Showing papers in "Ugeskrift for Læger in 2008"

[''R"--project for statistical computing].

Abstract: An introduction to the R project for statistical computing (www.R-project.org) is presented. The main topics are: 1. To make the professional community aware of "R" as a potent and free software for graphical and statistical analysis of medical data; 2. Simple well-known statistical tests are fairly easy to perform in R, but more complex modelling requires programming skills; 3. R is seen as a tool for teaching statistics and implementing complex modelling of medical data among medical professionals.

Quality of life concept

Abstract: Although WHO defined health as a "state of complete physical, mental and social well-being'' in 1948, it is only in recent years that health-related "quality-of-life'' (HRQOL) has gained acceptance in medicine. Changes in clinical outcome measures do not necessarily correspond to the increased benefits in HRQOL perceived by patients, and their HRQOL-related preferences may differ from those of health professionals. HRQOL measures can guide treatment decisions and increase the possibility of involving patients in decisions concerning treatment, care and rehabilitation.

How much liver resection is too much

Abstract: Because the liver has a remarkable ability to regenerate, extensive resections are possible. Most liver centres recommend that the remnant liver after resection in a non-cirrhotic liver constitutes at least 30% of the normal liver mass. Too extensive resection carries a risk of the small-for-size syndrome with coagulapathy, jaundice, multi-organ failure and high mortality. Resection in a liver with established cirrhosis is more difficult because the ability to regenerate is lost and function is reduced. Portal hypertension is considered a contraindication to resection.

Life expectancy and mortality in Denmark compared to Sweden. What is the effect of smoking and alcohol

Abstract: Introduction For many years life expectancy in Denmark has improved less than in other comparable western countries, e.g. Sweden. An unhealthy life style, in particular the consumption of alcohol and tobacco, has often been mentioned as a possible explanation. Materials and methods Life expectancy and mortality in Denmark and Sweden has been compared by means of nationwide cause of death registries. Alcohol- and tobacco-related deaths are defined from death certificate diagnoses. The comparisons between the two countries are made by age standardised mortality rates and life expectancies for the period 1997-2001. Results 50 years ago Denmark had one of the highest life expectancies in the world, but is now at the bottom of the list when compared to similar countries. Life expectancy in Sweden is now almost three years longer than in Denmark. Before the age of 75 there were a total of 3700 premature deaths among Danish men and 3400 among Danish women. Relative excess mortality was highest among Danish men aged 35-64 with a relative excess mortality at 40-50%. Among women excess mortality was 50-60% in the age group 35-74 years. Overall, alcohol and smoking account for almost the entire difference between Danish and Swedish men and for 75% of the difference between Danish and Swedish women. Conclusion A very substantial part of the Danish excess mortality and low life expectancy compared to Sweden can be attributed to high mortality related to alcohol and tobacco consumption. A reduction of this difference in life expectancy does not seem realistic without a reduction in the consumption of tobacco and alcohol.

Incidence of vestibular schwannoma in Denmark

Abstract: INTRODUCTION During the last 30 years the number of diagnosed vestibular schwannomas (VS) has increased from 15 in 1976 to 116 in 2006. The aim of this study is to describe and analyse this increase. MATERIALS AND METHODS In Denmark, the handling of VS patients has been centralised since 1976. Since 1976, 2046 new cases of unilateral VS have been diagnosed. RESULTS In 1976, 15 VS were diagnosed. Since then, the number of diagnosed tumours has increased almost linearly to 116 in 2006. The size of the diagnosed tumours has decreased from 35 mm in 1979 to 10 mm in 2006. In the beginning of the period, giant tumours dominated in contrast to the end of the period where the small tumours dominated. The mean age at the time of diagnosis has been slowly increasing from 50 years in the beginning to almost 60 years at the end of the period. CONCLUSION With easier access to MRI, vestibular schwannomas are found earlier when they are still small. The increase in the number of diagnosed tumours is mainly explained by the diagnosis of intrameatal and small tumours in the older age group which was not previously offered MRI examination.

Arrogance of power

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Postoperative peritoneal adhesions

Abstract: Postoperative adhesions occur after most surgical intraabdominal procedures, and small bowel obstruction is a common complication. Research has focused on the pathophysiology of adhesion formation and on the development of prophylactic barriers and drugs. The present paper provides a resume of existing research into peritoneal adhesion prophylaxis and pathophysiology. In conclusion, using minimal invasive technique is important to prevent adhesions. Adhesion studies should offer precise description of the adhesions and video documentation.

[Treatment of suicidal patients: The Collaborative Assessment and Management of Suicidality].

Abstract: INTRODUCTION: There is still a need for more knowledge about effective methods of assessing and treating the suicidal patient. The method The Collaborative Assessment and Management of Suicidality (CAMS) was tested on a group of out-patients. MATERIALS AND METHODS: 27 suicidal out-patients consecutively referred from psychiatric and somatic emergency-units in a Danish university hospital underwent CAMS treatment in a survey with qualitative and quantitative before and after measurements. The purpose was to gain more knowledge about the usefulness and effect of the CAMS method on a Danish material. Five important markers of suicidal behaviour were currently evaluated (psychological pain; press; perturbation; hopelessness; self-hate). Furthermore, we examined the patient's experience of the significance of the therapeutic sessions in relation to the elimination of his/her suicidality and collaboration with the therapist. RESULTS: A significant decrease was seen in the five suicidal markers after the CAMS course. Furthermore, 80% of the patients experienced that the therapeutic sessions, more than anything else, eliminated the suicidal behaviour, and 92% experienced that there was genuine collaboration between the patient and the therapist. Compliance was 92%. CONCLUSION: The Danish trial of the CAMS showed satisfying results - an elimination of suicidal thoughts and effective patient-therapist collaboration. Language: da

Epidemiology of primary and secondary liver cancers

Abstract: Most primary liver cancers are hepatocellular carcinomas (HCC) or cholangiocarcinomas. In clinical practice, the majority of secondary liver cancers are metastases from colorectal cancer. The HCC incidence rate is constant in Denmark (2 per 100,000 per year), which is lower than in many other countries due to the low prevalence of viral hepatitis. The incidence rate of cholangiocarcinoma is slightly lower, and decreasing. The incidence rate of liver metastases is at least 40 per 100,000 per year. The prognosis for patients with liver cancer is poor, but seems to be improving.

Childhood body mass index and the risk of coronary heart disease in adulthood

Abstract: The severity of the long term consequences of the current childhood obesity epidemic on coronary heart disease is unknown. Therefore we investigated the association between body mass index (BMI) at ages 7-13 years and heart disease in adulthood among 276,835 Danish schoolchildren. We found that higher BMI during this period of childhood is associated with an increased risk of any, non-fatal and fatal heart disease in adulthood. Worldwide, as children are becoming heavier, our findings suggest that greater numbers of children are at risk of having coronary heart disease in adulthood.

Strongly increasing incidence of hip fractures in Denmark from 1977 to 1999

Abstract: INTRODUCTION: The incidence of hip fractures has been increasing throughout the world including the Nordic countries. The aim of this study was to examine if there is a similar trend in Denmark. MATERIALS AND METHODS: Statistics from the National Hospital Discharge Register on the number of patients with at least one occurrence of hip fracture in the years 1977 to 1999 compared to the number of inhabitants in Denmark (numbers from Statistics Denmark). RESULTS: The total number of patients with at least one hip fracture increased from approximately 6,500 in 1977 to approximately 11,000 in 1999. Since approximately 1995 the number has been relatively stable. The largest absolute increase was among women (from 4,800 to 9,000 per year), while a smaller absolute but large relative increase was seen among men (from approximately 1,600 to 3,200 per year). The incidence rates increased among men below the age of 50 years, while a more moderate increase was observed among women below the age of 50. The incidence rates remained relatively stable among men and women aged 50 to 69 years, while a limited increase was observed among women aged 70 to 79 years. Among men and women above the age of 80, the incidence rates increased until approximately 1992, followed by stagnation. CONCLUSION: The number of hip fractures increased up to approximately 1995 in Denmark followed by stagnation. In view of the large number of hip fractures, a multi-pronged strategy including general practice, primary nursing care, nursing homes, orthopaedic surgeons, and medical specialties is needed in order to reduce the number of hip fractures. Language: da

Breakfast habits and overweight in Danish schoolchildren. The role of socioeconomic positions

Abstract: Introduction The prevalence of adolescent overweight has increased dramatically, and in many industrialised countries overweight is most prevalent in lower socioeconomic positions (SEP). It is therefore important to examine determinants of overweight and to understand the mechanisms behind social patterning. Several studies show that skipping breakfast is a risk factor for overweight. However, it is unknown whether this association is consistent across SEP. The aim was to examine the association between the frequency of eating breakfast and overweight among Danish adolescents and to examine whether the association differs between different SEP. Materials and methods The study is a cross-sectional school survey including all 11, 13, and 15-year-olds in a random sample of schools in Denmark, participation rate 89.3%, n=4,824. The study was the sixth Danish contribution to the international research project Health Behaviour in School-aged Children (HBSC). SEP was measured by parental occupational class and the frequency of breakfast was measured by the weekly number of weekdays on which breakfast was eaten. Results Skipping breakfast is associated with overweight. The OR (95% CI) for overweight was 1.80 (1.38-2.36) among students who only ate breakfast 0-1 weekday per week. Frequent consumption of breakfast is less protective against overweight among low-SEP schoolchildren than high-SEP schoolchildren. Conclusion No former studies have analysed the influence of SEP on the association between skipping breakfast and overweight. We found that frequent consumption of breakfast is most protective against overweight among high-SEP schoolchildren.

Complications from eye prosthesis

Abstract: In Denmark, 3,000-4,000 people have lost an eye, they are eye amputated. The most frequent complications associated with the use of an artificial eye, eye-prosthesis, are secretion, lagophthalmos, enophthalmos, rotating prosthesis, prosthesis falling out, and exophthalmos. The wearing of an eye prosthesis and the related complications are important issues that the medical doctor should discuss with the patient.

[Climate change, disease and public health].

Abstract: Infectious diseases, malnutrition, et cetera will all become more common as the earth gets warmer and the climate becomes more unstable. Even though obesity, type II diabetes and coronary artery disease do not result from climate change, they do share causes with climate change. The production of livestock in agriculture, for example, is an important source of greenhouse gas emissions as well as a source of many of our most energy-rich foods. Physicians and medical societies should therefore contribute to the public debate about climate change and what to do about it.

[Salivary gland tumors in the County of Funen, 1984-2003].

Abstract: INTRODUCTION The objective of this study is to estimate the incidence of major salivary gland tumors in a geographically well-defined area (the County of Funen, Denmark) and to analyse the demographic data and distribution of histological types. MATERIALS AND METHODS Patients with salivary gland tumors were identified through a search on pathology and diagnosis codes in the period 1984-2003, which initially resulted in a group of 951 patients. Of these a total of 682 patients (72%) fulfilled the criteria for inclusion. RESULTS The incidence of major salivary gland tumors for the County of Funen is calculated to 7.3 per 100,000 residents per year. The material consisted of 372 females (55%) and 310 males (45%), with a median age of 56 years. Pleomorphic adenoma (55%) was the most common type, followed by adenolymphoma (29%). 90% of the tumors were found in the parotid gland - 93% benign and 7% malignant. 10% were located in the submandibular gland - 73% benign and 27% malignant. Only one neoplasm was located in the sublingual gland and it was malignant (100%). The older group harboured significantly more malignant neoplasms (12%) than the younger group (7%). The occurrence of pleomorphic adenomas among females (66%) was higher than among males (43%), on the other hand more adenolymphomas were found in males (43%) than in females (17%). CONCLUSION The incidence of major salivary gland tumors in the County of Funen is calculated to 7.3 per 100,000 inhabitants per year which is equivalent to 383 new cases in Denmark per year.

Analysis of need for sick leave after hysterectomy

Abstract: INTRODUCTION The recommended sick leave after hysterectomy varies among operating wards and depends on many non-medical issues. The recommendation is rarely validated scientifically and is often without any connection to the women's actual handling of the leave if this is not recorded as part of a project. We analysed the postoperative period for a group of hysterectomised women who kept a diary over eight weeks. MATERIALS AND METHODS Between July 2005 and June 2006 all hysterectomised women entered the diary project if they fulfilled the following criteria: the operation was indicated by meno-metrorrhagia, dysplasia, pressure symptoms or pain, she was under 60, she was Danish-speaking and in full-time work which was to be recommenced after operation. Women were excluded if they were operated for descended uterus, if a major re-operation was performed or, unexpectedly, endometriosis or malignancy was found. Our ward's recommendation on sick leave was four weeks for vaginal hysterectomy and six weeks for abdominal hysterectomy, but with emphasis on the necessary individualization of sick leave. Once a week, the women answered eight questions on their well-being and activities in the diary and returned the diary. RESULTS In total, 71 women entered the study, 27 with vaginal hysterectomy and 44 with abdominal hysterectomy. After one week, none of the women suffered from nausea or discomfort, while 20% were still complaining of pain. Less than half of the women had commenced work one week after the recommended sick leave. At that time, two thirds had recommenced their former leisure activities but less than half of the women's sex lives were as before the operation. CONCLUSION The majority of women extend their sick leave beyond the recommended period on their own initiative, despite the ward's long recommended period of sick leave. It is questionable whether the actual period of sick leave can be cut by shortening the recommended sick leave.

[WHO-5 as a simple method for measuring quality of life in daily psychiatric clinics].

Abstract: INTRODUCTION WHO-5 is a questionnaire for self-administration developed to evaluate well-being and quality of life. It is documented that a score of <50 is often related to a depressive state. In this investigation it is used to evaluate the general quality of life and changes here of during treatment of patients from all diagnostic groups of psychiatry. MATERIALS AND METHODS The questionnaire was administered at admission and discharge to 377 patients in psychiatric wards. Another questionnaire MDI (major depression inventory) was used as a supplement. RESULTS By using the WHO-5 questionnaire in the psychosis group a progress in quality of life from 32 to 58 was obtained. In the affective group the progress was from 20 to 52. The method had a high sensitivity in its ability to discover the patients who were given a discharge diagnosis of depression. Specificity was lower. WHO-5 could be used to measure the effect of treatment with different psychopharmacological treatments. CONCLUSION WHO-5 can be used as a general measure of well-being and quality of life and it is demonstrated how different treatments can be evaluated. According to a philosophical analysis of the concept of quality of life, WHO-5 mainly covers the hedonistic aspects. The WHO-5 questionnaire is quite simple and most patients understand the concept immediately. It takes only a few minutes to answer the questionnaire.

Hernias as medical disease

Abstract: Abnormal systemic collagen metabolism is thought to dispose to the development of hernias. Studies have shown that a reduced type-I/III collagen ratio predisposes to the development of hernias. Patient groups with reduced type-I/III collagen ratio and consequently increased risk of herniation include patients with Ehlers-Danlos, Marfans syndrome, osteogenesis imperfecta, cutis laxa, and patients with abdominal aortic aneurysms, colonic diverticula or stress urinary incontinence. Looking ahead, the perspective may be individualization of the operative technique for patients with a hernia, depending on their collagen profile.

Mini mental state examination. Validation of new Danish version

Abstract: INTRODUCTION The Mini Mental State Examination (MMSE) is widely used in Denmark, but often in non-validated versions. In 2000 a cross-sectional workgroup decided on a new common version of the MMSE with a corresponding manual, which is validated for the first time in the present study. MATERIALS AND METHODS The study was performed from April 2003 until August 2005 in four psycho-geriatric departments. The participants (65+ years) were assessed on three consecutive occasions (week 0, 1 and 26) with the MMSE (nurse), and global scales as well as diagnostically with ICD-10 (psycho-geriatrician). RESULTS 101 persons were included, 29 were healthy, non-demented; 82 participants were assessed at visit two, 90 at visit three, but only 88 ratings were useable. The best cut-off value for the MMSE was > or = 26. Inter-rater and test-retest (r=0.91) correlations of the MMSE were high as were the correlations to the global scales. However, there were considerable variations in mean score (+/-SD) as well as median score and range in relation to CGI and GDS values. The MMSE score is independent of sex and educational level. CONCLUSION The MMSE also proved to be a robust scale in the present Danish version. It achieved excellent inter-rater and test-retest reliability. A cut-off value of = 26 proved better than 24 which was preferred hitherto. However, the ranges of the MMSE scores are so dispersed within the same global degree of severity that the MMSE should not generally be used to describe the severity of dementia disorders.

Cancer survival before and after initiating the Danish Cancer Control plan

Abstract: INTRODUCTION Has there been a visible effect on cancer survival after the launch of the first cancer control plan in year 2000? MATERIAL AND METHODS All cancers reported 1995-2003 to the Danish Cancer Registry were included. Three cohorts diagnosed 1995-1997, 1998-2000 and 2001-2003 were followed for death until 31 December 2006 and age standardized 1- and 3-year relative survival was calculated by the cohort method. RESULTS One-year survival increased for men from 59 to 65% and for women from 67 to 70%, and 3-year survival from 44 to 51% and 55 to 59%, respectively. The improved 3-year survival for women was after the launch of the cancer plan, whilst for men it was in the entire observation period. Improvement in 3-year survival for both sexes occurred for colon, rectum and lung cancer, and for bladder and prostate in men and esophagus, breast, ovary and leukemia in women. Worse survival was seen for oral and pharyngeal cancer in women. DISCUSSION The improved trend in survival has been maintained. The cancer plan may improve survival before onset due to the early implementation of recommendations. Since improvements in surgery presents early, 3-year survival is relevant. The improved survival for colo-rectal, lung, bladder, esophagus and ovarian cancer may be related to the cancer plan. Improvement in breast cancer survival is likely due to screening and the DBCG continued activity, whilst increasing incidence of prostate cancer due to PSA testing is likely to be behind our observation. Longer follow-up and a timely and updated cancer registry are needed to fully assess the impact of the cancer plan.

Compliance to drug prescriptions

Abstract: Non-adherence or incomplete adherence to drug prescriptions is common. In long-term therapy for chronic disease, it has been estimated that only half of all drug doses are taken as prescribed. In this article we discuss poor adherence in terms of prevalence, clinical significance, treatment opportunities and ethical aspects.

Prenatal diagnostics in Arhus and Viborg Counties after implementation of first trimester risk assessment

Abstract: INTRODUCTION In 2004 the Danish National Board of Health issued new guidelines for prenatal diagnostics in Denmark. The guidelines include a general offer to all pregnant women in Denmark of first trimester risk assessment of combined non-invasive tests integrating measurement of nuchal translucency and maternal biochemistry for detection of fetal chromosomal abnormalities like trisomy 21, and replacing the screening criteria of > or =35 of age. MATERIALS AND METHODS The study is based on registered data covering 5,504 pregnancies during the period 1 July 2005 to 31 December 2005 in Aarhus and Viborg Counties. RESULTS 77% of the pregnant women had a complete combined test and only 2% declined the program. At a cut off at 1:400 at term the detection rate for trisomy 21 was 85% (CI: 62.1-96.8%) with a false positive rate of 3.4%. There was a significant reduction in the number of prenatal karyotypes from 2002 to 2005 in both counties, with a 58% reduction in Viborg County and 33% in Aarhus County. The percentage of abnormal karyotypes over the same period increased from 2.8%% to 11.4% in Viborg County, and from 7.1% to 15.4% in Aarhus County. CONCLUSION With a significant reduction in invasive procedures and a detection rate of 85% with a false positive rate of 3.4%, the results of the first trimester risk assessment program comply with the requirements defined by the Danish National Board of Health.

Use of hearing aids five years after issue

Abstract: INTRODUCTION With an annual issue of 100,000 hearing aids in Denmark it is of interest to quantify their use and non-use. METHODS Adult reapplicants (n = 1003) with five-year-old hearing aids (median) were interviewed about their hearing aid use, and those possessing unused aids (n = 182) were contacted a year later with a postal questionnaire. The data were compared with 683 returned International Outcome Inventory - Hearing Aid (IOI-HA) questionnaires from a national quality control project conducted in the same period which had been mailed to 1125 of our patients from a central site. RESULTS Of the 1003 hearing-aid users, 83% wore an aid for at least 3-4 hours daily while 13% never wore any. In the IOI-HA-survey, non-use was reported by only 2%. Among the 182 who were contacted a year later, the proportion of users tripled to 67%. Non-use was predominantly (70%) due to unpleasant sound quality, lack of benefit, or a poorly fitting ear mould/shell. Hearing aid usage increased with increasing hearing loss and with the patients' level of experience. Conversely, non-use seemed to increase with the length of the observation period. CONCLUSION Although only 13% had stopped using their aids after five years, this represents a considerable loss which can be reduced through active follow up. The reported that the 2% non-use rate in the IOI-HA-clientele can be ascribed to the fact that the survey took place only 2-3 months post issue, but it may also reflect a non-response bias.

Muscular strength in patients with fibromyalgia. A literature review

Abstract: Do patients with fibromyalgia (FM) have reduced muscular strength? We examined 22 articles and conclude from the results of these that FM patients have reduced muscular strength in their hands and quadriceps. The material also suggests generalised reduced muscular strength. However, the studies have several methodological shortcomings and future studies should be carefully designed with respect to patients as well as the control group and should be larger. To avoid CNS influence from e.g. fatigue and pain, muscular electro-stimulation may be used to ensure that the actual maximal muscular strength is also measured.

Neonatal hearing screening. A comparison of automatic auditory brainstem audiometry and otoacoustic emissions

Abstract: INTRODUCTION The annual birth rate in Denmark is 65,000. Approximately 100 of these children have a congenital bilateral hearing loss which requires treatment. Furthermore, it is expected that yet another 150 newborns have a unilateral hearing loss. Treatment of the hearing loss within the first six months is fundamental in order to ensure optimal use of speech and language, as well as normal social adaptation. The purpose of this study is to compare the two screening methods for hearing loss in newborns as recommended in Denmark--ie. Transient-Evoked Oto-Acoustic Emission (TEOAE) and Automatic Auditory Brainstem Response (AABR). MATERIALS AND METHODS During a period of six months, 1627 children were bilaterally screened with both AABR and TEOAE. The equipment used was Bio-logic's ABaer hearing screening system. Time usage and the number of refers was recorded. RESULTS Of the 1627 children, 67 (4% ) were referred on one or both ears when using AABR, compared to 177 (11% ) when using TEOAE, which is a statistically significant difference (p = 2.43 x 10-16). Re-screening and further examinations in the Department of Audiology identified five children as suffering from a hearing loss. The average time used to perform AABR was 6.6 min.s compared to 3.8 min.s for TEOAE. CONCLUSION AABR is well chosen as primary screening method. The time usage and equipment costs related to AABR exceed those of TEOAE, but this seems acceptable considering the larger number of re-screenings and further examinations in the Department of Audiology when using TEOAE.