-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the Women's Health Initiative (WHI) hip fracture risk score in 15,648 postmenopausal Danish nurses. The algorithm was well calibrated for Denmark. However, the sensitivity was poor at common decision making thresholds. Obtaining sensitivity better than 80% led to a low specificity of 61.4%.
A new score based on data from the WHI has been designed to predict 5-year risk of hip fracture in postmenopausal women. The performance of the algorithm has not been validated in populations with different lifestyle characteristics and ethnicity. The aim of this study was to test the clinical performance of the algorithm in a large Danish cohort of postmenopausal Caucasian women against hip fracture.
The Danish Nurse Cohort is a prospective risk factor and hormone therapy (HT) study established in 1993. Participants in the present analysis were 15,648 postmenopausal nurses. The calibration and diagnostic performance of the WHI algorithm was evaluated using fracture events captured in the Danish National Hospital Registry.
During 5 years of follow-up, 122 participants suffered a hip fracture (1.8/1,000 person years). The WHI algorithm predicted that 107 hip fractures would occur, indicating an underestimation of the number of fractures by 12%. To obtain sensitivity better than 80%, the cut-off value for 5-year risk was set to 0.5%, which was accompanied by a low positive predictive value of 1.9% and a low specificity of 61.4%. The algorithm predicted too many fractures in HT-users (12 observed, 22 expected) and too few in non HT-users (107 observed, 81 expected).
While the WHI algorithm was well calibrated on the Danish population, the clinical utility of the WHI algorithm in Danish postmenopausal women was limited by poor sensitivity at common decision-making thresholds and suboptimal in non-HT-users.
Osteoporosis International 02/2010; 21(12):2135-42. · 4.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to analyze whether functional ability in daily activities among 75-year-old men and women is predicted by physical activity, isometric muscle strength and simple function tests. In this representative sample of a general population of 405 75-year-olds, isometric muscle strength and functional ability in daily activities were closely related (odds ratio of disability 1.2–2.1), stressing the importance of strength in the truncus, proximal and distal muscle groups for daily activities. There were strong correlations between physical activity, isometric muscle strength as well as simple function tests and ability to manage daily activities. Those with even light physical activities at least 2–4 h a week had significantly better functional ability than those with sedentary activities. Those with heavy physical activities further improved their functional abilities.
Scandinavian Journal of Medicine and Science in Sports 01/2007; 4(1):32 - 40. · 2.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: As part of the Danish WHO MONICA study, a register of patients with myocardial infarction was established in 1982, covering 11 municipalities in the western part of Copenhagen County, Denmark. During the period 1982-91, all cases of myocardial infarction among citizens aged 25-74 years were registered and validated according to the criteria set up for the WHO MONICA project. Short-term (28 days) and long-term (up to 15 years) survival in three periods were compared. The rate of mortality after a non-fatal myocardial infarction was compared with that of the general population, and causes of death were analyzed. Short-term survival did not change during the study period, whereas long-term survival improved for men but did not change for women. The excess mortality rate among female patients over that of the general population was due to ischemic heart disease, other cardiovascular diseases, cancer and other diseases. The excess mortality among male patients was due only to cardiovascular diseases.
Journal of Clinical Epidemiology 01/2002; 54(12):1244-50. · 4.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background: Growing awareness of risk factors for myocardial infarction (MI), continuous mass campaigns on lifestyle factors, increasing use of heart rehabilitation and improved treatment should imply decreases in the incidence, case-fatality and recurrence rates of MI. The purpose of the study was to assess trends in the incidence, case-fatality and recurrence rate of MI and to analyse whether any changes seen were due to a period or a cohort effect. Methods: The Danish MONICA population comprises all men and women aged 25–74 years in the period 1982–1991 living in a suburban area of Copenhagen, Denmark. Fatal and non-fatal attacks classified as definite MI and non-fatal attacks classified as possible MI were included. The incidence rate was analysed by Poisson regression, the case-fatality rate by logistic regression, and the rate of recurrence by Cox regression. Age–period–cohort analyses were carried out according to a method described by Clayton and Schifflers. Results: During the 10-year period a significant decrease in the incidence rate of MI was seen for men and women and for the rate of recurrent MI. The decrease in incidence and recurrence could not unambiguously be ascribed to a period or cohort effect. The rate of case-fatality after a first MI was not changed significantly during the period, whereas men and women had different trends in case-fatality after recurrent MI. Conclusions: In accordance with results from other Western countries we found a decline in the incidence and recurrence rate of MI. Contrary, the lack of a decrease in the case-fatality rate after a first MI was unexpected and difficult to explain.
European Journal of Epidemiology 11/2001; 17(12):1139-1145. · 4.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is a considerable gap between the recommended prevention of coronary heart disease (CHD) in the guidelines from the European Society of Cardiology and the actually conducted clinical practice in preventive cardiology. A new method for implementing the recommended clinical practice in preventive cardiology is described.
To develop a comprehensive and flexible health educational computer program (the PRECARD program) for individual coronary risk prediction and multifactorial prevention.
The PRECARD program contains a new coronary risk score (the Copenhagen Risk Score) for myocardial infarction and a model for calculating the effect of intervention. Two Danish population studies (n = 11,765) with 10 years of follow up were used to establish the risk score. The included risk factors were: age, sex, cholesterol (incl. HDL), systolic blood pressure, smoking, body mass index, diabetes, familial predisposition and previous heart disease. Nine randomized clinical trials were used to estimate the effect of intervention.
The findings in the Copenhagen Risk Score and the estimated effect of intervention deducted from the clinical trials were comparable to other similar studies. The PRECARD program gives a graphical or numerical presentation of absolute coronary risk, the potential benefit of intervention, the relative impact of modifiable risk factors and numbers needed to treat. The program compiles individually tailored health messages in print for the patient. The program can easily be adjusted to different regional risk scores, other end-points and languages.
The PRECARD program may promote the recommended clinical practice in preventive cardiology by serving as an integrated part of the lifestyle consultation.
Journal of Cardiovascular Risk 11/2001; 8(5):291-7.
-
[show abstract]
[hide abstract]
ABSTRACT: As part of the Danish contribution to the World Health Organization (WHO) MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Project, a register of patients with stroke was established in 1982. The purpose of the present study was to analyze long-term survival and causes of death after a first stroke and to compare them with those of the background population.
The study population comprised all subjects aged 25 years or older who were resident in a geographically defined region in Copenhagen County. All stroke events in the study population during 1982-1991 were ascertained and validated according to standardized criteria outlined for the WHO MONICA Project. After completion of the stroke registry at the end of 1991, all patients were followed up by record linkage to official registries. Standardized mortality ratios were calculated for various causes of death and periods after the stroke.
The estimated cumulative risks for death at 28 days, 1 year, and 5 years after onset were 28%, 41%, and 60%, respectively. Compared with the general population, nonfatal stroke was associated with an almost 5-fold increase in risk for death between 4 weeks and 1 year after a first stroke and a 2-fold increase in the risk for death subsequent to 1 year. The excess mortality rate in stroke patients was due mainly to cardiovascular diseases but also to cancer, other diseases, accidents, and suicide. The probability for long-term survival improved significantly during the observation period for patients with ischemic or ill-defined stroke.
Stroke is a medical emergency associated with a very high risk for death in the acute and subacute phases and with a continuous excess risk of death. Better prevention and management of strokes may improve the long-term survival rate.
Stroke 10/2001; 32(9):2131-6. · 5.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine trends in alcohol drinking in different educational groups.
Data from three cross-sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92 were analysed to estimate trends in abstention, moderate, heavy, and sporadic heavy alcohol use in relation to level of education, age and smoking. In total, 6,695 Danish men and women aged 30, 40, 50, and 60 years were included.
Alcohol drinking decreased in both men and women during the study period, but changes were only significant among the highest educated. In the highest educated men the prevalence of moderate alcohol use increased from 77 to 82%, while heavy alcohol use declined from 19 to 12%. In the highest educated women the prevalence of abstention increased from 15 to 22%, while moderate alcohol use declined from 78 to 68%.
During the 1980s, alcohol drinking decreased among the highest educated men and women and an educational gradient in alcohol drinking widened in men and attenuated in women.
Scandinavian Journal of Public Health 04/2001; 29(1):40-3. · 1.39 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The age-specific prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was estimated in 60-year-old individuals in 1996/97 and compared to the prevalence in 1974/75. The study also examined whether or not the change in prevalence of diabetes and IGT could be explained by changes in body mass index (BMI) and physical activity.
Diabetes and IGT were diagnosed by a standardized oral glucose tolerance test (OGTT) in two Danish population-based, age-specific, birth cohorts.
The prevalence of diabetes in 1996/97 was 12.3% among 60-year-old men and 6.8% among women, representing an increase in diabetes of 58% in men and 21% in women compared to 1974/75. The prevalence of IGT was 15.9% among men and 13.1% among women, representing increases of 109 and 16%, respectively. A concurrent increase in BMI in the 22-year period between the two studies explained the increase found in the prevalence of diabetes and IGT.
A marked increase in the prevalence of diabetes and IGT among 60-year-old individuals over a 22-year period was observed - especially in men. The increase was fully explained by a concurrent increase in BMI.
Diabetic Medicine 03/2001; 18(2):126-32. · 2.90 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Growing awareness of risk factors for myocardial infarction (MI), continuous mass campaigns on lifestyle factors, increasing use of heart rehabilitation and improved treatment should imply decreases in the incidence, case-fatality and recurrence rates of MI. The purpose of the study was to assess trends in the incidence, case-fatality and recurrence rate of MI and to analyse whether any changes seen were due to a period or a cohort effect.
The Danish MONICA population comprises all men and women aged 25-74 years in the period 1982-1991 living in a suburban area of Copenhagen, Denmark. Fatal and non-fatal attacks classified as definite MI and non-fatal attacks classified as possible MI were included. The incidence rate was analysed by Poisson regression, the case-fatality rate by logistic regression, and the rate of recurrence by Cox regression. Age-period-cohort analyses were carried out according to a method described by Clayton and Schifflers.
During the 10-year period a significant decrease in the incidence rate of MI was seen for men and women and for the rate of recurrent MI. The decrease in incidence and recurrence could not unambiguously be ascribed to a period or cohort effect. The rate of case-fatality after a first MI was not changed significantly during the period, whereas men and women had different trends in case-fatality after recurrent MI.
In accordance with results from other Western countries we found a decline in the incidence and recurrence rate of MI. Contrary, the lack of a decrease in the case-fatality rate after a first MI was unexpected and difficult to explain.
European Journal of Epidemiology 02/2001; 17(12):1139-45. · 4.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: With this study, we wanted to determine the incidence of symptom-giving pelvic girdle relaxation during pregnancy and the prevalence post partum, identify predisposing factors, and determine the frequency of sick leave. A total of 1600 pregnant women entered the study. The incidence during pregnancy was 14%, the prevalence two, six, and twelve months post partum was 5%, 4%, and 2%, respectively. Multivariate analysis indicated that the most important predisposing factor was pelvic pain in a previous pregnancy. Other factors were uncomfortable working conditions, lack of exercise, and previous low back and low abdominal pain. At least 37% of the women with symptom-giving pelvic girdle relaxation were on sick leave during pregnancy, on average for twelve weeks. Symptom-giving pelvic girdle relaxation is a considerable problem both in pregnancy and post partum. The occupational risk can possibly be prevented. The syndrome has a great social impact because of the high frequency of sick live.
Ugeskrift for laeger 10/2000; 162(36):4808-12.
-
[show abstract]
[hide abstract]
ABSTRACT: Pelvic pain in pregnancy appears to be a problem on the increase. This study was undertaken to describe and analyse the relationship between subjective symptoms, daily disability, and clinical findings in women with symptom-giving pelvic girdle relaxation in pregnancy. Out of 1600 pregnant women, 238 had pelvic pain. After a clinical examination 11 women were excluded due to low back pain. The rest, 227 women, was considered to have symptom-giving pelvic girdle relaxation during pregnancy. Symptom-giving pelvic girdle relaxation in pregnancy seriously interferes with many activities of daily living such as housekeeping, walking, working, and sexual life. The women's statements of pelvic pain are well correlated to the number of positive clinical tests. Symptom-giving pelvic girdle relaxation in pregnancy causes considerable disabilities concerning daily activities.
Ugeskrift for laeger 10/2000; 162(36):4813-7.
-
[show abstract]
[hide abstract]
ABSTRACT: The decline in cardiovascular mortality in Denmark during the 1980s has been greatest in the highest socioeconomic groups of the population. This study examines whether the increased social inequality in cardiovascular mortality has been accompanied by a different trend in cardiovascular risk factors in different educational groups.
Data from three cross sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92, were analysed to estimate trends in biological (weight, height, body mass index, blood pressure, and serum lipids) and behavioural (smoking, physical activity during leisure, and eating habits) risk factors in relation to educational status.
County of Copenhagen, Denmark.
6695 Danish men and women of ages 30, 40, 50, and 60 years.
The prevalence of smoking and heavy smoking decreased during the study but only in the most educated groups. In fact, the prevalence of heavy smoking increased in the least educated women. There was no significant interaction for the remaining biological and behavioural risk factors between time of examination and educational level, indicating that the trend was the same in the different educational groups. However, a summary index based on seven cardiovascular risk factors improved, and this development was only seen in the most educated men and women.
The difference between educational groups in prevalence of smoking increased during the 1980s, and this accounted for widening of an existing social difference in the total cardiovascular risk.
Journal of Epidemiology & Community Health 03/2000; 54(2):108-13. · 3.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A stroke register was established at the Glostrup Population Studies in 1982 with the objective to monitor stroke occurrence in the population continuously during a 10-year period and contribute data to the WHO Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Project. The purpose of the current analysis was to estimate temporal trends in stroke occurrence.
All stroke events in the study population were ascertained and validated according to standardized criteria outlined by the WHO MONICA Project. The study population comprised all subjects > or = 25 years of age. Stroke was defined by the clinical presentation. A total of 5262 stroke events in >2 million person-years were analyzed. Age-adjusted rates for first-ever stroke and for all stroke events were calculated and temporal trends estimated by means of Poisson regression.
The overall annual stroke attack rate per 100,000 person-years in the age range > or = 25 years was 272 in men and 226 in women. Age-adjusted stroke attack rates decreased among men by 3.9% per year and by 4.1% among women. Age-adjusted stroke incidence rates declined by 2.9% in men and by 3. 1% in women. The trends were statistically significant in both sexes. However, the proportion of elderly people in the study population increased during the time period of the study. Hence the numbers of stroke victims in the population remained largely unaltered.
Decreasing age-adjusted stroke incidence rates point to a reduction of stroke risk during the time period of the study. Cardiovascular prevention, in particular improved hypertension control, is believed to have contributed to the incidence reduction. However, the burden of stroke on the healthcare system did not substantially diminish. The gain likely achieved from reduction of preventable risk factors was almost counterbalanced by population aging.
Stroke 12/1999; 30(12):2529-34. · 5.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cardiovascular mortality has been declining in Denmark over the past 20 years. Trends in incidence of myocardial infarction (MI) over the period 1982-1991 are described within the framework of the World Health Organization MONICA Project.
The DAN-MONICA heart register included all cases of MI in 25-74-year-old men and women living in 11 municipalities around Glostrup County Hospital evolving over a period of 10 years. They were identified retrospectively based mainly on relevant ICD diagnoses in death certificates and hospital discharge reports. Cases meeting WHO-MONICA criteria for definite or possible MI, recurrent as well as first-ever MI, were registered. Subsequent tracing of cases through national registers on deaths and hospitalizations by means of the patient's civil registration number ensured the completeness of the registration.
A total of 6025 cases of MI occurred in the period, 4532 among men and 1493 among women. A total of 2923 men and 1047 women had a first-ever MI in the period. The age-standardized rates show a definite decline over the registration period for men and a less distinct decline for women.
The DAN-MONICA heart register meets the requirements for completeness and uniformity throughout the registration period. Causes and magnitude of bias are well described. Even when possible sources of bias are taken into account, the incidence of MI decreased significantly over the 10-year-period 1982-1991 by an average of 5.0% per year for men and 3.5% per year for women.
International Journal of Epidemiology 05/1999; 28(2):211-8. · 6.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Pelvic pain in pregnancy appears to be a problem that is increasing. This study was undertaken to describe and analyze the relationship between subjective symptoms, daily disability, and clinical findings in women with symptom-giving pelvic girdle relaxation in pregnancy
Out of 1600 pregnant women 238 had pelvic pain. After a clinical examination 11 women were excluded due to low back pain. The rest, 227 women, was considered having symptom-giving pelvic girdle relaxation during pregnancy.
Symptom-giving pelvic girdle relaxation in pregnancy seriously interferes with many activities of daily living such as housekeeping, walking, working, and sexual life. The women's statements of pelvic pain are well correlated to the number of positive clinical tests.
Symptom-giving pelvic girdle relaxation in pregnancy causes considerable disabilities concerning daily activities.
Acta Obstetricia Et Gynecologica Scandinavica 03/1999; 78(2):111-5. · 1.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Previous studies concerning symptom-giving pelvic girdle relaxation in pregnancy have to our knowledge been retrospective. We wanted to 1) determine the incidence during pregnancy and the prevalence two, six, and twelve months post partum, 2) identify possible predisposing factors, and 3) determine the frequency and duration of sicklisting, prospectively.
A cohort of 1600 consecutive pregnant women filled in a questionnaire. At the routine prenatal examinations they were asked about pelvic pain. Those who fulfilled the inclusion criteria were examined by a rheumatologist to confirm the diagnosis. The affected women were seen again two, six, and twelve months post partum. All participants were asked about sicklisting in pregnancy.
The incidence during pregnancy was 14%, the prevalence two, six, and twelve months post partum were 5%, 4%, and 2% respectively. Multivariate analysis indicates that the most important predisposing factor is pelvic pain in a previous pregnancy. Other factors were uncomfortable working conditions, lack of exercise, and previous low back pain and low abdominal pain. At least 37% of the women with symptom-giving pelvic girdle relaxation had been sicklisted in pregnancy due to pelvic pain, on average for twelve weeks.
Symptom-giving pelvic girdle relaxation is a considerable problem both in pregnancy and post partum. The occupational risk can possibly be prevented. The syndrome has a great social impact because of the frequent sicklisting.
Acta Obstetricia Et Gynecologica Scandinavica 03/1999; 78(2):105-10. · 1.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study examined whether self-reported tiredness in mobility and activities of daily living is predictive of mortality, when controlled for global self-rated health, smoking, and socio-demographic factors. The investigation is part of the 1984 longitudinal study of the residents of Glostrup, Denmark, born in 1914, and included 734 men and women who were interviewed about mobility, activities of daily living, self-rated health, smoking, and socio-demographic factors, when they were 70 years old. Ten years later, in November 1994, information about deaths was obtained from the Central National Register. When controlled for the other variables tiredness in mobility was an independent predictor of mortality during the next 10 years among both women and men. The finding persisted when the analysis was performed on a restricted sample of non-disabled 70-year-old people. The results in the present study indicate that we have identified a subgroup of independent elderly people who are at risk of dying earlier than others.
Journal of Clinical Epidemiology 04/1998; 51(4):323-33. · 4.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this article is to analyse item bias in a measure of self-reported functional ability among 75-year-old people in three Nordic localities. The present item bias analysis examines whether the construction of a functional ability index from several variables results in bias in relation to geographical locality and gender. Information about self-reported functional ability was gathered from surveys on 75-year-old men and women in Glostrup (Denmark), Göteborg (Sweden) and Jyväskylä (Finland). The data were collected by structured home interviews about mobility and Physical activities of daily living (PADL) in relation to tiredness, reduced speed and dependency and combined into three tiredness-scales, three reduced speed-scales and two dependency-scales. The analysis revealed item bias regarding geographical locality in seven out of eight of the functional ability scales, but nearly no bias in relation to gender in the combined data. The conclusion is that only one tiredness-scale (Lower Limb-T), one reduced speed-scale (Lower Limb-S) and the two dependency-scales (PADL-H and Mob-H) can be proposed for use in comparisons between the three localities (with removal of one or more items).
Scandinavian journal of social medicine 10/1996; 24(3):206-17.
-
[show abstract]
[hide abstract]
ABSTRACT: With the aim to assess the clustering of abdominal symptoms in a random population, data from a cohort study of a 70 year old Danish population were analysed. The cohort comprised 1,119 subjects of which 72% participated in a primary study and 91% of the survivors in a similar study five years later. The following clusters of symptoms were constantly associated. One group constituted abdominal distension, borborygmi, altering stool consistency and number of bowel movements. Pain relieved by bowel movement was associated with this cluster. Nausea and vomiting comprised another cluster. Heartburn/acid regurgitation did not show a consistent association to any other symptoms and may be considered as a cluster of it own. Pain characteristics traditionally related to upper dyspepsia did not specifically relate to any cluster. It is concluded that, in this 70-year-old population abdominal symptoms occur in clusters comparable to clusters in younger populations. The clusters, however, does not totally confirm the traditional concept of Upper Dyspepsia and Irritable Bowel Syndrome.
European Journal of Epidemiology 05/1996; 12(2):199-204. · 4.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The prognosis of patients with ulcerative colitis (UC) has previously been described with regard to mortality, cancer occurrence, and need for colectomy on the basis of an annual follow-up of a regional cohort of UC patients in Copenhagen County diagnosed in 1962-87. The objective of this study was to examine the prognosis with regard to spread of disease and to evaluate possible prognostic factors with regard to spread of disease and colectomy by multivariate regression analysis.
An inception cohort of 1161 patients with UC was examined by actuarial analysis and by multivariate regression analysis of a subgroup of 467 patients diagnosed in 1979-87.
The probability for further progression of proctosigmoiditis, evaluated by sigmoidoscopy and radiology, was 53% after 25 years. The probability for regression was 76.8% for substantial colitis and 75.7% for pancolitis after 25 years. Multivariate regression analysis showed that the occurrence of the symptoms abdominal pain and diarrhoea was prognostically unfavourable with regard to the progression from proctosigmoiditis. Age influenced the regression probability in extensive disease. With regard to colectomy the following variables influenced the prognosis: fever, general condition, serum albumin, mucopus in stools, and diarrhoea at onset.
Disease extent in UC is not static but changes with time in approximately half of the patients. This finding should have implications for the follow-up. Ulcerative proctitis should be considered the same disease as UC and needs the same long-term follow-up.
Scandinavian Journal of Gastroenterology 04/1996; 31(3):260-6. · 2.02 Impact Factor
