Center for Public Health

Central Denmark Region, Denmark

Center for Public Health

Central Denmark Region, Denmark
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Christensen A.I.,University of Southern Denmark | Ekholm O.,University of Southern Denmark | Kristensen P.L.,Region of Southern Denmark | Larsen F.B.,Center for Public Health | And 4 more authors.
European Journal of Public Health | Year: 2015

Background: Reminders are routinely applied in surveys to increase response rates and reduce the possibility of bias. This study examines the effect of multiple reminders on the response rate, non-response bias, prevalence estimates and exposure-outcome relations in a national self-administered health survey. Data derive from the Danish National Health Survey 2010, in which 298 550 individuals (16 years of age or older) were invited to participate in a cross-sectional survey using a mixed-mode approach (paper and web questionnaires). At least two reminders were sent to non-respondents, and 177 639 individuals completed the questionnaire (59.5%). Response patterns were compared between four groups of individuals (first mailing respondents, second mailing respondents, third mailing respondents and non-respondents). Results: Multiple reminders led to an increase in response rate from 36.7 to 59.5%; however, the inclusion of second and third mailing respondents did not change the overall characteristics of respondents compared with non-respondents. Furthermore, only small changes in prevalence estimates and exposure-outcome relationships were observed when including second and third mailing respondents compared with only first mailing respondents. Conclusions: Multiple reminders were an effective way to increase the response rate in a national Danish health survey. However, when differences do exist between respondents and non-respondents, the results suggest that second and third mailings are unlikely to eliminate these differences. Overall, multiple reminders seemed to have only minor effect on response patterns and study conclusions in the present study. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

PubMed | Queen's University of Belfast, University of Ulster, Center for Public Health, Patient and Public Involvement Representative and 2 more.
Type: Journal Article | Journal: BMC palliative care | Year: 2017

Pain assessment and management are key aspects in the care of people with dementia approaching the end of life but become challenging when patient self-report is impaired or unavailable. Best practice recommends the use of observational pain assessments for these patients; however, difficulties have been documented with health professionals use of these tools in the absence of additional collateral patient knowledge. No studies have explored the role, perspectives and experiences of healthcare assistants in pain assessment and management in dementia; this study provides insight into this important area.A qualitative approach was adopted, using key informant interviews with healthcare assistants caring for people with advanced dementia approaching the end of life in hospice, nursing home and acute care settings. Thematic analysis was the analytic approach taken to interpretation of interview data. Data were collected between June 2014 and September 2015.Fourteen participants took part in the study. Participants average length of caring experience was 15.4years and most were female. Three key themes emerged: recognising pain, reporting pain, and upskilling. Participants were often the first to notice obvious causes of pain and to detect changes in patient norms which signified hidden causes of pain. Comprehensive knowledge of resident norms enabled participants to observe for behavioural and nonverbal indicators of pain and distinguish these from non-pain related behaviours. Pain reporting was heavily impacted by relationships with professional staff and the extent to which participants felt valued in their role. Positive relationships resulted in comprehensive pain reports; negative relationships led to perfunctory or ambiguous reporting. Participants emphasised a desire for further training and upskilling, including in the use and reporting of basic pain tools.Healthcare assistants are frontline staff who have a key role in direct patient care, spending a considerable amount of time with patients in comparison to other health professionals. These staff are often first to notice changes in patients that may signify pain and to alert professional staff. However, to ensure the quality of these reports, further efforts must be made in reversing stigma attached to this role and in upskilling these members of the healthcare team.

Anderson L.,Cancer Epidemiology and Health Services Research Group | O'Rorke M.,Cancer Epidemiology and Health Services Research Group | Jamison J.,Antrim Area Hospital | Wilson R.,Antrim Area Hospital | Gavin A.,Center for Public Health
Journal of Medical Virology | Year: 2013

There is substantial international variation in human papillomavirus (HPV) prevalence; this study details the first report from Northern Ireland and additionally provides a systematic review and meta-analysis pooling the prevalence of high-risk (HR-HPV) subtypes among women with normal cytology in the UK and Ireland. Between February and December 2009, routine liquid based cytology (LBC) samples were collected for HPV detection (Roche Cobas® 4800 [PCR]) among unselected women attending for cervical cytology testing. Four electronic databases, including MEDLINE, were then searched from their inception till April 2011. A random effects meta-analysis was used to calculate a pooled HR-HPV prevalence and associated 95% confidence intervals (CI). 5,712 women, mean age 39 years (±SD 11.9 years; range 20-64 years), were included in the analysis, of which 5,068 (88.7%), 417 (7.3%) and 72 (1.3%) had normal, low, and high-grade cytological findings, respectively. Crude HR-HPV prevalence was 13.2% (95% CI, 12.7-13.7) among women with normal cytology and increased with cytological grade. In meta-analysis the pooled HR-HPV prevalence among those with normal cytology was 0.12 (95% CIs, 0.10-0.14; 21 studies) with the highest prevalence in younger women. HPV 16 and HPV 18 specific estimates were 0.03 (95% CI, 0.02-0.05) and 0.01 (95% CI, 0.01-0.02), respectively. The findings of this Northern Ireland study and meta-analysis verify the prevalent nature of HPV infection among younger women. Reporting of the type-specific prevalence of HPV infection is relevant for evaluating the impact of future HPV immunization initiatives, particularly against HR-HPV types other than HPV 16 and 18. J. Med. Virol. 85:295-308, 2013. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc.

Maresh M.J.A.,University of Manchester | Holmes V.A.,Center for Public Health | Patterson C.C.,Center for Public Health | Young I.S.,Center for Public Health | And 3 more authors.
Diabetes Care | Year: 2015

RESULTS : An A1C of 6.0-6.4% (42-47 mmol/mol) at 26 weeks' gestation was associated with a significantly increased risk of large for gestational age (LGA) (odds ratio 1.7 [95% CI 1.0-3.0]) and an A1C of 6.5-6.9% (48-52 mmol/mol) with a significantly increased risk of preterm delivery (odds ratio 2.5 [95% CI 1.3-4.8]), preeclampsia (4.3 [1.7-10.8]), need for a neonatal glucose infusion (2.9 [1.5-5.6]), and a composite adverse outcome (3.2 [1.3-8.0]). These risks increased progressively with increasing A1C. Results were similar at 34 weeks' gestation. Glucose data showed less consistent trends, although the risk of a composite adverse outcome increased with preprandial glucose levels between 6.0 and 6.9 mmol/L at 34 weeks (3.3 [1.3-8.0]).OBJECTIVE: To assess the relationship between second and third trimester glycemic control and adverse outcomes in pregnant women with type 1 diabetes, as uncertainty exists about optimum glycemic targets.RESEARCH DESIGN AND METHODS: Pregnancy outcomes were assessed prospectively in 725 women with type 1 diabetes from the Diabetes and Pre-eclampsia Intervention Trial. HbA1c (A1C) values at 26 and 34 weeks' gestationwere categorized into five groups, the lowest, <6.0% (42 mmol/mol), being the reference. Average pre-and postprandial results from an eight-point capillary glucose profile the previous day were categorized into five groups, the lowest (preprandial <5.0 mmol/L and postprandial <6.0 mmol/L) being the reference.CONCLUSIONS: LGA increased significantly with an A1C ‡6.0 (42 mmol/mol) at 26 and 34 weeks' gestation and with other adverse outcomes with an A1C ‡6.5% (48 mmol/mol). The data suggest that there is clinical utility in regularmeasurement of A1C during pregnancy. © 2015 by the American Diabetes Association.

McCance D.R.,Royal Victoria Hospital | Holmes V.A.,Nursing and Midwifery Research Unit | Maresh M.J.A.,St Marys Hospital for Women and Children | Patterson C.C.,Center for Public Health | And 3 more authors.
The Lancet | Year: 2010

Background Results of several trials of antioxidant use during pregnancy have not shown a reduction in pre-eclampsia, but the effect in women with diabetes is unknown. We aimed to assess whether supplementation with vitamins C and E reduced incidence of pre-eclampsia in women with type 1 diabetes. Methods We enrolled women from 25 UK antenatal metabolic clinics in a multicentre randomised placebo-controlled trial. Eligibility criteria were type 1 diabetes preceding pregnancy, presentation between 8 weeks' and 22 weeks' gestation, singleton pregnancy, and age 16 years or older. Women were randomly allocated in a 1:1 ratio to receive 1000 mg vitamin C and 400 IU vitamin E (α-tocopherol) or matched placebo daily until delivery. The randomisation sequence was stratified by centre with balanced blocks of eight patients. All trial personnel and participants were masked to treatment allocation. The primary endpoint was pre-eclampsia, which we defined as gestational hypertension with proteinuria. Analysis was by modified intention to treat. This study is registered, ISRCTN27214045. Findings Between April, 2003, and June, 2008, 762 women were randomly allocated to treatment groups (379 vitamin supplementation, 383 placebo). The primary endpoint was assessed for 375 women allocated to receive vitamins, and 374 allocated to placebo. Rates of pre-eclampsia did not differ between vitamin (15%, n=57) and placebo (19%, 70) groups (risk ratio 0.81, 95% CI 0.59-1.12). No adverse maternal or neonatal outcomes were reported. Interpretation Supplementation with vitamins C and E did not reduce risk of pre-eclampsia in women with type 1 diabetes. However, the possibility that vitamin supplementation might be beneficial in women with a low antioxidant status at baseline needs further testing.

News Article | November 30, 2016

Health Impacts of Nearly Two Dozen Diseases, Plus Lost and Unproductive Workdays, Create a Yearly Drag Twice as Large as U.S. Defense Budget & Equivalent to Economies of Texas, Korea or Russia WASHINGTON, DC--(Marketwired - November 30, 2016) - Obesity and excess weight is an expanding health problem for more than 60 percent of Americans, and a new study from the Milken Institute finds that it's a tremendous drain on the U.S. economy as well. The total cost to treat health conditions related to obesity -- ranging from diabetes to Alzheimer's -- plus obesity's drag on attendance and productivity at work exceeds $1.4 trillion annually. That's more than twice what the U.S. spends on national defense. The total, from 2014 data, was equivalent to 8.2 percent of U.S. GDP, and it exceeds the economies of all but three U.S. states and all but 10 countries. The Milken Institute's new report, "Weighing Down America: The Health and Economic Impact of Obesity," is the first to look at America's weight problem across all its dimensions: direct medical treatment for 23 health conditions causally related to obesity and indirect costs including the combination of lost workdays and lower productivity due to disease. In addition, more than 320,000 deaths were attributable to obesity and overweight in 2014, when the report's data were collected. "As a country, we are too heavy," said Ross DeVol, chief research officer of the Milken Institute, who co-authored the study with Hugh Waters, associate professor in the University of North Carolina Schools of Nursing and Public Health. "An overweight country is a problem for our physical health, certainly, but it's also an enormous problem for the health of our economy. Obesity is weighing down America." In 2014, 98.7 million U.S. residents had obesity, and another 89.9 million were overweight. In all, 188.6 million people -- or 60.7 percent of the population ages 2 and above -- either had obesity or were overweight. Among American adults, the prevalence of obesity has climbed from 13.4 percent in 1960-62 to 36.4 percent in 2014. The human suffering, medical costs and economic impacts of diseases caused by obesity now affect all geographic regions of the United States. In all 50 states, at least 20 percent of the population now has obesity. Abroad, obesity has been rising in all the member countries of the Organization for Economic Cooperation and Development (OECD) over the past two decades. "Weighing Down America" calculates the costs of direct medical treatment for heath conditions causally tied to obesity and overweight to be $427.8 billion in the U.S. in 2014, representing 14.3 percent of total health-care spending. Indirect costs including absenteeism, or lost workdays, and presenteeism (productivity loss or underperformance at work) amounted to $988.8 billion, leading to a total of $1.42 trillion. Fortunately, the Milken Institute study concludes, just as obesity's negative impacts on health can be reversed, so, too, can economic losses associated with excess weight. For example, a recent review of interventions designed to reduce obesity concluded that for individuals with a body mass index (BMI) of 40 or greater, a weight reduction of just 5 percent would yield $2,137 in medical cost savings annually, or $34.9 billion for all adults with extreme obesity. A 5 percent reduction in weight would amount to 14 lbs. for an American man of average height and a BMI of 40, or 12 lbs. for a woman. "Today, obesity is the number-one health concern for the people of the United States and the disease is a rapidly growing economic issue for all of us. Unfortunately, we are unable to solve the problem overnight, but we can make improving health and reducing body weight a national priority," said Edward Greissing, Executive Director of the Lynda and Stewart Resnick Center for Public Health at the Milken Institute, who joined the report's authors at a discussion today on Capitol Hill. "If we come together as a country and build on the commitment and work of employers, health providers, insurers, biopharmaceutical firms, the food and beverage industry, governments and other leaders in healthcare, by 2020 we can make significant advances to reduce obesity across the United States. It is important to remember as we tackle this crisis that most improvements in health begin with the individual and their local community." "If we fail to alter the trajectory we are on," the study concludes, "then higher medical costs, lost work time and productivity, unnecessary premature death, and slower long-term economic growth await us." "Weighing Down America" is the latest in a series of publications from the Milken Institute that examine the problem of obesity, its consequences and the effectiveness of interventions. Recent work stemming from the Institute's seminal 2007 report on the economic burden of chronic disease, "An Unhealthy America," includes: The latest report, "Weighing Down America: The Health and Economic Impact of Obesity," is on the Milken Institute's website at: Follow conversation about the report using the hashtag #weighingUSdown. The Milken Institute is a nonprofit, nonpartisan think tank determined to increase global prosperity by advancing collaborative solutions that widen access to capital, create jobs, and improve health. We do this through independent, data-driven research, action-oriented meetings and meaningful policy initiatives. ABOUT THE LYNDA AND STEWART RESNICK CENTER FOR PUBLIC HEALTH The Lynda and Stewart Resnick Center for Public Health at the Milken Institute is dedicated to finding solutions to complex public health challenges as an integral part of the Institute's mission to improve lives and build human capital. We believe that extending life and promoting health and wellness at all ages are among the most effective strategies for spreading prosperity and empowering people in America and across the globe. The following files are available for download:

Christensen A.I.,University of Southern Denmark | Ekholm O.,University of Southern Denmark | Glumer C.,Research Center for Prevention and Health | Andreasen A.H.,Research Center for Prevention and Health | And 5 more authors.
Scandinavian Journal of Public Health | Year: 2012

Aims: In 2010 the five Danish regions and the National Institute of Public Health at the University of Southern Denmark conducted a national representative health survey among the adult population in Denmark. This paper describes the study design and the sample and study population as well as the content of the questionnaire. Methods: The survey was based on five regional stratified random samples and one national random sample. The samples were mutually exclusive. A total of 298,550 individuals (16 years or older) were invited to participate. Information was collected using a mixed mode approach (paper and web questionnaires). A questionnaire with a minimum of 52 core questions was used in all six subsamples. Calibrated weights were computed in order to take account of the complex survey design and reduce non-response bias. Results: In all, 177,639 individuals completed the questionnaire (59.5%). The response rate varied from 52.3% in the Capital Region of Denmark sample to 65.5% in the North Denmark Region sample. The response rate was particularly low among young men, unmarried people and among individuals with a different ethnic background than Danish. Conclusions: The survey was a result of extensive national cooperation across sectors, which makes it unique in its field of application, e.g. health surveillance, planning and prioritizing public health initiatives and research. However, the low response rate in some subgroups of the study population can pose problems in generalizing data, and efforts to increase the response rate will be important in the forthcoming surveys. © 2012 the Nordic Societies of Public Health.

Loke Y.K.,University of East Anglia | Ho R.,University of East Anglia | Smith M.,University of East Anglia | Wong O.,University of East Anglia | And 3 more authors.
Journal of Clinical Pharmacy and Therapeutics | Year: 2013

Summary What is known and objectives A recently published large, long-term randomized controlled trial (RCT) brought into question the safety of dutasteride after a significantly increased risk of 'cardiac failure' was noted in the dutasteride arm of the trial compared with placebo. Our objective was to perform a meta-analysis to assess the risk of cardiovascular adverse events with the use of dutasteride for the prevention or treatment of prostatic disease. Methods We searched MEDLINE and EMBASE, unpublished articles identified through FDA/EMEA websites, study registers of pharmaceutical companies and reference lists of articles. Parallel-group, randomized controlled trials where men received dutasteride for the prevention of prostate cancer or treatment of prostatic hyperplasia against any comparator intervention were included. Heart failure was the primary outcome of interest but we also looked at myocardial infarction and stroke. Fixed-effect meta-analysis of pooled relative risk (RR) ratios of adverse effect outcomes was conducted. Results and discussion In all, 12 RCTs were included in the meta-analysis after detailed screening of 564 citations. The total number of participants was 18 802, and study duration ranged from 6 to 208 weeks. Only two trials provided details on adequate allocation concealment, whereas all the trials stated they were double blind in nature. Dutasteride was not associated with a statistically significant increased risk of heart failure (RR 1·05; 95% confidence interval [CI], 0·71-1·57, I2 = 20%), myocardial infarction (RR 1·00; 95% CI 0·77-1·30, I2 = 0%) and stroke (RR, 1·20; 95% CI 0·88-1·64, I2 = 0%) as compared to controls. What is new and conclusion We did not find consistent evidence of a significant association between dutasteride therapy and the risk of cardiovascular adverse events. © 2013 John Wiley & Sons Ltd.

McKay M.T.,Center for Public Health
Substance Use and Misuse | Year: 2015

Family factors have been widely implicated in the development of adolescent drinking behaviors. These include parental attachment and parental rules concerning drinking behaviors. Moreover, throughout adolescence attachment to parents gives way to attachment to peers, and parental rules about alcohol use become less strict. The present study examined the relationship between parental and peer attachment, parental rules on drinking and alcohol use in a large sample (n = 1,724) of adolescents in the United Kingdom. Controlling for school grade (proxy for age), sex and the non-independence of respondents (clustering at school level) results showed that scores on a parental rules on drinking questionnaire were a significant statistical predictor when comparing moderate drinkers and abstainers, as well as moderate drinkers and problematic drinkers. Scores on both attachment scales were also significant, but only in the comparison between moderate and problematic drinkers, with lower attachment to parents and higher attachment to peers associated with problematic drinking. © 2015 Informa Healthcare USA, Inc.

Neville C.E.,Center for Public Health | Young I.S.,Center for Public Health | Gilchrist S.E.C.M.,Center for Public Health | McKinley M.C.,Center for Public Health | And 4 more authors.
Age | Year: 2013

Fruit and vegetable (FV) intake, which is often low in older people, may be associated with improved muscle strength and physical function. However, there is a shortage of intervention trial evidence to support this. The current study examined the effect of increased FV consumption on measures of muscle strength and physical function among healthy, free-living older adults. A randomized controlled intervention study was undertaken. Eightythree participants aged 65-85 years, habitually consuming ≤2 portions of FV/day, were randomised to continue their normal diet (≤2 portions/day), or to consume ≥5 portions of FV/day for 16 weeks. FV were delivered to all participants each week, free ofcharge. Compliance was monitored at baseline, 6, 12 and 16 weeks by diet history and by measuring biomarkers of micronutrient status. Grip strength was measured by a hand-held dynamometer, while lower-extremity physical function was assessed by performance-based measures. Eighty-two participants completed the intervention. The 5 portions/day group showed greater change in daily FV consumption compared to the 2 portions/day group (P<0.001). This was reflected in significant increases in biomarkers of micronutrient status. No significant differences were evident in change in physical function between the two groups. However, there was a trend towards a greater change in grip strength in the 5 portions/day compared to the 2 portions/day group (mean change at 16 weeks±SD, 2.04±5.16 and 0.11±3.26 kg, respectively, P=0.06). Increased FV consumption may modestly increase grip strength but has no effect on physical function in healthy older adults. © American Aging Association 2013.

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