Infliximab Is Not Associated With a General Long-Term Weight Gain in Patients With Inflammatory Bowel Disease: A Nationwide Study.

INTRODUCTION: Patients with Crohn's disease (CD) and ulcerative colitis (UC) may lose weight during periods of active disease and may gain weight when inflammation heals. Studies have hypothesized an association between antitumor necrosis factor-alpha (anti-TNF-α) and unintended weight gain during maintenance therapy, and this association has not been previously clarified. METHODS: In a nationwide observational study based on Danish national health registries, we included patients who initiated therapy with infliximab and followed changes in weight during induction therapy (0-90 days) and maintenance therapy (91-270 days). The association between the use of infliximab and weight gain was analyzed by a multilevel mixed-effects linear regression model. RESULTS: Among 851 patients with CD and UC who initiated infliximab therapy, long-term weight gain was not observed during maintenance therapy in most of the patients. Women with CD who were underweight at the initiation of therapy had an average weight gain of 7.5 kg. Men and women with CD and UC with normal or increased body mass index had an average weight gain of <2 kg during maintenance therapy. Underweight men with CD and UC gained 2.9 kg (95% confidence interval 2.1-3.6) and 2.9 kg (95% confidence interval 1.9-3.9), respectively, in the first 90 days, although neither group had statistically significant weight gain in the maintenance period. Less than 3% of the patients had weight gain greater than 10% of their baseline body weight during the study period. DISCUSSION: Weight gain among patients treated with anti-TNF-α therapies is unlikely to be due to an effect from anti-TNF-α therapy.

Physical activity measured by accelerometry in paediatric and young adult patients with inflammatory bowel disease.

OBJECTIVES: Physical activity in paediatric and young adult patients suffering from inflammatory bowel disease (IBD) may play an important role in the overall health status. However, physical activity in these patients has not been reported using objective methods. We aimed to describe accelerometry-measured physical activity levels in paediatric and young adult IBD patients with either ulcerative colitis (UC) or Crohn's disease (CD). METHODS: We recruited Danish patients with IBD aged 10-20 years in clinical remission and with a faecal calprotectin below 200 µg/mg. Physical activity was assessed using tri-axial wrist accelerometry over seven days and quantified using the activity-related acceleration derived as the conventional Euclidian Norm Minus One (ENMO) metric expressed in milli-gravity units (mg). Time spent in Moderate-to-Vigorous Physical Activity (MVPA) was classified as ENMO > 210 mg in 5 s epoch resolution (unbouted). RESULTS: We included 61 patients with a median age of 17 years [Inter Quartile Range, IQR 14-19]. The total volume of activity expressed as average acceleration (ENMO) per day was 31.5 mg (95% CI 29.1-33.9). Time spent in unbouted MVPA was 32 min per day (95% CI 26-37). There was no significant difference in activity volume between patients with UC to patients with CD, the adjusted linear regression coefficient was - 1.7 mg (95% CI -6.2-2.7). Activity volume was higher for males (36.2 mg, 95% CI 31.9-40.5) than for females (27.8 mg, 95% CI 25.6-30.0), and younger patients were more active than older patients; Activity volume in 10-13 year olds was 37.2 mg (95% CI 28.6-45.7), whereas it was 28.5 mg (95% CI 25.2-31.7) for those aged 18-20 years. CONCLUSIONS: We collected tri-axial accelerometry in young patients with IBD in clinical remission, and described their level of physical activity by the conventional ENMO measure. We found no statistically significant difference in patients with UC compared to patients with CD. The volume of physical activity was higher in males compared to females, and inversely associated with age.

Outcome of COVID-19 in hospitalized patients with chronic inflammatory diseases. A population based national register study in Denmark.

OBJECTIVE: COVID-19 has substantial morbidity and mortality. We studied whether hospitalized patients with COVID-19 and chronic inflammatory diseases experienced worse outcomes compared to patients hospitalized with COVID-19 without chronic inflammatory diseases. METHODS: Danish nationwide registers were used to establish a cohort of hospitalized patients with COVID-19 and inflammatory bowel diseases (IBD), rheumatoid arthritis (RA), spondyloarthropathy (SpA), or psoriatic arthritis (PsA) (exposed), and a control cohort without these diseases (unexposed) between March 1, 2020, and October 31, 2020. We compared median length of hospital stay, used median regression models to estimate crude and adjusted differences. When estimating crude and adjusted odds ratio (OR) for continuous positive airway pressure (CPAP) and mechanical ventilation, in-hospital death, 14-day and 30-day mortality, we used logistic regression models. RESULTS: We identified 132 patients with COVID-19 and IBD, RA, SpA, or PsA, and 2811 unexposed admitted to hospital with COVID-19. There were no differences between exposed and unexposed regarding length of hospital stay (6.8 days vs. 5.5 days), need for mechanical ventilation (7.6% vs. 9.4%), or CPAP (11.4% vs. 8.8%). Adjusted OR for in-hospital death was 0.71 (95% CI 0.42-1.22), death after 14-days 0.70 (95% CI 0.42-1.16), and death after 30-days 0.68 (95% CI 0.41-1.13). CONCLUSION: Hospitalized patients with COVID-19 and chronic inflammatory diseases did not have statistically significant increased length of hospital stay, had same need for mechanical ventilation, and CPAP. Mortality was similar in hospitalized patients with COVID-19 and chronic inflammatory diseases, compared to patients hospitalized with COVID-19 and no chronic inflammatory diseases.

Hospitalization for COVID-19 in patients treated with selected immunosuppressant and immunomodulating agents, compared to the general population: A Danish cohort study.

AIMS: In the Danish population, we examined whether patients treated with thiopurines, methotrexate, systemic corticosteroids, anti-tumour necrosis factor (TNF)-α agents, anti-interleukin therapeutic agents, selective immunosuppressive agents and cyclosporine/tacrolimus had an increased risk of hospitalization for COVID- 19, compared to the background population. METHODS: A nationwide cohort study including all people alive in Denmark on 1 March 2020. Exposed patients constituted those exposed to thiopurines (n = 5484), methotrexate (n = 17 977), systemic corticosteroids (n = 55 868), anti-TNF-α agents (n = 17 857), anti-interleukin therapeutic agents (n = 3744), selective immunosuppressive agents (n = 3026) and cyclosporine/tacrolimus (n = 1143) in a period of 12 months prior to 1 March 2020 (estimated time of outbreak in Denmark). We estimated the adjusted risk of hospitalization for COVID-19 for patients treated with the above-mentioned categories of medications, compared to the rest of the population. RESULTS: The adjusted odds ratios of hospitalization in patients treated with corticosteroids and cyclosporine/tacrolimus were 1.64 (95% confidence interval [CI] 1.35 to 2.00) and 4.75 (95% CI 1.96 to 11.49), respectively. The risks of hospitalization in patients treated with thiopurines, methotrexate, and anti-TNF-α agents, were 1.93 (95% CI 0.91 to 4.08), 0.74 (95% CI 0.43 to 1.28), 1.00 (95% CI 0.52 to 1.94), respectively. The number of outcomes in patients treated with anti-interleukin therapeutic agents and selective immunosuppressive agents was too small for analysis. CONCLUSION: Patients treated with systemic corticosteroids and cyclosporine/tacrolimus had a significantly increased risk of being hospitalized for COVID-19. Our study does not uncover whether the increased risk is related to the drug itself, the underlying condition for which the patient is treated or other factors.

The Danish National Register of assisted reproductive technology: content and research potentials.

The Danish National Register of assisted reproductive technology (ART) was initially established in 1994. The register comprises complete information on all ART procedures in public and private clinics in Denmark from 2013 and onwards, including baseline information on the cause of infertility and a number of health-related patient characteristics. The register enables monitoring and research on infertility treatment and reproductive topics in single women or couples seeking assisted reproduction, and the register is thus a key component of the Danish health information system within human reproduction. We aimed to provide an updated description of the register including advantages and pitfalls when using the register for reproductive epidemiological research, and a description of the accessibility for researchers. The Danish ART register is a valuable tool for epidemiological research. However, the inherent strengths and limitations ought to be in perspective when designing studies and interpreting the study results. Reports with annually aggregated data on ART treatments, can be accessed on the Danish Health Data Authority web page and researchers may obtain access to individual pseudonomized data via secure servers at the Danish Health Data Authority and Statistics Denmark.

Body mass index influences the risk of reoperation after first-time surgery for pelvic organ prolapse. A Danish cohort study, 2010-2016.

INTRODUCTION AND HYPOTHESIS: The aims of this study were to evaluate the impact of body mass index (BMI) on the risk of reoperation for pelvic organ prolapse (POP) up to 5 years after first-time surgery. MATERIALS AND METHODS: This nationwide register-based study includes first-time POP surgery in 2010 through 2016. The cumulative incidence proportions of reoperation were analyzed in a Cox regression model and described using Kaplan-Meier plots stratified in BMI categories. RESULTS: A total of 28,533 first-time procedures were performed in 22,624 women; 76.6% had single-compartment repair. The 1- and 5-year reoperation rate within the same compartment was 2.6% and 6.1% respectively for women with BMI < 25, and for women with BMI > 35 it was 3.7% and 11.2 respectively. In the anterior compartment there was a significantly increased adjusted hazard ratio for reoperation in the same compartment with increasing BMI (reference group BMI < 25), BMI 30-34.9 with an aHR = 1.34 (CI 95% 1.04-1.71) and BMI ≥ 35 aHR = 1.77 (CI 95% 1.17-2.67). The 1- and 5-year reoperation rate in an adjacent compartment was 0.6% and 1.6% respectively for women with BMI < 25, and for women with BMI > 35 it was 1.0% and 4.4 respectively. For reoperation in an adjacent compartment the adjusted results were BMI 30-34.9 aHR = 1.64 (95% CI 1.05-2.56) and BMI > 35 aHR = 2.64 (95% CI 1.36-5.14) when the first-time operation was in the anterior compartment. CONCLUSIONS: If the woman had BMI > 35 and first-time surgery was in the anterior compartment, she had an almost doubled risk of reoperation within 5 years both in the same compartment and in an adjacent compartment compared to women with BMI < 35. In the apical and posterior compartment there was a trend towards increasing risk of reoperation with increasing BMI, although with a broad confidence interval.

Surgical repair of vaginal vault prolapse; a comparison between ipsilateral uterosacral ligament suspension and sacrospinous ligament fixation-a nationwide cohort study.

INTRODUCTION AND HYPOTHESIS: Hysterectomy is frequently performed and associated with increased risk of subsequent genital prolapse including vaginal vault prolapse. Ipsilateral uterosacral ligament suspension (IUSLS) and sacrospinous ligament fixation (SSLF) are two commonly performed surgical techniques to treat vaginal vault prolapse. There is no consensus on the ideal operation technique. The aim of this study was to compare IUSLS and SSLF to treat vaginal vault prolapse based on the number of repeat surgeries. METHODS: Previously hysterectomized patients operated on with IUSLS or SSLF in Denmark in 2010-2016 were included in this nationwide register-based cohort study and followed until June 2017. Data were obtained from Danish National Databases, to which reporting is mandatory by law, entailing high validity and completeness of data. Data were analyzed using Cox proportional hazard regression analysis adjusted for age, preoperative prolapse stage, smoking, BMI, and previous prolapse surgery. RESULTS: In total, 744 patients were included; 384 underwent IUSLS while 360 underwent SSLF. After 5 years, 6.5% of patients operated on with IUSLS and 21.8% operated on with SSLF had a repeat surgery in the apical compartment and 12.4% and 30.6% in any compartment, respectively. The risk of repeat surgery was 4.8 times higher after SSLF compared to IUSLS [confidence interval (CI): 2.7-8.4] in the apical compartment and 2.4 times higher (CI: 1.2-5.1) in the anterior compartment. No difference was seen in the posterior compartment. CONCLUSIONS: This study finds significantly higher numbers of repeat surgeries after SSLF compared to after IUSLS in a Danish nationwide cohort.

Live-born children after assisted reproduction in women with type 1 diabetes and type 2 diabetes: a nationwide cohort study.

AIMS/HYPOTHESIS: Type 1 and type 2 diabetes are among the most prevalent chronic diseases in women in the fertile years and women with diabetes may experience several reproductive issues. We aimed to examine the chance of biochemical pregnancy, clinical pregnancy and live birth after assisted reproductive technology (ART) treatment in women with type 1 and type 2 diabetes and whether obesity per se influenced the results. METHODS: This nationwide register-based cohort study is based on the Danish ART Registry comprising 594 women with either type 1 diabetes or type 2 diabetes from 2006 to 2017. RESULTS: Relative to women without diabetes, the adjusted OR (95% CI) of a live birth per embryo transfer was 0.50 (0.36, 0.71) in women with type 2 diabetes and 1.10 (0.86, 1.41) in women with type 1 diabetes. CONCLUSIONS/INTERPRETATION: Our data on the efficacy of ART treatment in women with type 1 and type 2 diabetes is the first in this field. When compared with women without diabetes, women with type 1 diabetes had an equivalent chance of a live birth per embryo transfer whereas women with type 2 diabetes had a reduced chance. The findings in women with type 2 diabetes did not seem to be driven by obesity per se as the same pattern was seen in both normal-weight and obese women. Graphical abstract.

The efficacy of assisted reproductive treatment in women with epilepsy.

RESEARCH QUESTION: The question of interest for this study was to examine the chance of a live birth following assisted reproductive technology (ART) treatment in women with epilepsy compared with women without epilepsy. In sub-analyses, the chance of biochemical and clinical pregnancies, and the impact of antiepileptic drugs (AED) treatment prior to embryo transfer, was analysed. DESIGN: This register-based cohort study was based on the Danish ART register comprising all women who underwent embryo transfer during 2006 to 2017, which included 730 ART treatments in 264 women with a history of epilepsy, and 128,387 ART treatments in 42,938 women without epilepsy. Adjustments were made for comorbidity, women's age, calendar year, type of infertility treatment and cause of infertility. A possible impact of AED use at the time of embryo transfer was studied in a sub-analysis. The primary outcome was live birth within a period of 140-308 days after the date of embryo transfer. RESULTS: The adjusted odds ratio for a live birth per embryo transfer in women with epilepsy, relative to women without epilepsy, was 1.06 (95% confidence interval [CI] 0.88-1.28). The adjusted odds ratio for a live birth among users of an AED was 1.22 (95% CI 0.77-1.92) relative to women who had stopped the use of AED prior to embryo transfer. CONCLUSIONS: The chances of a live birth per embryo transfer were similar in women with and without epilepsy. These are novel and reassuring findings on the efficacy of infertility treatment in women with epilepsy.

Live birth in women with multiple sclerosis receiving assisted reproduction.

RESEARCH QUESTION: Multiple sclerosis is predominant in women during the childbearing years and, in case of problems with conceiving naturally, assisted reproductive technology (ART) becomes relevant. The efficacy of ART treatment in women with multiple sclerosis has not previously been studied. Our aim was to examine the chance of a liveborn infant after an embryo transfer in women with multiple sclerosis and to examine whether corticosteroids before embryo transfer had a beneficial effect. DESIGN: This cohort study is based on nationwide Danish health registries, including all women who underwent embryo transfers between 1 January 1995 to 31 December 2017. The exposed cohort comprised 2267 embryo transfers in women with multiple sclerosis and the unexposed cohort comprised 200,684 in women without multiple sclerosis. Multilevel logistic regression analysis was used to compute the crude and the adjusted risk estimates. RESULTS: A total of 21.97% of the embryo transfers in women with multiple sclerosis resulted in a liveborn infant compared with 24.17% in women without multiple sclerosis, and the adjusted odds ratio was 0.91 (95% CI 0.81 to 1.02). The adjusted odds ratio of live birth in women with multiple sclerosis using corticosteroids before embryo transfer was 0.90 (95% CI 0.49 to 1.68), compared with women with multiple sclerosis receiving no corticosteroids. CONCLUSION: The chance of a live birth was not decreased in women with multiple sclerosis undergoing ART compared with women without multiple sclerosis. The use of corticosteroids had no effect on the result. These novel results on ART treatment are useful when counselling women with multiple sclerosis undergoing assisted reproduction.

Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study.

OBJECTIVES: No studies have examined the efficacy of assisted reproductive technology (ART) treatment in women with rheumatoid arthritis. Therefore, we examined the chance of live birth after ART treatment in women with rheumatoid arthritis compared with women without rheumatoid arthritis. METHODS: Our cohort study is based on nationwide Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 30 June 2017. The cohorts comprised 1149 embryo transfers in women with rheumatoid arthritis, and 198 941 embryo transfers in women without rheumatoid arthritis. Our outcome was live birth per embryo transfer, and we controlled for multiple covariates in the analyses. In subanalyses, we examined a chance of biochemical/clinical pregnancy after ART and a possible impact of corticosteroid use prior to embryo transfer. RESULTS: The adjusted OR (aOR) for a live birth per embryo transfer in women with rheumatoid arthritis, relative to women without rheumatoid arthritis, was 0.78 (95% CI 0.65 to 0.92). The aORs for biochemical and clinical pregnancies were 0.81 (95% CI 0.68 to 0.95) and 0.82 (95% CI 0.59 to 1.15), respectively. Corticosteroid prescription prior to embryo transfer increased the OR for live birth (aOR=1.32 (95% CI 0.85 to 2.05)). CONCLUSIONS: The chance of a live birth was significantly reduced in women with rheumatoid arthritis receiving ART treatment, relative to women without rheumatoid arthritis, and our result suggested that the problem was related to an impaired chance of embryo implantation. The role of corticosteroid use prior to embryo transfer must be a subject for further research.

Surgical treatment of primary uterine prolapse: a comparison of vaginal native tissue surgical techniques.

INTRODUCTION AND HYPOTHESIS: Uterine prolapse is a common diagnosis. Today no consensus exists on which operation technique is ideal to treat apical prolapse. Vaginal hysterectomy (VH) with suspension of the vaginal cuff is the most frequently used. The popularity of uterus-preserving techniques is increasing. The aim of this study was to compare the efficiency of vaginal native tissue operations to treat primary apical prolapse, evaluated on risk of relapse surgery. METHODS: Data were obtained from the Danish National Patient Registry (NPR), which contains all operations performed in Denmark. Patients operated on for primary apical prolapse in Denmark 2010-2016 were included and followed until 2017. Clinical data were obtained from the Danish Urogynecological Database. Patients who were previously hysterectomized or operated on for prolapse in the apical compartment were excluded. Data were analyzed using Cox proportional hazard regression analysis and adjusted for age, BMI, smoking, preoperative prolapse stage and previous POP operations. RESULTS: In total, 7247 operations were included. The hazard ratio (HR) for relapse operation in the apical compartment was significantly higher after sacrospinous hysteropexy (SH) compared with the Manchester-Fothergill procedure (MP) [40.2 confidence interval (CI) 21.6-74.7] and VH (8.5 CI: 6.0-12.1). Likewise, the HR was higher in the anterior compartment after SH compared with MP (4.3 CI: 2.9-6.4) and VH (2.8 CI: 2.0-4.0). No convincing difference was found in the posterior compartment. The 5-year reoperation rates were 30%, 7% and 11% after SH, MP, and VH, respectively. CONCLUSIONS: Sacrospinous hysteropexy has exceedingly high numbers of reoperations due to prolapse recurrence.

Perioperative cardiovascular complications following urogynecological operations.

INTRODUCTION: The risk of perioperative cardiovascular complications following operations for urinary incontinence and pelvic organ prolapse (POP) must be taken into consideration during surgical planning. The literature on the cardiovascular risk following urinary incontinence and POP operations shows conflicting results. Our aims were to provide an estimate of the mortality and the risk of cardiovascular complications following urinary incontinence and POP operations considering women's preoperative cardiovascular comorbidity. MATERIAL AND METHODS: This nationwide register-based study includes a total of 13 992 operations for urinary incontinence and 35 765 for POP from 2007 to 2017. The risk was estimated as an incidence/rate ratio for women with and without former cardiovascular comorbidity adjusted for relevant confounders by using a case-crossover study design. RESULTS: A total of 7677 patients were at high risk, with a cardiovascular comorbidity prior to the operation, and 42 076 patients were at low risk, with no cardiovascular comorbidity. Overall, 11 patients died within 30 days following an operation, of whom five were in the high-risk group and six in the low-risk group. Of the women at high risk, 0.59% had cardiovascular complications from 0 to 6 days following an operation, corresponding to an incidence/rate ratio of 3.64 (95% CI; 2.67-4.97), compared with women at low risk where no complications were registered in the first week. CONCLUSIONS: We found an increased risk of cardiovascular complications following urogynecological operations in women with preoperative cardiovascular comorbidity, and no increased risk in women without prior cardiovascular comorbidity. In general, the risk of cardiovascular complications was lower than that found in previous studies.

General practitioners' continuation and acceptance of medication changes at sectorial transitions of geriatric patients - a qualitative interview study.

BACKGROUND: Follow-up in general practice on medication initiated during hospitalisation is often perceived to be inadequate, which leads to unintended drug interaction and over- or underdosage of medication. Little is known about General Practitioners (GPs') views on medication changes during the transition from hospital to primary care. We conducted a qualitative interview study to understand GPs' views on the medication changes made for their patients by hospital physicians in a geriatric ward and the GPs' actions after discharge. METHODS: Qualitative semi-structured interviews comprising ten GPs from general practices in the Region of Southern Denmark, using a phenomenological approach. The GPs were selected strategically based on the principle of maximum variation. The analysis process was a cross-sectional analysis based on a phenomenological analysis. RESULTS: The GPs identified many reasons for the lack of medication continuation, including miscommunication between hospital doctors and GPs and delayed discharge letters. Several factors were involved, including patients not taking responsibility for their medication, no structure for follow-up visits to their GPs and for the renewal of their prescriptions. CONCLUSION: The main reason for the poor continuity of medication changes for geriatric patients at sector transition was neither the GPs' deliberate actions of removing the patients' medications, nor the patients' lack of compliance or of willingness to take the medication. It is largely due to procedural errors in the follow-up on the patient after discharge, due to the lack of a structured process and due to miscommunication between the primary sector and the hospital.

Birth Outcomes in Children Fathered by Men Treated with Anti-TNF-α Agents Before Conception.

OBJECTIVES: The safety of paternal use of anti-tumor necrosis factor-α (TNF-α) agents immediately prior to conception is practically unknown. On the basis of nationwide data from Danish health registries, we examined the association between paternal use of anti-TNF-α agents within 3 months before conception and adverse birth outcomes. METHODS: This nationwide cohort study is based on data from all women who had a live born singleton child in Denmark from 1 January 2007 through 2013. Children fathered by men treated with anti-TNF-α agents within three months before conception constituted the exposed cohort (N=372), and children fathered by men not treated before conception constituted the unexposed cohort (N=399,498). The outcomes were congenital abnormalities (CAs), preterm birth, and small for gestational age (SGA). We adjusted for multiple covariates, and considered paternal underlying disease and concomitant medication. RESULTS: The adjusted risks of CAs and preterm birth were close to unity, and the adjusted odds ratio (OR) for SGA was 1.70 (95% confidence interval (CI): 0.94-3.09). Restricting our analysis to fathers with inflammatory bowel disease, we found no increased risk of CAs or SGA, and the adjusted OR for pretem birth was 1.42 (95% CI: 0.52-3.86). Restricting our analysis to fathers with rheumatologic/dermatological diseases, we found no increased risk of CAs or preterm birth, and the adjusted OR for SGA was 1.70 (95% CI: 0.74-3.89). CONCLUSIONS: Our results are overall reassuring regarding the safety of paternal preconceptional use of anti-TNF-α agents. The result regarding SGA should, however, be interpreted with caution as we found an increased risk, although not significantly increased.

The incidence of Crohn's disease and ulcerative colitis since 1995 in Danish children and adolescents <17 years - based on nationwide registry data.

OBJECTIVE: Worldwide the incidence of pediatric Crohn's disease (CD) and ulcerative colitis (UC) is suspected to be increasing. Based on unselected nationwide register data the aim of this study is to examine the change in incidence of CD and UC in children and adolescents in Denmark. MATERIALS AND METHODS: All children and adolescents <17 years with a diagnosis of CD or UC registered in the Danish National Patient Registry from 1 January 1995 to 31 December 2013 were included. Using a Poisson regression model we estimated the incidence rate ratio (IRR) for the annual change in the incidence adjusted for gender and age. The cumulative incidence was described using Kaplan-Meier survival analyses. RESULTS: The IRR for CD was 1.052 (95% CI: 1.039-1.065), and for UC the IRR was 1.022 (95% CI: 1.011-1.033), adjusted for age and gender. The incidence rate of CD increased during the study period to 10.0 (95% CI: 7.5-13.2) per 100,000 person years for girls and 9.4 (95% CI: 7.0-13.2) for boys, in 2013. Similar, the incidence of UC increased to 7.2 (95% CI: 5.0-9.9) per 100,000 person years for girls and 6.2 (95% CI: 4.3-8.7) for boys. CONCLUSIONS: In a period of 19 years from 1995 to 2013 we found an increasing incidence for pediatric UC and CD, especially pronounced for CD.

Discrepancies between patient-reported outcome measures when assessing urinary incontinence or pelvic-prolapse surgery.

INTRODUCTION AND HYPOTHESIS: In order to assess the outcome following surgery for urinary incontinence (UI) and pelvic organ prolapse (POP) the importance of patient-reported outcome measures, in addition to the clinical objective measures, has been recognised. The International Consultation on Incontinence has initiated the development and evaluation of disease-specific questionnaires (ICIQ) to compare the patient's degree of improvement. Alternatively, the Patient's Global Impression of Improvement (PGI-I score) with an inherent before-after assessment has been widely accepted in recent studies. The aim of this study was to compare the PGI-I versus the ICIQ score for women undergoing UI or POP surgery. METHODS: This study is based on self-administered pre- and postoperative questionnaires, completed by women undergoing surgery for UI or POP in Denmark in 2013. Weighted Kappa statistics and 95 % limits of agreement method were used when comparing the PGI-I and ICIQ scores. RESULTS: Among the 3,310 women included the PGI-I score showed a higher improvement than the IQIC score, for UI 0.83 (CI 95 %: 0.80-0.85) vs 0.62 (0.60-0.64) and for POP 0.77 (0.75-0.78) vs 0.66 (0.65-0.67). CONCLUSIONS: The PGI-I score renders higher satisfaction than the ICIQ score and the PGI-I score overestimates the improvement following UI and POP surgery.

The influence of comprehensive geriatric assessment on drug therapy in elderly patients.

BACKGROUND: Comprehensive geriatric assessment of hospitalised patients implies optimising patients' medical treatment, and good coordination between hospital and general practice is essential for the quality of the drug treatment. Only a few studies have investigated the continuation of patients' medication from primary care to hospital and back again to primary care. OBJECTIVES: To describe changes of drug therapy during hospital stay in a geriatric ward and the following acceptance of these changes in primary cares after discharge. METHODS: An observational register study following 1,550 geriatric patients' pharmacological treatment longitudinally across hospital stay, by linkage of a primary care prescription database and hospital medical records. The medication regimens for the individual patients were compared at three cross sections: primary care before hospitalisation, during hospital stay and primary care after hospitalisation, analysed according to drug therapy, co-morbidity, functionality and outpatient follow-up. RESULTS: Patients were using an average of 8.2 drugs before hospital admission, of which an average of 0.9 drugs per patient was discontinued or switched during hospitalisation. An average of 1.7 new drugs per patient was initiated by the hospital physicians. After discharge, 63.9 % of the changes initiated by hospital physicians were continued in primary care. Of new drugs initiated in hospital 42.7 % were accepted in primary care. CONCLUSIONS: A relatively small proportion of drugs was switched or discontinued and the average number of drugs increased during hospital stay. Of these changes, two thirds were accepted in primary care after discharge and less than half of newly initiated drugs were continued in primary.

The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care.

AIM: This study had two aims: Firstly, to describe how prescriptions for proton pump inhibitor (PPI) in primary care were influenced by a change of the hospital drug policy, and secondly, to describe if a large discount on an expensive PPI (esomeprazole) to a hospital would influence prescribing patterns after discharge. METHODS: This register study was conducted at Odense University Hospital, Denmark, and by use of pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the medication regimens of patients were followed across hospitalisation. The influence of hospital drug policy on prescribings in primary care was measured by the likelihood of having a high-cost PPI prescribed before and after change of drug policy. RESULTS: In total, 9,341 hospital stays in 2009 and 2010 were included. The probability of a patient to be prescribed an expensive PPI after discharge decreased from 33.5 to 9.4%, corresponding to a risk ratio of 0.28. In primary care after discharge, 13.4% of esomeprazole use was initiated in the hospital, and this was 8.4% for PPIs in general. After the change of hospital drug policy, this decreased to 6.5% for esomeprazole and increased for the recommended PPIs pantoprazole and lansoprazole to 14.6 and 26.1%, respectively. The effect of a large discount on expensive PPI to hospital was 14.7%, and this decreased to 2.6% when coordinating drug policy in hospital and primary care. CONCLUSION: The likelihood of having an expensive PPI prescribed after hospital stay decreased when coordinating drug policy and the influence of a large discount to hospital could be minimised.

Use of exenatide and liraglutide in Denmark: a drug utilization study.

PURPOSE: The purpose of this study was to characterise the utilization of the glucagon-like peptide-1 (GLP-1) analogues exenatide and liraglutide in Denmark. METHODS: From the Danish National Prescription Registry, we extracted all prescriptions for either liraglutide or exenatide twice-daily in the period 1 April 2007 to 31 December 2012. Using descriptive statistics, we calculated incidence rates, prevalence proportions, daily consumption, and concomitant drug use. For a subset of users we included data from other registries and characterised the baseline characteristics of incident users of GLP-1 analogues. RESULTS: We identified 21,561 and 2,354 users of liraglutide and exenatide respectively. From market entry in 2009 liraglutide showed an increasing prevalence reaching 2.4 per thousand inhabitants in 2012. Exenatide ranged between 0.01 and 0.25 per thousand inhabitants from 2007 to 2012. Treatment intensity showed geographical variation ranging from 1.84per thousand inhabitants to 3.22 per thousand inhabitants for liraglutide. Average doses were 1.34 mg/day (liraglutide) and 16.4 µg/day (exenatide). Treatment initiation was most often performed by a hospital physician and was not associated with any changes in concomitant treatment with antihypertensives, cholesterol-lowering drugs or anticoagulants. Of liraglutide and exenatide users, 38 % and 43 % also used insulin. Low kidney function (eGFR < 30 ml/min) was found in 10.1 % and 9.0 % of users of liraglutide and exenatide respectively. CONCLUSIONS: The preferred GLP-1 analogue in Denmark is liraglutide. Certain aspects of the utilization of GLP-1 analogues, such as large regional differences and concomitant use of GLP-1 analogues and insulin, warrant further investigation.