Employment status 1 year after out-of-hospital cardiac arrest in comatose patients treated with therapeutic hypothermia.

BACKGROUND: Therapeutic hypothermia for comatose survivors of out-of-hospital cardiac arrest (OHCA) has improved survival and neurologic outcome. This study focused on return to work 1 year after therapeutic hypothermia. METHODS: From June 2004 to June 2009, patients between 18 and 65 years of age with OHCA, who were treated with hypothermia from two regions, representing one third of the national population, were identified from the Danish National Patient Registry, and from hospital and ambulance records. The patients' employment status was obtained from the Danish Ministry of Employment. RESULTS: One hundred thirty-three comatose patients after OHCA treated with hypothermia were identified. One hundred and four (78%) patients were employed, or able to work, at the time of cardiac arrest. This particular group of patients showed significant lower in-hospital mortality compared to the group of patients who were not able to work before cardiac arrest; 13% vs. 48%, respectively (P < 0.001). The workable group had a lower Charlson comorbidity score (P = 0.004), a higher incidence of witnessed cardiac arrest (P = 0.004) and a higher incidence of shockable heart rhythm (P < 0.001). Eighty-seven patients (84%), who were able to work prior to cardiac arrest, survived, and 55 (65%) of these patients were employed or able to work at 1 year follow-up. CONCLUSION: The majority of patients employed, or able to work prior to OHCA, had returned to work at one year follow-up. Predictors of return to work in comatose patients treated with hypothermia have to be identified in a larger-scale study.

Agreement between medical expert assessments in social medicine.

BACKGROUND AND AIMS: Medical specialists in social medicine play an important role in description of work-related health problems of the individual citizen in the Municipalities, yet knowledge of the consistency in their medical assessment remains poor. However, we expect good agreement between medical specialists' descriptions of health and work ability. The present paper aims to evaluate inter-rater differences between assessments issued by medical specialists in social medicine on health-related work ability in patients with musculoskeletal diseases and some lighter psychiatric diseases. METHODS: A total of 11 medical specialists in social medicine from four departments across Denmark each described eight subjects' health and health-related disability upon request from the municipal authorities. The resultant 88 written medical expert assessments were evaluated and scored independently by two medical specialists in social medicine with respect to functional impairment/ health-related work ability as intact, slightly reduced, much reduced, or extremely reduced. Kappa analysis described the inter-rater agreements. RESULTS: The combined Kappa value for work ability was 0.33 (slight agreement). In the category ''extremely reduced'' work ability the Kappa value was 0.61 (good agreement), but mostly this result was due to one subject. One department had better intra-departmental agreement than the other departments. Agreement on the level of work ability was poorer in subjects with psychiatric diseases. CONCLUSIONS: The assessments from medical specialists in social medicine on work ability and thereby occupational possibilities show much variation. The results of the present study demonstrate that there is much room for improving agreement on these assessments.

Non-calculus suppurative cholangitis in Danish patients with inflammatory bowel disease.

BACKGROUND/AIMS: We examined the risk of non-calculus suppurative cholangitis in patients with inflammatory bowel disease in the entire Danish population. METHODOLOGY: The study included all patients discharged from Danish hospitals with a diagnosis of Crohn's disease or ulcerative colitis as registered in the Danish National Registry of Patients from January 1, 1977 to December 31, 1992. We compared the observed number of patients hospitalized with suppurative cholangitis with expected numbers on the basis of age, gender, and calendar-specific incidence rates in the general population. RESULTS: Overall, 15,317 eligible patients with inflammatory bowel disease were discharged during the study period. Among these were 52 cases of non-calculus suppurative cholangitis. The incidence rate of non-calculus suppurative cholangitis in the cohort with inflammatory bowel disease was 46.1 per 100,000 person-years. The standardized incidence ratio (SIR) for suppurative cholangitis was increased similarly for patients with Crohn's disease [SIR=6.7, 95% confidence interval (CI): 3.1-12.7] and for patients with ulcerative colitis (SIR=6.6, 95% CI: 4.7-9.1). The highest relative risk was found in male patients younger than 40 years of age, for both Crohn's disease and ulcerative colitis (SIR=70.5 and 78.7, respectively). CONCLUSIONS: Patients with inflammatory bowel disease have an increased risk of non-calculus suppurative cholangitis.

Azathioprine, mercaptopurine and birth outcome: a population-based cohort study.

BACKGROUND: Data on the safety of azathioprine and mercaptopurine during pregnancy are very sparse. AIM: To examine the risk of adverse birth outcomes in women who took up prescriptions for azathioprine or mercaptopurine during pregnancy. METHODS: This is a Danish cohort study based on data from a population-based prescription registry, the Danish Birth Registry and the Hospital Discharge Registry. To examine the risk of congenital malformations, we included nine pregnancies exposed 30 days before conception or during the first trimester. To examine perinatal mortality, pre-term birth and low birth weight, we included 10 pregnancies exposed during the entire pregnancy. Eleven different exposed women were included in the study. Outcomes were compared with those of 19 418 pregnancies in which no drugs were prescribed to the mothers. RESULTS: Fifty-five per cent of the exposed women had inflammatory bowel disease and 45% other diseases. Adjusted odds ratios for congenital malformations, perinatal mortality, pre-term birth and low birth weight were 6.7 (95% confidence interval, 1.4-32.4), 20.0 (2.5-161.4), 6.6 (1.7-25.9) and 3.8 (0.4-33.3), respectively. CONCLUSIONS: Our results suggest that there is an increased risk of congenital malformations, perinatal mortality and pre-term birth in children born to women treated with azathioprine or mercaptopurine during pregnancy. More data are needed to determine whether the associations are causal or occur through confounding.

Birth outcome in women exposed to 5-aminosalicylic acid during pregnancy: a Danish cohort study.

BACKGROUND: 5-Aminosalicylic acid (5-ASA) preparations are the firstline drugs in the treatment of inflammatory bowel disease. Data on the safety of these drugs in pregnancy are sparse. AIMS: To examine the risk of adverse birth outcome in women who were prescribed 5-ASA drugs during pregnancy. PATIENTS: Women were included in the study if they were prescribed 5-ASA drugs immediately before or during pregnancy. To examine the risk of malformations, we included 60 pregnancies exposed to 5-ASA drugs 30 days before pregnancy or in the first trimester. To examine stillbirths, preterm births, and low birth weight, we included 88 pregnancies exposed during the entire pregnancy. Outcomes were compared with those of 19 418 pregnancies in which no drugs were prescribed for mothers during the study period. METHODS: We conducted a Danish cohort study based on data from a population based prescription registry, the Danish Birth Registry, and the Hospital Discharge Registry in North Jutland County. RESULTS: Odds ratios for malformations, stillbirth, preterm birth, and low birth weight in women who received prescriptions for 5-ASA drugs were 1.9 (95% confidence interval 0.7-5.4), 6.4 (1.7-24.9), 1.9 (0.9-3.9), and 1.2 (0.4-3.3), respectively. The increased risk of stillbirth and preterm birth were found only in patients with ulcerative colitis. CONCLUSIONS: We found an increased risk of stillbirth and preterm birth in women who had been prescribed 5-ASA drugs during pregnancy but no substantial increased risk of malformations. It was difficult to distinguish the specific effects of disease activity and 5-ASA drugs.

[Congenital malformations and fetal growth of children with intrauterine exposure to anticonvulsants]. / Medfødte misdannelser og intrauterin vaekst hos børn eksponeret for antiepileptika in utero.

OBJECTIVES: To examine the risk of malformations and fetal growth in the children of women treated with anticonvulsant drugs in North Jutland County, Denmark. MATERIAL AND METHODS: All women treated with anticonvulsant drugs in the county were identified in a Pharmaco-Epidemiological Prescription Database and linked to the Danish Medical Birth Registry and the Regional Hospital Information system. RESULTS: We identified 235 pregnancies where the mothers had used prescriptions for anticonvulsants around conception and/or during pregnancy, and 17,259 unexposed pregnancies where the mothers had not used prescriptions. One case of neural tube defect was found among 15 malformations in the exposed cohort. The overall odds ratio for malformations was 2.2 (95% confidence intervals 1.3-3.8). The odds ratios for low birth weight and preterm delivery were respectively 1.5 (95% confidence intervals 0.6-3.7) and 1.6 (95% confidence intervals 1.0-2.5). CONCLUSION: We found an increased risk of congenital malformations and a tendency to growth retardation in the children of women taking anticonvulsants.

Use of lipid-lowering drugs during 1991-98 in Northern Jutland, Denmark.

AIMS: To examine a) the use of lipid-lowering drugs in North Jutland County in Denmark from 1991 to 1998 and b) the pattern of usage according to sex and age. METHODS AND RESULTS: We used the Pharmaco-Epidemiological Prescription Database in the county to identify all reimbursed prescriptions for lipid-lowering therapy from 1991 to 1998. One-year incidence rates (IR) and prevalence (P) of the use of lipid-lowering drugs were calculated. Both IR and P of patients in lipid-lowering therapy were stable until 1994, with the IR below 100 per 100 000 for both sexes. The IR then increased from 59.9 to 236.5 per 100 000 person-years in 1998 for women, and from 88.6 to 322.8 per 100 000 person-years for men. The utilization patterns were identical between the sexes. Thus, in both women and men the highest prevalence and incidence rates of lipid-lowering drug therapy were seen in the 60-69-year-olds. Furthermore, the marked increase in both prevalence and incidence of persons on lipid-lowering drug therapy between 1994 and 1998 was the result of an increased number of prescriptions in the 50-59, 60-69 and 70 + years olds, in both women and men. There was a remarkable 4-5 fold increase in the numbers of new patients who received statins during the same period. CONCLUSIONS: The overall use of lipid-lowering drugs has increased markedly over the last few years in Northern Jutland, Denmark. The increase began following publication of the first major trial documenting the benefit of therapy with statins.

A comparative analysis of different methods for obtaining estimates of alcohol consumption in a Danish population survey.

AIMS: The aim of the present study was to compare different measures of alcohol consumption used in a Danish survey. METHODS: A stratified random sample was extracted from the Civil Registration System. From January 1997 to January 1998 approximately 8 telephone interviews were conducted every day, including Sundays and holidays, ending with a total of 3,050 interviews after 1 year. Two main approaches to measure alcohol consumption were used: the quantity-frequency and the recent occasion approaches; the latter is subdivided into previous week and previous day approaches. RESULTS: The overall estimated number of units (= 12 g of pure alcohol) per week was 6.8 (95% confidence intervals (CI): 6.5-7.1), 6.7 (95% CI: 6.4-7.1) and 8.5 (95% CI: 7.8-9.1) for the quantity-frequency, previous week and previous day approaches, respectively. A total of 50% of the men and 70% of the women did not drink alcohol the previous day. Among people classified as high consumers in the previous week and previous day approaches, less than 60% and 30%, respectively, were similarly classified in the quantity-frequency approach. CONCLUSION: There was agreement on the level of alcohol consumption between the quantity-frequency and previous week approaches, but higher estimates when using the previous day approach. The previous day approach varied more in relation to the interview day and season compared with the quantity-frequency approach and the previous week approach. The recent occasions approach showed some difficulties in classifying the individuals. If the alcohol consumption is included in a model as a risk indicator or a confounder, the quantity-frequency approach would be more preferable than the recent occasion approach.

Episodic heavy drinking in four Nordic countries: a comparative survey.

AIMS: The purpose of this study was to compare the phenomenon of episodic heavy drinking (binge drinking) and its different indicators in the Nordic countries. DESIGN: A comparative survey of four Nordic countries. SETTING: Telephone interviews in Denmark, 1997; Finland, 1996; Norway, 1996; and Sweden 1996-97. PARTICIPANTS: Random samples of men and women aged 19-71 years. MEASUREMENTS: Episodic heavy drinking was measured by the frequency of subjective intoxication, of drinking six or more drinks at a time (6+), and of negative consequences (mainly hangover symptoms). Additionally, annual consumption and measures of intake per occasion were used. FINDINGS: Annual consumption, overall frequency of drinking and frequency of drinking 6+ were highest in Denmark and lowest in Norway. Frequency of subjectively defined intoxication was highest in Finland. There it was clearly higher than the frequency of drinking 6+, whereas in Denmark the contrary was observed. Finnish and Norwegian men and Danish women reported the largest quantities drunk per occasion. Results on 6+ frequency and the prevalence of negative consequences, with annual consumption held constant, suggest that Danes have the least concentrated drinking pattern. With annual consumption held constant, Norwegians report as high a frequency of intoxication, as do Finns. CONCLUSIONS: The relations between subjective and more objective measures of episodic heavy drinking vary considerably between the Nordic countries. The results suggest that the definition, acceptability and experience of intoxication vary even when a set of relatively homogeneous countries are compared.

Birth outcomes of women with ulcerative colitis: a nationwide Danish cohort study.

OBJECTIVE: Our study aimed to compare the birth outcomes in offspring of women with ulcerative colitis with controls without the disease. METHODS: A cohort study of 1531 newborns to mothers with ulcerative colitis, and 9092 controls, based on linkage between the Danish National Registry of Patients and the Danish Birth Registry from 1982 to 1992. RESULTS: Among the births to women with ulcerative colitis, 569 took place before and 962 after the first hospitalization for ulcerative colitis. We found no increased risk of either low birth weight or intrauterine growth retardation for newborns born before or after the mothers' first hospitalization. The risk of preterm birth was increased when birth occurred after the mothers' first hospitalization (odds ratio = 1.4, 95% confidence interval = 1.1-1.9), and particularly when the first hospitalization for ulcerative colitis took place during pregnancy (odds ratio = 3.4, 95% confidence interval = 1.8-6.4). CONCLUSIONS: In the offspring of women with ulcerative colitis, we found no increased risk of low birth weight or signs of intrauterine growth retardation. The risk of preterm birth was increased in the offspring of women with ulcerative colitis, particularly when the first hospitalization for ulcerative colitis occurred during pregnancy.

Birth outcomes in women exposed to anticonvulsant drugs.

OBJECTIVES: To examine the risk of malformations and fetal growth in women treated with anticonvulsant drugs in North Jutland County, Denmark. MATERIAL AND METHODS: All women treated with anticonvulsant drugs in the county were identified in a Pharmaco-Epidemiological Prescription Database and linked to the Danish Medical Birth Registry and the Regional Hospital Discharge Registry. RESULTS: We identified 235 pregnancies exposed to anticonvulsants around conception and/or during pregnancy as well as 17,259 unexposed pregnancies where the mother had not received any prescription. There was 1 case of neural tube defect among 15 malformations in the exposed cohort. The overall risk of malformations was 2.2 (95% confidence intervals 1.3-3.8). The risk of low birth weight and preterm delivery was 1.5 (95% confidence intervals 0.6-3.7) and 1.6 (95% confidence intervals 1.0-2.5), respectively. CONCLUSION: We found an increased risk of congenital malformations and a tendency to growth retardation in children of women exposed to anticonvulsants.

Risk of ulcerative colitis and Crohn's disease among offspring of patients with chronic inflammatory bowel disease.

OBJECTIVE: The incidence of inflammatory bowel disease (IBD) varies among and within countries, but several studies have indicated that genetic factors may play an important role in the etiology of IBD. A Danish regional study has observed an almost 10-fold increased risk for ulcerative colitis (UC) and Crohn's disease (CD) among first-degree relatives of patients with these diseases. To give more precise risk estimates we conducted a nationwide study using population-based data from the Danish National Registry of Patients (NRP). METHODS: All patients from the entire Danish population (5.2 million), who were discharged between 1977 and 1992 with a diagnosis of either UC or CD were extracted from the NRP. The offspring of these patients born in 1958 or later were identified in the Civil Registration System and subsequently linked to the NRP by means of the civil registration number. All Danish citizens alive or born on April 1, 1968 or later are registered in the Civil Registration System by a unique registration number, which includes the data of birth and links the offspring to their parents. The prevalence proportion ratio (PPR) was estimated by dividing the observed number of offspring with UC or CD, respectively, with the expected number of cases from the general population. RESULTS: The PPRs of CD and UC among offspring of patients with UC were 2.6 and 5.1, respectively, and the PPRs of CD and UC among offspring of patients with CD were 12.8 and 4.0, respectively. All ratios were significantly increased. CONCLUSION: The risk for UC and CD among offspring of patients with IBD is 2-13 times higher than the risk within the general population.

Birth outcomes of women with celiac disease: a nationwide historical cohort study.

OBJECTIVE: We aimed to examine birthweight, low birthweight (<2500 g), and intrauterine growth retardation in offspring of women with celiac disease in relation to their first hospitalization for the disease. METHODS: This was a historical cohort study based on The Danish Medical Birth Registry data of celiac women discharged from Danish hospitals from 1977-1992. The study included 211 newborns to 127 mothers with celiac disease, and 1260 control deliveries. RESULTS: Before celiac women were first hospitalized the mean birthweight of their newborns was 238 g (95% confidence interval [95% CI] = 150, 325 g) lower than that of the control women, after adjustment for potential confounders. After the first hospitalization the mean birthweight for newborns of diseased women was higher than that of controls, by 67 g (95% CI = -88, 223 g) after adjustment for potential confounders. Before celiac women were first hospitalized we found an increased risk of low birthweight (odds ratio [OR] = 2.6, 95% CI = 1.3-5.5) and intrauterine growth retardation (OR = 3.4, 95% CI = 1.6-7.2). After celiac women were first hospitalized we found no increased risk of low birthweight and no babies with intrauterine growth retardation. CONCLUSIONS: Offspring of mothers with celiac disease had lower birthweight than expected and more than a three-fold higher risk of intrauterine growth retardation when birth occurred before the first hospitalization for the disease. After the mother's first hospitalization the birthweight was similar to controls and no increased risk of low birthweight was seen. Our study indicates that treatment of celiac women is important in the prevention of fetal growth retardation.

Risk of primary biliary liver cirrhosis in patients with coeliac disease: Danish and Swedish cohort data.

BACKGROUND: Several case reports, but only a few studies, have examined the coexistence of coeliac disease and primary biliary cirrhosis. AIM: To estimate the risk of primary biliary cirrhosis in two national cohorts of patients with coeliac disease in Denmark and Sweden. METHODS: Through record linkage all Danish patients hospitalised with coeliac disease were followed for possible occurrence of primary biliary cirrhosis from 1 January 1977 until 31 December 1992. All patients hospitalised with coeliac disease in Sweden from 1987 to 1996 were also followed in a separate analysis. RESULTS: A total of 896 patients with coeliac disease were identified in Denmark with a median follow up period of 9.1 years for a total of 8040 person-years at risk. Two cases of primary biliary cirrhosis were observed where 0.07 were expected, giving a standardised incidence ratio of 27.6 (95% confidence interval 2.9 to 133.5). A total of 7735 patients with coeliac disease were identified in Sweden with a median follow up period of 5.1 years for a total of 39 284 person-years at risk. Twenty two people with primary biliary cirrhosis were identified compared with 0.88 expected, giving a standardised incidence ratio of 25.1 (95% confidence interval 15.7 to 37.9). CONCLUSION: Patients with coeliac disease are at increased risk of having primary biliary cirrhosis.

Risk of acute pancreatitis in patients with chronic inflammatory bowel disease. A Danish 16-year nationwide follow-up study.

BACKGROUND: There are few epidemiologic data about the risk of acute pancreatitis in chronic inflammatory bowel diseases; we therefore wanted to estimate the risk of a first episode of acute pancreatitis in patients with Crohn's disease and ulcerative colitis in the total Danish population. METHODS: The study included all patients discharged from Danish hospitals with a diagnosis of Crohn's disease or ulcerative colitis registered in the Danish National Registry of Patients in the period from 1977 to 1992. The first episode of acute pancreatitis was identified in the cohort. The observed number of patients with acute pancreatitis was compared with expected numbers on the basis of age, sex, and calendar-specific incidence rates in the general population. RESULTS: Overall, 15,526 patients were discharged and followed up for 112,824 person-years. The standardized incidence ratio (SIR) for acute pancreatitis was increased both in patients with Crohn's disease (SIR = 4.3; 95% confidence interval (CI), 2.9-6.1) and in those with ulcerative colitis (SIR= 2.1; 95% CI, 1.6-2.8). CONCLUSION: Patients with chronic inflammatory bowel disease seem to be at increased risk of acute pancreatitis. Further validation and refinement of this registration-based study are needed.

Pregnancy outcome for women with Crohn's disease: a follow-up study based on linkage between national registries.

OBJECTIVE: Crohn's disease, characterized by chronic intestinal inflammation, is sometimes followed by malabsorption, which may interfere with embryogenesis and fetal growth. Therefore we examined birthweight, the frequency of preterm birth, and other reproductive outcomes in the offspring of women with Crohn's disease. METHODS: We used a historical registry-based study, with linkage between the Danish National Registry of Patients and the Danish Medical Birth Registry. Included were 510 newborns to mothers with Crohn's disease and 3018 controls in the study period from 1982 to 1992. RESULTS: The average birthweight of newborns to mothers with Crohn's disease was 185 g, 134 g less than expected for primiparas and multiparas. After adjusting for potential confounders the differences were 142 g (95% confidence interval [CI95%] = 76, 208) and 105 g (CI95% = 37, 173), respectively. The risk of low birthweight was increased in Crohn patients (odds ratio [OR] = 2.4; CI95% = 1.6-3.7), as was the risk of preterm birth (OR = 1.6; CI95% = 1.1-2.3). CONCLUSION: We found a lower birthweight in newborns of patients with Crohn's disease, indicating that Crohn's disease or its treatment may influence fetal growth.