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2.
Am J Orthod Dentofacial Orthop ; 156(4): 502-511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31582122

RESUMO

INTRODUCTION: The aims of this study were to analyze differences in craniofacial and upper cervical spine morphology, including posterior cranial fossa and growth prediction signs between European and Asian skeletal Class III children, and to analyze associations between morphologic deviations in the upper cervical spine and craniofacial characteristics. METHODS: A total of 60 skeletal Class III children, 19 Danes and 41 Koreans, were included. Upper spine morphology, Atlas dimensions, and craniofacial morphology, including posterior cranial fossa and growth prediction signs, were assessed on lateral cephalograms. Differences and associations were analyzed by multiple linear and logistic regression analyses adjusted for age and gender. RESULTS: In the craniofacial morphology, the inclination of the maxilla (NSL/NL, P <0.05) and the shape of the posterior cranial fossa (s-d, d-p, p-iop; P <0.01 and P <0.0001, respectively) were significantly different between the 2 groups. There was no significant difference in upper cervical spine morphology and Atlas dimensions between the groups. Fusion was significantly associated with the sagittal jaw relationship (P <0.05), and the total upper spine deviations were significantly associated with some growth prediction signs (P <0.05, P <0.01). Atlas dimensions were significantly associated with the prognathia of the mandible (P <0.05), posterior cranial fossa (P <0.01, P <0.0001), and some growth prediction signs (P <0.05, P <0.01). CONCLUSIONS: Upper spine morphology and Atlas dimensions may provide valuable information for predicting jaw growth and craniofacial morphology in Class III malocclusion.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Cefalometria/métodos , Atlas Cervical/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Anormalidades Craniofaciais/diagnóstico por imagem , Anormalidades Craniofaciais/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Má Oclusão de Angle Classe III/diagnóstico por imagem , Má Oclusão de Angle Classe III/etnologia , Adolescente , Atlas Cervical/crescimento & desenvolvimento , Vértebras Cervicais/crescimento & desenvolvimento , Criança , Dinamarca , Feminino , Humanos , Masculino , República da Coreia
3.
Medicine (Baltimore) ; 98(38): e17265, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568003

RESUMO

BACKGROUND: Observational studies indicate that religious values of physicians influence clinical practice. The aim of this study was to test prior hypotheses of prevalence of this influence using a meta-analysis design. METHODS: Based on a systematic literature search we performed individual participant data meta-analysis (IPDMA) on data based on 2 preselected questionnaires. Ten samples from 7 countries remained after exclusion (n = 3342). IPDMA was performed using a random-effects model with 2 summary measures: the mean value of the scale "Religiosity of Health Professionals"; and a dichotomized value of the question "My religious beliefs influence my practice of medicine." Also, a sensitivity analysis was performed using a mixed-models design controlling for confounders. RESULTS: Mean score of religiosity (95% confidence interval [CI]) was significantly lower in the European subgroup (8.46 [6.96-9.96]) compared with the Asian samples India (10.46 [9.82-10.21]) and Indonesia (12.52 [12.19-12.84]), whereas Brazil (9.76 [9.54-9.99]) and USA (10.02 [9.82-10.21]) were placed in between. The proportion of the European physicians who agreed to the statement "My religious beliefs influence my practice of medicine" (95% CI) was 42% (26%-59%) compared with Brazil (36% [29%-43%]), USA (57% [54%-60%]), India (58% [52%-63%]), and Indonesia (91% [84%-95%]). CONCLUSIONS: Although large cross-cultural variations existed in the samples, 50% of physicians reported to be influenced by their religious beliefs. Religiosity and influence of religious beliefs were most pronounced in India, Indonesia, and a European faith-based hospital. Education regimes of current and future physicians should encompass this influence, and help physicians learn how their personal values influence their clinical practice.


Assuntos
Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Religião e Medicina , Adulto , Austrália , Brasil , Dinamarca , Feminino , Alemanha , Humanos , Índia , Indonésia , Masculino , Médicos/psicologia , Religião , Inquéritos e Questionários , Estados Unidos
4.
BMC Ecol ; 19(1): 43, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615504

RESUMO

BACKGROUND: In light of the biodiversity crisis and our limited ability to explain variation in biodiversity, tools to quantify spatial and temporal variation in biodiversity and its underlying drivers are critically needed. Inspired by the recently published ecospace framework, we developed and tested a sampling design for environmental and biotic mapping. We selected 130 study sites (40 × 40 m) across Denmark using stratified random sampling along the major environmental gradients underlying biotic variation. Using standardized methods, we collected site species data on vascular plants, bryophytes, macrofungi, lichens, gastropods and arthropods. To evaluate sampling efficiency, we calculated regional coverage (relative to the known species number per taxonomic group), and site scale coverage (i.e., sample completeness per taxonomic group at each site). To extend taxonomic coverage to organisms that are difficult to sample by classical inventories (e.g., nematodes and non-fruiting fungi), we collected soil for metabarcoding. Finally, to assess site conditions, we mapped abiotic conditions, biotic resources and habitat continuity. RESULTS: Despite the 130 study sites only covering a minute fraction (0.0005%) of the total Danish terrestrial area, we found 1774 species of macrofungi (54% of the Danish fungal species pool), 663 vascular plant species (42%), 254 bryophyte species (41%) and 200 lichen species (19%). For arthropods, we observed 330 spider species (58%), 123 carabid beetle species (37%) and 99 hoverfly species (33%). Overall, sample coverage was remarkably high across taxonomic groups and sufficient to capture substantial spatial variation in biodiversity across Denmark. This inventory is nationally unprecedented in detail and resulted in the discovery of 143 species with no previous record for Denmark. Comparison between plant OTUs detected in soil DNA and observed plant species confirmed the usefulness of carefully curated environmental DNA-data. Correlations among species richness for taxonomic groups were predominantly positive, but did not correlate well among all taxa suggesting differential and complex biotic responses to environmental variation. CONCLUSIONS: We successfully and adequately sampled a wide range of diverse taxa along key environmental gradients across Denmark using an approach that includes multi-taxon biodiversity assessment and ecospace mapping. Our approach is applicable to assessments of biodiversity in other regions and biomes where species are structured along environmental gradient.


Assuntos
Biodiversidade , Ecossistema , Dinamarca , Fungos , Inquéritos e Questionários
5.
Br J Anaesth ; 123(5): 671-678, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31474350

RESUMO

BACKGROUND: Days alive and out of hospital (DAH) has been proposed as a pragmatic outcome measure of surgical quality. However, there is a lack of procedure specific data or data within an optimised fast-track protocol. Furthermore, information about influence of follow-up duration and types of complications on DAH is limited. METHODS: Observational multicentre cohort study of patients undergoing fast-track total hip (THA) and knee arthroplasty (TKA). Prospective information on comorbidity and complete 90 days follow-up was undertaken through the Danish National Patient Register and chart review. RESULTS: For 16 137 procedures, of which 18.6% were high-risk (≥2 preoperative risk factors), the median length of stay was 2 days (inter-quartile range [IQR], 2-3), and 30- and 90-day readmission rates were 5.7% and 8.1%, respectively. Median DAH30 and DAH90 days were 27 (26-28) and 87 (85-88) vs 28 (27-28) and 88 (87-89) (P<0.001) in high-vs low-risk patients, respectively. The fraction with DAH ≤25 at 30 days and DAH ≤85 at 90 days was increased in high-vs low-risk patients: 23.3% vs 6.8% (odds ratio [OR]=4.16; 95% confidence interval [CI], 3.73-4.65) and 26.0% vs 8.6% (OR=3.75; 95% CI, 3.38-4.16). There were relatively fewer 'surgical' complications in high- vs low-risk patients with DAH30 ≤25 (14.6% vs 25.8%) (OR=0.49; 95% CI, 0.37-0.65) and DAH90 ≤85 (16.9% vs 31.89%) (OR=0.43; 95% CI, 0.34-0.56). About 2% of patients had readmissions, but DAH was >25 and >85 at 30 and 90 days after operation, respectively. CONCLUSION: Median DAH in fast-track THA/TKA patients is 28 at 30 days and 88 at 90 days after surgery. DAH in high-risk patients was only slightly reduced compared with low-risk patients, but they have relatively more 'medical' complications.


Assuntos
Artroplastia de Quadril/mortalidade , Artroplastia do Joelho/mortalidade , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/normas , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/normas , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Período Pós-Operatório , Indicadores de Qualidade em Assistência à Saúde , Sistema de Registros , Fatores de Risco
6.
Ambio ; 48(11): 1252-1263, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542886

RESUMO

Pollution with excess nutrients deteriorate the water quality of the Baltic Sea. The effect of combined land use and climate scenarios on nitrate leaching and nitrogen (N) loads to surface waters from two Baltic Sea catchments (Norsminde in Denmark and Kocinka in Poland) was explored using different models; the NLES and Daisy models for nitrate leaching, and MIKE SHE or MODFLOW/MT3DMS for N transport. Three Shared Socioeconomic Pathways (SSP1, SSP2 and SSP5) defined change in land use and agricultural activities. The climate change scenarios covered 2041-2060 compared with 1991-2010 under RCP8.5, applying four different climate models. Increases in predicted N-load from climate change vary from 20 to 60% depending on climate model. SSPs moderate these N-load changes with small changes for SSP1 to large increases for SSP5, with greater increases for Norsminde than Kocinka due to land use differences. This stresses needs for new measures and governing schemes to meet sustainability targets.


Assuntos
Agricultura , Nitratos , Mudança Climática , Conservação dos Recursos Naturais , Dinamarca , Polônia
8.
BMJ ; 366: l4693, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412996

RESUMO

OBJECTIVE: To explore the association between pregnancy duration and risk of endometrial cancer. DESIGN: Nationwide register based cohort study. SETTING: Denmark. PARTICIPANTS: All Danish women born from 1935 to 2002. MAIN OUTCOME MEASURES: Relative risk (incidence rate ratio) of endometrial cancer by pregnancy number, type, and duration, estimated using log-linear Poisson regression. RESULTS: Among 2 311 332 Danish women with 3 947 650 pregnancies, 6743 women developed endometrial cancer during 57 347 622 person years of follow-up. After adjustment for age, period, and socioeconomic factors, a first pregnancy was associated with a noticeably reduced risk of endometrial cancer, whether it ended in induced abortion (adjusted relative risk 0.53 (95% confidence interval 0.45 to 0.64) or childbirth (0.66, 0.61 to 0.72). Each subsequent pregnancy was associated with an additional reduction in risk, whether it ended in induced abortion (0.81, 0.77 to 0.86) or childbirth (0.86, 0.84 to 0.89). Duration of pregnancy, age at pregnancy, spontaneous abortions, obesity, maternal birth cohort, fecundity, and socioeconomic factors did not modify the results. CONCLUSIONS: The risk of endometrial cancer is reduced regardless of whether a pregnancy ends shortly after conception or at 40 weeks of gestation. This reduction in risk could be explained by a biological process occurring within the first weeks of pregnancy, as pregnancies ending in induced abortions were associated with similar reductions in risk as pregnancies ending in childbirth.


Assuntos
Aborto Induzido/estatística & dados numéricos , Neoplasias do Endométrio/epidemiologia , Gravidez/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Adulto , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , História Reprodutiva , Fatores de Risco , Fatores Socioeconômicos , Fatores de Tempo
9.
BMJ ; 366: l4772, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31467044

RESUMO

OBJECTIVE: To investigate the cardiovascular effectiveness of sodium glucose cotransporter 2 (SGLT2) inhibitors in routine clinical practice. DESIGN: Cohort study using data from nationwide registers and an active-comparator new-user design. SETTING: Denmark, Norway, and Sweden, from April 2013 to December 2016. PARTICIPANTS: 20 983 new users of SGLT2 inhibitors and 20 983 new users of dipeptidyl peptidase 4 (DPP4) inhibitors, aged 35-84, matched by age, sex, history of major cardiovascular disease, and propensity score. MAIN OUTCOME MEASURES: Primary outcomes were major cardiovascular events (composite of myocardial infarction, stroke, and cardiovascular death) and heart failure (hospital admission for heart failure or death due to heart failure). Secondary outcomes were the individual components of the cardiovascular composite and any cause death. In the primary analyses, patients were defined as exposed from treatment start throughout follow-up (analogous to intention to treat); additional analyses were conducted with an as-treated exposure definition. Cox regression was used to estimate hazard ratios. RESULTS: Mean age of the study cohort was 61 years, 60% were men, and 19% had a history of major cardiovascular disease. Of the total 27 416 person years of follow-up in the SGLT2 inhibitor group, 22 627 (83%) was among patients who initiated dapagliflozin, 4521 (16%) among those who initiated empagliflozin, and 268 (1%) among those who initiated canagliflozin. During follow-up, 467 SGLT2 inhibitor users (incidence rate 17.0 events per 1000 person years) and 662 DPP4 inhibitor users (18.0) had a major cardiovascular event, whereas 130 (4.7) and 265 (7.1) had a heart failure event, respectively. Hazard ratios were 0.94 (95% confidence interval 0.84 to 1.06) for major cardiovascular events and 0.66 (0.53 to 0.81) for heart failure. Hazard ratios were consistent among subgroups of patients with and without history of major cardiovascular disease and with and without history of heart failure. Hazard ratios for secondary outcomes, comparing SGLT2 inhibitors with DPP4 inhibitors, were 0.99 (0.85 to 1.17) for myocardial infarction, 0.94 (0.77 to 1.15) for stroke, 0.84 (0.65 to 1.08) for cardiovascular death, and 0.80 (0.69 to 0.92) for any cause death. In the as-treated analyses, hazard ratios were 0.84 (0.72 to 0.98) for major cardiovascular events, 0.55 (0.42 to 0.73) for heart failure, 0.93 (0.76 to 1.14) for myocardial infarction, 0.83 (0.64 to 1.07) for stroke, 0.67 (0.49 to 0.93) for cardiovascular death, and 0.75 (0.61 to 0.91) for any cause death. CONCLUSIONS: In this large Scandinavian cohort, SGLT2 inhibitor use compared with DPP4 inhibitor use was associated with reduced risk of heart failure and any cause death, but not with major cardiovascular events in the primary intention-to-treat analysis. In the additional as-treated analyses, the magnitude of the association with heart failure and any cause death became larger, and a reduced risk of major cardiovascular events that was largely driven by the cardiovascular death component was observed. These data help inform patients, practitioners, and authorities regarding the cardiovascular effectiveness of SGLT2 inhibitors in routine clinical practice.


Assuntos
Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Insuficiência Cardíaca/epidemiologia , Infarto do Miocárdio/epidemiologia , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Idoso , Dinamarca/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Seguimentos , Insuficiência Cardíaca/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/induzido quimicamente , Noruega/epidemiologia , Sistema de Registros/estatística & dados numéricos , Acidente Vascular Cerebral/induzido quimicamente , Suécia/epidemiologia
10.
Stud Health Technol Inform ; 264: 694-698, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438013

RESUMO

Digital solutions transform the way clinical services can be provided and make it possible for patients to participate in decisions concerning their own treatment. With the aim to support a better and more efficient healthcare system in Denmark, it has been agreed among authorities and care providers to establish a national infrastructure for sharing data between hospitals, municipalities, general practitioners and patients and concurrently develop standardized national digital cross-sector questionnaires for the purpose. Sharing data via the national infrastructure enables proactive involvement through patient reported outcomes (PRO). The national infrastructure forms a paradigm shift 1) for collaboration by moving from a baton-passing workflow to sharing-based workflow and 2) for the development of digital cross-sector questionnaires. Cross-sector questionnaire definitions are stored in a national questionnaire repository, and are used in local PRO applications to capture the patients' responses.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Assistência à Saúde , Dinamarca , Clínicos Gerais , Humanos , Inquéritos e Questionários
12.
Bone Joint J ; 101-B(8): 960-969, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362543

RESUMO

AIMS: The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. MATERIALS AND METHODS: Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II). RESULTS: A total of 26 524 arthroplasties were analyzed. From 12 307 procedures that were undertaken before implementation of the compatibility check, 21 class A incompatibilities were identified (real- or high-risk combinations; 0.17%; 95% confidence interval (CI) 0.11 to 0.26). From 5692 hip and 6615 knee procedures prior to implementation of the compatibility check, we found rates of class A-I incompatibility (real- or high-risk combinations unknowingly inserted) of 0.14% (95% CI 0.06 to 0.28) and 0.17% (95% CI 0.08 to 0.30), respectively. From 14 217 procedures after the introduction of compatibility checking (7187 hips and 7030 knees), eight class A incompatibilities (0.06%; 95% CI 0.02 to 0.11) were identified. This difference was statistically significant (p = 0.008). CONCLUSION: Our data presents validated estimates of the baseline incidence of incompatibility events for hip and knee arthroplasty procedures and shows that a significant reduction in class A incompatibility events is possible using a web-based recording system. Cite this article: Bone Joint J 2019;101-B:960-969.


Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia do Joelho/instrumentação , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Erros Médicos/prevenção & controle , Desenho de Prótese/efeitos adversos , Falha de Prótese/etiologia , Estudos de Coortes , Sistemas de Computação , Dinamarca , Humanos , Erros Médicos/efeitos adversos , Erros Médicos/estatística & dados numéricos , Falha de Prótese/efeitos adversos , Sistema de Registros
13.
BMC Infect Dis ; 19(1): 740, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438877

RESUMO

BACKGROUND: Women living with HIV (WLWH) have high rates of persistent high-risk human papillomavirus (hrHPV) infections and cervical cancer. We aimed to assess the distribution of hrHPV genotypes, risk factors of type-specific hrHPV persistence, and high-grade squamous intraepithelial lesions or worse (≥HSIL) in WLWH in Denmark. METHODS: From the prospective Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) we identified WLWH with a positive hrHPV test during the study period; 2011-2014. HIV demographics were retrieved from the Danish HIV Cohort Study and pathology results from the The Danish Pathology Data Bank. Logistic regression was used to identify risk factors associated with persistent hrHPV infection (positivity of the same hrHPV type in two samples one-two years after the first hrHPV positive date) and ≥ HSIL. RESULTS: Of 71 WLWH, 31 (43.7%) had persistent hrHPV infection. Predominant hrHPV genotypes were HPV58, 52, 51, and 35 and most frequently observed persistent genotypes were HPV52, 33 and 31. CD4 < 350 cells/µL predicted genotype-specific hrHPV persistence (adjusted OR 4.36 (95%CI: 1.18-16.04)) and ≥ HSIL was predicted by prior AIDS (adjusted OR 8.55 (95% CI 1.21-60.28)). CONCLUSIONS: This prospective cohort study of well-treated WLWH in Denmark found a high rate of persistent hrHPV infections with predominantly non-16/18 hrHPV genotypes. CD4 count < 350 cells/µL predicted hrHPV persistence, while prior AIDS predicted ≥HSIL.


Assuntos
Colo do Útero/virologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Adulto , Contagem de Linfócito CD4 , Colo do Útero/patologia , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Genótipo , HIV , Infecções por HIV/virologia , Humanos , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Sistema de Registros , Fatores de Risco , Lesões Intraepiteliais Escamosas Cervicais/complicações , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia
14.
Gynecol Oncol ; 155(1): 112-118, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31378374

RESUMO

OBJECTIVES: We aimed to clarify if endometrial cancer patients are at higher risk of venous thromboembolism (VTE) following hysterectomy, compared to patients undergoing hysterectomy for benign gynecological disease. METHODS: In a nationwide registry-based cohort study, patients undergoing hysterectomy for endometrial cancer or benign disease were followed 30 days after surgery. The Danish Gynecological Cancer Database (DGCD) and the Danish National Patient Register (DNPR) were linked with four other administrative registries to describe the population and retrieve data on venous thromboembolism and mortality. Multivariable logistic regression models were used to estimate odds ratios (ORs) for 30-day postoperative VTE. RESULTS: We identified 5513 patients with endometrial cancer, and 45,825 patients with benign disease undergoing hysterectomy in the period 2005-2014. The overall incidence of 30-day VTE following hysterectomy was 0.2% (103/51,338). Thirty (0.5%) patients with endometrial cancer and 73 (0.16%) patients with benign disease developed VTE. In a multivariable logistic regression analysis, significant predictors of 30-day OR for VTE were open surgery (minimally invasive surgery vs. open: OR = 0.46; 95% CI, 0.30-0.71; p < 0.001), lymphadenectomy (OR = 4.00; 95% CI, 1.89-8.46; p < 0.001), BMI > 40 (OR = 2.34;95% CI, 1.10-5.01; p = 0.03) and previous VTE (OR = 34; 95% CI, 22.7-51.3; p < 0.001). There was no statistically significant difference in the 30-day OR for VTE in endometrial cancer compared to benign disease (OR = 1.47; 95% CI, 0.74-2.91; p = 0.27). CONCLUSIONS: This study did not identify endometrial cancer to be an independent risk factor for VTE following hysterectomy compared to benign disease. We identified open surgery, lymphadenectomy, BMI above 40 and previous VTE as independent risk factors for 30-day postoperative VTE.


Assuntos
Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/cirurgia , Histerectomia/estatística & dados numéricos , Tromboembolia Venosa/epidemiologia , Adulto , Estudos de Coortes , Dinamarca/epidemiologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histerectomia/efeitos adversos , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Sistema de Registros , Tromboembolia Venosa/etiologia
15.
BMC Public Health ; 19(1): 1092, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409343

RESUMO

BACKGROUND: Current evidence on chronic disease prevention suggests that interventions targeted at high-risk individuals represents the best way forward. We implemented a step-wise approach in the Danish primary care sector, designed for the systematic and targeted prevention of chronic disease. The intervention centered on a personal digital health profile for all participants, followed by targeted preventive programs for high-risk patients. The present paper examines individual characteristics and health-care usage of patients who took up the targeted preventive programs in response to their personal digital health profile. METHODS: A sample of patients born between 1957 and 1986 was randomly selected from the patient-list system of participating general practitioners in two Danish municipalities. The selected patients received a digital invitation to participate. Consenting patients received a second digital invitation for a personal digital health profile based on questionnaire and electronic patient record data. The personal digital health profile contained individualized information on risk profile and personalized recommendations on further actions. If at-risk or presenting with health-risk behaviour a patient would be advised to contact either their general practitioner or municipal health centre for targeted preventive programs. Attendance at the targeted preventive programs was examined using Poisson regression and chi-squared automatic interaction detection methods. RESULTS: A total of 9400 patients were invited. Of those who participated (30%), 22% were advised to get a health check at their general practitioner. Of these, 19% did so. Another 23% were advised to schedule an appointment for behaviour-change counselling at their municipal health centre. A total of 21% took the advice. Patients who had fair or poor self-rated health, a body mass index above 30, low self-efficacy, were female, non-smokers, or lead a sedentary lifestyle, were most likely to attend the targeted preventive programs. CONCLUSIONS: A personal digital health profile shows some promise in a step-wise approach to prevention in the Danish primary care sector and seems to motivate people with low self-efficacy to attend targeted preventive programs. TRIAL REGISTRATION: Registered at Clinical Trial Gov (Unique Protocol ID: TOFpilot2016 ). Prospectively registered on the 29th of April 2016.


Assuntos
Doença Crônica/prevenção & controle , Serviços Preventivos de Saúde/métodos , Atenção Primária à Saúde , Adulto , Estudos Transversais , Dinamarca , Registros Eletrônicos de Saúde , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos
16.
Ecol Lett ; 22(10): 1650-1657, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31364805

RESUMO

While biodiversity loss continues globally, assessments of regional and local change over time have been equivocal. Here, we assess changes in plant species richness and beta diversity over 140 years at the level of regions within a country. Using 19th-century flora censuses for 14 Danish regions as a baseline, we overcome previous criticisms concerning short time series and neglect of completely altered habitats. We find that species composition has changed dramatically and directionally across all regions. Substantial species losses were more than offset by large gains, resulting in a net increase in species richness in all regions. The occupancy of initially widespread species increased, while initially rare species lost terrain. These changes were accompanied by strong biotic homogenization; i.e. regions are more similar now than they were 140 years ago. Species declining in Denmark were found to be in similar decline all over Northern Europe.


Assuntos
Biodiversidade , Ecossistema , Plantas/classificação , Dinamarca
17.
Stud Health Technol Inform ; 265: 181-185, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431596

RESUMO

The provision of individualised treatment and care from health care services to patients with chronic conditions and multi-morbidities is under pressure because of an increasing elderly population. There is a need for services that are: 1) person-centred, 2) integrated and 3) proactive, and supported by digital technology. The research project 3P-Patients and Professionals in Productive Teams aims to study different patient-centred teamwork models in Norway and Denmark. This paper presents a study on patients' experiences and digital involvement in patient-centred care teams. Qualitative research methods were applied with interviews and demonstrations of technology use made at patient's homes. The results showed that the patients were satisfied with the patient-centred service models and had an increased feeling of safety. A constraint was information sharing between the patient-centred health care team and the patients. Most of them did not have access to read own medical information and mainly verbal information was shared between the patients and the health providers.


Assuntos
Equipe de Assistência ao Paciente , Assistência Centrada no Paciente , Doença Crônica , Dinamarca , Humanos , Noruega , Pesquisa Qualitativa
18.
Stud Health Technol Inform ; 264: 1075-1079, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438090

RESUMO

In order to realise the potential benefits of eHealth, governments develop eHealth policies to define and prioritise initiatives, the strategic goals and the resulting benefits. During the 23 years with eHealth policies in Denmark only a few status reports with a systematic and transparent evaluation have been made. This paper advocates a more systematic approach to strategic planning of development and implementation of eHealth systems, by encouraging the concept of evidence-based policy making through analysis of how focus of the Danish eHealth policies have evolved. The Danish eHealth policies have very different framings following the different focus points for the policies. Interestingly, strategies for evaluating the devolopment of eHealth and eHealth policies were very sparcely noted in the policies. For the first time the de-emphasising of evaluations of eHealth policies in Denmark has been empirically demonstrated, thus undermining the objective of obtaining evidence-based eHealth policies.


Assuntos
Informática Médica , Telemedicina , Dinamarca , Política de Saúde , Formulação de Políticas
19.
BMC Vet Res ; 15(1): 231, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286935

RESUMO

BACKGROUND: Monitoring systems are essential to detect if the number of cases of a specific disease is rising. Data collected as part of voluntary disease monitoring programs is particularly useful to evaluate if control and eradication programs achieve the target. These data are characterized by random noise which makes harder to interpret temporal changes in the data. Monitoring trends in the data is a possible approach to overcome this issue. The objective of this study was to assess the performance of three time-series models that allows monitoring trends in data in terms of its adaptability when used to monitor changes in disease sero-prevalence at a national scale based on data collected as part of voluntary monitoring programs. We compared two Bayesian forecasting methods and an Exponential smoothing method, specifically a Dynamic Linear Model, a Dynamic Generalized Linear Model and a Holt's linear trend method, respectively. These three different types of time series models were applied to data on weekly sero-prevalence of Porcine Reproductive and Respiratory Syndrome (PRRS) in Danish swine herds. RESULTS: Comparing the linear cross-dependence between the filtered values obtained from the three models and the raw data, we observed that the Holt's linear trend method shows negative linear dependence for roughly half of the time for breeding/nucleus and multiplier herds, having values close to zero for most of the period in finisher herds. CONCLUSIONS: Bayesian forecasting methods adapt faster to changes in the data, compared to the deterministic Holt's linear trend method. The practical implication of this greater flexibility is that the Bayesian methods will provide more reliable values of changes in the data and have potential to be implemented as part of a surveillance system in Denmark.


Assuntos
Doenças Endêmicas , Modelos Biológicos , Síndrome Respiratória e Reprodutiva Suína/epidemiologia , Estudos Soroepidemiológicos , Animais , Dinamarca , Doenças Endêmicas/estatística & dados numéricos , Vigilância da População , Suínos , Fatores de Tempo
20.
Cornea ; 38(8): 998-1002, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276461

RESUMO

PURPOSE: The purpose of this study was to investigate the use of anterior segment imaging in diagnosing Kayser-Fleischer rings in patients with Wilson disease. METHODS: In a tertiary center for Wilson disease, patients were examined with a Pentacam HR Scheimpflug-based tomography device in addition to conventional slit-lamp examination. The inferior part of the cornea was analyzed using both a built-in densitometry module and ImageJ. RESULTS: Thirty-one patients with Wilson disease (78% of all Danish patients) were included, resulting in 83 examinations over a 5-year period. Ten had a manifest Kayser-Fleischer ring in the inferior part of the cornea on at least 1 examination, 5 had other causes of peripheral corneal scatter, and 16 had normal examinations. The built-in densitometry module performed poorly in discriminating between the presence and absence of a Kayser-Fleischer ring. However, analysis of the images in ImageJ and calculation of a normalized signal (peak posterior value/peak anterior value) with a cutoff value set to 1 detected 28 of 31 Kayser-Fleischer rings and resulted in 96% sensitivity and 95% specificity. In 12 patients who underwent 3 or more examinations during the period, changes in the normalized signal seemed to reflect the efficiency of the treatment, although more studies are needed for this conclusion. CONCLUSIONS: ImageJ-based analysis of Pentacam images has a high sensitivity in detecting Kayser-Fleischer rings and can be used as a diagnostic procedure for Wilson disease and may be a tool to monitor the disease in an objective manner.


Assuntos
Segmento Anterior do Olho/diagnóstico por imagem , Doenças da Córnea/diagnóstico por imagem , Técnicas de Diagnóstico Oftalmológico , Degeneração Hepatolenticular/diagnóstico por imagem , Tomografia Óptica/métodos , Adulto , Estudos de Coortes , Dinamarca , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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