Schnohr P.,Frederiksberg Hospital |
O'Keefe J.H.,University of Missouri - Kansas City |
Marott J.L.,Frederiksberg Hospital |
Lange P.,Frederiksberg Hospital |
And 3 more authors.
Journal of the American College of Cardiology | Year: 2015
Background People who are physically active have at least a 30% lower risk of death during follow-up compared with those who are inactive. However, the ideal dose of exercise for improving longevity is uncertain. Objectives The aim of this study was to investigate the association between jogging and long-term, all-cause mortality by focusing specifically on the effects of pace, quantity, and frequency of jogging. Methods As part of the Copenhagen City Heart Study, 1,098 healthy joggers and 3,950 healthy nonjoggers have been prospectively followed up since 2001. Cox proportional hazards regression analysis was performed with age as the underlying time scale and delayed entry. Results Compared with sedentary nonjoggers, 1 to 2.4 h of jogging per week was associated with the lowest mortality (multivariable hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.11 to 0.80). The optimal frequency of jogging was 2 to 3 times per week (HR: 0.32; 95% CI: 0.15 to 0.69) or ≤1 time per week (HR: 0.29; 95% CI: 0.12 to 0.72). The optimal pace was slow (HR: 0.51; 95% CI: 0.24 to 1.10) or average (HR: 0.38; 95% CI: 0.22 to 0.66). The joggers were divided into light, moderate, and strenuous joggers. The lowest HR for mortality was found in light joggers (HR: 0.22; 95% CI: 0.10 to 0.47), followed by moderate joggers (HR: 0.66; 95% CI: 0.32 to 1.38) and strenuous joggers (HR: 1.97; 95% CI: 0.48 to 8.14). Conclusions The findings suggest a U-shaped association between all-cause mortality and dose of jogging as calibrated by pace, quantity, and frequency of jogging. Light and moderate joggers have lower mortality than sedentary nonjoggers, whereas strenuous joggers have a mortality rate not statistically different from that of the sedentary group. © 2015 American College of Cardiology Foundation.
News Article | December 22, 2016
Weight loss has a significant and prolonged positive impact on psoriasis symptoms and quality of life. The findings stem from a study conducted by Herlev and Gentofte Hospital, in collaboration with the University of Copenhagen's Department of Nutrition, Exercise and Sports and other participants. The results are published in The American Journal of Clinical Nutrition, an internationally renowned scientific journal. Sixty test-subjects, obese and affected by psoriasis, lost an average of fifteen kilos over a sixteen-week period while improving their quality of life and reducing the severity of their psoriasis. Upon follow up, one year later, the subjects remained ten kilos below their starting weights, and improvements in their psoriasis symptoms and quality of life were maintained. "150,000 Danes suffer from varying degrees of psoriasis," explains the study's project manager, Professor and Senior Physician Lone Skov, Herlev and Gentofte Hospital, Department of Dermatology and Allergy, University of Copenhagen. We know that there is a connection between being overweight and psoriasis; being more overweight makes the disease worse. Skov is supported by article co-author, Professor Arne Astrup, of the University of Copenhagen's Department of Nutrition, Exercise and Sports: "We know that both psoriasis and obesity are linked with an increased incidence of coronary heart disease, high blood pressure, high cholesterol and diabetes. If we could get obese psoriasis patients to lose weight and keep the weight off, we could potentially derive positive effects on their overall health and quality of life as well." A study conducted in 2012 lead to obese test subjects with psoriasis losing between 10-15% of their starting weights. The study demonstrated that there was a tendency for weight loss to reduce the severity of psoriasis among the subjects. Furthermore, the study clearly demonstrated that weight loss lead to a significantly better quality of life - with a lasting effect. "When we revisited test subjects one year later, they had only regained five kilos. Thus, they remained ten kilos beneath their starting weights. This was impressive in and of itself, but it was even more positive that they had maintained the effects of their initial weight loss with regards to the diminished severity of their psoriasis and quality of life," explains Dr. Peter Jensen, senior resident, ph.d. at Herlev and Gentofte Hospital, University of Copenhagen. Professor Arne Astrup points to the relevance of the results for psoriasis treatment: "The results underscore the importance of focusing on weight loss as one element in a broad spectrum approach to effective psoriasis treatment for overweight patients. A by-product of weight loss might be a reduction of the complications associated with obesity. This results in a significant effect on the overall well-being of patients." The study was a collaboration between the Department of Dermatology and Allergy, Department of Clinical Physiology and Nuclear Medicine, Department of Clinical Biochemistry and the Department of Cardiology at Herlev and Gentofte Hospital, University of Copenhagen; Musculoskeletal Statistics Unit, Parker Institute, Department of Rheumatology, Frederiksberg Hospital and the Department of Nutrition, Exercise and Sports at the University of Copenhagen; and the Nutrition Unit at Herlev and Gentofte Hospital, University of Copenhagen. The study results are published in the article, 'Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study', found in The American Journal of Clinical Nutrition. Psoriasis is a hereditary and chronic skin disease that affects roughly 150,000 Danes. The disease is characterized by the presence of red, itchy and scaly patches of abnormal skin. The severity varies greatly from person to person.
Rasmussen K.L.,Copenhagen University |
Tybjaerg-Hansen A.,Copenhagen University |
Tybjaerg-Hansen A.,Frederiksberg Hospital |
Tybjaerg-Hansen A.,Herlev Hospital |
And 5 more authors.
Annals of Neurology | Year: 2015
Objective: The apolipoprotein E (APOE) ε4 allele is a major genetic risk factor for Alzheimer disease and dementia. However, it remains unclear whether plasma levels of apoE confer additional risk. We tested this hypothesis. Methods: Using 75,708 participants from the general population, we tested whether low plasma levels of apoE at study enrollment were associated with increased risk of future Alzheimer disease and all dementia, and whether this association was independent of ε2/ε3/ε4 APOE genotype. Results: Multifactorially adjusted hazard ratios (HRs) for Alzheimer disease and all dementia increased from the highest to the lowest apoE tertile (p for trends < 1 × 10-6). Multifactorially adjusted HRs for lowest versus highest tertile were 2.68 (95% confidence interval [CI] = 2.04-3.52) and 1.80 (95% CI = 1.52-2.13) for Alzheimer disease and all dementia, respectively. After further adjustment for ε2/ε3/ε4 APOE genotype, plasma apoE tertiles remained associated with Alzheimer disease (p for trend = 0.007) and all dementia (p for trend = 0.04). Plasma apoE tertiles did not interact with ε2/ε3/ε4 APOE genotype on risk of Alzheimer disease (p = 0.53) or all dementia (p = 0.79). In a subanalysis, the -219G>T GT promoter genotype, associated with low plasma apoE levels, remained significantly associated with increased risk of Alzheimer disease after adjustment for ε2/ε3/ε4 APOE genotype (HR = 1.56, 95% CI = 1.05-2.30). Interpretation: Low plasma levels of apoE are associated with increased risk of future Alzheimer disease and all dementia in the general population, independent of ε2/ε3/ε4 APOE genotype. This is clinically relevant, because no plasma biomarkers are currently implemented. Hence, plasma levels of apoE may be a new, easily accessible preclinical biomarker. © 2015 American Neurological Association.
Andersen H.L.,Frederiksberg Hospital |
Andersen S.L.,Copenhagen University |
Tranum-Jensen J.,Copenhagen University
Regional Anesthesia and Pain Medicine | Year: 2012
BACKGROUND AND OBJECTIVES: There exists little anatomic knowledge regarding the structure and sonographic features of the sheath enveloping the sciatic nerve in the popliteal fossa. We investigated the spread of an injection inside the sheath to (1) determine whether the sheath is a structure distinct from the nerve or part of the epineurium and (2) to develop an ultrasound-guided injection technique. METHODS: Using gross dissection, ultrasound examination, and histologic study, we characterized the tissue layer surrounding the sciatic nerve in the popliteal fossa of 28 unembalmed cadaver legs. RESULTS: Grossly, we identified a thin, transparent, and fragile tissue layer surrounding the epineurium. Sonographically, this layer was identified with injectate as a hyperechoic layer detaching from the surface of the sciatic nerve. Histologically, the sheath was seen as a multilayered circular fascia as part of the paraneural tissue. An injection of 10 mL inside the sheath spread 10 to 15 cm closely along the nerve, however, not completely circumferential, compared with 5 to 6 cm if the injection was outside the sheath. Characteristics of the ultrasound-guided injection technique are described. CONCLUSIONS: There is a distinct tissue layer surrounding the popliteal sciatic nerve as a paraneural sheath that has distinct gross anatomic, histologic, and sonographic features. This sheath may have implications for regional anesthesia involving the popliteal sciatic nerve. We suggest that the ultrasound-guided injection technique described here could be used in future clinical studies investigating the importance of the paraneural sheath. Copyright © 2012 by American Society of Regional Anesthesia and Pain Medicine.
Andersen H.L.,Frederiksberg Hospital |
Gyrn J.,Frederiksberg Hospital |
Moller L.,Copenhagen University |
Christensen B.,Frederiksberg Hospital |
Zaric D.,Frederiksberg Hospital
Regional Anesthesia and Pain Medicine | Year: 2013
Background and Objectives: Local infiltration analgesia (LIA) reduces pain after total knee arthroplasty without the motor blockade associated with epidural analgesia or femoral nerve block. However, the duration and efficacy of LIA are not sufficient. A saphenous nerve block, in addition to single-dose LIA, may improve analgesia without interfering with early mobilization. Methods: Forty patients were included in this double-blind randomized controlled trial. All patients received spinal anesthesia for surgery and single-dose LIA during the operation. An ultrasound-guided saphenous nerve catheter was placed postoperatively in the adductor canal at midthigh level. Patients were randomized into 2 groups to receive 15-mL boluses of either ropivacaine 7.5 mg/mL or saline twice daily for 2 postoperative days. Results: Worst pain scores during movement on the day of surgery were significantly lower in the ropivacaine group (median [range] visual analog scale, 3 [0-7] vs 5.5 [0-10]; P < 0.050), as well as pain at rest (visual analog scale, 2 [0-8] vs 4 [0-8]; P = 0.032). Breakthrough pain occurred later in the ropivacaine group (10.5 [range, 0.5-48] hours vs 3.4 [range, 0.5-24] hours; P = 0.011). All patients in the ropivacaine group were able to ambulate on the day of surgery versus 13 patients in the control group (P = 0.004). Fewer patients had sleep disturbance on the first postoperative night in the ropivacaine group (P = 0.038). We found no differences in morphine consumption. Conclusions: The combination of a saphenous nerve block with single-dose LIA offered better pain relief on the day of surgery than LIA alone. © 2013 by American Society of Regional Anesthesia and Pain Medicine.
Female survival advantage relates to male inferiority rather than female superiority: A hypothesis based on the impact of age and stroke severity on 1-week to 1-year case fatality in 40,155 men and women
Olsen T.S.,Frederiksberg Hospital |
Andersen K.K.,Technical University of Denmark
Gender Medicine | Year: 2010
Background: It is generally believed that differences in age, stroke characteristics, and cardiovascular risk factors account for observed sex-specific differences in stroke survival. Objectives: We aimed to study female stroke survival advantage before and after the average age of menopause, and whether female survival advantage applies only to patients for whom stroke is the most likely cause of death. Methods: The Danish National Indicator Project, a registry designed to list all hospitalized stroke patients in Denmark beginning in March 2001, had 40,155 registered patients as of February 2007. All registered patients had undergone evaluation including stroke severity (as measured by the Scandinavian Stroke Scale [SSS], using a total score of 058, in which lower scores indicate more severe strokes), computed tomography, and cardiovascular risk factors. Patients were followed from admission until death or censoring. Case fatality (stratified by 1 week, 1 month, 3 months, and 1 year) in men and women was correlated with age and stroke severity. Adjustment for cardiovascular risk factors was performed by means of multivariate regression analysis. Results: A total of 20,854 (51.9%) men and 19,301 (48.1%) women were registered. Women were significantly older than men at the time of stroke (74.5 vs 69.7 years, respectively; P < 0.001) and had signficantly more severe strokes, as expressed by the mean SSS score (39.6 vs 43.3; P < 0.001). Stratification of 1-week to 1-year case fatality according to age and stroke severity indicated that women survived significantly better than men from the mid-fifties onward, when controlling for age, stroke severity, and cardiovascular risk factor profile. The observed female survival advantage increased with age. The female survival advantage was seen in patients with severe as well as mild strokes, but not in those younger than age 50 years. Conclusions: Our findings dispute the effects of female sex hormones as the underlying cause of female survival superiority over men. Instead, we propose the hypothesis that the progressive deficiency of male sex hormones (testosterone), beginning in men in middle age, is the underlying cause of the gap in survival rates between men and women. Accordingly, the female survival advantage is rooted in male inferiority rather than innate female superiority. © 2010 Excerpta Medica Inc.
Andersen K.K.,Technical University of Denmark |
Olsen T.S.,Frederiksberg Hospital
Journal of Stroke and Cerebrovascular Diseases | Year: 2011
We studied the association of stroke severity with survival from 1 month to 10 years after stroke and explored how stroke severity interacts with other prognostic indicators with time. The study is based on 999 stroke patients from the community-based Copenhagen Stroke Study (mean age, 74.3 ± 11.0 years; 56% women; mean Scandinavian Stroke Scale [SSS], 38.0 ± 17.4). Evaluation included stroke severity (based on the SSS), computed tomography scan, and a cardiovascular risk profile. Using logistic regression models, we examined the relevance of the SSS on mortality at 1 month and 1, 5, and 10 years. We analyzed the proportion of the variation explained by the models and bias of risk factors estimates with and without the SSS in the model. Mortality rate was 16.6% at 1 month, 31.5% at 1 year, 60.2% at 5 years, and 81.3% at 10 years. In models including the SSS, 22.4%, 20.9%, 32.8%, and 39.5% of the variance was explained for the endpoints of 1 month, 1 year, 5 years, and 10 years, respectively. When SSS was left out of the model, the corresponding values were 6.9%, 13.3%, 29.0%, and 35.1%. Factors significantly associated with survival were SSS at 1 month; SSS, age, diabetes, and stroke type at 1 year; SSS, age, sex, previous stroke, other complicating diseases, diabetes, smoking, and atrial fibrillation at 5 years; and SSS, age, sex, other complicating diseases, and diabetes at 10 years. Our data suggest that stroke severity is significantly associated with short-term and long-term survival. It is the all-important predictor of short-term survival, whereas it is of less importance in predicting long-term survival. © 2011 by National Stroke Association.
Amris K.,Frederiksberg Hospital |
Jespersen A.,Frederiksberg Hospital |
Bliddal H.,Frederiksberg Hospital
Pain | Year: 2010
Widespread pain and pain hypersensitivity are the hallmark of fibromyalgia, a complex pain condition linked to central sensitization. In this study the painDETECT questionnaire (PDQ), validated to identify neuropathic pain and based on pain quality items, was applied in a cross-sectional sample of patients with chronic widespread pain (CWP). The aims of the study were to assess the patient-reported sensory neuropathic symptoms by PDQ and to correlate these with tender point (TP) count and pressure-pain thresholds. Eighty-one patients (75 F, 6 M) with CWP (ACR-criteria) filled in the PDQ. Manual TP examination was conducted according to ACR guidelines. Computerized cuff pressure algometry was used for the assessment of pressure-pain detection thresholds (PDT, unit: kPa) and pressure-pain tolerance thresholds (PTT, unit: kPa). Mean TP count was 14.32 (range: 2-18), mean PDQ score 22.75 (range: 5-37). Mean PDT was 8.8 kPa (range: 2-36) and mean PTT 30.9 kPa (range: 4-85). Deep-tissue hyperalgesia was the predominant somatosensory symptom reported in 83%, but other neuropathic symptoms were also frequent, e.g. burning 51% and prickling 47%. Statistically significant correlations were found between PDQ score and TP count: r = 0.35 (p < 0.01), and PDQ score and PDT: r = 0.45 (p < 0.01), and PTT: r = 0.43 (p < 0.01). The study indicates that pain in CWP has neuropathic features, and that the presence and number of tender points are associated with neuropathic pain symptoms. A high mean PDQ score was found to correlate with TP count and pressure-pain thresholds. The PDQ may become a useful tool assisting in the identification of central sensitization in patients with CWP and in the future diagnostic assessment fibromyalgia. © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Mehlsen J.,Frederiksberg Hospital |
Wiinberg N.,Frederiksberg Hospital
International Journal of Vascular Medicine | Year: 2014
The present study aimed at examining the interarm difference in blood pressure and its use as an indicator of peripheral arterial disease (PAD). Data were included from consecutive patients referred from their general practitioner to our vascular laboratory for possible PAD aged 50 years or older without known cardiac disease, renal disease, or diabetes mellitus. 824 patients (453 women) with mean age of 72 years (range: 50-101) were included. 491 patients had a diagnosis of hypertension and peripheral arterial disease (PAD) was present in 386 patients. Systolic blood pressure was 143 ± 24 mmHg and 142 ± 24 mmHg on the right and left arm, respectively (P = 0.015). The interarm difference was greater in patients with hypertension (P = 0.002) and PAD (P < 0.0005). 443 patients were measured on two separate occasions and the interarm difference for systolic blood pressure was reproducible for differences >20 mmHg. This study confirmed the presence of a systematic but clinically insignificant difference in systolic blood pressure between arms. The interarm difference was larger in hypertension and PAD. Consistent lateralisation is present for differences ≥20 mmHg and an interarm difference >25 mmHg is a reliable indicator of PAD in the legs. © 2014 Jesper Mehlsen and Niels Wiinberg.
Bohm A.,Frederiksberg Hospital |
Heitmann B.L.,Frederiksberg Hospital
European Journal of Clinical Nutrition | Year: 2013
Background/Objectives:Bioelectrical impedance analysis (BIA) is a relatively simple, inexpensive and non-invasive technique to measure body composition and is therefore suitable in field studies and larger surveys.Subjects/Methods:We performed an overview of BIA-derived body fat percentages (BF%) from 55 published studies of healthy populations aged 6-80 years. In addition, the relationship between body mass index (BMI) and body composition is documented in the context of BIA as a good alternative to closely differentiate which composition of the body better relates to the risk of cardiovascular diseases (CVDs)and all-cause mortality.Results and Conclusions:BIA-estimated percentage of BF varies greatly with population and age. BIA-estimated BF% is directly and closely related to various health outcomes such as CVDs, which is in contrast to BMI where both high and low BMIs are associated with increased risk of developing chronic diseases. Studies, among others using BIA, suggest that low BMI may reflect low muscle and high BMI fat mass (FM). BIA-derived lean and FM is directly associated with morbidity and mortality. To the contrary, BMI is rather of limited use for measuring BF% in epidemiological studies. © 2013 Macmillan Publishers Limited All rights reserved.