Research Center for Prevention and Health

Capital Region of Denmark, Denmark

Research Center for Prevention and Health

Capital Region of Denmark, Denmark
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Westergaard M.L.,Copenhagen University | Hansen E.H.,Copenhagen University | Glumer C.,Research Center for Prevention and Health | Glumer C.,University of Aalborg | And 2 more authors.
Cephalalgia | Year: 2014

Background: Case definitions of medication-overuse headache (MOH) in population-based research have changed over time. This study aims to review MOH prevalence reports with respect to these changes, and to propose a practical case definition for future studies based on the ICHD-3 beta. Methods: A systematic literature search was conducted to identify MOH prevalence studies. Findings were summarized according to diagnostic criteria. Results: Twenty-seven studies were included. The commonly used case definition for MOH was headache ≥15 days/ month with concurrent medication overuse ≥3 months. There were varying definitions for what was considered as overuse. Studies that all used ICHD-2 criteria showed a wide range of prevalence among adults: 0.5%-7.2%. Conclusions: There are limits to comparing prevalence of MOH across studies and over time. The wide range of reported prevalence might not only be due to changing criteria, but also the diversity of countries now publishing data. The criterion "headache occurring on ≥15 days per month with concurrent medication overuse can be applied in population- based studies. However, the new requirement that a respondent must have "a preexisting headache disorder has not been previously validated. Exclusion of other headache diagnoses by expert evaluation and ancillary examinations is not feasible in large population-based studies. © 2013 International Headache Society.


Shabanzadeh D.Mo.,Copenhagen University | Shabanzadeh D.Mo.,Research Center for Prevention and Health | Sorensen L.T.,Copenhagen University | Jorgensen T.,Research Center for Prevention and Health | And 2 more authors.
Gastroenterology | Year: 2016

Background & Aims No one knows exactly what proportion of gallstones cause clinical events among subjects unaware of their gallstone status. We investigated the long-term occurrence of clinical events of gallstones and associations between ultrasound observations and clinical events. Methods We analyzed data from 3 randomly selected groups in the general population of urban Copenhagen (age, 30-70 y) participating in an international study of cardiovascular risk factors (the Multinational mONItoring of trends and determinants in CArdiovascular disease study). In this study, participants (n = 6037) were examined from 1982 through 1994, and underwent abdominal ultrasound examinations to detect gallstones. Our study population comprised 664 subjects with gallstones; subjects were not informed of their gallstone status. Participants were followed up for clinical events through central registers until December 31, 2011. Independent variables included ultrasound characteristics, age, sex, comorbidity, and female-associated factors, which were analyzed using Cox regression. Results Study participants were followed up for a median of 17.4 years (range, 0.1-29.1 y); 99.7% of participants completed the study. A total of 19.6% participants developed events (8.0% complicated and 11.6% uncomplicated). Ten percent had awareness of their gallstones; awareness was associated with uncomplicated and complicated events. Stones larger than 10 mm were associated with all events (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.45-3.69), acute cholecystitis (HR, 9.49; 95% CI, 2.05-43.92), and uncomplicated events (HR, 2.55; 95% CI, 1.38-4.71), including cholecystectomy (HR, 2.69; 95% CI, 1.29-5.60). Multiple stones were associated with all events (HR, 1.68; 95% CI, 1.00-2.81), complicated events (HR, 2.52; 95% CI, 1.05-6.04), and common bile duct stones (HR, 11.83; 95% CI, 1.54-91). There was an association between gallstones more than 5 years old and acute cholecystitis. Female sex was associated with all and uncomplicated events. We found a negative association between participant age and all events, uncomplicated events, and acute cholecystitis. Comorbidities and female-associated factors (intake of birth control pills or estrogens and number of births) were not associated with events. Compared with men with a single stone of 10 mm or smaller (reference), women with multiple stones greater than 10 mm had the highest risk for events (HR, 11.05; 95% CI, 3.76-32.44; unadjusted absolute risk, 0.0235 events/person-years). Conclusions Fewer than 20% of subjects with gallstones develop clinical events. Larger, multiple, and older gallstones are associated with events. Further studies are needed to confirm the prediction rules. © 2016 AGA Institute.


Christensen A.I.,University of Southern Denmark | Ekholm O.,University of Southern Denmark | Glumer C.,Research Center for Prevention and Health | Glumer C.,University of Aalborg | Juel K.,University of Southern Denmark
European Journal of Public Health | Year: 2014

Background: While face-to-face interviews are considered the gold standard of survey modes, self-administered questionnaires are often preferred for cost and convenience. This article examines response patterns in two general population health surveys carried out by face-to-face interview and self-administered questionnaire, respectively. Method: Data derives from a health interview survey in the Region of Southern Denmark (face-to-face interview) and The Danish Health and Morbidity Survey 2010 (self-administered questionnaire). Identical questions were used in both surveys. Data on all individuals were obtained from administrative registers and linked to survey data at individual level. Multiple logistic regression analyses were used to examine the effect of survey mode on response patterns. Results: The non-response rate was higher in the self-administered survey (37.9%) than in the face-to-face interview survey (23.7%). Marital status, ethnic background and highest completed education were associated with non-response in both modes. Furthermore, sex and age were associated with non-response in the self-administered mode. No significant mode effects were observed for indicators related to use of health services, but significant mode effects were observed for indicators related to self-reported health-related quality of life, health behaviour, social relations and morbidity (long-standing illness). Conclusions: The same factors were generally associated with non-response in both modes. Indicators based on factual questions with simple answers categories were overall more comparable according to mode than indicators based on questions that involved more subjective assessments. Other measures such as efficiency and cost-effectiveness of the mode should also be considered when determining the most appropriate form of data collection. © 2013 The Author.


Ebstrup J.F.,Research Center for Prevention and Health | Eplov L.F.,Psychiatric University Center Ballerup | Pisinger C.,Research Center for Prevention and Health | Jorgensen T.,Research Center for Prevention and Health
Anxiety, Stress and Coping | Year: 2011

Ill-health resulting from chronic stress is influenced by personality traits leading to different ways of appraising and coping with life's daily hassles. Using a large population sample the study aimed to investigate possible associations between perceived stress and the personality dimensions of neuroticism, extroversion, openness, agreeableness, and conscientiousness, and to explore the role of general self-efficacy (GSE). A population-based cross-sectional study was conducted at the Research Centre for Prevention and Health, Denmark, in 2006-2008. Men and women (N=3471) aged 18-69, were randomly sampled in the suburbs of Copenhagen. We used the NEO Five-Factor Inventory (NEO-FFI), Cohen's Perceived Stress Scale and the General Self-Efficacy Scale. Negative associations were found between perceived stress and extroversion, conscientiousness, agreeableness, and openness - the latter initially non-significant - whilst neuroticism had a positive association. The associations with agreeableness and openness became positive and significant, respectively, when GSE was included. All five personality-stress models were mediated by GSE, with extroversion and conscientiousness having the strongest mediating effect. The strongest stress association was found for neuroticism. GSE was shown to change the impact and interpretation of the personality dimensions on perceived stress. These results indicate that GSE is an important factor to consider in the link between personality and perceived stress. © 2011 Taylor & Francis.


Friedrich N.,University of Greifswald | Thuesen B.,Research Center for Prevention and Health | Jrogensen T.,Research Center for Prevention and Health | Jrogensen T.,Copenhagen University | And 4 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - IGF-I has an almost 50% amino acid sequence homology with insulin and elicits nearly the same hypoglycemic response. Studies showed that low and high IGF-I levels are related to impaired glucose tolerance and to a higher risk of type 2 diabetes. The aim of the current study was to evaluate the association between IGF-I level and insulin resistance in a Danish general population. RESEARCH DESIGNANDMETHODS - Included were 3,354 adults, aged 19-72 years, from the cross-sectional Health 2006 study. The homeostasis model assessment of insulin resistance (HOMA-IR) was used as the index to estimate insulin resistance. Serum IGF-I levelswere determined by an immunoassay and grouped into quintiles (Q1-Q5). Linear or multinomial logistic regression analyses were performed. RESULTS - In the study population, 520 subjects (15.5%) had increased HOMA-IR values above 2.5. After adjustment for age, sex, physical activity, and waist-to-height ratio, a U-shaped association between IGF-I and HOMA-IR was found. Low IGF-I (Q1: odds ratio [OR] 1.65 [95% CI 1.16-2.34], P < 0.01) as well as high IGF-I (Q5: 1.96 [1.38-2.79], P < 0.01) levels were related to a higher odds of increased HOMA-IR values compared with subjects with intermediate (Q3) IGF-I levels. These associations remained statistically significant after the exclusion of subjects with type 2 diabetes and by using the updated computer HOMA2-IR model. CONCLUSIONS - Low- and high-normal IGF-I levels are both related to insulin resistance. The biological mechanism of this complex phenomenon has to be elucidated in more detail for future risk stratification. © 2012 by the American Diabetes Association.


Levenstein S.,Aventino Medical Group | Rosenstock S.,Hvidovre University Hospital | Jacobsen R.K.,Research Center for Prevention and Health | Jorgensen T.,Research Center for Prevention and Health
Clinical Gastroenterology and Hepatology | Year: 2015

Background & Aims: There is controversy over whether psychological stress contributes to development of peptic ulcers. We collected data on features of life stress and ulcer risk factors from a defined population in Denmark and compared these with findings of confirmed ulcers during the next 11-12 years. Methods: We collected blood samples and psychological, social, behavioral, and medical data in 1982-1983 from a population-based sample of 3379 Danish adults without a history of ulcer participating in the World Health Organization's MONICA study. A 0- to 10-point stress index scale was used to measure stress on the basis of concrete life stressors and perceived distress. Surviving eligible participants were reinterviewed in 1987-1988 (n= 2809) and 1993-1994 (n= 2410). Ulcer was diagnosed only for patients with a distinct breach in the mucosa. All diagnoses were confirmed by review of radiologic and endoscopic reports. Additional cases of ulcer were detected in a search of all 3379 subjects in the Danish National Patient Register. Results: Seventy-six subjects were diagnosed with ulcer. On the basis of the stress index scale, ulcer incidence was significantly higher among subjects in the highest tertile of stress scores (3.5%) than the lowest tertile (1.6%) (adjusted odds ratio, 2.2; 95% confidence interval [CI], 1.2-3.9; P< .01). The per-point odds ratio for the stress index (1.19; 95% CI, 1.09-1.31; P < .001) was unaffected after adjusting for the presence of immunoglobulin G antibodies against Helicobacter pylori in stored sera, alcohol consumption, or sleep duration but lower after adjusting for socioeconomic status (1.17; 95% CI, 1.07-1.29; P < .001) and still lower after further adjustments for smoking, use of nonsteroidal anti-inflammatory drugs, and lack of exercise (1.11; 95% CI, 1.01-1.23; P= .04). The risk for ulcer related to stress was similar among subjects who were H pylori seropositive, those who were H pylori seronegative, and those exposed to neither H pylori nor nonsteroidal anti-inflammatory drugs. On multivariable analysis, stress, socioeconomic status, smoking, H pylori infection, and use of nonsteroidal anti-inflammatory drugs were independent predictors of ulcer. Conclusions: In a prospective study of a population-based Danish cohort, psychological stress increased the incidence of peptic ulcer, in part by influencing health risk behaviors. Stress had similar effects on ulcers associated with H pylori infection and those unrelated to either H pylori or use of nonsteroidal anti-inflammatory drugs. © 2015 AGA Institute.


Bertelsen C.A.,Copenhagen University | Andreasen A.H.,Research Center for Prevention and Health | Jorgensen T.,Copenhagen University | Harling H.,Copenhagen University
Colorectal Disease | Year: 2010

Objective: The study aimed to identify risk factors for clinical anastomotic leakage (AL) after anterior resection for rectal cancer in a consecutive national cohort. Method: All patients with an initial first diagnosis of colorectal adenocarcinoma were prospectively registered in a national database. The register included 1495 patients who had had a curative anterior resection between May 2001 and December 2004. The association of a number of patient- and procedure-related factors with clinical AL after anterior resection was analysed in a cohort design. Results: Anastomotic leakages occurred in 163 (11%) patients. In a multivariate analysis, the risk of AL was significantly increased in patients with tumours located below 10 cm from the anal verge if no faecal diversion was undertaken (OR 5.37 5 cm (tumour level from anal verge), 95% CI 2.10-13.7, OR 3.57 7 cm, CI 1.81-7.07 and OR 1.96 10 cm, CI 1.22-3.10), in male patients (OR 2.36, CI 1.18-4.71), in smokers (OR 1.88, CI 1.02-3.46), and perioperative bleeding (OR 1.05 for intervals of 100 ml blood loss, CI 1.02-1.07). Conclusion: Anastomotic leakage after anterior resection for low rectal tumours is related to the level, male gender, smoking and perioperative bleeding. Faecal diversion is advisable after total mesorectal excision of low rectal tumours in order to prevent AL. © 2009 The Authors. Journal Compilation.


Krarup P.-M.,Copenhagen University | Jorgensen L.N.,Copenhagen University | Andreasen A.H.,Research Center for Prevention and Health | Harling H.,Copenhagen University
Colorectal Disease | Year: 2012

Aim Anastomotic leakage (AL) is a major challenge in colorectal cancer surgery due to increased morbidity and mortality. Possible risk factors should be investigated differentially, distinguishing between rectal and colonic surgery in large-scale studies to avoid selection bias and confounding. Method The incidence and risk factors associated with AL were analysed in an unselected nationwide prospective cohort of patient subjected to curative colonic cancer surgery with primary anastomosis and entered into The Danish Colorectal Cancer Group database between May 2001 and December 2008. Results AL occurred in 593 (6.4%) of 9333 patients. Laparoscopic surgery [odds ratio (OR) 1.34; 95% confidence interval (CI) 1.05-1.70; P=0.03); left hemicolectomy (OR 2.02; 95% CI 1.50-2.72; P=0.01) or sigmoid colectomy (OR 1.69; 95% CI 1.32-2.17; P=0.01); intra-operative blood loss (OR 1.04; 95% CI 1.01-1.07; P=0.03); blood transfusion (OR 10.27; 95% CI 6.82-15.45; P<0.001) and male gender (OR 1.41; 95% CI 1.12-1.75; P=0.02) were associated with AL in the multivariate analysis. Conclusion The main finding that a laparoscopic approach was associated with an increased risk of AL should prompt close future monitoring. There was no evidence that centralization of surgery to high-volume hospitals reduced the rate of AL. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.


Pisinger C.,Research Center for Prevention and Health | Aadahl M.,Research Center for Prevention and Health | Toft U.,Research Center for Prevention and Health | Jorgensen T.,Research Center for Prevention and Health
Preventive Medicine | Year: 2011

ObjectiveTo investigate motives, strategies and experiences to quit smoking and reasons to relapse as a function of socioeconomic status. MethodsA population-based study, Inter99, Denmark. Two thousand six hundred twenty-one daily smokers with a previous quit attempt completed questionnaires at baseline. Cross-sectional baseline-data (1999-2001) were analysed in adjusted regression analyses. Results: Consistent findings across the three indicators of socioeconomic status (employment, school education, higher education/vocational training): smokers with low socioeconomic status were significantly more likely than smokers with high socioeconomic status to report that they wanted to quit because smoking was too expensive (OR: 1.85 (1.4-2.4), for school education) or because they had health related problems (OR: 1.75 (1.4-2.2)). When looking at previous quit attempts, smokers with low socioeconomic status were significantly more likely to report that it had been a bad experience (OR: 1.41 (1.1-1.8)) and that they had relapsed because they were more nervous/restless/depressed (OR: 1.43 (1.1-1.8)). Conclusions: This study shows that smokers with low socioeconomic status have other motives to quit and other reasons to relapse than smokers with high socioeconomic status. Future tobacco prevention efforts aimed at smokers with low socioeconomic status should maybe focus on current advantages of quitting smoking, using high cost of smoking and health advantages of quitting as motivating factors and by including components of mental health as relapse prevention. © 2010 Elsevier Inc.


Sigurd L.B.,Research Center for Prevention and Health
Danish Medical Journal | Year: 2016

Introduction: Thyroid disorders are common with occurrence primarily determined by the availability of dietary iodine. Iodine fortification programmes are internationally recommended to ensure sufficient iodine intake in populations. An understanding of the role of thyroid hormone levels within the normal range, set points and etiological factors related to thyroid disease develop-ment is important for optimal prevention and treatment. Limited data, however, exist regarding the impact of iodine fortification on thyroid function development. Additionally, the relation be-tween body weight and thyrotropin (TSH) within the normal range and the role of female reproductive factors in the etiology of thyroid autoimmunity is debated. Objective: The aim of this PhD project was to analyse the effect of a nationwide iodine fortification programme on individual devel-opment in thyroid function and to identify concurrent determi-nants for the possible changes. Furthermore, we aimed to inves-tigate the association between weight and serum TSH change as well as the association between female reproductive factors and change in TSH and thyroid peroxidase antibody (TPO-Ab) status. Methods: A longitudinal population-based study of the DanThyr C1 cohort examined before (1997-1998) and after (2008-2010) the introduction of mandatory iodine fortification of salt on July 1 2000. A total of 2,465 individuals participated in the follow-up examination. The main outcome measure was change in serum TSH. Change in TPO-Ab status was additionally used in Paper III. Results: Urinary iodine excretion levels increased significantly during follow-up. Serum TSH also increased significantly, most pronounced in the region with the highest iodine intake, whereas the increase was not significant in the low-iodine-intake region. The presence of TPO-Ab at baseline and absence of goitre and multiple nodules were identified as determinants of TSH increase. Moreover, a low-normal TSH at baseline was a determinant of future decreased serum TSH, while likewise a high-normal base-line TSH values determined a TSH above normal reference range at follow-up. A positive association between 11-year serum TSH change and weight change was found, but without baseline body mass index being a determinant of future weight change and without baseline TSH being a determinant of future weight change. An inverse association between the time on HRT treat-ment and the risk of increased TPO-Ab status during follow-up was found, but the association was not significant when applying the Bonferroni adjusted significance level and not associated with TSH change. Parity, OCP use, abortions, age at menarche and menopausal status were associated neither with TSH change nor with increased TPO-Ab status during follow-up. Conclusion: TSH increased significantly, and the difference be-tween regions with different iodine intakes could indicate that iodine, at least partly, explains the TSH increase. The identified determinants of TSH change may indicate that susceptible indi-viduals were subject to well-known adverse effects of iodine fortification. The predictive value of TSH on future TSH levels suggests a gradual development of thyroid disease. Whether body weight and TSH are causally connected remains to be prov-en. These results are an important contribution to the discussion of the role of thyroid hormones level within the normal range, set points and the association with body weight. A minor role, if any, is suggested for the studied female reproductive factors in devel-opment of thyroid autoimmunity. The longitudinal study neither solves the problem of causality nor is of the optimal design to measure the impact of iodization of salt, but can be informative in the study of determinants. © 2016, Danish Medical Association. All rights reserved.

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