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Juhl B.,Aarhus University Hospital | Lauszus F.F.,Herning Hospital | Lykkesfeldt J.,Copenhagen University
Nutrients | Year: 2017

Vitamin C (vitC) is essential for normal pregnancy and fetal development and poor vitC status has been related to complications of pregnancy. We have previously shown lower vitC status in diabetic women throughout pregnancy compared to that of non-diabetic controls. Here, we evaluate the relationship between vitC status late in diabetic pregnancy in relation to fetal outcome, complications of pregnancy, diabetic characteristics, and glycemic control based on data of 47 women from the same cohort. We found a significant relationship between the maternal vitC level > or ≤ the 50% percentile of 26.6 µmol/L, respectively, and the umbilical cord blood vitC level (mean (SD)): 101.0 µmol/L (16.6) versus 78.5 µmol/L (27.8), p = 0.02; n = 12/16), while no relation to birth weight or Apgar score was observed. Diabetic women with complications of pregnancy had significantly lower vitC levels compared to the women without complications (mean (SD): 24.2 µmol/L (10.6) vs. 34.6 µmol/L (14.4), p = 0.01; n = 19 and 28, respectively) and the subgroup of women (about 28%) characterized by hypovitaminosis C (<23 µmol/L) had an increased relative risk of complications of pregnancy that was 2.4 fold higher than the one found in the group of women with a vitC status above this level (p = 0.02, 95% confidence interval 1.2–4.4). No correlation between diabetic characteristics of the pregnant women and vitC status was observed, while a negative association of maternal vitC with HbA1c at delivery was found at regression analysis (r = −0.39, p < 0.01, n = 46). In conclusion, our results may suggest that hypovitaminosis C in diabetic women is associated with increased risk of complications of pregnancy. © 2017 by the authors. Licensee MDPI, Basel, Switzerland.

Liv P.,University of Gävle | Liv P.,Umeå University | Mathiassen S.E.,University of Gävle | Svendsen S.W.,Herning Hospital
Annals of Occupational Hygiene | Year: 2011

Objectives: To investigate the statistical efficiency of strategies for sampling upper arm elevation data, which differed with respect to sample sizes and sample allocations within and across measurement days. The study was also designed to compare standard theoretical predictions of sampling efficiency, which rely on several assumptions about the data structure, with 'true' efficiency as determined by bootstrap simulations.Methods: Sixty-five sampling strategies were investigated using a data set containing minute-by-minute values of average right upper arm elevation, percentage of time with an arm elevated <15°, and percentage of time with an arm elevated >90° in a population of 23 house painters, 23 car mechanics, and 26 machinists, all followed for four full working days. Total sample times per subject between 30 and 240 min were subdivided into continuous time blocks between 1 and 240 min long, allocated to 1 or 4 days per subject. Within day(s), blocks were distributed using either a random or a fixed-interval principle. Sampling efficiency was expressed in terms of the variance of estimated mean exposure values of 20 subjects and assessed using standard theoretical models assuming independence between variables and homoscedasticity. Theoretical performance was compared to empirical efficiencies obtained by a nonparametric bootstrapping procedure.Results: We found the assumptions of independence and homoscedasticity in the theoretical model to be violated, most notably expressed through an autocorrelation between measurement units within working days. The empirical variance of the mean exposure estimates decreased, i.e. sampling efficiency increased, for sampling strategies where measurements were distributed widely across time. Thus, the most efficient allocation strategy was to organize a sample into 1-min block collected at fixed time intervals across 4 days. Theoretical estimates of efficiency generally agreed with empirical variances if the sample was allocated into small blocks, while for larger block sizes, the empirical 'true' variance was considerably larger than predicted by theory. Theory overestimated efficiency in particular for strategies with short total sample times per subject.Conclusions: This study demonstrates that when exposure data are autocorrelated within days - which we argue is the major reason why theory overestimates sampling performance - sampling efficiency can be improved by distributing the sample widely across the day or across days, preferably using a fixed-interval strategy. While this guidance is particularly valid when small proportions of working days are assessed, we generally recommend collecting more data than suggested by theory if a certain precision of the resulting exposure estimate is needed. More data per se give a better precision and sampling larger proportion(s) of the working day(s) also alleviate the negative effects of possible autocorrelation in data. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. © The Author 2011. Published by Oxford University Press [on behalf of the British Occupational Hygiene Society.].

Hammer A.,Herning Hospital | Lauszus F.F.,Herning Hospital | Petersen A.C.,University of Aalborg
Acta Obstetricia et Gynecologica Scandinavica | Year: 2013

Granulosa cell tumor of the ovary (GCT) is a rare neoplasm. The tumor often secretes estrogens and then presents at an earlier stage due to hormone-related symptoms. GCT women are at increased risk of endometrial carcinoma, but there is only limited information about GCTs and potential association to other hormone-related neoplasms such as breast cancer. We conducted a retrospective follow-up study on 163 women with GCT. Medical records and histological sections were reviewed and a search in the pathology registry performed. Eight [95% confidence interval (CI); 3.4-15.8] GCT women were diagnosed with a breast neoplasm; one with Paget's disease of the nipple and seven with breast carcinoma. Based on calculations using incidence rates on breast cancer among Danish women, we would have expected 2.5 cases of breast cancer. The odds ratio was 3.3 (95% CI, 1.6-6.6), suggesting an increased risk of breast cancer in GCT women. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Background: Intensive treatment of patients with type 1 diabetes delays the onset of long-term complications. Objectives: On the basis of the information from two nation-wide quality registers, we investigated to which extent HbA1c values 3-15months after diagnosis in childhood are related to metabolic control, albuminuria, and retinopathy in early adulthood. Methods: In Sweden, physicians register all children and adolescents with type 1 diabetes mellitus in the Swedish Pediatric Quality Registry. After 18yr of age, people with diabetes are followed by the Swedish National Diabetes Register. We identified 1543 children and adolescents with a mean age of 13.9yr at diagnosis and a mean duration of type 1 diabetes mellitus of 7.1yr. Results: Children and adolescents with poor metabolic control (mean HbA1c ≥ 70mmol/mol (8.6 %)) adjacent to diagnosis had a significantly higher mean HbA1c value years later as adults than did patients with a good metabolic control [<50mmol/mol (6.7%) (p<0.001)]. The patients in the high group were also less physically active and smoked more as adults. The proportion of females was higher in the poor metabolic group. Patients with a high mean HbA1c 3-15months after diagnosis had significantly more often macroalbuminuria and retinopathy in early adulthood. Conclusions: Metabolic control adjacent to the diagnosis of type 1 diabetes in childhood or adolescence can predict metabolic control in early adulthood. It is therefore very important that pediatric diabetes teams identify key factors for successful early metabolic control. Actively using quality registries may be one such factor. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Wittbrodt P.,Herning Hospital | Haase N.,Rigshospitalet | Butowska D.,Copenhagen University | Winding R.,Herning Hospital | Poulsen J.B.,Rigshospitalet
Critical Care | Year: 2013

Introduction: The effects of hydroxyethyl starch (HES) on patient-centered outcome measures have not been fully described in patients with severe sepsis. We assessed health-related quality of life (HRQoL) and the occurrence of pruritus in patients with severe sepsis randomized to resuscitation with HES 130/0.42 or Ringer's acetate.Methods: We did post hoc analyses of the Danish survivors (n = 295) of the 6S trial using mailed questionnaires on self-perceived HRQoL (Short Form (SF) - 36) and pruritus.Results: Median 14 months (interquartile range 10 to 18) after randomization, 182 (61%) and 185 (62%) completed questionnaires were obtained for the assessment of HRQoL and pruritus, respectively. Responders were older than nonresponders, but characteristics at randomization of the responders in the HES vs. Ringer's groups were comparable. At follow-up, the patients in the HES group had lower mental component summary scores than those in the Ringer's group (median 45 (interquartile range 36 to 55) vs. 53 (39 to 60), P = 0.01). The group differences were mainly in the scales of vitality and mental health. There was no difference in the physical component summary scores between groups, but patients in the HES group scored worse in bodily pain. Forty-nine percent of patients allocated to HES had experienced pruritus at any time after ICU discharge compared to 43% of those allocated to Ringer's (relative risk 1.13, 95% confidence interval 0.83 to 1.55, P = 0.43).Conclusions: At long-term follow-up patients with severe sepsis assigned to resuscitation with HES 130/0.42 had worse self-perceived HRQoL than those assigned to Ringer's acetate whereas there were no statistically significant differences in the occurrence of pruritus. © 2013 Wittbrodt et al.; licensee BioMed Central Ltd.

Trolle B.,Aarhus University Hospital | Lauszus F.F.,Herning Hospital | Frystyk J.,Aarhus University Hospital | Flyvbjerg A.,Aarhus University Hospital
Fertility and Sterility | Year: 2010

Objective: To evaluate the effect of metformin in polycystic ovary syndrome (PCOS). As follow-up on a previous paper describing hormonal and metabolic factors, this paper focuses on correlations between adiponectin and anthropometric, hormonal, and metabolic factors in PCOS and the effect of metformin. Design: Randomized, double-blind, placebo-controlled crossover study. Setting: District and university hospital. Patient(s): Fifty-two women with PCOS. Three groups were defined according to baseline adiponectin. Intervention(s): Metformin or placebo for 6 months, followed by 3 months' washout before switching to opposite treatment. Blood tests and measurements were performed before and after treatment periods. Main Outcome Measure(s): Adiponectin, insulin, homeostasis model assessment (HOMA) index, and testosterone. Result(s): Waist-hip ratio (WHR), insulin, and HOMA index were significantly higher in the lower adiponectin group than in the upper and middle group, and high-density lipoprotein (HDL) cholesterol was higher in the upper than in the lower adiponectin group. Multiple regression analysis with adiponectin as the dependent variable and HOMA index, HDL cholesterol, testosterone, and WHR as independent variables showed an R2 of 0.43 with β-coefficients of -0.12 for the HOMA index, 0.72 for HDL cholesterol, and -1.49 for WHR. Testosterone did not contribute to the prediction of adiponectin levels. Metformin had no effect on adiponectin in spite of significant decreases in weight, fasting glucose, and insulin resistance. Conclusion(s): In PCOS, adiponectin levels are closely linked to insulin resistance, HDL cholesterol, and abdominal adiposity and unaffected by metformin. Copyright © 2010 American Society for Reproductive Medicine, Published by Elsevier Inc.

Svendsen S.W.,Herning Hospital | Frost P.,Aarhus University Hospital | Jensen L.D.,Aarhus University Hospital
Scandinavian Journal of Rheumatology | Year: 2012

Objectives: Three previous randomized controlled trials found no overall difference in the effect of surgery compared with non-surgical treatment including exercise for patients with non-traumatic shoulder disorders. We assessed Danish temporal trends in the incidence of surgery for rotator cuff-related shoulder disorders, frozen shoulder, and osteoarthritis (OA) of the acromioclavicular (AC) joint, and the subsequent risk of permanent work disability. Methods: Based on registers, we calculated annual incidence rates for the Danish population aged 1863 years between 1996 and 2008. For a cohort of 19 264 first-time shoulder-operated patients who were in the labour market on admission, we used Cox proportional hazards models to assess risk of permanent work disability within 2 years after surgery. Results: The annual incidence increased from 3.5 to 14.8 per 10 000, and 9.8% of the patients became permanently work disabled. No time trend was observed in this percentage. Formal education level was an important prognostic factor. Using 'higher or medium-level education' as a reference, the hazard ratio (HR) was 1.5 [95% confidence interval (CI) 1.31.8] for 'vocational education and training' and 2.0 (95% CI 1.82.3) for 'low education level'. For 'missing information on education', the HR was 0.7 (95% CI 0.60.9). Conclusions: We found a fourfold increase in surgery rates and a substantial risk of postoperative permanent work disability that remained constant over time. The risk was related to education level. These findings suggest that indications for surgery may need to be revisited and that attention should be given to supporting return to work, especially for blue-collar workers. © 2011 Informa Healthcare on behalf of The Scandinavian Rheumatology Research Foundation.

Lauszus F.F.,Herning Hospital
Current Hypertension Reviews | Year: 2016

The most recent Cochrane reviews on oral antihypertensive drugs in pregnancy conclude that no substantial benefits for the mother or fetus are demonstrated so far. Whether this applies for a high-risk and diabetic pregnancy is doubtful. The aim of this short review is an introduction to the field of ambulatory blood pressure measurements in pregnancy and in particular in women with type 1 diabetes. Diabetic pregnancy is complicated with a 50% risk of hypertension/preeclampsia. In the nonpregnant, diabetic women minute increases in blood pressure as well as in albuminuria are forerunners for incipient and overt nephropathy. Medication is essential and can conserve renal function, modifying the risk of renal insufficiency. During pregnancy, renal insufficiency in women with diabetes leads to termination of pregnancy. Therefore, detection of minute changes based on reliable measurements in this high-risk population is invaluable to protect the mother’s kidney function and, if possible, prolong pregnancy for the benefit of the fetus. Estimates of risk by blood pressure evaluation in these women are influenced by pregnancy per se and diabetes vasculopathy. Several factors have to be considered as few monitors are validated for use in pregnancy and not many of the different methodologies have undergone thorough investigation. The use of absolute values of blood pressure have the advantage that fewer assumptions are necessary on how blood pressure behaves due to modes of evaluation and biological rhythm. Monitors should be chosen with care considering the clinical setting, timing, and population, which influences the outcome, thus, the monitors ought to be validated for the specific condition they are applied for. The strategy for the studies used for safe conclusions in this brief review was chosen with priority of the papers with the best, validated methodology on BP measurements, which is by no way guaranteed in numerous recent publications. Inherent characteristics of the measurements to be considered are reproducibility, consistency, precision, and trend over scale of measurement. Studies on these issues suggest that consistency and precision depend on which monitor is used. During pregnancy, the reproducibility and specificity depend on the timing and whether measurements are performed repeatedly. Over- and underestimations of blood pressure are typical for 24-h monitoring in high- as well as low risk pregnancies. Preeclampsia is associated with urinary albumin excretion rate, reduced night/day ratio, and elevated diurnal blood pressure from first trimester and onwards. However, due to blunting of the diurnal variation, the night/day rhythm provides no good prediction of preeclampsia. Diurnal measurement is a valuable estimate of blood pressure in terms of sensitivity, specificity, and predictive values. © 2016 Bentham Science Publishers.

Pedersen L.M.,Herning Hospital | Nielsen K.J.,Herning Hospital | Kines P.,Helmholtz Center Munich
Safety Science | Year: 2012

Recent debates regarding the criteria for evaluating occupational health and safety interventions have focused on the need for incorporating qualitative elements and process evaluation, in addition to attempting to live up to the Cochrane criteria. Reflecting fundamental epistemological conflicts and shortcomings of the Cochrane criteria in evaluating intervention studies, the debate challenges the traditional (quasi-) experimental design and methodology, which are often used within safety research. This article discusses a revised 'realistic evaluation' approach as a way to meet these challenges. Evidence from the literature as well as examples from an integrated (leader-based/worker-based) safety intervention study (2008-2010) in a large wood manufacturing company are presented, with focus on the pros and cons of using randomised-controlled-trials and a revised realistic evaluation model.A revised realistic evaluation model is provided which includes factors such as role behaviour, leader and worker motivation, underreporting of accidents/injuries, production pressure, unplanned organisational change and accounting for multilayer effects. These can be attained through qualitative and/or quantitative methods, allowing for the use of realistic evaluation in both large and small scale studies, as well as in systematic reviews. The revised realistic evaluation model offers a promising new way of designing and evaluating occupational safety research. This model can help safety science move forward in setting qualitative and/or quantitative criteria regarding context, mechanisms and processes for single studies and for reviews. Focus is not limited to whether the expected results appear or not, but include suggestions for what works for whom, under what circumstances, in what respects and how. © 2011 Elsevier Ltd.

Larsen P.S.,Copenhagen University | Strandberg-Larsen K.,Copenhagen University | Juhl M.,Copenhagen University | Svendsen S.W.,Herning Hospital | And 2 more authors.
Scandinavian Journal of Work, Environment and Health | Year: 2013

Objective Pelvic pain during pregnancy is a common ailment, and the disease is a major cause of sickness absence during pregnancy. It is plausible that occupational lifting may be a risk factor of pelvic pain during pregnancy, but no previous studies have examined this specific exposure. The aim of this study was to examine the association between occupational lifting and pelvic pain during pregnancy. Methods The study comprised 50 143 pregnant women, enrolled in the Danish National Birth Cohort in the period from 1996-2002. During pregnancy, the women provided information on occupational lifting (weight load and daily frequency), and six months post partum on pelvic pain. Adjusted odds ratios for pelvic pain during pregnancy according to occupational lifting were calculated by logistic regression. Results Any self-reported occupational lifting (>1 time/day and loads weighing >10 kg) was associated with an increased risk of pelvic pain during pregnancy as compared to no such lifting. A confounder-adjusted expo- sure-response relation was observed between self-reported total loads lifted and pelvic pain during pregnancy. Daily lifting of both medium (11-20 kg) and heavy loads (>20 kg) were associated with increased risk, and the highest risk was observed among women who lifted heavy loads independent of exposure to medium loads. Conclusion Occupational lifting may increase the risk of pelvic pain during pregnancy.

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