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Purpose: This study examined whether the health-survival paradox could be due partially to sex-specific selection and information bias in surveys.Methods: The study is based on the linkage of three population-based surveys of 15,330 Danes aged 46-102 years with health registers covering the total Danish population regarding hospitalizations within the last 2 years and prescription medicine within 6 months before the baseline surveys.Results: Men had higher participation rates than women at all ages. Hospitalized women and women taking medications had higher participation rate compared with nonhospitalized women (difference=0.7%-3.0%) and female nonusers (difference=0.8%-7.6%), respectively, whereas no consistent pattern was found among men according to hospitalization or medication use status. Men used fewer medications than women, but they underreported medication use to a similar degree as did women.Conclusions: Hospitalized women, as well as women using prescription medicine, were slightly overrepresented in the surveys. Hence, the study found some evidence that selection bias in surveys may contribute to the explanation of the health-survival paradox, but its contribution is likely to be small. However, there was no evidence for sex-specific reporting of medication use among study participants. [ABSTRACT FROM AUTHOR]

Summary: Objective: The aim of the study was to estimate the age and gender specific incidence rates of first time contact with an A&E Department and/or an Institute of Forensic Medicine due to violent victimisation in a Danish low-risk urban population and, secondly to estimate the corresponding lifetime risk of violence based upon these incidence rates. Methods: All first time contacts of victims of violence with the A&E Department at Odense University Hospital and/or the Institute of Forensic Medicine, University of Southern Denmark 1991–2002 were included. Based on estimated age and gender specific annual incidence rates of first time violence and on the survival rates of the background population, the lifetime risk was estimated assuming calendar time stationarity of incidence and survival rates. Results: The overall annual incidence rate of first time violence was 9.2 [95% CI: 9.0–9.4] per 1000 population/year for males and 2.6 [95% CI: 2.5–2.7] per 1000 population/year for females. The estimated lifetime risk was 0.440 [95% CI: 0.438–0.442] for males and 0.180 [95% CI: 0.178–0.181] for females. The highest cumulative risk for both males and females was in the age group 15–24 years, 0.192 [95% CI: 0.188–0.195] for males and 0.048 [95% CI: 0.046–0.051] for females. Conclusion: The current study shows, that even in a country with a relatively low risk of violent victimisation a considerable part of the population over a lifetime will need medical assistance after violent victimisation. [Copyright &y& Elsevier]

Objectives: This study aimed to compare antibody trajectories among individuals with SARS-CoV-2 hybrid and vaccine-induced immunity., Methods: Danish adults receiving three doses of BTN162b2 or mRNA-1237 were included prior to first vaccination (Day 0). SARS-CoV-2 anti-spike IgG levels were assessed before each vaccine dose, at Day 90, Day 180, 28 days after 3rd vaccination (Day 251), Day 365, and prior to 4th vaccination (Day 535). SARS-CoV-2 PCR results were extracted from the national microbiology database. Mixed-effect multivariable linear regression investigated the impact of hybrid-immunity (stratified into 4 groups: no hybrid immunity, PCR+ prior to 3rd dose, PCR+ after 3rd dose and before Day 365, PCR+ after Day 365) on anti-spike IgG trajectories., Results: A total of 4,936 individuals were included, 47% developed hybrid-immunity. Anti-spike IgG increases were observed in all groups at Day 251, with the highest levels in those PCR+ prior to 3rd dose (Geometric Mean; 535,647AU/mL vs. 374,665AU/mL with no hybrid-immunity, P<0.0001). Further increases were observed in participants who developed hybrid immunity after their 3rd dose. Anti-spike IgG levels declined from Day 251-535 in individuals without hybrid-immunity and in those who developed hybrid-immunity prior to their 3rd dose, with lower rate of decline in those with hybrid-immunity., Conclusion: Hybrid-immunity results in higher and more durable antibody trajectories in vaccinated individuals., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Health checks have been suggested as an early detection approach aiming at lowering the risk of chronic disease development. This study aimed to evaluate the effectiveness of a health check programme offered to the general population, aged 30-49 years., Methods: The entire population aged 30-49 years (N=26 216) living in the municipality of Randers, Denmark, was invited to a health check during 5 years. A pragmatic household cluster-randomised controlled trial was conducted in 10 505 citizens. The intervention group (IG, N=5250) included citizens randomised to the second year and reinvited in the 5th year. The comparison group (CG, N=5255) included citizens randomised to the 5th year. Outcomes were modelled cardiovascular disease (CVD) risk; self-reported physical activity (PA) and objectively measured cardio respiratory fitness (CRF); self-rated health (short-form 12 (SF-12)), self-rated mental health (SF-12&#95;Mental Component Score (MCS)) and, registry information on sick-leave and employment. Due to low participation, we compared groups matched on propensity scores for participation when reinvited., Results: Participation in the first health check was 51% (N=2698) in the IG and 40% (N=2120) in the CG. In the IG 26% (N=1340) participated in both the first and second health checks. No intervention effects were found comparing IG and CG. Mean differences were (95% CI): modelled CVD risk: -0.052 (95% CI -0.107 to 0.003)%, PA: -0.156 (-0.331 to 0.019) days/week with 30 min moderate PA, CRF: 0.133 (-0.560 to 0.826) mL O 2 /min/kg, SF-12: -0.003 (-0.032 to 0.026), SF-12&#95;MCS: 0.355 (-0.423 to 1.132), sick leave periods ≥3 weeks: -0.004 (-0.025 to 0.017), employment: -0.004 (-0.032 to 0.024)., Conclusions: Preventive health checks offered to the general population, aged 30-49 years, had no effects on a wide range of indicators of chronic disease risk., Trial Registration Number: NCT02028195., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Studies suggest that gestational weight gain (GWG) and breastfeeding behavior may influence long-term maternal abdominal fat mass. However, this could be confounded by abdominal fat mass before pregnancy because it is unknown whether abdominal fat mass, independently of body size, affects GWG and breastfeeding behavior., Objective: We investigated how maternal prepregnancy fat distribution, described by waist circumference (WC) and body mass index (BMI), is associated with GWG and breastfeeding behavior., Design: We analyzed 1371 live births to 1024 women after enrollment in the Coronary Artery Risk Development in Young Adults study (1985-1996). For each birth, maternal prepregnancy BMI and WC were measured at year 0 (baseline), 2, 5, or 7 examinations. Recalled GWG and breastfeeding behavior were collected at years 7 and 10. GWG was analyzed by using linear regression and breastfeeding behavior by using logistic regression and discrete-time logistic regression., Results: Adjusted for potential confounders, a 1-cm larger WC adjusted for BMI was associated with a 0.19-kg (95% CI: -0.29-, -0.10-kg) lower GWG. In contrast, a 1-unit higher BMI adjusted for WC was associated with a 0.27-kg (95% CI: 0.06-, 0.47-kg) higher GWG. The OR for ever breastfeeding compared with never breastfeeding was 0.93 (95% CI: 0.90, 0.97) per 1-cm larger WC after adjustment for BMI, whereas it was 1.10 (95% CI: 1.02, 1.19) per 1-unit higher BMI adjusted for WC., Conclusions: Maternal prepregnancy body size was differently associated with GWG and breastfeeding behavior depending on the location of the fat mass. Thus, maternal fat distribution may be a more important determinant of GWG and breastfeeding behavior than BMI alone., (© 2015 American Society for Nutrition.)

Objective: We studied the influence of maternal behavior on weight change from prepregnancy to 7 years postpartum., Methods: We used linear regression to study the independent and combined associations between self-reported behavior in pregnancy (dietary intake, leisure-time exercise, sedentary activity, smoking) and postpartum (breastfeeding duration and smoking) on weights at 6 months, 18 months, and 7 years postpartum., Results: Women's average 7-year weight gain was 2.07 kg, with 23% gaining >5 kg. Multivariable analyses suggested that women with healthier dietary intake, more leisure-time exercise, less sedentary behavior, and longer duration of breastfeeding on average gained 1.66 kg [95% confidence interval (CI): 1.40; 1.91] with a significantly reduced odds [OR 0.56 (95% CI: 0.49; 0.64)] of gaining >5 kg from prepregnancy to 7 years postpartum compared to women with none or one of these behaviors [mean gain 3.03 kg (95% CI: 2.68; 3.39)]. Women who ceased smoking had higher long-term weight gain than nonsmokers, but not smokers., Conclusions: Adherence to healthy behaviors during pregnancy lowered long-term weight gain considerably by lowering postpartum weight retention and subsequent weight gain. Public health efforts to help mothers achieve healthy behaviors might prevent childbearing-related weight gain., (© 2015 The Obesity Society.)

Background: Reproduction has been related to long-term maternal weight gain, and changes in fat mass, with gestational weight gain, have been identified as an important contributor. However, the influence of weight changes during the whole reproductive cycle and the modifying effect of breastfeeding are unknown., Objective: The objective was to examine how prepregnancy weight, gestational weight gain, postpartum weight changes, and breastfeeding influence maternal weight and body mass index-adjusted waist circumference (WCBMI) 7 y after delivery., Design: This was a prospective cohort study of 23,701 women participating in the Danish National Birth Cohort with singleton births and no births during follow-up. Path analysis was used to assess the total, direct, and indirect effects; the latter was mediated through weight changes on the pathways., Results: Postpartum weight retention at 6 mo and weight gain from 6 to 18 mo postpartum were highly positively associated with both outcomes. A 1-kg increase in weight retention at 6 mo postpartum corresponded to an average increase of 0.5 kg at 7 y. Gestational weight gain was not associated with WCBMI but was positively associated with weight at 7 y; 87% of this effect was mediated through later weight changes. For both outcomes, a small inverse association was observed for breastfeeding duration. This was strongest for WCBMI, for which 97% of the effect was direct, ie, not mediated through postpartum weight., Conclusions: These findings show that postpartum weight retention at 6 mo and weight gain from 6 to 18 mo postpartum contribute equally to adverse maternal anthropometric measures 7 y after delivery. Breastfeeding duration may have a beneficial effect.

Clozapine is a uniquely efficacious antipsychotic drug in treatment-resistant schizophrenia. Its use is restricted due to adverse effects including a rare but dangerous reduction in neutrophils (agranulocytosis) and the mandatory hematological monitoring this entails in many countries. We review the statistical, ethical and legal issues arising from a hypothetical pharmacogenetic test for clozapine, using the UK as an exemplary case for consideration. Our key findings include: a consideration of the probabilistic results that a pharmacogenetic test may return; the impact on drug licensing; and the potential for pharmacogenetic tests for clozapine being used without consent under the UK's legal framework. We make recommendations regarding regulatory changes applicable to the special case of pharmacogenetic testing in clozapine treatment.

Background: Non-compliance with medication is a major health problem. Cultural differences may explain different compliance patterns. The size of the compliance burden and the impact of socio-demographic and socio-economic status within and across countries in Europe have, however, never been analysed in one survey. The aim of this study was to analyse 1) medical drug compliance in different European countries with respect to socio-demographic and socio-economic factors, and to examine 2) whether cross-national differences could be explained by these factors., Methods: A multi-country interview survey European Social Survey, Round 2 was conducted in 2004/05 comprising questions about compliance with last prescribed drug. Non-compliance was classified as primary and secondary, depending whether the drug was purchased or not. Statistical weighting allowed for adjustment for national differences in sample mechanisms. A multiple imputation strategy was used to compensate for missing values. The analytical approach included multivariate and multilevel analyses., Results: The survey comprised 45,678 participants. Response rate was 62.5% (range 43.6-79.1%). Reported compliance was generally high (82%) but the pattern of non-compliance showed large variation between countries. Some 3.2% did not purchase the most recently prescribed medicine, and 13.6% did not take the medicine as prescribed. Multiple regression analyses showed that each variable had very different and in some cases opposite impact on compliance within countries. The multilevel analysis showed that the variation between countries did not change significantly when adjusted for increasing numbers of covariates., Conclusion: Reported compliance was generally high but showed wide variation between countries. Cross-national differences could, however, not be explained by the socio-demographic and socio-economic variables measured.

Background: There is uncertainty about how GPs should convey information about treatment effectiveness to their patients in the context of cardiovascular disease. Hence we study the concordance of decisions based on one of four single information formats for treatment effectiveness with subsequent decisions based on all four formats combined with a pictorial representation., Methods: A randomized study comprising 1,169 subjects aged 40-59 in Odense, Denmark. Subjects were randomized to receive information in terms of absolute risk reduction (ARR), relative risk reduction (RRR), number needed to treat (NNT), or prolongation of life (POL) without heart attack, and were asked whether they would consent to treatment. Subsequently the same information was conveyed with all four formats jointly accompanied by a pictorial presentation of treatment effectiveness. Again, subjects should consider consent to treatment., Results: After being informed about all four formats, 52%-79% of the respondents consented to treatment, depending on level of effectiveness and initial information format. Overall, ARR gave highest concordance, 94% (95% confidence interval (91%; 97%)) between initial and final decision, but ARR was not statistically superior to the other formats., Conclusion: Decisions based on ARR had the best concordance with decisions based on all four formats and pictorial representation, but the difference in concordance between the four formats was small, and it is unclear whether respondents fully understood the information they received.

Objective: The aim of this study was to describe the epidemiology of repeat contacts with an urban emergency department (ED) and/or an institute of forensic medicine., Methods: All victims of violence in contact with the ED at Odense University Hospital and/or the Institute of Forensic Medicine, University of Southern Denmark 1991-2002 were included. Victims who had two or more contacts were identified as repeat victims and a recurrence proportion was estimated. Survival analysis was made with time of observation from the first to the second contact due to violence and a repetition percentage was estimated as the proportion with repeated characteristics in the incident leading to the second contact compared to the index contact and a repetition percentage was estimated., Results: Overall 10,216 individuals with 14,307 incidents were included in the study. Overall, the recurrence proportion was 22% and repeat victims who were responsible for 44% of all contacts to the ED and/or the Institute of Forensic Medicine in the study period. The median time from first to the next incident was 1.75 years for males and 1.64 years for females. Overall 34% of the males and 37% of the females experienced the next incident within 1 year. The time span decreased significantly with increasing age for both males and females. The frequency of weapon use was low with a repetition percentage of 17% for males and 7% for females. For potential severe lesions such as bone fractures and internal lesions the repetition percentage was 28% and 19% for males and 23% and 25% for females., Conclusions: The present study showed that contact with an ED due to violent victimization often is followed by subsequent contacts with the same ED and/or the IFM due re-victimization and that recurrent incidents share characteristics.

Objective: To analyse the effect of GP home visits on the granting of a terminal declaration (TD) and on place of death., Participants and Design: A total of 2025 patients with cancer as the primary cause of death in the period 1997-1998, were investigated in a mortality follow-back design using the Danish Cancer Register and four administrative registers. The Danish TD can be issued by a physician for patients with an estimated prognosis of six months or less. The TD gives the right to economic benefits and increased care for the dying patient., Setting: The island of Funen/Denmark., Main Outcome Measures: Main outcome--hospital death. Intermediate outcome--TD., Results: A total of 38% of patients received a TD and 56% died in hospital. GP home visits in the week before TD (odds ratio (OR): 16.8; 95% CI: 8.2-34.4), as well as four weeks before TD (OR: 6.4; 95% CI: 4.5-9.2) were associated with an increased likelihood of receiving a TD. GP home visits in the group with TD (OR: 0.18; 95% CI: 0.11-0.29) and the group without TD (OR: 0.08; 95% CI: 0.05-0.13) was inversely associated with hospital death. A dose-response relationship was found in both groups., Conclusion: Persistent involvement by the GP is associated with improved end-of-life care for cancer patients. Provided that temporal relations are taken into account, the mortality follow-back design can be a suitable and ethical research method to highlight and monitor end-of-life cancer care.

Objectives: The optimal approach for management of patients with dyspepsia has not been determined. The aim of this study was to compare the efficacy of three strategies for management of dyspepsia: empirical antisecretory therapy, testing for Helicobacter pylori (H. pylori), or a combination of the two., Methods: Cluster-randomized trial in general practices. Initial treatment with proton pump inhibitor (PPI) was performed in 222 patients, H. pylori test-and-eradicate in 250 patients, and PPI followed by H. pylori-testing if symptoms improved in 250 patients. Symptoms, quality of life, patient satisfaction, and use of resources were recorded during a 1-yr follow-up., Results: The prevalence of H. pylori infection was 24%. We found no difference among the three strategies (p=0.16) in terms of the proportion of days without dyspeptic symptoms. After 1 yr gastrointestinal symptom scores and quality-of-life scores had improved significantly and equally in the three groups (p<0.001), but no statistically significant differences were found among the groups. The mean use of endoscopies per patient after 1 yr was higher in the PPI group (0.36 [95% CI 0.30-0.43]) than in the test-and-eradicate group (0.28 [95% CI 0.23-0.34]) and the combination group (0.22 [95% CI 0.17-0.27]), p=0.02. H. pylori-positive patients given eradication therapy had more days without dyspeptic symptoms (p<0.001), used less antisecretory therapy (p<0.01), and were more satisfied (p<0.001) than H. pylori-negative patients., Conclusion: The strategies based on H. pylori test enjoyed similar symptom resolution, but reduced endoscopic workload and lower 1-yr total costs compared with empirical antisecretory therapy.