Showing papers by "Elsebeth Lynge published in 2010"

E-health empowers patients with ulcerative colitis: a randomised controlled trial of the web-guided ‘Constant-care’ approach

Abstract: Background The natural history of ulcerative colitis requires continuous monitoring of medical treatment via frequent outpatient visits. The European health authorities9 focus on e-health is increasing. Lack of easy access to inflammatory bowel disease (IBD) clinics, patients9 education and understanding of the importance of early treatment at relapse is leading to poor compliance. To overcome these limitations a randomised control trial ‘Constant-care’ was undertaken in Denmark and Ireland. Methods 333 patients with mild/moderate ulcerative colitis and 5-aminosalicylate acid treatment were randomised to either a web-group receiving disease specific education and self-treatment via http://www.constant-care.dk or a control group continuing the usual care for 12 months. A historical control group was included to test the comparability with the control group. We investigated: feasibility of the approach, its influence on patients9 compliance, knowledge, quality of life (QoL), disease outcomes, safety and health care costs. Results 88% of the web patients preferred using the new approach. Adherence to 4 weeks of acute treatment was increased by 31% in Denmark and 44% in Ireland compared to the control groups. In Denmark IBD knowledge and QoL were significantly improved in web patients. Median relapse duration was 18 days (95% CI 10 to 21) in the web versus 77 days (95% CI 46 to 108) in the control group. The number of acute and routine visits to the outpatient clinic was lower in the web than in the control group, resulting in a saving of 189 euro/patient/year. No difference in the relapse frequency, hospitalisation, surgery or adverse events was observed. The historical control group was comparable with the control group. Conclusion The new web-guided approach on http://www.constant-care.dk is feasible, safe and cost effective. It empowers patients with ulcerative colitis without increasing their morbidity and depression. It has yet to be shown whether this strategy can change the natural disease course of ulcerative colitis in the long term.

Occupation and occupational exposure to endocrine disrupting chemicals in male breast cancer: a case-control study in Europe.

Abstract: Objectives Male breast cancer is a rare disease of largely unknown aetiology. In addition to genetic and hormone-related risk factors, a large number of environmental chemicals are suspected of playing a role in breast cancer. The identification of occupations or occupational exposures associated with an increased incidence of breast cancer in men may help to identify mammary carcinogens in the environment. Methods Occupational risk factors for male breast cancer were investigated in a multi-centre case-control study conducted in eight European countries which included 104 cases and 1901 controls. Lifetime work history was obtained during in-person interviews. Occupational exposures to endocrine disrupting chemicals (alkylphenolic compounds, phthalates, polychlorinated biphenyls and dioxins) were assessed on a case-by-case basis using expert judgement. Results Male breast cancer incidence was particularly increased in motor vehicle mechanics (OR 2.1, 95% CI 1.0 to 4.4) with a dose-effect relationship with duration of employment. It was also increased in paper makers and painters, forestry and logging workers, health and social workers, and furniture manufacture workers. The OR for exposure to alkylphenolic compounds above the median was 3.8 (95% CI 1.5 to 9.5). This association persisted after adjustment for occupational exposures to other environmental oestrogens. Conclusion These findings suggest that some environmental chemicals are possible mammary carcinogens. Petrol, organic petroleum solvents or polycyclic aromatic hydrocarbons are suspect because of the consistent elevated risk of male breast cancer observed in motor vehicle mechanics. Endocrine disruptors such as alkylphenolic compounds may play a role in breast cancer.

Research recommendations for selected IARC-classified agents.

Abstract: ObjectivesThere are some common occupational agents and exposure circumstances for which evidence of carcinogenicity is substantial but not yet conclusive for humans Our objectives were to identif

Determinants of participation in colorectal cancer screening with faecal occult blood testing

Abstract: Background Colorectal cancer is one of the most common cancers in men and women. Participation rates in faecal occult blood testing (FOBT) screening activities are, however, relatively low. In terms of lowering the colorectal cancer mortality, high participation rates are essential, and therefore it is important to understand the barriers to FOBTscreening. Methods We undertook a systematic search through PUBMED, Medline, EMBASE and PsycINFO in order to identify studies that provide information on socio-demographic determinants of participation in FOBT screening. Results FOBT participation varied considerably across countries, but they have rarely been above 60%. The use of other health-care services was in most studies a strong determinant for participation in screening with FOBT. There was a tendency to higher participation among women than among men and among married as opposed to not married, but determinants varied across countries and test settings. There was no systematic variation in participation across age groups. Conclusion The participation pattern depends in part on local circumstances, which makes it difficult to point to a general strategy for increasing the uptake in FOBT screening. This stresses the need for monitoring of individual screening programmes and developing information strategies targeted to the local participation pattern.

A fall-off in cervical screening coverage of younger women in developed countries

Abstract: ObjectivesTo analyse cervical screening coverage data by age over time in a number of developed countries throughout the world, with specific emphasis on trends for younger women and on age differentials between younger and older womenMethodsRoutinely collected cervical screening statistics and survey data were collected on the proportion of women who have undergone cervical screening with cytology in seven countries in the period 1995 to 2005ResultsData for the 25-29 age group were examined Coverage fell in most countries, in three by more than 5 percentage points In two countries while overall coverage rose in the period, the rise was not as steep in the youngest group of women Data for each available 5-year age group for the different countries shows a similar gradient in most, regardless of the absolute level of coverage Although the trend is not uniform in every country, it appears that generally the gap between coverage of younger women and coverage of older women increased, sometimes dramatic

Why did the breast cancer lymph node status distribution improve in Denmark in the pre-mammography screening period of 1978-1994?

Abstract: Background. Danish breast cancer patients diagnosed in 1978–1994 experienced a trend over time towards a more favourable distribution of lymph node status at time of diagnosis, which was not due to mammography screening. We investigated how this trend could be explained by patient characteristics at diagnosis: age (biological processes), calendar period (e.g. environmental changes), birth cohort (living conditions over a life time), post-menopausal status (a predictor of less favourable nodal status), and tumour diameter (a marker of detection time). Material and methods. The data set consisted of 22 955 patients aged 30–69 years at time of diagnosis with known lymph node status, known tumour diameter, known menopausal status, and clinically detected tumours, available from the Danish Breast Cancer Cooperative Group (DBCG). Age, period, cohort, menopausal status, and tumour diameter were used as predictors in generalised linear models with either node-positive status (at least one of the excised l...

Incomplete follow-up of positive HPV tests: overview of randomised controlled trials on primary cervical screening.

Abstract: Incomplete follow-up of positive HPV tests: overview of randomised controlled trials on primary cervical screening

Performance of diagnostic mammography differs in the United States and Denmark.

Abstract: Diagnostic mammography is the primary imaging modality to diagnose breast cancer. However, few studies have evaluated variability in diagnostic mammography performance in communities, and none has done so between countries. We compared diagnostic mammography performance in community-based settings in the United States and Denmark. The performance of 93,585 diagnostic mammograms from 180 facilities contributing data to the US Breast Cancer Surveillance Consortium (BCSC) from 1999 to 2001 was compared to that of all 51,313 diagnostic mammograms performed at Danish clinics in 2000. We used the imaging workup's final assessment to determine sensitivity, specificity and an estimate of accuracy: area under the receiver-operating characteristics (ROCs) curve (AUC). Diagnostic mammography had slightly higher sensitivity in the United States (85%) than in Denmark (82%). In contrast, it had higher specificity in Denmark (99%) than in the United States (93%). The AUC was high in both countries: 0.91 in United States and 0.95 in Denmark. Denmark's higher accuracy may result from supplementary ultrasound examinations, which are provided to 74% of Danish women but only 37% to 52% of US women. In addition, Danish mammography facilities specialize in either diagnosis or screening, possibly leading to greater diagnostic mammography expertise in facilities dedicated to symptomatic patients. Performance of community-based diagnostic mammography settings varied markedly between the 2 countries, indicating that it can be further optimized.

Occupational exposure to electromagnetic fields and sex-differential risk of uveal melanoma

Abstract: Objectives The association between occupational exposure to electromagnetic fields (EMF) and the risk of uveal melanoma was investigated in a caseecontrol study in nine European countries. Methods Incident cases of uveal melanoma and population as well as hospital controls were included and frequency matched by country, 5-year birth cohort and sex. Subjects were asked whether they had worked close to high-voltage electrical transmission installations, computer screens and various electrical machines, or in complex electrical environments. Measurements of two Scandinavian jobeexposure matrices were applied to estimate lifelong cumulative EMF exposure. Unconditional logistic regression analyses, stratified by sex and eye colour were calculated, adjusting for several potential confounders. Results 293 patients with uveal melanoma and 3198 control subjects were interviewed. Women exposed to electrical transmission installations showed elevated risks (OR 5.81, 95% CI 1.72 to 19.66). Positive associations with exposure to control rooms were seen among men and women, but most risk increases were restricted to subjects with dark iris colour. Application of published EMF measurements revealed stronger risk increases among women compared to men. Again, elevated risks were restricted to subjects with dark eye colour. Conclusion Although based on a low prevalence of exposure to potential occupational sources of EMF, our data indicate that exposed dark-eyed women may be at particular risk for uveal melanoma.

Data on education: From population statistics to epidemiological research

Abstract: Background: Level of education is in many fields of research used as an indicator of social status. Methods: Using Statistics Denmark's register for education and employment of the population, we examined highest completed education with a birth-cohort perspective focusing on people born between 1930 and 1974. Results: Irregularities in the educational data were found for both men and women born from 1951 to 1957. For the birth cohorts born from 1951 to 1954, a sudden increase in the proportion of persons with basic school education only was seen, and a following decrease in this proportion was seen for the birth cohorts born from 1955 to 1957. For the same birth cohorts, a reverse curve was found for the proportion with vocational training as highest completed education. Using proportion of women with at least one child at the age of 30, our analysis illustrated that spurious patterns may emerge when other social phenomena are analysed by partly misclassified educational groups. Conclusions: Our findings showed that register data are not always to be taken at face value and that thorough analysis may unravel unexpected irregularities. Although such data errors may be remedied in analyses of population trends by use of extrapolated values, solutions are less obvious in epidemiological research using individual level data.

Has cytology become obsolete as a primary test in screening for cervical cancer

Abstract: Firstly, despite randomization women in the cytology arm (n ¼ 32,058) tended to have a higher background incidence for cervical cancer than women in the HPV arm (n ¼ 34,126). This can be illustrated with women who did not undergo screening, as the same percentage, 20.3%, among those invited in either of the two arms failed to attend (6509 in the cytology arm and 6934 in the HPV arm). Among these women, the risk of cervical cancer was 6.5 per 1000 (¼42/ 6509) in the cytology arm, and 4.6 per 1000 (¼32/6934) in the HPV arm, 1 resulting in a non-significantly increased risk of 40% in the cytology arm, RR 1.40 (95% CI 0.88-2.21). This tendency to an elevated background risk in the cytology arm may have also played a role among the screened women; however, this cannot be independently quantified because the effectiveness of the respective screening tests would then have to be taken into account. Secondly, in the cytology arm 54 deaths from cervical cancer were observed among the 152 diagnosed patients, while 34 deaths from cervical cancer were observed among the 127 diagnosed patients in the HPV arm. The number of deaths depends on the length of follow-up of the patients, and on the stage distribution of the patients at the time of diagnosis. Women in the two arms of the trial were followed for the same eight-year period. A slightly higher proportion of patients in the HPV arm, 69% (¼87/ 127), than in the cytology arm, 58% (¼88/152), were diag- nosed following a positive screening test, x 2 ¼ 3.33, df ¼ 1, P ¼ 0.07. Patients in the HPV arm therefore tended to spend somewhat more time with the cancer diagnosis than patients in the cytology arm, so variation in the length of follow-up of patients cannot explain why more deaths were observed in the cytology arm before the reported eight-year follow-up ended. Further, patients in the two arms had the same stage distribution at time of diagnosis, x 2 ¼ 4.04, df ¼ 3, P ¼ 0.26. One would therefore expect that roughly equal proportions of cervical cancer patients would die from their disease during the follow-up period. Applying the death proportion of 34/127 from the HPV arm 1 on the 152 patients from the cytology arm would result in an expected number of 40.7 cervical cancer deaths in the cytology arm. Thus, had the estimated 40.7 instead of 54 deaths been observed, no differ- ence would have been found between the risk of dying from cervical cancer with 34 cervical cancer deaths during the observed 268,674 person-years in the HPV arm, and the expected risk of 40.7 cervical cancer deaths during 251,144 person-years in the cytology arm, RR 0.78 (95% CI 0.50- 1.23). To sum up, the significantly decreased mortality from cer- vical cancer in the HPV arm compared with the cytology arm, RR 0.59 (95% CI 0.38-0.90), observed in the random- ized trial in India may not necessarily have been a conse- quence of differences in the effectiveness between the two screening tests. A possibly higher background incidence rate in the cytology than in the HPV arm, as well as relatively poor survival among the patients in the cytology arm may also have contributed to the study outcome. This trial, there- fore, 'does not negate the benefit found from primary HPV

Re: Age-Specific Evaluation of Primary Human Papillomavirus Screening vs Conventional Cytology in a Randomized Setting

Abstract: Leinonen et al. (1) recently reported results for women aged 25–65 years from the base line round of cervical screening in a Finnish randomized controlled trial that compared human papillomavirus (HPV) DNA screening with conventional cytology screening. The authors reported that HPV DNA screening combined with cytology triage had a specificity of 98.9% for cer vical intraepithelial neoplasia grade 3 or higher (CIN 3+; number of women with a negative screening test divided by total number of women screened minus the number with histologically confirmed CIN 3+). The same specificity was found for conventional cytology screening. In calcu lating these specificities, all women without a direct referral for colposcopy, that is, those with a less severe abnormality than low-grade squamous intraepithelial lesion on cytology, were considered screen nega tive. In this case, it is hardly surprising that the two screening methods appeared to have the same specificity, given that only a small proportion of low-grade squamous intraepithelial lesions or more severe ab