Danish Data Agency (J.nr. 2015-41-4057). Ethics Committee approval was not required.
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http://dx.doi.org/10.1186/s12955-018-0927-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956969PMC
May 2018

KNEES-ACL has superior responsiveness compared to the most commonly used patient-reported outcome measures for anterior cruciate ligament injury.

Knee Surg Sports Traumatol Arthrosc 2018 Aug 28;26(8):2438-2446. Epub 2018 Apr 28.

Section for Sports Traumatology M51, Bispebjerg-Frederiksberg Hospital, IOC Sports Medicine Copenhagen, Copenhagen, Denmark.

Purpose: For clinical trials, it is essential that measures are sensitive to change. The aim of this study was to conduct a head-to-head comparison of responsiveness of four PROMs used to measure outcome after anterior cruciate ligament (ACL) reconstruction. The PROMs compared were the knee injury osteoarthritis outcome score (KOOS), the international knee documentation committee subjective form (IKDC), the Lysholm score, and the knee numeric-entity evaluation score (KNEES-ACL). We hypothesized that KNEES-ACL would be more responsive than the other PROMs, as KNEES-ACL was created based on patient interviews and validated using Rasch analysis.

Methods: One-hundred and sixty-six consecutive adults completed the four PROMs before and 3, 6, and 12 months after ACL-reconstructive surgery. Responsiveness was calculated as Cohen's Effect Size and Standardized Response Means. Bootstrapping was used to generate 95% confidence intervals for comparisons of responsiveness across PROMs. Repeated-measures ANOVA was also computed for each PROM.

Results: The largest effect sizes at 12 months were seen for KNEES-ACL (1.35, p < 0.001) and KNEES-ACL (1.19, p < 0.001), the smallest for KOOS (0.35, p < 0.001) and KOOS (0.39, p < 0.001). IKDC and Lysholm lay between these with IKDC slightly more responsive. Head-to-head comparisons of similar subscales of KOOS and KNEES-ACL showed substantial differences in effect size in the domains of symptoms (0.69, p < 0.001), daily activities (0.31, p = 0.005), and Sports activity (0.63, p = 0.013) all in favour of KNEES-ACL.

Conclusion: These results demonstrate superior responsiveness for KNEES-ACL, which is the only PROM that has been constructed through exhaustive patient feedback and validated for patients with ACL deficiency using the most stringent psychometric methods (Rasch analysis). KNEES-ACL is the most precise and accurate PROM for patients with ACL injury and the most trustworthy instrument for clinicians and clinical researchers.

Level Of Evidence: Prospective cohort study, Level II.
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http://dx.doi.org/10.1007/s00167-018-4961-zDOI Listing
August 2018

How well do general practitioners know their elderly patients' social relations and feelings of loneliness?

BMC Fam Pract 2018 02 26;19(1):34. Epub 2018 Feb 26.

Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Background: Social relationships are important to people and affect their quality of life, morbidity and mortality. The aim of this study was to examine the correlation between elderly patients' descriptions of their social relations and feelings of loneliness, and their general practitioners' assessments of these.

Methods: Cross-sectional study in 12 general practices in the Capital Region of Denmark. During a three-week period each practice asked their patients aged 65 and older to fill out a questionnaire regarding health, social relations and loneliness; the general practitioner (GP) filled out a matching questionnaire regarding their perception of the patient's social relations and loneliness. Data were collected from February to September 2014.

Results: Of the 767 eligible patients 476 were included in the study. For 447 patients both GP and patient had answered at least one question on loneliness or social participation. The correlations between patients' and GPs' answers regarding social participation and loneliness were low (0.04-0.26). While GPs were less able to identify lonely patients and patients with low social participation, they were better at identifying not-lonely patients or those with high social participation. It was especially difficult for GPs to identify lonely patients when they were not living alone or if the GP believed the patient had high social participation.

Conclusion: GPs have difficulty identifying patients who are lonely or have low social participation and this ability is further diminished when the patients do not live alone or if the GP believes them to have high social participation. Given the consequences of loneliness and limited social participation on patients' health and well-being, and GPs' limited ability to identify these patients, GPs' obligations and resources in this area need to be clarified.
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http://dx.doi.org/10.1186/s12875-018-0721-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828068PMC
February 2018

Major Depressive Symptoms Increase 3-Year Mortality Rate in Patients with Mild Dementia.

Int J Alzheimers Dis 2017 6;2017:7482094. Epub 2017 Apr 6.

Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Depression and dementia are commonly concurrent and are both associated with increased mortality among older people. However, little is known about whether home-dwelling patients newly diagnosed with mild dementia coexisting with depressive symptoms have excess mortality. We conducted a post hoc analysis based on data from the Danish Alzheimer's Intervention Study of 330 individuals who were diagnosed with mild dementia within the past 12 months. Thirty-four patients were identified with major depressive symptoms (MD-S) at baseline. During the 3-year follow-up period, 56 patients died, and, among them, 12 were with MD-S at baseline. Multivariable analysis adjusting for the potential confounders (age, sex, smoking status, alcohol consumption, education, BMI, household status, MMSE, CCI, QoL-AD, NPIQ, ADSC-ADL, medication, and RCT allocation) showed that patients with MD-S had a 2.5-fold higher mortality as compared to the patients without or with only few depressive symptoms. Our result revealed that depression is possibly associated with increased mortality in patients with mild dementia. Given that depression is treatable, screening for depression and treatment of depression can be important already in the earliest stage of dementia to reduce mortality.
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http://dx.doi.org/10.1155/2017/7482094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397625PMC
April 2017

Perioperative hyperoxia - Long-term impact on cardiovascular complications after abdominal surgery, a post hoc analysis of the PROXI trial.

Int J Cardiol 2016 Jul 14;215:238-43. Epub 2016 Apr 14.

Department of Anaesthesiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark. Electronic address:

Background: Increased long-term mortality was found in patients exposed to perioperative hyperoxia in the PROXI trial, where patients undergoing laparotomy were randomised to 80% versus 30% oxygen during and after surgery. This post hoc follow-up study assessed the impact of perioperative hyperoxia on long-term risk of cardiovascular events.

Methods: A total of 1386 patients undergoing either elective or emergency laparotomy were randomised to 80% versus 30% oxygen during and two hours after surgery. At follow-up, the primary outcome of acute coronary syndrome was assessed. Secondary outcomes included myocardial infarction, other heart disease, and acute coronary syndrome or death. Data were analysed in the Cox proportional hazards model.

Results: The primary outcome, acute coronary syndrome, occurred in 2.5% versus 1.3% in the 80% versus 30% oxygen group; HR 2.15 (95% CI 0.96-4.84). Patients in the 80% oxygen group had significantly increased risk of myocardial infarction; HR 2.86 (95% CI 1.10-7.44), other heart disease; HR 1.40 (95% 1.06-1.83), and acute coronary syndrome or death; HR 1.22 (95% CI 1.01-1.49).

Conclusions: Perioperative hyperoxia may be associated with an increased long-term risk of myocardial infarction and other heart disease.
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http://dx.doi.org/10.1016/j.ijcard.2016.04.104DOI Listing
July 2016

Associations between plasma concentrations of PCB 28 and possible indoor exposure sources in Danish school children and mothers.

Environ Int 2016 Feb 28;87:13-9. Epub 2015 Nov 28.

Section of Environmental Health, Faculty of Health Sciences, University of Copenhagen, Denmark. Electronic address:

Background: Polychlorinated biphenyls (PCBs) are ubiquitously present in the environment and are suspected of carcinogenic, neurotoxic and immunotoxic effects. Significantly higher plasma concentrations of the congener PCB 28 occur in children compared to adults. Exposure in schools may contribute to this difference.

Objective: To determine whether increased blood plasma concentrations of PCB 28 in Danish school children and mothers are associated with living in homes or attending schools constructed in the PCB period (1959-1977).

Methods: PCB 28 was analyzed in plasma samples from 116 children aged 6-11years and 143 mothers living in an urban and a rural area in Denmark and participating in the European pilot project DEMOCOPHES (Demonstration of a study to COordinate and Perform Human Biomonitoring on a European Scale). In Denmark, PCBs were used in construction in the period 1950-1977, and year of construction or renovation of the homes and schools was used as a proxy for indoor PCB exposure. Linear regression models were used to assess the association between potential PCB exposure from building materials and lipid adjusted concentrations of PCB 28 in plasma, with and without adjustment for potential confounders.

Results: Among the 116 children and 143 mothers, we were able to specify home construction period in all but 4 children and 5 mothers leaving 111 children and 138 mothers for our analyses. The median lipid adjusted plasma PCB 28 concentration was 3 (range: 1-28) ng/g lipid in the children and 2 (range: 1-8) ng/g lipid in the mothers. Children living in homes built in the PCB period had significantly higher lipid adjusted plasma PCB 28 concentrations compared to children living in homes built before or after the PCB period. Following adjustment for covariates, PCB 28 concentrations in children were 40 (95% CI: 13; 68) percent higher than concentrations of children living in homes constructed at other times. Furthermore, children attending schools built or substantially refurbished in the PCB period also had significantly higher (46%, 95% CI: 22; 70) PCB 28 concentrations compared to children attending schools constructed before or after the PCB period, while their mothers had similar concentrations. Adjustment for the most prevalent congener, PCB 153, did not change this effect of home or school construction. When both home and school construction year were included in the models, the increase in lipid adjusted plasma PCB 28 for children living in or attending schools from the PCB period was no longer statistically significant. The individual effect of home and school construction periods could not be evaluated further with the available data.

Conclusion: Our results suggest that PCB exposure in the indoor environment in schools and homes constructed during the PCB period may contribute significantly to children's plasma PCB 28 concentration. Efforts to minimize PCB exposure in indoor environments should be considered.
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http://dx.doi.org/10.1016/j.envint.2015.11.005DOI Listing
February 2016

Sample Size in Qualitative Interview Studies: Guided by Information Power.

Qual Health Res 2016 Nov 10;26(13):1753-1760. Epub 2016 Jul 10.

1 University of Copenhagen, Copenhagen, Denmark.

Sample sizes must be ascertained in qualitative studies like in quantitative studies but not by the same means. The prevailing concept for sample size in qualitative studies is "saturation." Saturation is closely tied to a specific methodology, and the term is inconsistently applied. We propose the concept "information power" to guide adequate sample size for qualitative studies. Information power indicates that the more information the sample holds, relevant for the actual study, the lower amount of participants is needed. We suggest that the size of a sample with sufficient information power depends on (a) the aim of the study, (b) sample specificity, (c) use of established theory, (d) quality of dialogue, and (e) analysis strategy. We present a model where these elements of information and their relevant dimensions are related to information power. Application of this model in the planning and during data collection of a qualitative study is discussed.
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http://dx.doi.org/10.1177/1049732315617444DOI Listing
November 2016

Diagnostic invasiveness and psychosocial consequences of false-positive mammography.

Ann Fam Med 2015 May-Jun;13(3):242-9

The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Purpose: We undertook a study to assess whether women with false-positive mammography have worse psychosocial consequences if managed with a workup that involves a biopsy (invasive group) than if managed with only additional imaging (noninvasive group).

Methods: We performed subgroup analysis of a cohort study of 454 women with abnormal screening mammography and 908 matched control women with normal results. Using a condition-specific questionnaire (Consequences of Screening in Breast Cancer), we assessed 12 psychosocial consequences at 5 time points (0, 1, 6, 18, and 36 months after final diagnosis) and compared the 2 groups of women with false-positives (invasive and noninvasive management groups).

Results: Among the 252 women with false-positive mammography eligible for this study, psychosocial consequences were similar for those managed invasively and those managed noninvasively during the 36 months of follow-up. In 60 comparisons (12 scales and 5 time points), differences between the groups were never statistically significant (P <.01) and the point estimates for the differences were always close to zero. The psychosocial consequences of women with false-positive results, regardless of management, fell between those of women with normal mammography and those of women determined to have breast cancer.

Conclusions: We found no evidence that use of more invasive diagnostics was associated with worse psychosocial consequences. It is therefore reasonable to pool subgroups of women with false-positives in a single analysis. The invasiveness of subsequent diagnostic procedures does not help to identify women at higher risk for adverse psychosocial consequences of false-positive mammography.
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http://dx.doi.org/10.1370/afm.1762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427419PMC
February 2016

Weight changes following the diagnosis of type 2 diabetes: the impact of recent and past weight history before diagnosis. results from the Danish Diabetes Care in General Practice (DCGP) study.

PLoS One 2015 15;10(4):e0122219. Epub 2015 Apr 15.

The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Aims: The association between recent and more distant weight changes before and after the diagnosis of type 2 diabetes has been little researched. The aim of this study is to determine the influence of patients' weight history before diabetes diagnosis on the observed 6-year weight changes after diagnosis.

Methods: A clinical cohort study combined with self-reported past weight history. In total 885 patients aged ≥40 years and newly diagnosed with clinical type 2 diabetes were included. Body weight was measured immediately after diabetes diagnosis and again at the 6-year follow up examination (median, 5.7 years). At diagnosis patients reported their weight 1 year and 10 years previously, and also at the age of 20. Multivariate linear regression analyses controlled for 20 baseline patient characteristics.

Results: The median (interquartile range) age at diagnosis was 63.2 (53.9; 71.4) years. Median body weight was 80.0 (72.0; 90.0) kg 10 years before diagnosis, 85.0 (75.0; 95.0) kg 1 year before diagnosis, 82.4 (72.0; 94.0) kg at diagnosis, and 80.0 (70.0; 91.1) kg at 6-year follow up. Each kg of weight gain during the year preceding the diagnosis was associated with a weight change (95% CI) of -0.20 (-0.28; -0.13) kg during the follow up period. In all models age and body mass index at diagnosis predicted future weight changes, while the weight at age 20 (-0.01 (-0.06; 0.03) kg/kg), and the weight change from 10 years to 1 year before diagnosis (-0.01 (-0.06; 0.04) kg/kg), did not predict weight change after diagnosis.

Conclusions: During the first on average 5.7 years after diagnosis of type 2 diabetes, patients generally follow a course of declining average weight, and these weight developments are related primarily to recent weight changes, body mass index, and age, but not to the more distant weight history.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122219PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398495PMC
January 2016

Comparing the effect of non-medical mechanical restraint preventive factors between psychiatric units in Denmark and Norway.

Nord J Psychiatry 2015 Aug 23;69(6):433-43. Epub 2015 Jan 23.

Jesper Bak, R.N., S.D., M.P.H., Ph.D. student, Head nurse, Mental Health Centre Sct. Hans , Roskilde , Denmark . E-mail:

Background: The use of mechanical restraint (MR) is controversial, and large differences regarding the use of MR are often found among countries. In an earlier study, we observed that MR was used twice as frequently in Denmark than Norway.

Aims: To examine how presumed MR preventive factors of non-medical origin may explain the differing number of MR episodes between Denmark and Norway.

Methods: This study is a cross-sectional survey of psychiatric units. Linear regression was used to assess the confounding effects of the MR preventive factors, i.e. whether a difference in the impact of these factors is evident between Denmark and Norway.

Results: Six MR preventive factors confounded [∆exp(B)> 10%] the difference in MR use between Denmark and Norway, including staff education (- 51%), substitute staff (- 17%), acceptable work environment (- 15%), separation of acutely disturbed patients (13%), patient-staff ratio (- 11%), and the identification of the patient's crisis triggers (- 10%).

Conclusions: These six MR preventive factors might partially explain the difference in the frequency of MR episodes observed in the two countries, i.e. higher numbers in Denmark than Norway. One MR preventive factor was not supported by earlier research, the identification of the patient's crisis triggers; therefore, more research on the mechanisms involved is needed.

Clinical Implications: None of the six MR preventive factors presents any adverse effects; therefore, units in Denmark and Norway may consider investigating the effect of implementing, the identification of the patient's crisis triggers, an increased number of staff per patient, increased staff education, a better work environment and reduced use of substitute staff in practice.
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http://dx.doi.org/10.3109/08039488.2014.996600DOI Listing
August 2015

The Copenhagen Primary Care Differential Count (CopDiff) database.

Clin Epidemiol 2014 12;6:199-211. Epub 2014 Jun 12.

The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Background: The differential blood cell count provides valuable information about a person's state of health. Together with a variety of biochemical variables, these analyses describe important physiological and pathophysiological relations. There is a need for research databases to explore associations between these parameters, concurrent comorbidities, and future disease outcomes.

Methods And Results: The Copenhagen General Practitioners' Laboratory is the only laboratory serving general practitioners in the Copenhagen area, covering approximately 1.2 million inhabitants. The Copenhagen General Practitioners' Laboratory has registered all analytical results since July 1, 2000. The Copenhagen Primary Care Differential Count database contains all differential blood cell count results (n=1,308,022) from July 1, 2000 to January 25, 2010 requested by general practitioners, along with results from analysis of various other blood components. This data set is merged with detailed data at a person level from The Danish Cancer Registry, The Danish National Patient Register, The Danish Civil Registration System, and The Danish Register of Causes of Death.

Conclusion: This paper reviews methodological issues behind the construction of the Copenhagen Primary Care Differential Count database as well as the distribution of characteristics of the population it covers and the variables that are recorded. Finally, it gives examples of its use as an inspiration to peers for collaboration.
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http://dx.doi.org/10.2147/CLEP.S60991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062550PMC
June 2014

Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.

PLoS One 2014 10;9(6):e99388. Epub 2014 Jun 10.

Department of Rheumatology, Odense University Hospital, Odense, Denmark.

Background: Several studies have demonstrated an association between rheumatoid arthritis (RA) and lymphoproliferative malignancies, but pathogenic mechanisms remain unclear. We investigated 1) the risk of lymphoproliferative malignancies and solid tumors in adults with RA identified in primary care and 2) the possible mediating role of blood eosinophilia in the clonal evolution of cancer in these patients.

Methods: From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count between 2000-2007. From these, one DIFF was randomly chosen (the index DIFF). By linking to the Danish National Patient Register, we categorized the selected individuals according to known longstanding (≥3 years) or recent onset (<3 years) RA prior to the index DIFF. In addition, the cohort was stratified according to management in primary or secondary care. From the Danish Cancer Registry we ascertained malignancies within four years following the index DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for sex, age, year, month, eosinophilia, comorbid conditions and C-reactive protein (CRP).

Results: 921 patients had recent onset RA and 2,578 had longer disease duration. Seventy three percent of RA patients were managed in primary care. After adjustment for sex, age, year, and month, neither recent onset nor long-standing RA was associated with incident lymphoproliferative malignancies or solid cancers. These risk estimates did not change when eosinophilia, CRP, and comorbidities were included in the models.

Conclusions: In this large cohort of patients with RA of short or long duration recruited from a primary care resource, RA was not associated with an increased risk of lymphoproliferative or solid cancers during 4 years of follow-up, when the models were adjusted for confounders. Blood eosinophilia could not be identified as a mediator of cancer development in the present setting.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0099388PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051682PMC
January 2015

Eosinophilia in routine blood samples as a biomarker for solid tumor development - A study based on the Copenhagen Primary Care Differential Count (CopDiff) Database.

Acta Oncol 2014 Sep 10;53(9):1245-50. Epub 2014 Mar 10.

Department of Hematology, Roskilde University Hospital , Roskilde , Denmark.

Background: Eosinophilia may represent an early paraclinical sign of malignant disease and a host anti-tumor effect. The association between eosinophilia and the development of solid tumors has never before been examined in an epidemiological setting. The aim of the present study was to investigate eosinophilia in routine blood samples as a potential biomarker of solid tumor development in a prospective design.

Material And Methods: From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356 196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (< 0.5 × 10(9)/l), mild (≥ 0.5-1.0 × 10(9)/l) or severe (≥ 1.0 × 10(9)/l) eosinophilia. From the Danish Civil Registration System and the Danish Cancer Registry we ascertained all-cause death and solid tumors within the first three years following the DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for previous eosinophilia, sex, age, year, month, C-reactive protein, previous cancer and Charlson's Comorbidity Index.

Results: The risk of bladder cancer was increased with mild eosinophilia [OR 1.93 (CI 1.29-2.89), p = 0.0013]. No associations with eosinophilia were observed for the remaining solid cancers.

Conclusion: We demonstrate that eosinophilia in routine blood samples associates with an increased risk of bladder cancer. Our data emphasize that additional preclinical studies are needed in order to shed further light on the role of eosinophils in carcinogenesis, where it is still unknown whether the cells contribute to tumor immune surveillance or neoplastic evolution.
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http://dx.doi.org/10.3109/0284186X.2014.887857DOI Listing
September 2014

The effectiveness of a semi-tailored facilitator-based intervention to optimise chronic care management in general practice: a stepped-wedge randomised controlled trial.

BMC Fam Pract 2014 Apr 9;15:65. Epub 2014 Apr 9.

The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Background: The Danish health care sector is reorganising based on disease management programmes designed to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The disease management programmes assign a central role to general practice; and in the Capital Region of Denmark a facilitator-based intervention was undertaken to support the implementation of the programmes in general practice. The purpose of the study was to assess the effectiveness of this semi-tailored facilitator-based intervention.

Method: The study was a stepped-wedge, randomised, controlled trial among general practices in the Capital Region of Denmark. The intervention group was offered three one-hour visits by a facilitator. The intervention was semi-tailored to the perceived needs as defined by each general practice, and the practices could choose from a list of possible topics. The control group was a delayed intervention group. The primary outcome was change in the number of annual chronic disease check-ups. Secondary outcomes were: changes in the number of annual check-ups for type 2 diabetes (DM2) and chronic obstructive pulmonary disease (COPD); changes in the number of spirometry tests, changes in the use of ICPC diagnosis coding and patient stratification; sign-up for a software program for patient overview; and reduction in number of practices with few annual chronic disease check-ups.

Results: We randomised 189 general practices: 96 practices were allocated to the intervention group and 93 to the delayed intervention group. For the primary outcome, 94 and 89 practices were analysed. Almost every outcome improved from baseline to follow-up in both allocation groups. At follow-up there was no difference between allocation groups for the primary outcome (p = 0.1639). However, some secondary outcomes favoured the intervention: a higher reported use of ICPC diagnosis coding for DM2 and COPD (p = 0.0050, p = 0.0243 respectively), stratification for COPD (p = 0.0185) and a faster initial sign-up rate for the software program.

Conclusion: The mixed results from this study indicate that a semi-tailored facilitator-based intervention of relatively low intensity is unlikely to add substantially to the implementation of disease management programmes for DM2 and COPD in a context marked by important concurrent initiatives (including financial incentives and mandatory registry participation) aimed at moving all practices towards changes in chronic care.

Trial Registration: ClinicalTrials.gov: NCT01297075.
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http://dx.doi.org/10.1186/1471-2296-15-65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234362PMC
April 2014

Educational intervention and functional decline among older people: the modifying effects of social capital.

Scand J Public Health 2014 May 6;42(3):295-303. Epub 2014 Feb 6.

1Department of Public Health, University of Copenhagen, Denmark.

Aim: To analyse if social capital modifies the effect of educational intervention of home visitors on mobility disability. Earlier studies have found that educational intervention of home visitors has a positive effect of older peoples' functional decline, but how social capital might modify this effect is still unknown.

Methods: We used the Danish Intervention Study on Preventive Home Visits - a prospective cohort study including 2863 75-year-olds and 1171 80-year-olds in 34 Danish municipalities - to analyse the modifying effect of different aspects of social capital on the effect of educational intervention of home visitors on functional decline. The three measures of social capital (bonding, bridging, and linking) were measured at contextual level. Data was analysed with multivariate linear regression model using generalised estimating equations to account for repeated measurements.

Results: We found that 80-year-olds living in municipalities with high bonding (B=0.089, p=0.0279) and high linking (B=0.0929; p=0.0217) had significant better mobility disability in average at 3-year follow up if their municipality had received intervention.

Conclusions: With the unique design of the Danish Intervention Study on Preventive Home Visits and with theory-based measures of social capital that distinguish between three aspects of social capital with focus on older people, this study contributes to the literature about the role of social capital for interventions on mobility disability.
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http://dx.doi.org/10.1177/1403494813520353DOI Listing
May 2014

Association of maternal self-medication and over-the-counter analgesics for children.

Pediatrics 2014 Feb 6;133(2):e291-8. Epub 2014 Jan 6.

Section of Environmental Health and.

Objective: Self-medication with over-the-counter (OTC) analgesics, such as paracetamol (PCM), among children and adolescents is increasing and constitutes an important public health issue internationally. Reasons for this development are unclear; parental influence is suggested. Our objective was to examine whether self-medication with OTC analgesics among school-aged children is influenced by maternal self-reported health and medicine use, taking the child's frequency of pain into account.

Methods: A quantitative cross-sectional survey was conducted on 131 children aged 6 to 11 years and their mothers in the framework of the Demonstration Of A Study To Coordinate And Perform Human Biomonitoring On A European Scale (DEMOCOPHES) European project. Participants were selected from 1 urban and 1 rural area of Denmark, and equally distributed in age and gender. Data were collected through structured interviews with all children and self-report questionnaires for mothers regarding health, pain, and medicine use.

Results: After adjusting for several sociodemographic and health parameters, maternal use of OTC analgesics was significantly associated with self-medication with OTC analgesics, particularly PCM, in our population of schoolchildren, even when the child's pain was adjusted for (odds ratio 3.00, P = .008). A clear association between child pain and OTC analgesic use was not found. Additionally, maternal health (self-rated health, chronic pain, chronic disease, daily medicine intake) did not significantly influence child use of OTC analgesics.

Conclusions: Maternal self-medication with OTC analgesics is associated with self-medication of OTC analgesics, predominantly PCM, among school-aged children, perhaps more than the child's pain. Maternal health seems of less importance. Information to parents about pain self-management is important to promote appropriate PCM use among schoolchildren.
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http://dx.doi.org/10.1542/peds.2013-1107DOI Listing
February 2014

Eosinophilia in routine blood samples as a biomarker for solid tumor development - A study based on The Copenhagen Primary Care Differential Count (CopDiff) Database.

Acta Oncol 2013 Dec 20. Epub 2013 Dec 20.

Department of Hematology, Roskilde University Hospital , Denmark.

Background. Eosinophilia may represent an early paraclinical sign of malignant disease and a host anti-tumor effect. The association between eosinophilia and the development of solid tumors has never before been examined in an epidemiological setting. The aim of the present study was to investigate eosinophilia in routine blood samples as a potential biomarker of solid tumor development in a prospective design. Material and methods. From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356 196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (< 0.5 × 10(9)/l), mild (≥ 0.5-1.0 × 10(9)/l) or severe (≥ 1.0 × 10(9)/l) eosinophilia. From the Danish Cancer Registry we ascertained solid tumors within the first three years following the DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for previous eosinophilia, sex, age, year, month, C-reactive protein, previous cancer and Charlson's comorbidity index. Results. The risk for breast cancer was significantly lower in individuals exhibiting mild eosinophilia than in individuals with normal eosinophil counts [OR (95% confidence intervals) = 0.51 (0.35-0.76), p = 0.0005]. The risk of bladder cancer, however, increased with severity of eosinophilia [2.27 (1.53-3.39), p < 0.0001 and 2.62 (0.96-7.14), p = 0.0592 for mild and severe eosinophilia, respectively]. No associations with eosinophilia were observed for remaining solid cancers. Conclusion. We demonstrate that eosinophilia in routine blood samples associate with a decreased risk of breast cancer and an increased risk of bladder cancer. Our data emphasize that additional preclinical studies are needed in order to shed further light on the role of eosinophils in carcinogenesis, where it is still unknown whether the cells contribute to tumor immune surveillance or neoplastic evolution.
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http://dx.doi.org/10.3109/0284186X.2013.866270DOI Listing
December 2013

Eosinophilia in routine blood samples and the subsequent risk of hematological malignancies and death.

Am J Hematol 2013 Oct 1;88(10):843-7. Epub 2013 Aug 1.

Department of Hematology, Roskilde University Hospital, Denmark; The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark.

Eosinophilia may represent an early paraclinical sign of hematological malignant disease, but no reports exist on its predictive value for hematological malignancies. From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (<0.5 × 10(9) /L), mild (≥ 0.5-1.0 × 10(9) /L) or severe (≥ 1.0 × 10(9) /L) eosinophilia. From the Danish Cancer Registry and the Danish Civil Registration System, we ascertained hematological malignancies and death within 3 years following the DIFF. Using multivariable logistic regression odds ratios (ORs) were calculated and adjusted for previous eosinophilia in a DIFF, sex, age, year, month, C-reactive protein, previous cancer, and comorbidity. ORs for developing Hodgkin's lymphoma (HL) was significantly increased in individuals exhibiting severe eosinophilia, OR = 9.09 (C.I. 2.77-29.84), P = 0.0003. The association with classical myeloproliferative neoplasms (cMPNs) showed an increasing risk with OR = 1.65 (1.04-2.61) P = 0.0322 and OR = 3.87 (1.67-8.96) P = 0.0016 for mild and severe eosinophilia. Eosinophilia was in a similar fashion associated with chronic lymphatic leukemia (CLL), OR = 2.57 (1.50-4.43), P = 0.0006 and OR = 5.00 (1.57-15.94), P = 0.0065, and all-cause death, OR of 1.16 (1.09-1.24), P < 0.0001 and 1.60 (1.35-1.91), P < 0.0001. We confirm associations between eosinophilia and HL and cMPNs, and in addition for the first time demonstrate a dose-dependent association between eosinophilia and CLL as well as death. Unexplained eosinophilia should prompt clinicians to consider conditions where early diagnosis may improve prognosis.
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http://dx.doi.org/10.1002/ajh.23515DOI Listing
October 2013

Long-term psychosocial consequences of false-positive screening mammography.

Ann Fam Med 2013 Mar-Apr;11(2):106-15

Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Purpose: Cancer screening programs have the potential of intended beneficial effects, but they also inevitably have unintended harmful effects. In the case of screening mammography, the most frequent harm is a false-positive result. Prior efforts to measure their psychosocial consequences have been limited by short-term follow-up, the use of generic survey instruments, and the lack of a relevant benchmark-women with breast cancer.

Methods: In this cohort study with a 3-year follow-up, we recruited 454 women with abnormal findings in screening mammography over a 1-year period. For each woman with an abnormal finding on a screening mammogram (false and true positives), we recruited another 2 women with normal screening results who were screened the same day at the same clinic. These participants were asked to complete the Consequences of Screening in Breast Cancer-a validated questionnaire encompassing 12 psychosocial outcomes-at baseline, 1, 6, 18, and 36 months.

Results: Six months after final diagnosis, women with false-positive findings reported changes in existential values and inner calmness as great as those reported by women with a diagnosis of breast cancer (Δ = 1.15; P = .015; and Δ = 0.13; P = .423, respectively). Three years after being declared free of cancer, women with false-positive results consistently reported greater negative psychosocial consequences compared with women who had normal findings in all 12 psychosocial outcomes (Δ >0 for 12 of 12 outcomes; P <.01 for 4 of 12 outcomes).

Conclusion: False-positive findings on screening mammography causes long-term psychosocial harm: 3 years after a false-positive finding, women experience psychosocial consequences that range between those experienced by women with a normal mammogram and those with a diagnosis of breast cancer.
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http://dx.doi.org/10.1370/afm.1466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601385PMC
September 2013

Impact of social capital on 8-year mortality among older people in 34 Danish municipalities.

J Aging Health 2012 Oct 6;24(7):1203-22. Epub 2012 Aug 6.

Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Objective: To analyze the impact of social capital measures (bonding, bridging, and linking) on all-cause mortality at 8-year follow-up among older people aged 75 and 80 at baseline.

Method: Prospective cohort study on preventive home visits including 2,863 seventy-five-year-olds and 1,171 eighty-year-olds in 34 Danish municipalities. The associations of the three aspects of social capital measures with mortality were tested in Cox regression models on time to death.

Results: In the 80-year-old cohort significant associations were seen between mortality and both bridging (hazards ratio (HR)=1.24, 95% CI [1.07, 1.45]) and linking (HR=1.21, 95% CI [1.03, 1.43]), but the associations attenuated when controlling for relevant confounders. None of the social capital measures were associated with mortality among the 75-year-olds.

Conclusion: The measures of social capital used in the present study include key aspects of social capital that are associated to mortality in older populations via physical activity and mobility disability.
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http://dx.doi.org/10.1177/0898264312454574DOI Listing
October 2012

Risk factors for 48-hours mortality after prehospital treatment of opioid overdose.

Emerg Med J 2013 Mar 13;30(3):223-5. Epub 2012 Apr 13.

Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Introduction: Opioid overdose is commonly treated by prehospital emergency services and the majority of the patients are discharged immediately after treatment and a short observation period. There is a minor risk for rebound opioid toxicity and other life-threatening conditions might occur after such episodes. The authors describe the short-term outcome and identify risk factors for death within 48 h after prehospital treatment of opioid overdose in Copenhagen, the capital of Denmark.

Methods: Data on all cases of opioid overdose treated by the medical emergency care unit between 1994 and 2003 were recorded prospectively. Risk factors for death within 48 h after initial medical emergency care unit contact were analysed in a multivariable logistic regression analysis.

Results: The authors recorded 4762 episodes of opioid overdose, covering 1967 unique identified patients. A total of 78 patients (8.4%, 95% CI 7.0 to 10.4) died within 48 h in the period 1999-2003, and 85% (66/78) of these had cardiac arrest and died. The authors found age >50 years and overdose during the weekend significantly associated with 48-h mortality. Gender, former episodes of opioid overdose, time of the day, month or year were not significantly associated with increased mortality.

Conclusions: The author found a 48-hours mortality of 8.4%. Advanced age and opioid overdose in the weekends were significant risk factors. Release on scene after treatment was associated with a very small risk.
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http://dx.doi.org/10.1136/emermed-2012-201124DOI Listing
March 2013

Lacrimal gland lesions in Denmark between 1974 and 2007.

Acta Ophthalmol 2013 Jun 4;91(4):349-54. Epub 2012 Apr 4.

Eye Pathology Institute, Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.

Purpose: To evaluate the incidence rate, distribution, patient characteristics and indications for surgical intervention of lacrimal gland lesions in Denmark between 1974 and 2007.

Material And Methods: All biopsied/surgically removed lacrimal gland lesions in Denmark during the period 1974-2007 were identified by searching two population-based registries. Specimens were collected and re-evaluated. The following data were collected: age, gender, indications for surgical intervention and local recurrence.

Results: A total of 232 lesions from 210 patients with a histologically verified lesion of the lacrimal gland were included. The incidence rate of lacrimal gland lesions was 1.3/1 000 000/year. The overall annual age- and gender-adjusted incidence rate more than doubled during the study period, owing to an increase in non-malignant lesions. Approximately half of the lesions were neoplasms (119) and 55% (66) of these were malignant. Dacryops constituted 10% (24), inflammatory lesions 27% (62), normal tissue 12% (27), benign tumours 23% (53) and malignant tumours 29% (66). Patients with malignant neoplasms were significantly older than patients with benign neoplasms (63 versus 48 years, p < 0.001). The indication for surgical intervention was suspicion of a tumour in more than 90% of the neoplastic lesions and in 30% of the non-neoplastic lesions.

Conclusion: Lacrimal gland lesions that require surgical evaluation are rare in the Danish population and represent a wide spectrum of diagnoses, mostly benign. The overall incidence rate of biopsied lacrimal gland lesions is increasing.
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http://dx.doi.org/10.1111/j.1755-3768.2012.02403.xDOI Listing
June 2013

Documenting organisational development in general practice using a group-based assessment method: the Maturity Matrix.

Qual Saf Health Care 2010 Oct 1;19(5):e37. Epub 2010 Jul 1.

Research Unit and Department of General Practice, Institute of Public Health, University of Copenhagen, Munkegårdsvej 41b, 3490 Kvistgård, Denmark.

Objective: The Maturity Matrix (MM) comprises a formative evaluation instrument for primary care practices to self-assess their degree of organisational development in a group setting, guided by an external facilitator. The practice teams discuss organisational development, score their own performance and set improvement goals for the following year. The objective of this project was to introduce a translated and culturally adapted version of the MM in Denmark, to test its feasibility, to promote and document organisational change in general practices and to analyse associations between the recorded change(s) and structural factors in practices and the factors associated with the MM process.

Setting: MM was used by general practices in three counties in Denmark, in two assessment sessions 1 year apart. First rounds of MM visits were carried out in 2006-2007 in 60 practice teams (320 participants (163 GPs, 157 staff)) and the second round in 2007-2008. A total of 48 practice teams (228 participants (117 GPs; 111 staff) participated in both sessions.

Method: The MM sessions were the primary intervention. Moreover, in about half of the practices, the facilitator reminded practice teams of their goals by sending them the written report of the initial session and contacted the practices regularly by telephone reminding them of the goals they had set. Those practice teams had password-protected access to their own and benchmark data.

Results: Where the minimum possible is 0 and maximum possible is 8, the mean overall MM score increased from 4.4 to 5.3 (difference=0.9, 95%, CI 0.76 to 1.06) from first to second sessions, indicating that development had taken place as measured by this group-based self-evaluation method. There was some evidence that lower-scoring dimensions were prioritised and more limited evidence that the prioritisation and interventions between meetings were helpful to achieve changes.

Conclusions: This study provides evidence that MM worked well in general practices in Denmark. Practice teams appeared to be learning about the process, directing their efforts more efficiently after a year's experience of the project. This experience also informs the further improvement of the facilitation and follow-up components of the intervention.
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http://dx.doi.org/10.1136/qshc.2009.033787DOI Listing
October 2010
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