Characteristics of Religious and Spiritual Beliefs of Danish Physicians: And Likelihood of Addressing Religious and Spiritual Issues with Patients.

This study investigated the association between physicians' R/S characteristics and frequency of addressing patients' R/S issues. Information was obtained through a questionnaire mailed to 1485 Danish physicians (response rate 63%) (42% female). We found significant associations between physicians' personal R/S and the frequency of addressing R/S issues. Moreover, we identified significant gender differences in most R/S characteristics. However, no differences in frequency of addressing R/S issues were identified across gender. This raises some questions regarding the effects of gender on associations between R/S characteristics and frequency of addressing R/S issues.

Genetic epidemiology of Scheuermann's disease.

BACKGROUND AND PURPOSE: The genetic/environmental etiology of Scheuermann's disease is unclear. We estimated the heritability of the disease using an etiological model adjusted for sex and time of diagnosis, and examined whether the prevalence of Scheuermann's disease was constant over time. METHODS: 46,418 twins were sent a questionnaire about health and disease. Of these, 75% returned the questionnaire and 97% answered the question "Have you been diagnosed as having Scheuermann's disease by a doctor?" RESULTS: Responders included 11,436 complete pairs of twins. Data were analysed using classical twin modeling methods. Tetrachoric correlations were used to decide which etiological model to fit. The best-fitting model was the AE model. Heritability was 0.74 (95% CI: 0.65-0.81), while variance explained by environmental factors was 0.26 (95% CI: 0.19-0.35). A threshold of 2.1 (95% CI: 1.9-2.2) was calculated, corresponding to a prevalence of 1.9% (95% CI: 1.3-2.8) for women. Regression coefficients for age and sex were 0.000 (95% CI: -0.003 to 0.002) and -0.32 (95% CI: -0.42 to -0.23). INTERPRETATION: We found a heritability of 0.74 in Scheuermann's disease. The threshold in men was lower than in women, corresponding to a male prevalence that was almost twice that of females. We found no change in the prevalence of Scheuermann's disease throughout the 50-year age span that we examined.

An existential support program for people with cancer: Development and qualitative evaluation.

PURPOSE: To describe the development process of an existential support program and to explore participants' evaluation of supportive/unsupportive processes of change. METHOD: A five-day existential support program called "Energy for life" was designed including three main elements: 1. existential group counseling, 2. art therapy and 3. interaction with nature and aesthetic surroundings. The program was implemented at two different study sites. Focus group interviews were conducted to evaluate the program. RESULTS: 40 subjects were recruited (20 for each one of the two study sites) and 36 completed the study (31 women, five men) in the age range from 31 to 76 years and living with cancer across all stages and types. The program resulted in supportive processes of "existential sharing". The existential group counseling included a sharing process which led to an increased awareness and acceptance of one's existential situation and a preparation for the next steps in one's life. Art therapy offered a respite from the illness or the opportunity to express and share difficult thoughts and feelings connected to the illness experience. The interaction with nature/surroundings induced feelings of calmness and peace, increasing self-worth and spiritual belonging. Unsupportive processes of change related to the organization of the existential counseling groups, feelings of discomfort with creative engagement and feelings of distress provoked by a hospital environment. CONCLUSION: Through "Energy for life" existential concerns and distress were shared, contained and transformed. Knowledge has been gained about how an existential support program can be designed that explicitly focuses on alleviating patients' existential distress.

What is spiritual care? Professional perspectives on the concept of spiritual care identified through group concept mapping.

OBJECTIVES: The overall study aim was to synthesise understandings and experiences regarding the concept of spiritual care (SC). More specifically, to identify, organise and prioritise experiences with the way SC is conceived and practised by professionals in research and the clinic. DESIGN: Group concept mapping (GCM). SETTING: The study was conducted within a university setting in Denmark. PARTICIPANTS: Researchers, students and clinicians working with SC on a daily basis in the clinic and/or through research participated in brainstorming (n=15), sorting (n=15), rating and validation (n=13). RESULTS: Applying GCM, ideas were identified, organised and prioritised online. A total of 192 unique ideas of SC were identified and organised into six clusters. The results were discussed and interpreted at a validation meeting. Based on input from the validation meeting a conceptual model was developed. The model highlights three overall themes: (1) 'SC as an integral but overlooked aspect of healthcare' containing the two clusters SC as a part of healthcare and perceived significance; (2) 'delivering SC' containing the three clusters quality in attitude and action, relationship and help and support, and finally (3) 'the role of spirituality' containing a single cluster. CONCLUSION: Because spirituality is predominantly seen as a fundamental aspect of each individual human being, particularly important during suffering, SC should be an integral aspect of healthcare, although it is challenging to handle. SC involves paying attention to patients' values and beliefs, requires adequate skills and is realised in a relationship between healthcare professional and patient founded on trust and confidence.

Venous thromboembolic complications following surgical treatment for degenerative spinal disease.

INTRODUCTION: A venous thromboembolism (VTE), i.e. deep vein thrombosis (DVT) or pulmonary embolism (PE), is a potentially lethal complication to surgical procedures. The aim of this study was to evaluate the incidence of symptomatic VTEs in a large consecutive Danish cohort treated surgically for degenerative spinal disease. METHODS: This was a retrospective, consecutive, one-centre cohort study of patients treated surgically for either cervical or lumbar degenerative disease. According to the local treatment protocol, patients with an increased risk of VTE received rivaroxaban as thrombosis prophylaxis. VTE events within six months from the surgical procedure were identified via the Danish National Patient Register and confirmed by patient chart review. RESULTS: A total of 6,145 surgical procedures were included - 808 cervical and 5,337 lumbar procedures. Twelve patients (0.2%) were examined on suspicion of symptomatic VTE, ten for DVT and two for PE. VTE was confirmed in eight patients (0.1%), seven DVT and one PE. One patient died within six months, producing a mortality rate of 0.01%. CONCLUSIONS: VTEs are an uncommon but potentially lethal complication in patients who undergo surgery for a degenerative spinal disease. Incidence and mortality were low in a consecutive cohort where rivaroxaban was used as thrombosis prophylaxis in patients with an increased preoperative risk of VTE. FUNDING: none. TRIAL REGISTRATION: not relevant.

Prevalence, concordance, and heritability of Scheuermann kyphosis based on a study of twins.

BACKGROUND: The purpose of this study was to establish a cohort of symptomatic twins with Scheuermann kyphosis to provide estimates of prevalence, concordance, odds ratio, and heritability. These estimates indicate to what extent genetic factors contribute to the etiology of this disease. METHODS: The Odense-based Danish Twin Registry is unique in that it contains data on all 73,000 twin pairs born in Denmark over the last 130 years. For the present study, all 46,418 twins born from 1931 through 1982 received a seventeen-page questionnaire, in which one question was "Have you been diagnosed with Scheuermann disease by a doctor"? The prevalence of self-reported Scheuermann disease was calculated, with the total number of answers used as the general population. Pairwise and probandwise concordance, odds ratio, tetrachoric correlations, and heritability were calculated. RESULTS: We found that the overall prevalence of Scheuermann disease was 2.8%, with a prevalence of 2.1% among women and 3.6% among men (p < 0.0001). The pairwise concordance for monozygotic twins was 0.19 compared with 0.07 for dizygotic twins. The probandwise concordance was 0.31 for monozygotic twins and 0.13 for dizygotic twins. The odds ratios were 32.92 and 6.25 in the monozygotic and dizygotic twins, respectively. These differences were significant (p < 0.01). Heritability was 74%. CONCLUSIONS: In a large cohort of twins that included almost 35,000 individuals, the self-reported overall prevalence of Scheuermann disease was 2.8% and the male-to-female ratio was close to 2:1. Because the pairwise and probandwise concordance and the odds ratio were two to three times higher in monozygotic than in dizygotic twins and the heritability was high, we concluded that there is a major genetic contribution to the etiology of Scheuermann disease.

Early weaning might reduce the psychological strain of Boston bracing: a study of 136 patients with adolescent idiopathic scoliosis at 3.5 years after termination of brace treatment.

From 1983 to 1990 a total of 136 patients with adolescent idiopathic scoliosis were treated with the Boston brace. With the aim of examining the social and psychological impact of the brace treatment all patients received a questionnaire at an average of 3.5 years after termination of the treatment. Ninety-three percent responded to the questionnaire. The overall picture was that the patient's daily activities and social contacts, not least with the opposite sex, were affected both during the bracing period and at follow-up. It is important that the indications for the treatment are assured, and weaning should be initiated at the latest 3 years after menarche.

[Diagnosis and procedure coding in relation to the DRG system]. / Diagnose- og procedurekodning i relation til DRG-systemet på en ortopaedkirurgisk afdeling.

INTRODUCTION: The aim was to investigate the consequences of missing or wrong diagnoses and procedure codes in relation to the DRG system. MATERIAL AND METHODS: All patients admitted to the orthopaedic department during the course of one week, 155 patients, were consecutively entered. Former diagnoses were registered from interviews with all the patients, former case notes, and present hospital records. They were then compared to the department case notes, including diagnosis and procedure codes. All codes were then compared in Visual DRG (version 97) for grouping. RESULTS: The coding was correct in 103 of 155 cases (65%). In 52 cases (35%) the coding was incorrect or insufficient, in 18 of the 52 cases (12% overall) it lead to a decrease in the DRG value, which extrapolated on a yearly base, would lead to a loss of DDK 23 million. In total, coding was incorrect or insufficient in one third of the records. DISCUSSION: Irrespective of whether the DRG system is implemented or not, it is important that departments register the correct diagnoses and procedures, not only those relevant to the department. There is a continued need to teach and inform the staff about the correct coding procedures.

There are only minor changes in quality of life in patients with Scheuermann's disease.

INTRODUCTION: The impact of Scheuermannss disease (SD) on health-related quality of life (HRQoL) is unclear. The aim of this study was to study HRQoL based on The Medical Outcome Study Short Form-12 (SF-12) in adult life in a group of SD patients. MATERIAL AND METHODS: A total of 46,418 twins were sent a questionnaire. 75.3% answered. Included in the questionnaire were questions from the SF-12. We compared SF-12 values in SD patients and control patients. We also identified 259 "non-concordant" twin pairs and compared SF-12 values from the SD twin with values from the healthy twin. RESULTS: In all, 943 persons were identified to have SD, leaving 33,064 persons in the control group. SF-12 Physical Component Summary (PCS) (mean (standard deviation)) was found to be 50.50 (9.89) in SD and 53.21 (8.00) in controls (p < 0.001), and SF-12 Mental Component Summary (MCS) was found to be 51.52 (8.49) in SD and 51.81 (8.45) in controls (p = 0.71). In the non-concordant twin pairs, SF-12 PCS was found to be 50.74 (9.87) in SD and 52.74 (8.84) in controls (p < 0.001), and SF-12 MCS was found to be 53.91 (8.19) in SD and 53.72 (8.70) in controls (p = 0.64). CONCLUSION: SF-12 PCS is moderately, though highly statistically significantly worse in SD patients than in controls in this big group of twins. We found no statistical difference in SF-12 MCS between the two groups. SD patients evaluate their physical health worse and their mental health like controls. FUNDING: This study was funded by The Sahva Foundation. The sponsor had no influence on the study or its publication. No conflicts of interest exist between the sponsor and the authors. TRIAL REGISTRATION: Approved by the Scientific-ethical Committee in Denmark (no. 20010202).

Heritability of clubfoot: a twin study.

INTRODUCTION: The aetiology of congenital clubfoot is unclear. Although studies on populations, families, and twins suggest a genetic component to the aetiology, other studies have identified environmental factors. The purpose of this study was to calculate heritability in order to determine to what extent genetic and/or environmental factors contribute to the aetiology of congenital clubfoot and to asses whether there was a change in the prevalence over time. MATERIALS AND METHODS: The Odense based Danish Twin Registry is unique as it contains data on all the approximately 85,000 twin pairs born in Denmark over the last 140 years. All 46,418 twin individuals born from 1931 through 1982, who had earlier consented to contact, received a 17-page Omnibus questionnaire in the spring of 2002. Data were analysed with structural equation models to identify the best fitting aetiological model based on a balance of goodness-of-fit and parsimony and to estimate heritability. RESULTS: We found an overall self-reported prevalence of congenital clubfoot of 0.0027 (95 % confidence interval 0.0022-0.0034). Fifty-five complete (both twins answered the question) twin pairs were identified representing 12 monozygotic, 22 same-sex dizygotic, 18 opposite-sex dizygotic, and 3 with unclassified zygosity. The model with only environmental factors (CE) was best fitting based on AIC, and the model with an additive genetic factor (ACE) came in second. Due to the small statistical power, we hypothesise that the model with both genetic and environmental effects (ACE) was the better model. Choosing the ACE-model we found a heritability of clubfoot of 30 %. Regression coefficient for age was -0.002 (-0.011 to 0.005), indicating that there has been no change in prevalence of clubfoot over the 50-year age span we examined. DISCUSSION: We conclude that non-genetic factors must play a role, and a genetic factor might contribute, in the aetiology of congenital clubfoot.

Perceived health status in self-reported adolescent idiopathic scoliosis: a survey based on a population of twins.

STUDY DESIGN: A questionnaire-based identification of adolescent idiopathic scoliosis (AIS) patients and measure of Short Form-12 (SF-12) in a big twin-cohort. OBJECTIVE: The purpose was to study the effect that AIS has on the health-related quality of life in the patients. SUMMARY OF BACKGROUND DATA: The effect of AIS on the perceived health status is still unclear. METHODS: All 46,418 twins registered in the Danish Twin Registry born between 1931 and 1982 were sent a questionnaire including SF-12. The questionnaire was returned by 34,944 (75.3%) twins representing 23,204 pairs. RESULTS: A group of 220 subjects considered to have AIS was identified corresponding to a prevalence of 1.05%. In this group, the SF-12 could be calculated in 187 twins. CONCLUSION: We found the perceived both mental and physical health status from SF-12 to be moderately but significantly worse than in controls. Approximately 75% of the twins with AIS reported to have the same or a better health than their twin- and age-matched peers.

Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty: a clinical randomized study.

STUDY DESIGN: Clinical randomized study. OBJECTIVE: Percutaneous vertebroplasty is compared to conservative treatment in patients with acute or subacute osteoporotic vertebral fractures with respect to pain, physical and mental outcomes. The risk of vertebral fractures adjacent to treated levels is assessed. SUMMARY OF BACKGROUND DATA: There are some disagreements of the benefits of PVP for the treatment of acute osteoporotic vertebral fractures, but the long-term clinical outcome of PVP compared to conservative treatment has not been evaluated in a randomized study. METHODS: The 3-months follow-up of this study has been published previously, and here we report the completed 12-months analysis. About 50 patients (41 females) were included from January 2001 until January 2008. Patients with vertebral fractures less than 8 weeks old were included and randomized to either PVP or conservative treatment. Pain was assessed with a visual analogue scale. Physical and mental outcomes were assessed by validated questionnaires and tests. Tests, questionnaires, and plain radiographs were performed at the inclusion and after 3 and 12 months. RESULTS: Pain score before and after the operation in the PVP group was 7.9 and 2.0, respectively. There was no difference between the groups concerning pain at the 3- and 12-months follow-up. Supplementary assessment of back pain 1 month after discharge from hospital showed a significant lower VAS score in the PVP group over the conservative group. In the study period, 2 adjacent fractures in the PVP group and no adjacent fractures in the conservative group were registered. CONCLUSION: PVP is a good treatment for some patients with acute/subacute painful osteoporotic vertebral fractures, but the majority of fractures will heal after 8 to 12 weeks of conservative treatment with subsequent decline in pain. The risk of new fractures needs further research.

[Iatrogenic dural lesions in lumbar neural decompressive surgery]. / Iatrogene duralaesioner ved dekompressionskirurgi i lumbalcolumna.

INTRODUCTION: Iatrogenic dural tear with cerebrospinal fluid leakage is a known complication of lumbar surgery of the columna. In the literature, the incidence is 3-16%. MATERIAL AND METHODS: The study was a retrospective, consecutive review of electronic patient records after spinal surgery at the Private Hospital Hamlet. The study covers cases from the 10-month period from September 1, 2007 to June 30, 2008. Data was collected after this period and consists of surgeon-documented dural tears. At the time of surgery, the surgeon was unaware that there would be a subsequent registration. A total of 634 patients had lumbar neural decompressive surgery - 479 patients were treated for spinal stenosis and 155 for prolapsed disc. RESULTS: The incidence of dural tear was 3.9% (25 dural tears in 634 operations). The risk of a dural tear after secondary surgery was 7.9% versus 3.3% for primary (p = 0.02) and the mean age was 65.9 years for patients with dural tear compared with 58.1 years for patients without (p = 0.00). The difference in the mean duration of surgery was significant being 72 minutes in the group suffering a dural tear compared with 56 minutes (p = 0.03) among the remaining patients, and in the former group length of stay was increased by 1.1 day (p = 0.00). CONCLUSION: The incidence of iatrogenic dural tear was 3.9%. The incidence of dural tear was doubled in secondary surgery. The duration of surgery increased by 16 minutes and the patients with dural tear were also hospitalized one day longer.

Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three-months follow-up in a clinical randomized study.

STUDY DESIGN: Clinical randomized study. OBJECTIVE: The aim of this study is to compare percutaneous vertebroplasty (PVP) to conservative treatment of patients with osteoporotic vertebral fractures in a clinical randomized study with respect to pain, physical and mental outcome, and to asses the risk of adjacent fractures. SUMMARY OF BACKGROUND DATA: PVP is a therapeutic procedure performed to reduce pain in vertebral lesions. Despite the lack of comparative randomized clinical trials PVP is generally seen as a safe and efficient procedure for painful osteoporotic fractures. METHODS: Fifty patients (41 females) were included from January 2001 until January 2008. Patients with acute (<2 weeks) and subacute (between 2 and 8 weeks) osteoporotic fractures were included and randomized to either PVP or conservative treatment. Pain was assessed with a visual analogue scale and physical and mental outcome were assessed by validated questionnaires and tests. Tests, questionnaires, and plain radiographs were performed at the inclusion and after 3 months. RESULTS: Reduction in pain from initial visit to 3-month follow-up was comparable in the 2 groups (P = 0.33) from approximate visual analogue scale 8.0 to visual analogue scale 2.0, intragroup difference was significant (P = 0.00). Reduction in pain in the PVP group was immediate 12 to 24 hours after the procedure (P = 0.00). There was no significant difference in the other parameters when comparing the results at inclusion and after 3 months within both groups and between the groups after 3 months with a few exceptions. We observed 2 adjacent fractures in the PVP group and non in the conservative group. CONCLUSION: The majority of patients with acute or subacute painful osteoporotic compression fractures in the spine will recover after a few months of conservative treatment. The risk of adjacent fractures needs further research. No major adverse events were observed.

[Percutaneous vertebroplasty with only few complications--a retrospective study]. / Perkutan vertebroplastik med kun få komplikationer--et retrospektivt studie.

INTRODUCTION: Percutaneous vertebroplasty (PVP) was introduced in 1984 and has proved to be valuable in the treatment of painful vertebral lesions such as haemangiomas, metastasis, and osteoporotic fractures. According to the literature, the operation provides pain relief with only few and harmless complications. The aim of this study was to evaluate our perioperative experiences with special reference to the safety of the procedure. MATERIAL AND METHODS: A total of 156 procedures were performed in 148 patients with osteoporotic fractures. Both acute and chronic fractures were treated. All patients had plain radiographs of the spine. Magnetic resonance imaging (MRI) or bone scans were performed in case of old fractures or more than one fracture in patients with acute back-pain. At follow-up after three and 12 months, plain radiographs were performed in conjunction with physical examinations and interviews. Data were collected retrospectively. RESULTS: We identified 40.4% cemental leaks (confidence interval (CI) 32.6; 48.5). None of these resulted in neurological symptoms. One patient experienced shortness of breath after the procedure, one had atrial fibrillation, and one patient had an iatrogenic pneumothorax. In all, the frequency of symptomatic complications was 1.9% (CI -0.4; 5.5). CONCLUSION: We believe that PVP is a safe procedure with only few symptomatic complications when performed under local anaesthesia and by a specialist in transpedicular approach.

Adolescent idiopathic scoliosis in twins: a population-based survey.

STUDY DESIGN: A questionnaire-based identification of adolescent idiopathic scoliosis (AIS) patients in a twin cohort. OBJECTIVE: The purpose of this study was to establish a scoliosis twin cohort to provide data on the heritability of AIS. SUMMARY OF BACKGROUND DATA: The etiology of AIS is still unclear, and the true mode of inheritance has yet to be established. Concordance rates in monozygotic twins have been reported to be between 0.73 and 0.92, and in dizygotic twins between 0.36 and 0.63. Studies on concordance in twin pairs provide a basis for analyzing the influence of genetic versus environmental factors. METHODS: All 46,418 twins registered in the Danish Twin Registry born from 1931 to 1982 were sent a questionnaire, which included questions about scoliosis. A total of 34,944 (75.3%) representing 23,204 pairs returned the questionnaire. RESULTS: A subgroup of 220 subjects considered to have AIS was identified, thus giving a prevalence of 1.05%. The concordant twin pairs were all monozygotic. Pairwise, the concordance rate was 0.13 for monozygotic and zero for dizygotic twin pairs; proband-wise concordance was 0.25 for monozygotic and zero for dizygotic pairs. The concordance of monozygotic and dizygotic pairs was significantly different (P < 0.05). CONCLUSION: We have found evidence for a genetic etiology in AIS, but the risk of developing scoliosis in 1 twin whose other twin has scoliosis is smaller than believed up until now.