Jan Sorensen - Academia.edu (original) (raw)
Papers by Jan Sorensen
Value in Health, 2006
Potential savings if the cheapest generic omeprazole equivalent were dispensed (instead of propri... more Potential savings if the cheapest generic omeprazole equivalent were dispensed (instead of proprietary omeprazole) would be approximately 6.2% of the total hospital expenditure on PPIs for the period examined. When follow-up prescriptions in the community were examined approximately 60% of patients did not receive further PPI medication. Of those who continued to receive a prescription for a PPI, approximately 30% remained on the PPI prescribed in hospital. CONCLUSIONS: Considering that generic omeprazole has the same therapeutic indications as proprietary omeprazole, there exists a case for more generic PPI utilisation in Irish hospitals. However, the fact that lansoprazole is priced comparably to generic omeprazole is encouraging. Regarding follow-up PPI prescribing in the community, it appears that where follow-up prescriptions are issued, GPs are more likely to reproduce the hospital prescription, rather than switch to an alternative PPI.
International Journal of Technology Assessment in Health Care, 2005
Objectives:Obesity and dyslipidemia are risk factors for ischemic heart disease, and prevention a... more Objectives:Obesity and dyslipidemia are risk factors for ischemic heart disease, and prevention and treatment in primary care can reduce these risks. The objective of this cost-effectiveness analysis was to compare the costs and effects (in terms of life years gained) of providing nutritional counseling by a general practitioner (GP) or a dietician.Methods:A total of 60 GPs, who accepted to participate, were randomized either to give nutritional counseling or to refer patients to a dietician for counseling. The life years gained was estimated using a Cox regression model. Costs were estimated on the basis of registered use of time (dieticians) or agreed salaries (GPs).Results:The effect of nutritional counseling comparing GPs and dieticians is greatest when counseling is performed by a GP—0.0919 years versus 0.0274 years. These effects appear to be moderate, but they are significant. It is also proven that the GP group was the most cost-effective—the cost of gaining 1 extra life yea...
Systematic Reviews, 2019
Background: Depression is common in patients with coronary artery disease (CAD) and is associated... more Background: Depression is common in patients with coronary artery disease (CAD) and is associated with poorer outcomes and higher costs. Several randomised controlled trials (RCTs) targeting depression, of various modalities (including pharmacological, psychotherapeutic and other approaches), have been conducted and summarised in pairwise meta-analytic reviews. However, no study has considered the cumulative evidence within a network, which can provide valuable indirect comparisons and information about the relative efficacy of interventions. Therefore, we will adopt a review of review methodology to develop a network meta-analysis (NMA) of depression interventions for depression in CAD. Methods: We will search relevant databases from inception for systematic reviews of RCTs of depression treatments for people with CAD, supplementing this with comprehensive searches for recent or ongoing studies. We will extract data from and summarise characteristics of individual RCTs, including participants, study characteristics, outcome measures and adverse events. Cochrane risk of bias ratings will also be extracted or if not present will be conducted by the authors. RCTs that compare depression treatments (grouped as pharmacological, psychotherapeutic, combined pharmacological/ psychotherapeutic, exercise, collaborative care) to placebo, usual care, waitlist control or attention controls, or directly in head-to-head comparisons, will be included. Primary outcomes will be the change in depressive symptoms (summarised with a standardised mean difference) and treatment acceptability (treatment discontinuation: % of people who withdrew). Secondary outcomes will include change in 6-month depression outcomes, health-related quality of life (HRQoL), mortality, cardiovascular morbidity, health services use and adverse events. Secondary analyses will
Clinical epidemiology, 2017
In Denmark, patients with rheumatoid arthritis (RA) are registered in the nationwide clinical DAN... more In Denmark, patients with rheumatoid arthritis (RA) are registered in the nationwide clinical DANBIO quality register and the Danish National Patient Registry (DNPR). The aim was to study the validity of the RA diagnosis and to estimate the completeness of relevant RA cases in each registry. Patients registered for the first time in 2011 with a diagnosis of RA were identified in DANBIO and DNPR in January 2013. For DNPR, filters were applied to reduce false-positive cases. The diagnosis was verified by a review of patient records. We calculated the positive predictive values (PPVs) of the RA diagnosis registrations in DANBIO and DNPR, and estimated the registry completeness of relevant RA cases for both DANBIO and DNPR. Updated data from 2011 to 2015 from DANBIO were retrieved to identify patients with delayed registration, and the registry completeness and PPV was recalculated. We identified 1,678 unique patients in DANBIO or in DNPR. The PPV (2013 dataset) was 92% in DANBIO and 79...
Journal of Environmental and Public Health, Apr 17, 2013
Scandinavian Journal of Public Health, 2008
A large number of indicators of mortality, morbidity and social economic costs have been calculat... more A large number of indicators of mortality, morbidity and social economic costs have been calculated for up to 19 risk factors. This is the first attempt in Denmark to present an overall description of the impact of these risk factors on public health. The analyses should contribute to the planning foundation for disease prevention and health promotion. The risk factors have been selected on the basis of data availability, importance and public interest. * Behavioural factors such as smoking, physical inactivity and unhealthy dietary habits have a great impact on the health of both men and women, while the effects of alcohol and drug abuse are mainly seen among men and those of unsafe sex are mainly seen among women. * Biological risk factors such as overweight and hypertension have a great impact on the health of both men and women. * Among employed persons, occupational diseases and ill-health caused by psychosocial job strain are more frequent among men. With regard to accidents, traffic accidents involving young men and accidental falls among elderly women entail the greatest burden. * There is a marked excess of premature deaths and disease among persons with a low educational level. * The causes of disease are complex and multifactorial, and in order to relate the indicators of health and social economic costs to the risk factors it is necessary to make a number of simple and crude assumptions. Nevertheless, the method can provide a greater insight into the impact of a number of risk factors on public health, and can thus prove useful in prevention planning, both nationally and regionally. * The importance or rank order of the various risk factors varies depending on the health indicator in question. In addition, the behavioural and biological factors are influenced by living conditions, for example education and occupation, which are in turn affected by the way in which society is organised. The rank order does not take into account the mutual interdependence of the risk factors or the fact that they are located at different levels in a causal network. Comparison of the importance of smoking and educational level requires careful interpretation as smoking habits differ between population groups having different educational levels. Similarly, comparison of physical inactivity, overweight and an unhealthy diet requires careful interpretation. * It is nevertheless evident that smoking, educational level, physical inactivity, alcohol and overweight play a major role with most of the indicators of health and social economic costs. With certain indicators, e.g. emergency department contacts, accidents play an important role. * The importance of the selected risk factors has changed dramatically over the past 50 years, and it is likely that the rank order will change again within some years.
Annals of the rheumatic diseases, 2014
In the study, which was based on a large number of patients, we investigated the time between sym... more In the study, which was based on a large number of patients, we investigated the time between symptom onset and diagnosis during the last 10 years. Our analysis was presented at the European League Against Rheumatism 2013 before a large audience and subsequently the paper was scrutinised by three independent reviewers, who had no comments on the choice of method. In the paper, and in the subsequent letter, we discussed and acknowledged a number of potential methodological challenges in an observational setting like this, including the risk of right censorship. 2 3 Based on your comments, however, we acknowledge that this bias arising from patients who have symptoms, but not yet have been diagnosed and, therefore, not included in the data set, may have a larger impact than we understood at the time when the paper was written.
BMJ open, Jan 15, 2014
To assess the cost utility of early psychosocial intervention for patients with Alzheimer's d... more To assess the cost utility of early psychosocial intervention for patients with Alzheimer's disease and their primary caregivers. Cost utility evaluation alongside a multicentre, randomised controlled trial with 3 years of follow-up. Primary care and memory clinics in five Danish districts. 330 community-dwelling patients and their primary caregivers. Psychosocial counselling and support lasting 8-12 months after diagnosis and follow-up at 3, 6, 12 and 36 months in the intervention group or follow-up only in the control group. The primary outcome measure was the cost of additional quality-adjusted life years (QALYs). Costs were measured from a societal perspective, including the costs of healthcare, social care, informal care and production loss. QALYs were estimated separately for the patient and the caregiver before aggregation for the main analysis. None of the observed cost and QALY measures were significantly different between the intervention and control groups, although a...
![Research paper thumbnail of Health-related quality of life: validity, reliability, and responsiveness of SF-36, 15D, EQ-5D [corrected] RAQoL, and HAQ in patients with rheumatoid arthritis](https://attachments.academia-assets.com/101081824/thumbnails/1.jpg)
](The Journal of rheumatology, 2008
To compare validity, reliability, and responsiveness of generic and disease specific health-relat... more To compare validity, reliability, and responsiveness of generic and disease specific health-related quality of life (HRQOL) instruments in rheumatoid arthritis (RA). Two samples of patients completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36), EuroQol (EQ)-5D, 15D, Rheumatoid Arthritis Quality of Life Scale (RAQoL), Health Assessment Questionnaire (HAQ), and visual analog scales (VAS) for pain, fatigue, and global RA. VALIDITY (convergent, discriminant, and known-groups) was evaluated in a cross-section of 200 patients. Reliability was evaluated by agreement (intraclass correlation coefficient; baseline to 2 weeks) and internal consistency (Cronbach's alpha); and responsiveness by the standardized response mean stratified on improvement, status quo, or deterioration in health status after 6 months in 150 patients followed longitudinally. Followup questionnaires (at 2 weeks and 6 months) included questions about changes in health status since baseline. The cro...
International Journal of Rheumatology, 2014
Objectives. To investigate travel time, and travel cost related to contacts with health care prov... more Objectives. To investigate travel time, and travel cost related to contacts with health care providers for patients with rheumatoid arthritis (RA) during a three-month period.Methods. Patient-reported travel time and travel cost were obtained from 2847 patients with RA. Eleven outpatient clinics across Denmark recruited patients to the study. Data collected included frequency, travel time and travel costs for contacts at rheumatology outpatient clinics, other outpatient clinics, general practitioners, privately practicing medical specialists, inpatient hospitals and accident and emergency departments.Results. Over a 3-month period, patients with RA had on average 4.4 (sd 5.7) contacts with health care providers, of which 2.8 (sd 4.0) contacts were with rheumatology outpatient clinics. Private car and public travel were the most frequent modes of travel. The average patient spent 63 minutes and 13 € on travelling per contact, corresponding to a total of 4.6 hours and 56 € during the ...
Value in Health, 2005
Objectives: Although the clinical grounds for recommending breast self-examination (BSE) have bee... more Objectives: Although the clinical grounds for recommending breast self-examination (BSE) have been extensively debated in the literature, there has been no investigation into women's preferences for BSE training. The aim of this study was to test the conjoint ranking method using data on women's preferences for different BSE training programs. Different econometric specifications were tested and sample subgroup differences were investigated. Methods: Postal data were collected from 1258 women with and without previous participation in a BSE training program. The women ranked eight hypothetical training programs that were defined in terms of three attributes. Inclusion of a payment attribute enabled the calculation of marginal willingness-to-pay (WTP) estimates. Results: The marginal WTP for individual training in comparison to group training with 18 to 20 participants was estimated to be 225 Danish Kroner (DKK) to 462 DKK. The marginal WTP for training in groups of eight to 10 participants was 180 DKK to 270 DKK. The respondents also preferred to receive instruction using their own breasts, although this was valued lower than a small group size. The results were similar regardless of whether or not the women had previously participated in BSE training. Around 20% of respondents violated a basic assumption of economic theory, in which the cheaper of two otherwise identical goods should be preferred. Conclusions: Conjoint ranking can provide comprehensive information about benefit assessment. The approach is cognitively demanding, however, and may cause some respondents to violate the axiom of nonsatiation.
Multiple Sclerosis International, 2011
The functional assessment of multiple sclerosis (FAMS) is a disease-specific instrument that desc... more The functional assessment of multiple sclerosis (FAMS) is a disease-specific instrument that describes functional status of individuals with multiple sclerosis. The instrument was originally developed in the US and has been adapted to different languages including Danish. This study is a validation of the Danish version of FAMS in a sample of individuals referred to a four-week rehabilitation program at either of the two Multiple Sclerosis Rehabilitation centers in Denmark. FAMS data were obtained through self-completed questionnaires from 190 individuals who attended the rehabilitation centers after referral by their general practitioner or specialist neurologist. The validation of the FAMS included assessment of data quality, scale assumptions, acceptability, construct validity, and reliability. Responsiveness was assessed by comparing individual FAMS scores at admission with the discharge score for groups of respondents who reported no change, improvement, or deterioration in the...
Scandinavian Journal of Public Health, 2007
Aims: The construct quality-adjusted life years (QALYs) combines mortality and overall health sta... more Aims: The construct quality-adjusted life years (QALYs) combines mortality and overall health status and can be used to quantify the impact of risk factors on population health. The purpose of the study was to estimate the impact of tobacco smoking, high alcohol consumption, physical inactivity, and overweight on QALYs. Methods: Life tables for each level of exposure to the risk factor were constructed mainly on the basis of the Danish National Cohort Study. QALYs were estimated for exposed and unexposed by Sullivan's method, by combining life tables, EQ-5D self-classified health status from the Danish Health Survey 2000, and Danish EQ-5D values. Results: The quality-adjusted life expectancy of 25-yearolds was 10—11 QALYs shorter for heavy smokers than for those who never smoke. The difference in life expectancy was 9— 10 years. Men and women with high alcohol consumption could expect to lose about 5 and 3 QALYs, respectively. Sedentary persons could expect to have about 7 fewer...
Scandinavian Journal of Public Health, 2010
Aims: The aim of this study was twofold. Firstly we identified victims of violence in national re... more Aims: The aim of this study was twofold. Firstly we identified victims of violence in national registers and discussed strengths and weaknesses of this approach. Secondly we assessed the magnitude of violence and the characteristics of the victims using register-based data. Methods: We used three nationwide registers to identify victims of violence: The National Patient Register, the Victim Statistics, and the Causes of Death Register. We merged these data and assessed the degree of overlap between data sources. We identified a reference population by selecting all individuals in Denmark over 15 years of age that had not been exposed to violence. For the study population and the reference population, socioeconomic and demographic information were retrieved from Statistics Denmark. We used logistic regression models in a cross-sectional analysis to identify characteristics of victims of violence. Results: In 2006, 22,000 individuals were registered as having been exposed to violence....
Preventive Medicine, 2007
Objective. To estimate the impacts of tobacco smoking, high alcohol consumption, physical inactiv... more Objective. To estimate the impacts of tobacco smoking, high alcohol consumption, physical inactivity and overweight on expected lifetime with and without long-standing, limiting illness. Methods. Life tables for each level of exposure to the risk factors were constructed, mainly on the basis of the Danish National Cohort Study. Expected lifetime without long-standing, limiting illness was estimated for exposed and unexposed persons by combining life tables and prevalence data from the Danish Health Interview Survey 2000 (14,503 participants aged 25+). Results. The life expectancy of 25-year-olds was 9-10 years shorter for heavy smokers than for those who never smoke, and all the lifetime lost would have been without long-standing, limiting illness. Similarly, all 5 years of expected lifetime lost by men with high alcohol consumption would have been without illness. The expected lifetime without long-standing, limiting illness was 8-10 years shorter among sedentary than physically active people. Obesity shortened lifetime without illness by 5 years for men and ten years for women. Conclusion. The results of this study could be used in health policy-making, as the potential gains in public health due to interventions against these risk factors could be evaluated, when the prevalence of exposure to the risk factor is available.
Neuroepidemiology, 2011
Background: There is a lack of appropriately designed trials investigating the efficacy of psycho... more Background: 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. Methods: The study was a 1-year multicentre randomized controlled rater-blinded trial with randomization to follow-up and a multifaceted semitailored intervention programme or to follow-up only (with extension of follow-up to 3 years). The intervention included a counselling programme, teaching courses, written information and logbooks. The outcomes included clinical efficacy parameters, patient satisfaction and health economic consequences. Results: A total of 330 patients and their 330 caregivers were included during a period of 18 months. The majority (65.2 %) of the caregivers were spouses. At inclusion the mean age of the patients and caregivers was 76.2 and 66.0 ye...
Medical Teacher, 2013
Background: Interprofessional collaboration potentially enhances patient safety and satisfaction,... more Background: Interprofessional collaboration potentially enhances patient safety and satisfaction, and reduces tensions and conflicts among health professionals. However, health professionals often lack sufficient knowledge of other professional roles and competences to engage in interprofessional teamwork. The aim of this study was to assess the impact of an interprofessional training programme on students' perceived self-efficacy. Methods: A quasi-experimental study with an intervention group (239 students) and a control group (405 students). The intervention was an interprofessional clinical study (ICS) unit including students from nursing, medicine, physiotherapy, occupational therapy, laboratory technology and radiography. Data on students' perceived self-efficacy were collected through web-based questionnaires. Aspects of self-efficacy measured were: (1) collaboration with other professions in planning goals and actions for patients; (2) collaboration with other professions for rehabilitation; (3) identifying the functions of other professions and (4) assessing and describing patients' needs and problems. Results: All scores of perceived self-efficacy for the ICS group improved over time although one score change was non-significant (p ¼ 0.08). After adjustment for baseline differences and the score change for the control group, the ICS group's self-efficacy score gain remained statistically significant. Conclusion: The study showed that interprofessional training improved students' perception of self-efficacy more than traditional clinical training.
The Journal of Rheumatology, 2009
Objective.The Health Assessment Questionnaire Disability Index (HAQ) is a widely used outcome mea... more Objective.The Health Assessment Questionnaire Disability Index (HAQ) is a widely used outcome measure in rheumatoid arthritis (RA), whereas the SF-12v2 Health Survey (SF-12) was introduced recently. We investigated how the HAQ and SF-12 were associated with socio-demographic, lifestyle, and disease- and treatment-related factors in patients with RA.Methods.In RA patients from 11 Danish centers, clinical and patient-reported data, including the HAQ and SF-12, were collected. Three multiple linear regression models were estimated, with the HAQ, SF-12 physical component score (PCS), and SF-12 mental component score (MCS) as outcome and sociodemographic, lifestyle, and RA-related treatment and comorbidity characteristics as explanatory variables.Results.In total, 3156 (85%) of 3704 invited patients participated — 75% women, 76% rheumatoid factor-positive, median age 61 years (range 15–93 yrs), disease duration 7 years (range 0–68 yrs), Disease Activity Score on 28 joints (DAS28) 2.97 (r...
Value in Health, 2006
Potential savings if the cheapest generic omeprazole equivalent were dispensed (instead of propri... more Potential savings if the cheapest generic omeprazole equivalent were dispensed (instead of proprietary omeprazole) would be approximately 6.2% of the total hospital expenditure on PPIs for the period examined. When follow-up prescriptions in the community were examined approximately 60% of patients did not receive further PPI medication. Of those who continued to receive a prescription for a PPI, approximately 30% remained on the PPI prescribed in hospital. CONCLUSIONS: Considering that generic omeprazole has the same therapeutic indications as proprietary omeprazole, there exists a case for more generic PPI utilisation in Irish hospitals. However, the fact that lansoprazole is priced comparably to generic omeprazole is encouraging. Regarding follow-up PPI prescribing in the community, it appears that where follow-up prescriptions are issued, GPs are more likely to reproduce the hospital prescription, rather than switch to an alternative PPI.
International Journal of Technology Assessment in Health Care, 2005
Objectives:Obesity and dyslipidemia are risk factors for ischemic heart disease, and prevention a... more Objectives:Obesity and dyslipidemia are risk factors for ischemic heart disease, and prevention and treatment in primary care can reduce these risks. The objective of this cost-effectiveness analysis was to compare the costs and effects (in terms of life years gained) of providing nutritional counseling by a general practitioner (GP) or a dietician.Methods:A total of 60 GPs, who accepted to participate, were randomized either to give nutritional counseling or to refer patients to a dietician for counseling. The life years gained was estimated using a Cox regression model. Costs were estimated on the basis of registered use of time (dieticians) or agreed salaries (GPs).Results:The effect of nutritional counseling comparing GPs and dieticians is greatest when counseling is performed by a GP—0.0919 years versus 0.0274 years. These effects appear to be moderate, but they are significant. It is also proven that the GP group was the most cost-effective—the cost of gaining 1 extra life yea...
Systematic Reviews, 2019
Background: Depression is common in patients with coronary artery disease (CAD) and is associated... more Background: Depression is common in patients with coronary artery disease (CAD) and is associated with poorer outcomes and higher costs. Several randomised controlled trials (RCTs) targeting depression, of various modalities (including pharmacological, psychotherapeutic and other approaches), have been conducted and summarised in pairwise meta-analytic reviews. However, no study has considered the cumulative evidence within a network, which can provide valuable indirect comparisons and information about the relative efficacy of interventions. Therefore, we will adopt a review of review methodology to develop a network meta-analysis (NMA) of depression interventions for depression in CAD. Methods: We will search relevant databases from inception for systematic reviews of RCTs of depression treatments for people with CAD, supplementing this with comprehensive searches for recent or ongoing studies. We will extract data from and summarise characteristics of individual RCTs, including participants, study characteristics, outcome measures and adverse events. Cochrane risk of bias ratings will also be extracted or if not present will be conducted by the authors. RCTs that compare depression treatments (grouped as pharmacological, psychotherapeutic, combined pharmacological/ psychotherapeutic, exercise, collaborative care) to placebo, usual care, waitlist control or attention controls, or directly in head-to-head comparisons, will be included. Primary outcomes will be the change in depressive symptoms (summarised with a standardised mean difference) and treatment acceptability (treatment discontinuation: % of people who withdrew). Secondary outcomes will include change in 6-month depression outcomes, health-related quality of life (HRQoL), mortality, cardiovascular morbidity, health services use and adverse events. Secondary analyses will
Clinical epidemiology, 2017
In Denmark, patients with rheumatoid arthritis (RA) are registered in the nationwide clinical DAN... more In Denmark, patients with rheumatoid arthritis (RA) are registered in the nationwide clinical DANBIO quality register and the Danish National Patient Registry (DNPR). The aim was to study the validity of the RA diagnosis and to estimate the completeness of relevant RA cases in each registry. Patients registered for the first time in 2011 with a diagnosis of RA were identified in DANBIO and DNPR in January 2013. For DNPR, filters were applied to reduce false-positive cases. The diagnosis was verified by a review of patient records. We calculated the positive predictive values (PPVs) of the RA diagnosis registrations in DANBIO and DNPR, and estimated the registry completeness of relevant RA cases for both DANBIO and DNPR. Updated data from 2011 to 2015 from DANBIO were retrieved to identify patients with delayed registration, and the registry completeness and PPV was recalculated. We identified 1,678 unique patients in DANBIO or in DNPR. The PPV (2013 dataset) was 92% in DANBIO and 79...
Journal of Environmental and Public Health, Apr 17, 2013
Scandinavian Journal of Public Health, 2008
A large number of indicators of mortality, morbidity and social economic costs have been calculat... more A large number of indicators of mortality, morbidity and social economic costs have been calculated for up to 19 risk factors. This is the first attempt in Denmark to present an overall description of the impact of these risk factors on public health. The analyses should contribute to the planning foundation for disease prevention and health promotion. The risk factors have been selected on the basis of data availability, importance and public interest. * Behavioural factors such as smoking, physical inactivity and unhealthy dietary habits have a great impact on the health of both men and women, while the effects of alcohol and drug abuse are mainly seen among men and those of unsafe sex are mainly seen among women. * Biological risk factors such as overweight and hypertension have a great impact on the health of both men and women. * Among employed persons, occupational diseases and ill-health caused by psychosocial job strain are more frequent among men. With regard to accidents, traffic accidents involving young men and accidental falls among elderly women entail the greatest burden. * There is a marked excess of premature deaths and disease among persons with a low educational level. * The causes of disease are complex and multifactorial, and in order to relate the indicators of health and social economic costs to the risk factors it is necessary to make a number of simple and crude assumptions. Nevertheless, the method can provide a greater insight into the impact of a number of risk factors on public health, and can thus prove useful in prevention planning, both nationally and regionally. * The importance or rank order of the various risk factors varies depending on the health indicator in question. In addition, the behavioural and biological factors are influenced by living conditions, for example education and occupation, which are in turn affected by the way in which society is organised. The rank order does not take into account the mutual interdependence of the risk factors or the fact that they are located at different levels in a causal network. Comparison of the importance of smoking and educational level requires careful interpretation as smoking habits differ between population groups having different educational levels. Similarly, comparison of physical inactivity, overweight and an unhealthy diet requires careful interpretation. * It is nevertheless evident that smoking, educational level, physical inactivity, alcohol and overweight play a major role with most of the indicators of health and social economic costs. With certain indicators, e.g. emergency department contacts, accidents play an important role. * The importance of the selected risk factors has changed dramatically over the past 50 years, and it is likely that the rank order will change again within some years.
Annals of the rheumatic diseases, 2014
In the study, which was based on a large number of patients, we investigated the time between sym... more In the study, which was based on a large number of patients, we investigated the time between symptom onset and diagnosis during the last 10 years. Our analysis was presented at the European League Against Rheumatism 2013 before a large audience and subsequently the paper was scrutinised by three independent reviewers, who had no comments on the choice of method. In the paper, and in the subsequent letter, we discussed and acknowledged a number of potential methodological challenges in an observational setting like this, including the risk of right censorship. 2 3 Based on your comments, however, we acknowledge that this bias arising from patients who have symptoms, but not yet have been diagnosed and, therefore, not included in the data set, may have a larger impact than we understood at the time when the paper was written.
BMJ open, Jan 15, 2014
To assess the cost utility of early psychosocial intervention for patients with Alzheimer's d... more To assess the cost utility of early psychosocial intervention for patients with Alzheimer's disease and their primary caregivers. Cost utility evaluation alongside a multicentre, randomised controlled trial with 3 years of follow-up. Primary care and memory clinics in five Danish districts. 330 community-dwelling patients and their primary caregivers. Psychosocial counselling and support lasting 8-12 months after diagnosis and follow-up at 3, 6, 12 and 36 months in the intervention group or follow-up only in the control group. The primary outcome measure was the cost of additional quality-adjusted life years (QALYs). Costs were measured from a societal perspective, including the costs of healthcare, social care, informal care and production loss. QALYs were estimated separately for the patient and the caregiver before aggregation for the main analysis. None of the observed cost and QALY measures were significantly different between the intervention and control groups, although a...
The Journal of rheumatology, 2008
To compare validity, reliability, and responsiveness of generic and disease specific health-relat... more To compare validity, reliability, and responsiveness of generic and disease specific health-related quality of life (HRQOL) instruments in rheumatoid arthritis (RA). Two samples of patients completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36), EuroQol (EQ)-5D, 15D, Rheumatoid Arthritis Quality of Life Scale (RAQoL), Health Assessment Questionnaire (HAQ), and visual analog scales (VAS) for pain, fatigue, and global RA. VALIDITY (convergent, discriminant, and known-groups) was evaluated in a cross-section of 200 patients. Reliability was evaluated by agreement (intraclass correlation coefficient; baseline to 2 weeks) and internal consistency (Cronbach's alpha); and responsiveness by the standardized response mean stratified on improvement, status quo, or deterioration in health status after 6 months in 150 patients followed longitudinally. Followup questionnaires (at 2 weeks and 6 months) included questions about changes in health status since baseline. The cro...
International Journal of Rheumatology, 2014
Objectives. To investigate travel time, and travel cost related to contacts with health care prov... more Objectives. To investigate travel time, and travel cost related to contacts with health care providers for patients with rheumatoid arthritis (RA) during a three-month period.Methods. Patient-reported travel time and travel cost were obtained from 2847 patients with RA. Eleven outpatient clinics across Denmark recruited patients to the study. Data collected included frequency, travel time and travel costs for contacts at rheumatology outpatient clinics, other outpatient clinics, general practitioners, privately practicing medical specialists, inpatient hospitals and accident and emergency departments.Results. Over a 3-month period, patients with RA had on average 4.4 (sd 5.7) contacts with health care providers, of which 2.8 (sd 4.0) contacts were with rheumatology outpatient clinics. Private car and public travel were the most frequent modes of travel. The average patient spent 63 minutes and 13 € on travelling per contact, corresponding to a total of 4.6 hours and 56 € during the ...
Value in Health, 2005
Objectives: Although the clinical grounds for recommending breast self-examination (BSE) have bee... more Objectives: Although the clinical grounds for recommending breast self-examination (BSE) have been extensively debated in the literature, there has been no investigation into women's preferences for BSE training. The aim of this study was to test the conjoint ranking method using data on women's preferences for different BSE training programs. Different econometric specifications were tested and sample subgroup differences were investigated. Methods: Postal data were collected from 1258 women with and without previous participation in a BSE training program. The women ranked eight hypothetical training programs that were defined in terms of three attributes. Inclusion of a payment attribute enabled the calculation of marginal willingness-to-pay (WTP) estimates. Results: The marginal WTP for individual training in comparison to group training with 18 to 20 participants was estimated to be 225 Danish Kroner (DKK) to 462 DKK. The marginal WTP for training in groups of eight to 10 participants was 180 DKK to 270 DKK. The respondents also preferred to receive instruction using their own breasts, although this was valued lower than a small group size. The results were similar regardless of whether or not the women had previously participated in BSE training. Around 20% of respondents violated a basic assumption of economic theory, in which the cheaper of two otherwise identical goods should be preferred. Conclusions: Conjoint ranking can provide comprehensive information about benefit assessment. The approach is cognitively demanding, however, and may cause some respondents to violate the axiom of nonsatiation.
Multiple Sclerosis International, 2011
The functional assessment of multiple sclerosis (FAMS) is a disease-specific instrument that desc... more The functional assessment of multiple sclerosis (FAMS) is a disease-specific instrument that describes functional status of individuals with multiple sclerosis. The instrument was originally developed in the US and has been adapted to different languages including Danish. This study is a validation of the Danish version of FAMS in a sample of individuals referred to a four-week rehabilitation program at either of the two Multiple Sclerosis Rehabilitation centers in Denmark. FAMS data were obtained through self-completed questionnaires from 190 individuals who attended the rehabilitation centers after referral by their general practitioner or specialist neurologist. The validation of the FAMS included assessment of data quality, scale assumptions, acceptability, construct validity, and reliability. Responsiveness was assessed by comparing individual FAMS scores at admission with the discharge score for groups of respondents who reported no change, improvement, or deterioration in the...
Scandinavian Journal of Public Health, 2007
Aims: The construct quality-adjusted life years (QALYs) combines mortality and overall health sta... more Aims: The construct quality-adjusted life years (QALYs) combines mortality and overall health status and can be used to quantify the impact of risk factors on population health. The purpose of the study was to estimate the impact of tobacco smoking, high alcohol consumption, physical inactivity, and overweight on QALYs. Methods: Life tables for each level of exposure to the risk factor were constructed mainly on the basis of the Danish National Cohort Study. QALYs were estimated for exposed and unexposed by Sullivan's method, by combining life tables, EQ-5D self-classified health status from the Danish Health Survey 2000, and Danish EQ-5D values. Results: The quality-adjusted life expectancy of 25-yearolds was 10—11 QALYs shorter for heavy smokers than for those who never smoke. The difference in life expectancy was 9— 10 years. Men and women with high alcohol consumption could expect to lose about 5 and 3 QALYs, respectively. Sedentary persons could expect to have about 7 fewer...
Scandinavian Journal of Public Health, 2010
Aims: The aim of this study was twofold. Firstly we identified victims of violence in national re... more Aims: The aim of this study was twofold. Firstly we identified victims of violence in national registers and discussed strengths and weaknesses of this approach. Secondly we assessed the magnitude of violence and the characteristics of the victims using register-based data. Methods: We used three nationwide registers to identify victims of violence: The National Patient Register, the Victim Statistics, and the Causes of Death Register. We merged these data and assessed the degree of overlap between data sources. We identified a reference population by selecting all individuals in Denmark over 15 years of age that had not been exposed to violence. For the study population and the reference population, socioeconomic and demographic information were retrieved from Statistics Denmark. We used logistic regression models in a cross-sectional analysis to identify characteristics of victims of violence. Results: In 2006, 22,000 individuals were registered as having been exposed to violence....
Preventive Medicine, 2007
Objective. To estimate the impacts of tobacco smoking, high alcohol consumption, physical inactiv... more Objective. To estimate the impacts of tobacco smoking, high alcohol consumption, physical inactivity and overweight on expected lifetime with and without long-standing, limiting illness. Methods. Life tables for each level of exposure to the risk factors were constructed, mainly on the basis of the Danish National Cohort Study. Expected lifetime without long-standing, limiting illness was estimated for exposed and unexposed persons by combining life tables and prevalence data from the Danish Health Interview Survey 2000 (14,503 participants aged 25+). Results. The life expectancy of 25-year-olds was 9-10 years shorter for heavy smokers than for those who never smoke, and all the lifetime lost would have been without long-standing, limiting illness. Similarly, all 5 years of expected lifetime lost by men with high alcohol consumption would have been without illness. The expected lifetime without long-standing, limiting illness was 8-10 years shorter among sedentary than physically active people. Obesity shortened lifetime without illness by 5 years for men and ten years for women. Conclusion. The results of this study could be used in health policy-making, as the potential gains in public health due to interventions against these risk factors could be evaluated, when the prevalence of exposure to the risk factor is available.
Neuroepidemiology, 2011
Background: There is a lack of appropriately designed trials investigating the efficacy of psycho... more Background: 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. Methods: The study was a 1-year multicentre randomized controlled rater-blinded trial with randomization to follow-up and a multifaceted semitailored intervention programme or to follow-up only (with extension of follow-up to 3 years). The intervention included a counselling programme, teaching courses, written information and logbooks. The outcomes included clinical efficacy parameters, patient satisfaction and health economic consequences. Results: A total of 330 patients and their 330 caregivers were included during a period of 18 months. The majority (65.2 %) of the caregivers were spouses. At inclusion the mean age of the patients and caregivers was 76.2 and 66.0 ye...
Medical Teacher, 2013
Background: Interprofessional collaboration potentially enhances patient safety and satisfaction,... more Background: Interprofessional collaboration potentially enhances patient safety and satisfaction, and reduces tensions and conflicts among health professionals. However, health professionals often lack sufficient knowledge of other professional roles and competences to engage in interprofessional teamwork. The aim of this study was to assess the impact of an interprofessional training programme on students' perceived self-efficacy. Methods: A quasi-experimental study with an intervention group (239 students) and a control group (405 students). The intervention was an interprofessional clinical study (ICS) unit including students from nursing, medicine, physiotherapy, occupational therapy, laboratory technology and radiography. Data on students' perceived self-efficacy were collected through web-based questionnaires. Aspects of self-efficacy measured were: (1) collaboration with other professions in planning goals and actions for patients; (2) collaboration with other professions for rehabilitation; (3) identifying the functions of other professions and (4) assessing and describing patients' needs and problems. Results: All scores of perceived self-efficacy for the ICS group improved over time although one score change was non-significant (p ¼ 0.08). After adjustment for baseline differences and the score change for the control group, the ICS group's self-efficacy score gain remained statistically significant. Conclusion: The study showed that interprofessional training improved students' perception of self-efficacy more than traditional clinical training.
The Journal of Rheumatology, 2009
Objective.The Health Assessment Questionnaire Disability Index (HAQ) is a widely used outcome mea... more Objective.The Health Assessment Questionnaire Disability Index (HAQ) is a widely used outcome measure in rheumatoid arthritis (RA), whereas the SF-12v2 Health Survey (SF-12) was introduced recently. We investigated how the HAQ and SF-12 were associated with socio-demographic, lifestyle, and disease- and treatment-related factors in patients with RA.Methods.In RA patients from 11 Danish centers, clinical and patient-reported data, including the HAQ and SF-12, were collected. Three multiple linear regression models were estimated, with the HAQ, SF-12 physical component score (PCS), and SF-12 mental component score (MCS) as outcome and sociodemographic, lifestyle, and RA-related treatment and comorbidity characteristics as explanatory variables.Results.In total, 3156 (85%) of 3704 invited patients participated — 75% women, 76% rheumatoid factor-positive, median age 61 years (range 15–93 yrs), disease duration 7 years (range 0–68 yrs), Disease Activity Score on 28 joints (DAS28) 2.97 (r...