Association between nutritional status and socio-economic status among school children aged 9-17 years in a semi-urban area of Nepal.

BACKGROUND: In many low-and middle-income countries (LMICs), childhood overweight is increasing, while underweight remains a problem. This study aimed to investigate the association between socio-economic status (SES) and nutritional status among Nepalese school children. METHODS: This cross-sectional study used a multistage random cluster sampling method and included 868 students aged 9-17 years from both public and private schools located in a semi-urban area of Pokhara Metropolitan City, Nepal. SES was determined based on a self-reported questionnaire. Body weight and height were measured by health professionals and body mass index (BMI) was categorized based on the World Health Organization BMI-for-age cut-offs. The association between Lower and Upper SES and BMI was assessed using mixed-effects logistic regression model estimating the adjusted odds ratio (aOR) with a corresponding 95% confidence interval (CI) and compared to Middle SES. RESULTS: The proportion of obesity, overweight, underweight, and stunting among school children was 4%, 12%, 7%, and 17%, respectively. More girls were overweight/obese compared with boys (20% vs. 13%). The mixed-effects logistic regression model showed that both participants from Lower SES households and Upper SES households had a higher tendency to be overweight compared to participants from Middle SES; aOR = 1.4; 95% CI 0.7-3.1 and aOR = 1.1; 95% CI 0.6-2.1, respectively. Furthermore, stunting and overweight occurred simultaneously. CONCLUSIONS: This study found that about one out of four children and adolescents in the study setting was malnourished. There was a tendency that both participants from Lower SES and Upper SES had higher odds of being overweight compared to participants from Middle SES. Furthermore, both stunting and overweight were present simultaneously in some individuals. This emphasizes the complexity and importance of awareness of childhood malnutrition in LMICs like Nepal.

Long-term growth in offspring of infertile parents: A 20-year follow-up study.

INTRODUCTION: Long-term growth has been poorly investigated in boys and girls born to parents receiving fertility treatment. This study aimed to investigate the growth of children born following fertility treatment up to adulthood hypothesizing comparable growth in children born to parents receiving fertility treatment or to subfertile parents conceiving spontaneously to that in children spontaneously conceived by fertile parents. MATERIAL AND METHODS: In this historical long-term follow-up study the study population consisted of 4151 singletons born at term in the Aarhus Birth Cohort between 1990 and 1992. Parental lifestyle and sociodemographic characteristics together with multiple measurements of weight and height were collected up to 20 years of age (6.1% of children contributed with at least one measurement for height or weight at age 20 years). The main outcome was difference in z-score for height (m) and weight (kg) between children conceived spontaneously (reference) and children conceived following fertility treatment, children conceived spontaneously by subfertile parents, or unplanned. Results were adjusted for pre-pregnancy maternal and paternal body mass index, maternal educational level, smoking during pregnancy, maternal age, and parity. RESULTS: Singletons conceived following fertility treatment (n = 164; 4.0%) or by subfertile parents (n = 271; 6.5%) had comparable magnitude of weight estimates to children conceived spontaneously (difference in z-score per year 0.0148 [95% CI 0.0026-0.0270] and 0.0069 [95% CI -0.0028 to 0.0165], respectively). Height estimates were also comparable between groups of children conceived following fertility treatment or by subfertile parents (difference in z-score per year 0.0022 [95% CI -0.0075 to 0.0119]) compared with children conceived spontaneously (difference in z-score per year -0.0026 (95% CI -0.0103 to 0.0052). From the beginning of adolescence, we found lower weight for children born to subfertile parents and to parents receiving fertility treatment compared with spontaneously conceived children. CONCLUSIONS: The main finding was equal long-term growth for children born at term by parents who received fertility treatment or parents waiting more than 12 months to conceive compared with spontaneously conceived children.

Differential Parent and Teacher Reports of ADHD Symptoms According to the Child's Country of Origin: A Quantitative Study From Denmark Exploring the Implication for Diagnosis.

Objective: This study aimed to investigate differences in parent- and teacher-reported ADHD symptoms according to the child's country of origin. Method: We conducted a cross-sectional study of 4,207 nonimmigrant (Danish origin) and 233 immigrant (non-Danish origin) children including ratings of phenotypical ADHD symptoms on the Strengths and Difficulties Questionnaires. The association between ADHD symptoms and country of origin, separately for parents and teachers, was analyzed using multiple logistic regression. Results: Teachers reported similar numbers of ADHD symptoms for immigrant and nonimmigrant children (odds ratio [OR] = 0.95, confidence interval [CI] = [0.58, 1.54]), whereas immigrant parents were less likely than nonimmigrant parents to report ADHD symptoms (OR = 0.42, CI = [0.21, 0.84]). Conclusion: Immigrant parents were less likely than nonimmigrant parents to report ADHD symptoms, whereas the teachers reported similar amount of ADHD symptoms in the two groups of children. Our results emphasize the importance of paying attention to teacher reporting of ADHD symptoms when assessing immigrant children.

Social selection in cohort studies and later representation of childhood psychiatric diagnoses: The Danish National Birth Cohort.

Aim: This study aimed to estimate the relative representation of childhood psychiatric diagnoses and use of psychotropic medication in the Danish National Birth Cohort (DNBC) compared to the general population. Methods: The general population was identified as all childbirths in Denmark during 1998-2002 (N=344,160). Linking the DNBC (N=91,442) and the general population to the Danish national health registries, all children were followed until they received an ICD-10 psychiatric diagnosis, had a prescription of psychotropic medication or to the end of follow-up in 2013. The prevalence ratios (PRs) with corresponding 95% confidence intervals (CI) were estimated for each psychiatric diagnosis and by sex. Age at first diagnosis presented as means were compared using the one-sample t-test. Results: In the DNBC, the selected childhood psychiatric diagnoses were underrepresented by 3% (PR=0.97, 95% CI 0.94-0.99), ranging from a 20% underrepresentation for schizophrenia (PR=0.80, 95% CI 0.59-1.09) to a 6% over-representation for anxiety disorder or obsessive-compulsive disorder (PR=1.06, 95% CI 0.97-1.17). The majority of the specific diagnoses were modestly underrepresented in the DNBC compared to the general population, while use of psychotropic medication had similar representation. Girls were generally more underrepresented than boys. Depression was on average diagnosed 0.4 years earlier in the DNBC than in the general population (p=0.023). Conclusions: These findings suggest that the social selection may influence the prevalence of diagnosed childhood psychiatric disorders in the DNBC.

Family dissolution and children's social well-being at school: a historic cohort study.

BACKGROUND: Family dissolution has become more common and one third of the child population in most Western countries now experience family dissolution. Studies show that children from dissolved families have lower levels of social well-being than children from intact families, but only few studies have examined the impact on social well-being specifically in the school setting. We investigated the association between family dissolution and children's social well-being at school, including the possible influence of the child's age at the time of the family dissolution. METHODS: We defined a historic cohort study of 219,226 children and adolescents aged 9-16 years and combined demographic registry data of family structure with questionnaire data on social well-being based on the Danish National Well-being Questionnaire completed in 2015. The definition of social well-being was constructed on the children's perception of sense of belonging in the school setting, in the class and the school community, as well as perceptions on safety, loneliness and bullying. We examined low social well-being according to family dissolution and used multiple logistic regression analyses to adjust for parental educational level, ethnicity and siblings and further stratified for gender and age. RESULTS: A total of 5% of the children had a low social well-being at school. Among the 31% who lived in dissolved families, we found more children with a low level of social well-being at school (adjusted OR 1.41, 95% CI 1.36;1.47) than those in intact families; especially among those who at the time of family dissolution were in the preschool age (1.55, 95% CI 1.47;1.64). CONCLUSION: Children from dissolved families had higher odds for low social well-being at school compared with children from intact families, especially those who experienced family dissolution in the preschool age. The school may be an important setting for identifying and providing help and support in children experiencing family dissolution.

The impact of childhood bullying on the daily lives of Nordic children and young adolescents.

AIM: Childhood bullying may negatively affect the mental health in children and adolescents, but few studies have explored this potential link. We aimed to investigate the association between childhood bullying and the impact of poor mental health on the daily life in a population of Nordic children and adolescents aged 5-16 years. METHODS: This cross-sectional study was based on data from the Nordic survey on Children's Health and Wellbeing (NordChild) from 2011. The study population included 4966 children from Denmark, Finland, Iceland, Norway and Sweden. Mental health was measured by a parent-reported version of the Strength and Difficulties Questionnaire. We conducted multiple logistic regression analyses to estimate the odds ratios of poor mental health in bullied compared to non-bullied children and adolescents while adjusting for sex, age, body mass index and parental socioeconomic status. RESULTS: Bullied children and adolescents were four times more likely than their non-bullied peers to have mental health problems with negative impact on their daily life at home, in their relations to friends, learning in school or leisure activities (adjusted odds ratio: 4.32; 95% CI: 3.54-5.26). CONCLUSION: This study found negative impact on the mental health in bullied children and adolescents, which affected several arenas of daily life.

Parental Body Mass Index and Behavioral Problems in Their Offspring: A Danish National Birth Cohort Study.

Maternal obesity has been associated with increased risk of offspring behavioral problems. We examined whether this association could be explained by familial factors by comparing associations for maternal body mass index (BMI) with associations for paternal BMI. We studied 38,314 children born to mothers enrolled in the Danish National Birth Cohort during 1996-2002. Data on maternal BMI was collected at 15 weeks of gestation, and paternal BMI was assessed when the child was 18 months old. When the child was 7 years old, the Strengths and Difficulties Questionnaire was completed by the parents. We estimated odds ratios for behavioral problems in offspring born to overweight/obese parents, and we found that maternal BMI was associated with offspring behavioral problems. Maternal BMI of 25.0-29.9 was associated with a 33% (odds ratio = 1.33, 95% confidence interval: 1.13, 1.57) higher risk of total difficulties in offspring, and maternal BMI of ≥30.0 was associated with an 83% (odds ratio = 1.83, 95% confidence interval: 1.49, 2.25) higher risk. Paternal obesity was also associated with higher risk of offspring behavioral problems, but stronger associations were observed with maternal prepregnancy obesity. Our results suggest that part of the association between maternal BMI and behavioral problems can be accounted for by genetic and social factors, but environmental risk factors may also contribute to the etiology of behavioral problems.

Long-awaited pregnancy: intelligence and academic performance in offspring of infertile parents-a cohort study.

OBJECTIVE: To study whether fertility treatment, subfertility, or pregnancy planning are related to long-term intellectual development. DESIGN: Cohort study. SETTING: Not applicable. PATIENT(S): A total of 5,032 singletons born from 1990 to 1992 in the Aarhus Birth Cohort were followed up to a mean age of 19 years. These children were born as a result of fertility treatment (n = 210), had subfertile parents who took more than 12 months before conceiving naturally (n = 334), had fertile parents who conceived naturally within 12 months (n = 2,661), or had parents who reported the pregnancy as unplanned (n = 1,827). INTERVENTION(S): The children were followed up using questionnaires and information from Danish national registers. MAIN OUTCOME MEASURE(S): Parent reported school difficulties at ages 9-11 years, register-based school grades at ages 16, 17, and 19 years, and conscription intelligence test scores at age 19 years. RESULT(S): We found no evidence of school difficulties in childhood, impaired school performance in adolescence, or lower intelligence in young adulthood in multivariate analyses adjusted for parental age, educational level, maternal parity, before pregnancy body mass index (BMI), smoking and alcohol intake in pregnancy, cohabitation status, child gender, and age. CONCLUSION(S): In the longest follow-up of cognitive development of children conceived after fertility treatment or by subfertile parents conducted so far, this study did not show any association between pregnancy planning, subfertility, or fertility treatment and cognitive ability or academic performance.

Prenatal parental separation and body weight, including development of overweight and obesity later in childhood.

BACKGROUND: Early parental separation may be a stress factor causing a long-term alteration in the hypothalamic-pituitary-adrenal-axis activity possibly impacting on the susceptibility to develop overweight and obesity in offspring. We aimed to examine the body mass index (BMI) and the risk of overweight and obesity in children whose parents lived separately before the child was born. METHODS: A follow-up study was conducted using data from the Aarhus Birth Cohort in Denmark and included 2876 children with measurements of height and weight at 9-11-years-of-age, and self-reported information on parental cohabitation status at child birth and at 9-11-years-of-age. Quantile regression was used to estimate the difference in median BMI between children whose parents lived separately (n = 124) or together (n = 2752) before the birth. We used multiple logistic regression to calculate odds ratio (OR) for overweight and obesity, adjusted for gender, parity, breast feeding status, and maternal pre-pregnancy BMI, weight gain during pregnancy, age and educational level at child birth; with and without possible intermediate factors birth weight and maternal smoking during pregnancy. Due to a limited number of obese children, OR for obesity was adjusted for the a priori confounder maternal pre-pregnancy BMI only. RESULTS: The difference in median BMI was 0.54 kg/m2 (95% confidence intervals (CI): 0.10; 0.98) between children whose parents lived separately before birth and children whose parents lived together. The risk of overweight and obesity was statistically significantly increased in children whose parents lived separately before the birth of the child; OR 2.29 (95% CI: 1.18; 4.45) and OR 2.81 (95% CI: 1.05; 7.51), respectively. Additional, adjustment for possible intermediate factors did not substantially change the estimates. CONCLUSION: Parental separation before child birth was associated with higher BMI, and increased risk of overweight and obesity in 9-11-year-old children; this may suggest a fetal programming effect or unmeasured difference in psychosocial factors between separated and non-separated parents.

Maternal salivary cortisol levels during pregnancy are positively associated with overweight children.

INTRODUCTION: Animal and human studies suggest that programing of the hypothalamic-pituitary-adrenal (HPA) axis may be involved in the development of obesity, but human studies of biological indicators of HPA axis activity are lacking. We studied the association between levels of the stress hormone cortisol during pregnancy and overweight offspring during childhood into adolescence. METHODS: Salivary samples from 655 Danish pregnant women with singleton pregnancies (1989-1991) were collected once in the morning and once in the evening in their second and third trimester. We followed the offspring from two to 16 years of age with at least one measurement of height and weight, and classified their body mass index into overweight and normal weight. The adjusted relative difference in median salivary cortisol (with 95% confidence interval (CI)) during pregnancy (the four samples), in second and third trimester (morning and evening samples) between overweight and normal weight offspring was estimated. Furthermore, the adjusted median ratio between morning and evening maternal salivary cortisol level was estimated for normal weight and overweight children. All the analyses were stratified into the equal age groups: 2-6, 7-11, and 12-16 years. RESULTS: We found non-significant higher maternal cortisol levels during pregnancy in offspring that were overweight at the age of 2-6, 7-11 and 12-16 years than in normal weight peers; adjusted relative difference in median salivary cortisol 11% (95% CI: -2; 25), 6% (95% CI: -7; 20), and 9% (95% CI: -4; 24), respectively. A statistically significantly higher level of maternal cortisol was found in the second trimester in 2-6-year-old and 12-16-year-old overweight offspring; relative difference 19% (95% CI: 3; 37), and 20% (95% CI: 3; 41), respectively. The median ratio between morning and evening maternal salivary cortisol level was similar for overweight and normal weight children; e.g. at age 2-6 years in third trimester 4.31 (95% CI: 4.05; 4.60)nmol/l and 4.28 (95% CI: 3.60; 5.09)nmol/l, respectively (P=0.93). CONCLUSION: Our findings suggest a relatively consistent association between pregnancy cortisol levels and overweight offspring, especially in the second trimester.

Prevalence of overweight in 2 to 17 year-old children and adolescents whose parents live separately: a Nordic cross-sectional study.

BACKGROUND: Comparative data of parental separation and childhood overweight has not been available before across the Nordic countries. The aim of this study was to examine the within-country prevalence and association between parental cohabitation and overweight in Nordic children. METHODS: A cross-sectional survey of 2-17-year-old children was conducted in 2011, titled: "NordChild". A random sample of 3,200 parents in each of the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden were invited to participate in the study with parents of 6,609 children accepting to give answers about their children's health and welfare including information on height and weight of each child and parental cohabitation (response rate 41.5%). The group differences in prevalence and adjusted odds ratio (OR) for overweight, with corresponding 95% confidence intervals (CI) were performed in children whose parents lived separately. Additionally, a missing data analysis was performed to determine whether the adjusted estimates might result from confounding or selection bias. RESULTS: A significant difference was observed in Iceland between children whose parents live separately compared to those who live with both parents (difference: 9.4%, 95% CI: 2.8; 15.9) but no such difference was observed in Denmark, Finland, Norway and Sweden. No significant odds of overweight were observed in children whose parents lived separately compared to children in normal weight at the time of study; Denmark: OR 1.03 (95% CI: 0.42; 2.53), Finland: OR 1.27 (95% CI: 0.74; 2.20), Iceland: OR 1.50 (95% CI: 0.79; 2.84), Norway: OR 1.46 (95% CI: 0.81; 2.62), and Sweden: 1.07 (95% CI: 0.61; 1.86). The missing data analysis indicated that the findings in Norway, Finland and Iceland were partly observed due to selection effects, whereas the adjustment in Denmark was due to confounding. The crude OR for overweight was higher in the 2-9-year-old group than in the 10-17-year-old group whose parents lived separately in Iceland, Norway and Sweden. CONCLUSIONS: No association between parental cohabitation and overweight in Nordic children was found. Our finding of greater prevalence of overweight in Icelandic children whose parents live separately may be an indication that the welfare system in Iceland is separating from the other Nordic countries.

Symptoms of emotional, behavioral, and social difficulties in the danish population of children and adolescents with type 1 diabetes--results of a national survey.

OBJECTIVE: To assess the prevalence of psychological difficulties in Danish children and adolescents with type 1 diabetes using both child/adolescent and caregiver reports, and to investigate associations between these symptoms and metabolic control, adherence, and quality of life. RESEARCH DESIGN AND METHOD: A total of 786 children and adolescents (8-17 years) recruited through the Danish Registry of Childhood Diabetes completed subscales of the Beck's Youth Inventories (BYI-Y), while 910 caregivers completed the Strength and Difficulties Questionnaire (SDQ). The participants also completed questionnaires assessing adherence and quality of life. BYI-Y and SDQ responses were compared with results from normative samples. RESULTS: Children with diabetes generally reported a lower level of symptoms of depression and anxiety, while older adolescents in most cases were comparable to the normative samples. However, the numbers of patients with elevated scores were similar to normative groups, especially regarding the proportion of participants with 'Extremely elevated' scores. Caregivers of children and adolescents with diabetes generally reported the prevalence of elevated scores on the SDQ to exceed the prevalence observed in the norm sample--particularly with regard to older boys. Both BYI-Y and SDQ responses were significantly correlated with HbA1c, adherence, and quality of life. CONCLUSIONS: This study finds Danish children and adolescents with diabetes to report lower or comparable levels of emotional difficulties compared to norms, while caregiver reports are less positive. The results therefore support the value of a multi-informant approach to the assessment of symptoms of psychological difficulty in girls and boys with diabetes.

Severe maternal stress exposure due to bereavement before, during and after pregnancy and risk of overweight and obesity in young adult men: a Danish National Cohort Study.

BACKGROUND: Perinatal stress may programme overweight and obesity. We examined whether maternal pre- and post-natal bereavement was associated with overweight and obesity in young men. METHODS: A cohort study was conducted including 119,908 men born from 1976 to 1993 and examined for military service between 2006 and 2011. Among them, 4,813 conscripts were born to mothers bereaved by death of a close relative from 12 months preconception to birth of the child (exposed group). Median body mass index (BMI) and prevalence of overweight and obesity were estimated. Odds ratio of overweight (BMI≥25 kg/m2) and obesity (BMI≥30 kg/m2) were estimated by logistic regression analysis adjusted for maternal educational level. RESULTS: Median BMI was similar in the exposed and the unexposed group but the prevalence of overweight (33.3% versus 30.4%, p = 0.02) and obesity (9.8% versus 8.5%, p = 0.06) was higher in the exposed group. Conscripts exposed 6 to 0 months before conception and during pregnancy had a higher risk of overweight (odds ratio 1.15, 95% confidence interval (CI): 1.03; 1.27 and odds ratio 1.13, 95% CI: 1.03; 1.25, respectively). Conscripts born to mothers who experienced death of the child's biological father before child birth had a two-fold risk of obesity (odds ratio 2.00, 95% CI: 0.93; 4.31). There was no elevated risk in those who experienced maternal bereavement postnatally. CONCLUSION: Maternal bereavement during the prenatal period was associated with increased risk of overweight or obesity in a group of young male conscripts, and this may possibly be reflected to severe stress exposure early in life. However, not all associations were clear, and further studies are warranted.

Web-based versus traditional paper questionnaires: a mixed-mode survey with a Nordic perspective.

BACKGROUND: Survey response rates have been declining over the past decade. The more widespread use of the Internet and Web-based technologies among potential health survey participants suggests that Web-based questionnaires may be an alternative to paper questionnaires in future epidemiological studies. OBJECTIVE: To compare response rates in a population of parents by using 4 different modes of data collection for a questionnaire survey of which 1 involved a nonmonetary incentive. METHODS: A random sample of 3148 parents of Danish children aged 2-17 years were invited to participate in the Danish part of the NordChild 2011 survey on their children's health and welfare. NordChild was conducted in 1984 and 1996 in collaboration with Finland, Iceland, Norway, and Sweden using mailed paper questionnaires only. In 2011, all countries used conventional paper versions only except Denmark where the parents were randomized into 4 groups: (1) 789 received a paper questionnaire only (paper), (2) 786 received the paper questionnaire and a log-in code to the Web-based questionnaire (paper/Web), (3) 787 received a log-in code to the Web-based questionnaire (Web), and (4) 786 received log-in details to the Web-based questionnaire and were given an incentive consisting of a chance to win a tablet computer (Web/tablet). In connection with the first reminder, the nonresponders in the paper, paper/Web, and Web groups were also present with the opportunity to win a tablet computer as a means of motivation. Descriptive analysis was performed using chi-square tests. Odds ratios were used to estimate differences in response rates between the 4 modes. RESULTS: In 2011, 1704 of 3148 (54.13%) respondents answered the Danish questionnaire. The highest response rate was with the paper mode (n=443, 56.2%). The other groups had similar response rates: paper/Web (n=422, 53.7%), Web (n=420, 53.4%), and Web/tablet (n=419, 53.3%) modes. Compared to the paper mode, the odds for response rate in the paper/Web decreased by 9% (OR 0.91, 95% CI 0.74-1.10) and by 11% (OR 0.89, 95% CI 0.73-1.09) in the Web and Web/tablet modes. The total number of responders for NordChild declined from 10,291 of 15,339 (67.09%) in 1984 and 10,667 of 15,254 (69.93%) in 1996 to 7805 of 15,945 (48.95%) in 2011 with similar declines in all 5 Nordic countries. CONCLUSIONS: Web-based questionnaires could replace traditional paper questionnaires with minor effects on response rates and lower costs. The increasing effect on the response rate on participants replying for a nonmonetary incentive could only be estimated within the 2 Web-based questionnaire modes before the first reminder. Alternative platforms to reach higher participation rates in population surveys should reflect the development of electronic devices and the ways in which the population primarily accesses the Internet.

[Contact from general practitioners to unvaccinated girls can increase HPV vaccination consent]. / Tilslutningen til HPV-vaccination kan øges ved henvendelse fra almen praksis til ikkevaccinerede piger.

The aim of the study was to evaluate the impact of general practitioners (GPs) follow-up of unvaccinated girls in the Danish Human Papillomavirus catch-up vaccination programme. Telephone interviews were conducted with the GPs to explore their follow-up procedure. The girls were divided into two groups: 1) girls contacted by their GP and 2) girls not contacted by their GP. Ten months later 61% of the girls, who had been contacted, had started vaccination in the follow-up group compared to 53% of girls, who had not been contacted (p < 0.02). Follow-up by GPs increased the likelihood of subsequent vaccination in a group of unvaccinated girls.

A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy.

OBJECTIVE: To evaluate cost effectiveness and cost utility comparing robot-assisted laparoscopic prostatectomy (RALP) versus retropubic radical prostatectomy (RRP). METHODS: In a retrospective cohort study a total of 231 men between the age of 50 and 69 years and with clinically localised prostate cancer underwent radical prostatectomy (RP) at the Department of Urology, Aarhus University Hospital, Skejby from 1 January 2004 to 31 December 2007, were included. The RALP and RRP patients were matched 1:2 on the basis of age and the D'Amico Risk Classification of Prostate Cancer; 77 RALP and 154 RRP. An economic evaluation was made to estimate direct costs of the first postoperative year and an incremental cost-effectiveness ratio (ICER) per successful surgical treatment and per quality-adjusted life-year (QALY). A successful RP was defined as: no residual cancer (PSA <0.2 ng/ml, preserved urinary continence and erectile function. A one-way sensitivity analysis was made to investigate the impact of changing one variable at a time. RESULTS: The ICER per extra successful treatment was €64,343 using RALP. For indirect costs, the ICER per extra successful treatment was €13,514 using RALP. The difference in effectiveness between RALP and RRP procedures was 7% in favour of RALP. In the present study no QALY was gained 1 year after RALP, however this result is uncertain due to a high degree of missing data. The sensitivity analysis did not change the results noticeably. LIMITATIONS: The study was limited by the design resulting in a low percentage of information on the effect of medication for erectile dysfunction and only short-term quality of life was measured at 1 year postoperatively. CONCLUSION: RALP was more effective and more costly. A way to improve the cost effectiveness may be to perform RALP at fewer high volume urology centres and utilise the full potential of each robot.

Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: a comparison of length of sick leave.

OBJECTIVE: It remains uncertain whether the increased direct costs of robot-assisted laparoscopic radical prostatectomy (RALP) are outweighed by cost savings due to shorter postoperative hospital care and shorter sick leave. This study compared the length of sick leave after RALP with that after radical retropubic prostatectomy (RRP). MATERIAL AND METHODS: In a cohort study, information on length of sick leave was retrieved for 274 working men undergoing radical prostatectomy (127 RALP and 147 RRP). Data on confounders such as physical workload, average salary, body mass index and disease characteristics were collected from the medical records. Cox regression models were used to compare the treatment groups. RESULTS: The median number of days with sick leave was 11 in the RALP group and 49 in the RRP group. After adjustment for confounders, patients in the RALP group were twice as likely to return to work at any time during follow-up (hazard ratio = 2.13, 95% confidence interval 1.62-2.80). High physical workload, low salary and high tumour grade were more common in the RRP group and associated with longer sick leave. CONCLUSIONS: Patients in the RALP group had shorter postoperative hospital stay and less need for paid sick leave than patients in the RRP group. These data indicate that RALP shortens the convalescence. Part of this difference may, however, be attributable to different selection of patients and different a priori expectations among patients and their doctors. A prospective randomized study is advocated, although blinding is unfeasible.

Oral oxycodone hydrochloride versus epidural anaesthesia for pain control after radical retropubic prostatectomy.

OBJECTIVE: To evaluate whether combined oral intake of paracetamol (4 x 1 g) + oxycodone hydrochloride (2x10 mg) is adequate and equivalent to epidural anaesthesia (EDA) with respect to postoperative pain control and postoperative mobilization after radical retropubic prostatectomy (RRP). MATERIAL AND METHODS: Forty consecutive patients scheduled for RRP were randomized to either: EDA with ropivacaine + paracetamol (4 x 1 g tablet) + injected or oral morphine on demand (EDA group); or infiltration of 25-40 ml of 0.25% bupivacaine into the wound + oxycodone hydrochloride (2 x 10 mg tablet) + paracetamol (4x1 g tablet) + injected or oral morphine on demand (OXY group). The groups were compared with respect to pain control determined by means of a visual analogue scale (VAS), time to free mobilization, hospital stay, complications, operation time and bleeding. RESULTS: Both analgesic regimens provided satisfactory analgesia, i.e. VAS scores remained significantly below 4 (p<0.0001). The EDA group experienced slightly less pain than the OXY group on the operation day but this was not significant: median VAS scores of 0.7 and 1.8, respectively (p=0.27). Median VAS scores during hospital stay were 1.7 in both treatment groups. VAS scores ranged from 0.1 to 3.3 and from 0.2 to 3.5 in the EDA and OXY groups, respectively. There was no significant difference in postoperative mobilization between the groups (p=0.06). The median duration of hospital stay was 3 nights in both groups. CONCLUSION: Postoperative pain control after RRP with oral oxycodone hydrochloride, paracetamol and extra morphine on demand is preferable to EDA when pain control as well as mobilization and costs are taken into account.