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OBJECTIVE: To assess the efficacy at 12 months of an early psychosocial counselling and support programme for outpatients with mild Alzheimer's disease and their primary care givers. DESIGN: Multicentre, randomised, controlled, rater blinded trial. SETTING: Primary care and memory clinics in five Danish districts. PARTICIPANTS: 330 outpatients with mild Alzheimer's disease and their 330 primary care givers. INTERVENTIONS: Participating dyads (patient and primary care giver) were randomised to control support during follow-up or to control support plus DAISY intervention (multifaceted and semi-tailored counselling, education, and support). MAIN OUTCOME MEASURES: Primary outcomes at 12 months for patients were change from baseline in mini mental state examination (MMSE) score, Cornell depression scale score, and proxy rated European quality of life visual analogue scale (EQ-VAS) score. For care givers, outcomes were change from baseline in geriatric depression scale (GDS 30 items) score and EQ-VAS score. RESULTS: Because of multiple testing, statistical significance was set at an adjusted P limit of, To assess the efficacy at 12 months of an early psychosocial counselling and support programme for outpatients with mild Alzheimer's disease and their primary care givers.

OBJECTIVE: To assess the efficacy at 12 months of an early psychosocial counselling and support programme for outpatients with mild Alzheimer's disease and their primary care givers. DESIGN: Multicentre, randomised, controlled, rater blinded trial. SETTING: Primary care and memory clinics in five Danish districts. PARTICIPANTS: 330 outpatients with mild Alzheimer's disease and their 330 primary care givers. INTERVENTIONS: Participating dyads (patient and primary care giver) were randomised to control support during follow-up or to control support plus DAISY intervention (multifaceted and semi-tailored counselling, education, and support). MAIN OUTCOME MEASURES: Primary outcomes at 12 months for patients were change from baseline in mini mental state examination (MMSE) score, Cornell depression scale score, and proxy rated European quality of life visual analogue scale (EQ-VAS) score. For care givers, outcomes were change from baseline in geriatric depression scale (GDS 30 items) score and EQ-VAS score. RESULTS: Because of multiple testing, statistical significance was set at an adjusted P limit of, To assess the efficacy at 12 months of an early psychosocial counselling and support programme for outpatients with mild Alzheimer's disease and their primary care givers.

There is a lack of appropriately designed trials investigating the efficacy of psychosocial interventions for patients with mild dementia and their family caregivers. This paper reports the rationale and design of the Danish Alzheimer Disease Intervention Study and baseline characteristics of the cohort.

Backward recurrence times in stationary renewal processes and current durations in dynamic populations observed at a cross-section may yield estimates of underlying interarrival times or survival distributions under suitable stationarity assumptions. Regression models have been proposed for these situations, but accelerated failure time models have the particularly attractive feature that they are preserved when going from the backward recurrence times to the underlying survival distribution of interest. This simple fact has recently been noticed in a sociological context and is here illustrated by a study of current duration of time to pregnancy

Backward recurrence times in stationary renewal processes and current durations in dynamic populations observed at a cross-section may yield estimates of underlying interarrival times or survival distributions under suitable stationarity assumptions. Regression models have been proposed for these situations, but accelerated failure time models have the particularly attractive feature that they are preserved when going from the backward recurrence times to the underlying survival distribution of interest. This simple fact has recently been noticed in a sociological context and is here illustrated by a study of current duration of time to pregnancy

Backward recurrence times in stationary renewal processes and current durations in dynamic populations observed at a cross-section may yield estimates of underlying interarrival times or survival distributions under suitable stationarity assumptions. Regression models have been proposed for these situations, but accelerated failure time models have the particularly attractive feature that they are preserved when going from the backward recurrence times to the underlying survival distribution of interest. This simple fact has recently been noticed in a sociological context and is here illustrated by a study of current duration of time to pregnancy

There is a lack of appropriately designed trials investigating the efficacy of psychosocial interventions for patients with mild dementia and their family caregivers. This paper reports the rationale and design of the Danish Alzheimer Disease Intervention Study and baseline characteristics of the cohort.

We consider situations where data have been collected such that the sampling depends on the outcome of interest and possibly further covariates, as for instance in case-control studies. Graphical models represent assumptions about the conditional independencies among the variables. By including a node for the sampling indicator, assumptions about sampling processes can be made explicit. We demonstrate how to read off such graphs whether consistent estimation of the association between exposure and outcome is possible. Moreover, we give sufficient graphical conditions for testing and estimating the causal effect of exposure on outcome. The practical use is illustrated with a number of examples.

Norredam M, Garcia-Lopez A, Keiding N, Krasnik A. Excess use of coercive measures in psychiatry among migrants compared with native Danes.Objective: To investigate differences in risk of compulsory admission and other coercive measures in psychiatric emergencies among refugees and immigrants compared with that among native Danes. Method: A register-based retrospective cohort design. All refugees (n = 29 174) and immigrants (n = 33 287) who received residence permission in Denmark from 1.1.1993 to 31.12.1999 were included and matched 1 : 4 on age and sex with native Danes. Civil registration numbers were cross-linked to the Danish Psychiatric Central Register and the Registry of Coercive Measures in Psychiatric Treatment. Results: Refugees (RR = 1.82; 95%CI: 1.45; 2.29) and immigrants (RR = 1.14; 95%CI: 0.83; 1.56) experienced higher rates of compulsory admissions than did native Danes. This was most striking for refugee men (RR = 2.00; 95%CI: 1.53; 2.61) and immigrant women (RR = 1.73; 95%CI: 1.45; 2.60). Moreover, refugees and immigrants experienced higher frequencies of other coercive measures during hospitalisation compared with native Danes. Conclusion: Coercive measures in psychiatry are more likely to be experienced by migrants than by native Danes.

We consider situations where data have been collected such that the sampling depends on the outcome of interest and possibly further covariates, as for instance in case-control studies. Graphical models represent assumptions about the conditional independencies among the variables. By including a node for the sampling indicator, assumptions about sampling processes can be made explicit. We demonstrate how to read off such graphs whether consistent estimation of the association between exposure and outcome is possible. Moreover, we give sufficient graphical conditions for testing and estimating the causal effect of exposure on outcome. The practical use is illustrated with a number of examples.

Norredam M, Garcia-Lopez A, Keiding N, Krasnik A. Excess use of coercive measures in psychiatry among migrants compared with native Danes.Objective: To investigate differences in risk of compulsory admission and other coercive measures in psychiatric emergencies among refugees and immigrants compared with that among native Danes. Method: A register-based retrospective cohort design. All refugees (n = 29 174) and immigrants (n = 33 287) who received residence permission in Denmark from 1.1.1993 to 31.12.1999 were included and matched 1 : 4 on age and sex with native Danes. Civil registration numbers were cross-linked to the Danish Psychiatric Central Register and the Registry of Coercive Measures in Psychiatric Treatment. Results: Refugees (RR = 1.82; 95%CI: 1.45; 2.29) and immigrants (RR = 1.14; 95%CI: 0.83; 1.56) experienced higher rates of compulsory admissions than did native Danes. This was most striking for refugee men (RR = 2.00; 95%CI: 1.53; 2.61) and immigrant women (RR = 1.73; 95%CI: 1.45; 2.60). Moreover, refugees and immigrants experienced higher frequencies of other coercive measures during hospitalisation compared with native Danes. Conclusion: Coercive measures in psychiatry are more likely to be experienced by migrants than by native Danes.

Udgivelsesdato: 2009-Aug, BACKGROUND: It is plausible that a couple's ability to achieve the desired number of children is limited by biological fertility, especially if childbearing is postponed. Family size has declined and semen quality may have deteriorated in much of Europe, although studies have found an increase rather than a decrease in couple fertility. METHODS: Using four high-quality European datasets, we took the reported time to pregnancy (TTP) as the predictor variable; births reported as following contraceptive failure were an additional category. The outcome variable was final or near-final family size. Potential confounders were maternal age when unprotected sex began prior to the first birth, and maternal smoking. Desired family size was available in only one of the datasets. RESULTS: Couples with a TTP of at least 12 months tended to have smaller families, with odds ratios for the risk of not having a second child approximately 1.8, and for the risk of not having a third child approximately 1.6. Below 12 months no association was observed. Findings were generally consistent across datasets. There was also a more than 2-fold risk of not achieving the desired family size if TTP was 12 months or more for the first child. CONCLUSIONS: Within the limits of the available data quality, family size appears to be predicted by biological fertility, even after adjustment for maternal age, if the woman was at least 20 years old when the couple's first attempt at conception started. The contribution of behavioural factors to this result also needs to be investigated.

Udgivelsesdato: 2009-Aug, BACKGROUND: It is plausible that a couple's ability to achieve the desired number of children is limited by biological fertility, especially if childbearing is postponed. Family size has declined and semen quality may have deteriorated in much of Europe, although studies have found an increase rather than a decrease in couple fertility. METHODS: Using four high-quality European datasets, we took the reported time to pregnancy (TTP) as the predictor variable; births reported as following contraceptive failure were an additional category. The outcome variable was final or near-final family size. Potential confounders were maternal age when unprotected sex began prior to the first birth, and maternal smoking. Desired family size was available in only one of the datasets. RESULTS: Couples with a TTP of at least 12 months tended to have smaller families, with odds ratios for the risk of not having a second child approximately 1.8, and for the risk of not having a third child approximately 1.6. Below 12 months no association was observed. Findings were generally consistent across datasets. There was also a more than 2-fold risk of not achieving the desired family size if TTP was 12 months or more for the first child. CONCLUSIONS: Within the limits of the available data quality, family size appears to be predicted by biological fertility, even after adjustment for maternal age, if the woman was at least 20 years old when the couple's first attempt at conception started. The contribution of behavioural factors to this result also needs to be investigated.

Udgivelsesdato: 2008/2/2

Udgivelsesdato: 2008/7/11

Udgivelsesdato: 2008/2/2

Udgivelsesdato: 2008/7/11

Udgivelsesdato: 2007-Dec, STUDY AIMS: To investigate the incidence of cancer among 1st generation migrants compared to native Danes, including time trends in the risk of cancer among migrants. METHODS: A retrospective cohort study design. Migrants were matched 1:4 on age and sex with a Danish born reference population. The cohort was linked to the Danish Cancer Register and cancer cases among migrants (n=537) and native Danes (n=2829) were identified. RESULTS: The overall cancer incidence did not differ significantly between migrants from East Europe and native Danes; whereas migrants from the Middle East and North Africa had a significantly lower incidence. All migrants had a significantly lower incidence of breast and colorectal cancer but male migrants from East Europe had a significantly higher incidence of lung cancer. CONCLUSIONS: The overall cancer incidence among migrants was lower compared to native Danes. The time trends of the study are interesting and a relevant topic for further research.

Udgivelsesdato: 2007-Sep, OBJECTIVE: To investigate whether immediate effects of a 3-year educational intervention in primary health care were confirmed 18 months after the end of the intervention. STUDY DESIGN AND SETTING: A controlled 3-year intervention study in 34 Danish municipalities with randomization and intervention at municipality level. The 17 intervention municipality visitors received regular education, and GPs were introduced to a short assessment program. The effect was measured at the individual level by questions about functional ability at the end of the intervention period and 1(1/2) years later; 4,060 older adults living in the municipalities participated. We adopt the approach introduced by Dufouil et al. (2004) and treat dropouts due to death differently from dropouts from other reasons. RESULTS: Educational intervention to primary care professionals was associated with better functional ability in surviving women at the end of the intervention (odds ratio [OR]: 1.24, 95% confidence interval [CI]=1.07-1.45), from the end of the intervention until 1(1/2) years later (OR: 1.21, 95% CI=1.03-1.44) and during the total study period (OR: 1.22, 95% CI=1.06-1.42). No effects were seen in men. CONCLUSION: The effect of a brief, feasible educational intervention for primary care professionals is sustained in women 1(1/2) years after the end of the intervention.

Udgivelsesdato: 2007-Dec, STUDY AIMS: To investigate the incidence of cancer among 1st generation migrants compared to native Danes, including time trends in the risk of cancer among migrants. METHODS: A retrospective cohort study design. Migrants were matched 1:4 on age and sex with a Danish born reference population. The cohort was linked to the Danish Cancer Register and cancer cases among migrants (n=537) and native Danes (n=2829) were identified. RESULTS: The overall cancer incidence did not differ significantly between migrants from East Europe and native Danes; whereas migrants from the Middle East and North Africa had a significantly lower incidence. All migrants had a significantly lower incidence of breast and colorectal cancer but male migrants from East Europe had a significantly higher incidence of lung cancer. CONCLUSIONS: The overall cancer incidence among migrants was lower compared to native Danes. The time trends of the study are interesting and a relevant topic for further research.

Udgivelsesdato: 2007-Sep, OBJECTIVE: To investigate whether immediate effects of a 3-year educational intervention in primary health care were confirmed 18 months after the end of the intervention. STUDY DESIGN AND SETTING: A controlled 3-year intervention study in 34 Danish municipalities with randomization and intervention at municipality level. The 17 intervention municipality visitors received regular education, and GPs were introduced to a short assessment program. The effect was measured at the individual level by questions about functional ability at the end of the intervention period and 1(1/2) years later; 4,060 older adults living in the municipalities participated. We adopt the approach introduced by Dufouil et al. (2004) and treat dropouts due to death differently from dropouts from other reasons. RESULTS: Educational intervention to primary care professionals was associated with better functional ability in surviving women at the end of the intervention (odds ratio [OR]: 1.24, 95% confidence interval [CI]=1.07-1.45), from the end of the intervention until 1(1/2) years later (OR: 1.21, 95% CI=1.03-1.44) and during the total study period (OR: 1.22, 95% CI=1.06-1.42). No effects were seen in men. CONCLUSION: The effect of a brief, feasible educational intervention for primary care professionals is sustained in women 1(1/2) years after the end of the intervention.

Randomised clinical trials find no protection against development of ischaemic heart disease by use of Hormone Therapy (HT) after the age of 50 years. Observational studies suggest that early menopause is a risk factor for ischaemic heart disease. Yet, a clinical very relevant question is whether HT reduces this risk associated with early menopause.

Udgivelsesdato: 2006

Udgivelsesdato: 2006/2

Udgivelsesdato: 2006/2

Randomised clinical trials find no protection against development of ischaemic heart disease by use of Hormone Therapy (HT) after the age of 50 years. Observational studies suggest that early menopause is a risk factor for ischaemic heart disease. Yet, a clinical very relevant question is whether HT reduces this risk associated with early menopause.

Udgivelsesdato: 2006/2

Udgivelsesdato: 2006

Udgivelsesdato: 2006/2

Udgivelsesdato: 2006/2

Udgivelsesdato: 2006

Udgivelsesdato: 2006/2

Randomised clinical trials find no protection against development of ischaemic heart disease by use of Hormone Therapy (HT) after the age of 50 years. Observational studies suggest that early menopause is a risk factor for ischaemic heart disease. Yet, a clinical very relevant question is whether HT reduces this risk associated with early menopause.

The aim of this study is to investigate the risk of developing prognostic different types of breast cancer in women using hormone replacement therapy (HRT). A total of 10 874 postmenopausal Danish Nurses were followed since 1993. Incident breast cancer cases and histopathological information were retrieved through the National Danish registries. The follow-up ended on 31 December 1999. Breast cancer developed in 244 women, of whom 172 were invasive ductal carcinomas. Compared to never users, current users of HRT had an increased risk of a hormone receptor-positive breast cancer, but a neutral risk of receptor-negative breast cancer, relative risk (RR) 3.29 (95% confidence interval (CI): 2.27-4.77) and RR 0.99 (95% CI: 0.42-2.36), respectively (P for difference=0.013). The risk of being diagnosed with low histological malignancy grade was higher than high malignancy grade with RR 4.13 (95% CI: 2.43-7.01) and RR 2.17 (95% CI: 1.42-3.30), respectively (P=0.063). For breast cancers with other prognostic characteristics, the risk was increased equally for the favourable and non favourable types. Current users of HRT experience a two- to four-fold increased risk of breast cancer with various prognostic characteristics, both the favourable and non favourable types. For receptor status, the risk with HRT was statistically significantly higher for hormone receptor-positive breast cancer compared to receptor-negative breast cancer.

The aim of this study is to investigate the risk of developing prognostic different types of breast cancer in women using hormone replacement therapy (HRT). A total of 10 874 postmenopausal Danish Nurses were followed since 1993. Incident breast cancer cases and histopathological information were retrieved through the National Danish registries. The follow-up ended on 31 December 1999. Breast cancer developed in 244 women, of whom 172 were invasive ductal carcinomas. Compared to never users, current users of HRT had an increased risk of a hormone receptor-positive breast cancer, but a neutral risk of receptor-negative breast cancer, relative risk (RR) 3.29 (95% confidence interval (CI): 2.27-4.77) and RR 0.99 (95% CI: 0.42-2.36), respectively (P for difference=0.013). The risk of being diagnosed with low histological malignancy grade was higher than high malignancy grade with RR 4.13 (95% CI: 2.43-7.01) and RR 2.17 (95% CI: 1.42-3.30), respectively (P=0.063). For breast cancers with other prognostic characteristics, the risk was increased equally for the favourable and non favourable types. Current users of HRT experience a two- to four-fold increased risk of breast cancer with various prognostic characteristics, both the favourable and non favourable types. For receptor status, the risk with HRT was statistically significantly higher for hormone receptor-positive breast cancer compared to receptor-negative breast cancer.

To investigate the risk of ischaemic heart disease and myocardial infarction among women using hormone replacement therapy, especially the potential modifying effect of cardiovascular risk factors.