K. Juel | University of Southern Denmark (original) (raw)
Papers by K. Juel
Ugeskrift for laeger, Jan 28, 1986
Differences in mortality by selected causes are analyzed for Denmark for the period 1970-1983. Th... more Differences in mortality by selected causes are analyzed for Denmark for the period 1970-1983. The authors are primarily concerned with whether geographic differences can be used to identify differences in the quality and quantity of health services available. (SUMMARY IN ENG) (ANNOTATION)
Ugeskrift for laeger, Jan 6, 2001
The aim of the study was to estimate the national impact of smoking, alcohol, and drugs on mortal... more The aim of the study was to estimate the national impact of smoking, alcohol, and drugs on mortality. The analysis was based on the cause of death register. Deaths attributable to smoking were calculated by an indirect method. Deaths related to alcohol and drugs (illegal drugs and prescription drugs) were defined by the underlying and contributory causes of death. In the period, 1993-1997, 30% of all deaths in men and 20% in women were related to tobacco, alcohol, or drugs. The percentages of all deaths for tobacco, alcohol, and drugs were respectively 22.8%, 6.3%, and 1.2% for men and 16.5%, 2.5%, and 0.7% for women. Every year 12,000 Danes die 11-13 years prematurely, because of tobacco, more than 2500 die more than 20 years prematurely, because of alcohol, and about 600 die almost 30 years prematurely, because of drugs. The standardised lifetime risk of death from one of these three causes was about 30% for men, highest in the middle five-year period. For women--because of substa...
Ugeskrift for laeger, Jan 27, 1997
This study examines mortality rates of Danish doctors and describes pattern and causes of death f... more This study examines mortality rates of Danish doctors and describes pattern and causes of death for the period 1973-1992. The study comprises 21,943 medical doctors, 6012 of whom were women. At the end of 1992 there were 2387 recorded deaths. The doctors had lower mortality rates than the general population. A significant lower mortality was seen for male medical specialists compared to general practitioners. A gender-difference was seen among the youngest doctors with the female doctors suffering a considerably higher mortality than the male doctors did. Both sexes showed SMR below unity for cancer, circulatory diseases and other natural causes. Mortality due to lung cancer was particularly low. The suicide mortality was increased for both sexes, in particular because of an increased number of suicides by poisoning. Compared with the general population the doctors' mortality was low, but the mortality from external causes was increased, mainly due to an excess number of suicides.
European Journal of Epidemiology, 2012
The aim of this study on cancer mortality among Turkish immigrants, for the first time, tradition... more The aim of this study on cancer mortality among Turkish immigrants, for the first time, traditional comparisons in migrant health research have been extended simultaneously in two ways. First, comparisons were made to cancer mortality from the immigrants' country of origin and second, cancer mortality among Turkish immigrants across four host countries (Belgium, Denmark, France and the Netherlands) was compared. Population-based cancer mortality data from these countries were included. Age-standardized mortality rates were computed for the local-born and Turkish population of each country. Relative differences in cancer mortality were examined by fitting country-specific Poisson regression models. Globocan data on cancer mortality in Turkey from 2008 were used in order to compare mortality rates of Turkish immigrants with those from their country of origin. Turkish immigrants had lower all-cancer mortality than the local-born populations of their host countries, and mortality levels comparable to all-cancer mortality rates in Turkey. In the Netherlands and France breast cancer mortality was consistently lower in Turkish immigrants women than among local-born women. Lung cancer mortality was slightly lower in Turkish immigrants in the Netherlands and France but varied considerably between migrants in these two host countries. Stomach cancer mortality was significantly higher in Turkish immigrants when compared to local-born French and Dutch. Our findings indicate that exposures both in the country of origin and in the host country can have an effect on the cancer mortality of immigrants. Despite limitations affecting any cross-country comparison of mortality, the innovative multi-comparison approach is a promising way to gain further insights into determinants of trends in cancer mortality of immigrants.
Journal of Clinical Epidemiology, 1995
A register-based study was performed to elucidate whether workers employed on the Thule air base ... more A register-based study was performed to elucidate whether workers employed on the Thule air base in the clean-up period after the crash of a U.S. B-52 bomber carrying nuclear bombs had reduced fertility, as measured by the numbers of liveborn children. The highest birth rates were among 25-34-year olds with l-3 years of employment on the base, but who had not worked at the base the year before, who already had one child, with a 2-5-year interval since the birth of the last child. No difference was seen between the group of men who had worked at the base during the clean-up period after the crash-the possibly exposed group-and those people who had worked at the base only outside the clean-up period. Because of the massive media coverage and possible claims for damages a register-based study is the only practicable way of elucidating statements about infertility. The main conclusion is that the accident has not reduced fertility. Disasters Follow-up studies Infertility Male Radiation effects Registries Sterilization
Ugeskrift for laeger, Jan 16, 1998
The study quantifies the influence of smoking on mortality in Denmark and computes measures for t... more The study quantifies the influence of smoking on mortality in Denmark and computes measures for the individual risk. Mortality due to lung cancer among Danish women is now the highest in Europe. Smoking-attributable deaths among men amounted to 3% in 1945, 26% in 1985, and 25% in 1995; the proportion is lower among women, but is increasing considerably. In 1995 in the age-group 35-69 years such deaths make up the same proportion among men and women. The risk that a 35-year old Dane dies before attaining the age of 70 due to other than smoking-attributable causes has decreased since 1945, most significantly among women. Women have experienced a considerable increase in smoking-attributable mortality over the last 20 years, increasing the total risk of a 35 year-old of dying before reaching the age of 70. In 1995 a little over 13,000 of a total of a little less than 63,000 deaths could be attributed to smoking. Smoking is responsible for a significant part of the adverse development i...
European Journal of Preventive Cardiology, 2016
Topic: Cardiac rehabilitation Background: Literature shows that patients with an ICD obtains bett... more Topic: Cardiac rehabilitation Background: Literature shows that patients with an ICD obtains better quality of life, a lower degree of anxiety and depression, and less shocks from their ICD through knowledge and health behavior education. At present, there are no guidelines on cardiac rehabilitation to patients with an ICD. Based on literature and field visits, we developed a local model, consisting of four groupsessions for ICD-patients and their relatives. Each session lasted 2 x 45 minutes. An ICDnurse facilitated every session, and a physiotherapist, a psychologist and a social worker attended in one session each. Themes included: living with an ICD, psychological reactions, physical activity, socioeconomic implications, end-of-life, cardiac resuscitation, home-monitoring and the future. The educational approach was a high degree of patient-participation. Purpose: To evaluate a multidisciplinary rehabilitation programme for patients with newly implanted first time ICD Method: The model was implemented as a pilotstudy in a regional hospital through 12 months, and all patients were invited to the programme after first ICD implant. Participation rate was 43% (44/102). Mean age was 67 years, and 91% (n=40) were male. The evaluation was conducted as a self-reported questionnaire, with content, method and benefits for the patients as main topics. The questions were based on literature and response from patients and the multidisciplinary team. Descriptive statistics were used. Results: Among the patients, 63% (n=28) experience that the programme made them less worried about the function of the ICD, 58% (n=26) experience being less nervous about physical activity, 98% (n=43) find the programme relevant, and 100% (n=44) experience that the programme have given them sufficient knowledge about daily life with an ICD. Also 60% (n=26) experience that the programme have made them less worried about getting a shock, 98% (n=43) report having sufficient knowledge about what to do in case of getting a shock, and 86% (n=38) report having sufficient knowledge about the possibility of deactivating the ICD after attending the programme. All (n=44) experience contact with others in a comparable situation, as positive. Of 44 patients, 36% have had cardiac arrest (n=16). Data shows a tendancy that these patients benefits more from the programme, but the study doesn't have enough statistical power to show significant differences. Waitingtime for starting the programme was assessed too long for 23% (n=10). These participants waited mean time 5½ weeks longer compared to the rest of the patients, who all assessed waitingtime appropriate. Conclusion: The programme created valuable benefits for the patients. Based on the evaluation the patients should start the programme within 3 months after ICD implant. Further research is needed in relation to benefits for ICD patients with vs without cardiac arrest.
Nordic Journal of Psychiatry, 2006
Restriction of means for suicide is an important part of suicide preventive strategies in differe... more Restriction of means for suicide is an important part of suicide preventive strategies in different countries. All suicides in Denmark between 1970 and 2000 were examined with regard to method used for suicide. Overall suicide mortality and method-specific suicide mortality was compared with official information about availability of medical compounds (barbiturates, benzodiazepines, analgesics, antidepressants) and carbon monoxide in vehicle exhaust and household gas. Restrictions on the availability of carbon monoxide, barbiturates and dextropropoxyphen was associated with a decline in the number of suicides by self-poisoning with these compounds. Restricted access occurred concomittantly with a 55% decrease in suicide rate. Acetaminophon, epidemiology, overdose, poisoning, suicide.
BMC Public Health, 2012
Background: Comparisons of mortality patterns between different migrant groups, and between migra... more Background: Comparisons of mortality patterns between different migrant groups, and between migrants and natives, are relevant to understanding, and ultimately reducing, inequalities in health. To date, European studies on migrants' mortality patterns are scarce and are based solely on country of birth, rather than migrant status. However, mortality patterns may be affected by implications in relation to migrant status, such as health hazards related to life circumstances before and during migration, and factors related to ethnic origin. Consequently, we investigated differences in both all-cause and cause-specific mortality from cancer and cardiovascular disease among refugees and immigrants, compared with the mortality among native Danes. Methods: A register-based, historical prospective cohort design. All refugees (n = 29,139) and family-reunited immigrants (n = 27,134) who, between 1 January1993 and 31 December1999, were granted right of residence in Denmark were included and matched 1:4 on age and sex with native Danes. To identify deaths, civil registration numbers were cross-linked to the Register of Causes of Death (01.01.1994-31.12.2007) and the Danish Civil Registration System (01.01.1994-31.12.2008). Mortality rate ratios were estimated separately for men and women by migrant status and region of birth, adjusting for age and income and using a Cox regression model, after a median follow-up of 10-13 years after arrival. Results: Compared with native Danes, all-cause mortality was significantly lower among female (RR = 0.78; 95%CI: 0.71;0.85) and male (RR = 0.64; 95%CI: 0.59-0.69;) refugees. The rates were also significantly lower for immigrants: women (RR = 0.44; 95%CI: 0.38;0.51) and men (RR = 0.43; 95%CI: 0.37;0.51). Both migrant groups also had lower cause-specific mortality from cancer and cardiovascular diseases. For both all-cause and cause-specific mortality, immigrants generally had lower mortality than refugees, and differences were observed according to ethnic origin. Conclusions: Mortality patterns were overall advantageous for refugees and immigrants compared with native Danes. Research should concentrate on disentangling the reasons behind migrants' health advantages, in order to enlighten future preventive public-health efforts, for the benefit of the entire population.
Aging Clinical and Experimental Research, 2008
This review examines sex differences in health and survival, with a focus on the Nordic countries... more This review examines sex differences in health and survival, with a focus on the Nordic countries. There is a remarkable discrepancy between the health and survival of the sexes: men are physically stronger and have fewer disabilities, but have substantially higher mortality at all ages compared with women: the so-called male-female health-survival paradox. A number of proposed explanations for this paradox are rooted in biological, social, and psychological interpretations. It is likely to be due to multiple causes that include fundamental biological differences between the sexes such as genetic factors, immune system responses, hormones, and disease patterns. Behavioral differences such as risk-taking and reluctance to seek and comply with medical treatment may also play a role. Another consideration is that part of the difference may be due to methodological challenges, such as selective non-participation and under-reporting of health problems, and delayed seeking of treatment by men. The Nordic countries provide a unique opportunity for such studies, as theyhave good-quality data in their national health registers, which cover the whole population, and a long tradition of high participation rates in surveys.
The Lancet, 2014
Background-The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction ... more Background-The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods-We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61
Lancet (London, England), Jan 10, 2015
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a s... more The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental...
Lancet (London, England), Jan 7, 2015
Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and year... more Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally...
The National Danish Death Register contains information on 1.88 million deaths during the period ... more The National Danish Death Register contains information on 1.88 million deaths during the period 1943–83. The information in the register is derived from the death certificates and is filed on magnetic tape. The organization of the register and its content will be described in the following. Furthermore, examples of applications of the register will be shown.
Ugeskrift for laeger, Jan 21, 1987
European Heart Journal, 2017
Heart and mind / Novel methods for atrial fibrillation screening economical groups using EQ-5D, t... more Heart and mind / Novel methods for atrial fibrillation screening economical groups using EQ-5D, to assess the relation of QOL and treatment status, associated with QOL factors in hypertensive subjects. Material and methods: A cross-sectional study ESSE-RF (Epidemiology of cardiovascular diseases in Russian Federation) was carried out in 14 regions. Randomly selected males and females aged 25-64 years (N=21 923, response rate>80%) were included. Arterial hypertension (AH) defined as SBP≥140 mmHg, DBP≥90 mmHg, or if the person had taken antihypertensive medications (AM). The AH subjects were divided into the 3 groups by blood pressure (BP) levels and AH treatment: 1-treated and controlled hypertensives (TCH), 2-hypertensives never treated (HNT), and 3-treated but not achieved target BP level (TNA). Health-related quality of life was measured by EuroQol questionnaire (EQ-5D)-1) no decline; 2) mild decline; 3) significant decline and the EuroQol visual analogue scale (EQ-VAS). Age-standardized parameters were calculated using computer-based statistic software SAS. We calculated the prevalence of problems for each dimensions and index scale EQ-5D. Results: EQ-5D index of Russian population was 0,88 and declined with age. The negative association between wealth level and QOL was found. Most common (p<0,0005) were disorders by the components pain/discomfort and anxiety/depression. Educational gradient of QOL was significant only in EQ-VAS (p<0,05).Regional specifics of QOL by EQ-5D index: from 0,82 (Vladikcaucas) to 0,95 (Orenburg), p<0,0005. The significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in RF was found. The AH prevalence in RF was 43.5%. The results showed that AH subjects had worse quality of life in all dimensions and EQ-5D index scale compared with non-hypertensive: mean EQ-VAS score for AH subjects self-reporting was 66.4 (males-69.0 > females 63.8, p<0.0005) compared with those with no AH (70.1, p<0.0005). EQ-5D index score was 0.86, better among HNT-group of hypertensive subjects compared with TCH and TNA groups-89.1 vs 83.1 and 84.8 accordingly, p<0,0005. Similar to EQ-5D index score, EQ-VAS score was higher among HNT (69.4) vs 63.8 and 63.7 among TCH and TNA groups (p<0.0005). Conclusion: EQ-5D index of Russian population was declined with age; wealth level negatively associated with QOL. In general hypertension population has worse quality of life compared with normotensive subjects and mainly because the TCH and TNA group. In HNT group QOL was almost the same as in the normal BP group. Treatment of hypertension, but not hypertension can be associated with quality of life decreasing and it is important to consider it in adherenceimproving strategies.
Ugeskrift for Læger, 1986
Ugeskrift for Læger, 1981
The study quantifies the influence of smoking on mortality in Denmark and computes measures for t... more The study quantifies the influence of smoking on mortality in Denmark and computes measures for the individual risk. Mortality due to lung cancer among Danish women is now the highest in Europe. Smoking-attributable deaths among men amounted to 3% in 1945, 26% in 1985, and 25% in 1995; the proportion is lower among women, but is increasing considerably. In 1995 in the age-group 35-69 years such deaths make up the same proportion among men and women. The risk that a 35-year old Dane dies before attaining the age of 70 due to other than smoking-attributable causes has decreased since 1945, most significantly among women. Women have experienced a considerable increase in smoking-attributable mortality over the last 20 years, increasing the total risk of a 35 year-old of dying before reaching the age of 70. In 1995 a little over 13,000 of a total of a little less than 63,000 deaths could be attributed to smoking. Smoking is responsible for a significant part of the adverse development i...
Ugeskrift for laeger, Jan 28, 1986
Differences in mortality by selected causes are analyzed for Denmark for the period 1970-1983. Th... more Differences in mortality by selected causes are analyzed for Denmark for the period 1970-1983. The authors are primarily concerned with whether geographic differences can be used to identify differences in the quality and quantity of health services available. (SUMMARY IN ENG) (ANNOTATION)
Ugeskrift for laeger, Jan 6, 2001
The aim of the study was to estimate the national impact of smoking, alcohol, and drugs on mortal... more The aim of the study was to estimate the national impact of smoking, alcohol, and drugs on mortality. The analysis was based on the cause of death register. Deaths attributable to smoking were calculated by an indirect method. Deaths related to alcohol and drugs (illegal drugs and prescription drugs) were defined by the underlying and contributory causes of death. In the period, 1993-1997, 30% of all deaths in men and 20% in women were related to tobacco, alcohol, or drugs. The percentages of all deaths for tobacco, alcohol, and drugs were respectively 22.8%, 6.3%, and 1.2% for men and 16.5%, 2.5%, and 0.7% for women. Every year 12,000 Danes die 11-13 years prematurely, because of tobacco, more than 2500 die more than 20 years prematurely, because of alcohol, and about 600 die almost 30 years prematurely, because of drugs. The standardised lifetime risk of death from one of these three causes was about 30% for men, highest in the middle five-year period. For women--because of substa...
Ugeskrift for laeger, Jan 27, 1997
This study examines mortality rates of Danish doctors and describes pattern and causes of death f... more This study examines mortality rates of Danish doctors and describes pattern and causes of death for the period 1973-1992. The study comprises 21,943 medical doctors, 6012 of whom were women. At the end of 1992 there were 2387 recorded deaths. The doctors had lower mortality rates than the general population. A significant lower mortality was seen for male medical specialists compared to general practitioners. A gender-difference was seen among the youngest doctors with the female doctors suffering a considerably higher mortality than the male doctors did. Both sexes showed SMR below unity for cancer, circulatory diseases and other natural causes. Mortality due to lung cancer was particularly low. The suicide mortality was increased for both sexes, in particular because of an increased number of suicides by poisoning. Compared with the general population the doctors' mortality was low, but the mortality from external causes was increased, mainly due to an excess number of suicides.
European Journal of Epidemiology, 2012
The aim of this study on cancer mortality among Turkish immigrants, for the first time, tradition... more The aim of this study on cancer mortality among Turkish immigrants, for the first time, traditional comparisons in migrant health research have been extended simultaneously in two ways. First, comparisons were made to cancer mortality from the immigrants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; country of origin and second, cancer mortality among Turkish immigrants across four host countries (Belgium, Denmark, France and the Netherlands) was compared. Population-based cancer mortality data from these countries were included. Age-standardized mortality rates were computed for the local-born and Turkish population of each country. Relative differences in cancer mortality were examined by fitting country-specific Poisson regression models. Globocan data on cancer mortality in Turkey from 2008 were used in order to compare mortality rates of Turkish immigrants with those from their country of origin. Turkish immigrants had lower all-cancer mortality than the local-born populations of their host countries, and mortality levels comparable to all-cancer mortality rates in Turkey. In the Netherlands and France breast cancer mortality was consistently lower in Turkish immigrants women than among local-born women. Lung cancer mortality was slightly lower in Turkish immigrants in the Netherlands and France but varied considerably between migrants in these two host countries. Stomach cancer mortality was significantly higher in Turkish immigrants when compared to local-born French and Dutch. Our findings indicate that exposures both in the country of origin and in the host country can have an effect on the cancer mortality of immigrants. Despite limitations affecting any cross-country comparison of mortality, the innovative multi-comparison approach is a promising way to gain further insights into determinants of trends in cancer mortality of immigrants.
Journal of Clinical Epidemiology, 1995
A register-based study was performed to elucidate whether workers employed on the Thule air base ... more A register-based study was performed to elucidate whether workers employed on the Thule air base in the clean-up period after the crash of a U.S. B-52 bomber carrying nuclear bombs had reduced fertility, as measured by the numbers of liveborn children. The highest birth rates were among 25-34-year olds with l-3 years of employment on the base, but who had not worked at the base the year before, who already had one child, with a 2-5-year interval since the birth of the last child. No difference was seen between the group of men who had worked at the base during the clean-up period after the crash-the possibly exposed group-and those people who had worked at the base only outside the clean-up period. Because of the massive media coverage and possible claims for damages a register-based study is the only practicable way of elucidating statements about infertility. The main conclusion is that the accident has not reduced fertility. Disasters Follow-up studies Infertility Male Radiation effects Registries Sterilization
Ugeskrift for laeger, Jan 16, 1998
The study quantifies the influence of smoking on mortality in Denmark and computes measures for t... more The study quantifies the influence of smoking on mortality in Denmark and computes measures for the individual risk. Mortality due to lung cancer among Danish women is now the highest in Europe. Smoking-attributable deaths among men amounted to 3% in 1945, 26% in 1985, and 25% in 1995; the proportion is lower among women, but is increasing considerably. In 1995 in the age-group 35-69 years such deaths make up the same proportion among men and women. The risk that a 35-year old Dane dies before attaining the age of 70 due to other than smoking-attributable causes has decreased since 1945, most significantly among women. Women have experienced a considerable increase in smoking-attributable mortality over the last 20 years, increasing the total risk of a 35 year-old of dying before reaching the age of 70. In 1995 a little over 13,000 of a total of a little less than 63,000 deaths could be attributed to smoking. Smoking is responsible for a significant part of the adverse development i...
European Journal of Preventive Cardiology, 2016
Topic: Cardiac rehabilitation Background: Literature shows that patients with an ICD obtains bett... more Topic: Cardiac rehabilitation Background: Literature shows that patients with an ICD obtains better quality of life, a lower degree of anxiety and depression, and less shocks from their ICD through knowledge and health behavior education. At present, there are no guidelines on cardiac rehabilitation to patients with an ICD. Based on literature and field visits, we developed a local model, consisting of four groupsessions for ICD-patients and their relatives. Each session lasted 2 x 45 minutes. An ICDnurse facilitated every session, and a physiotherapist, a psychologist and a social worker attended in one session each. Themes included: living with an ICD, psychological reactions, physical activity, socioeconomic implications, end-of-life, cardiac resuscitation, home-monitoring and the future. The educational approach was a high degree of patient-participation. Purpose: To evaluate a multidisciplinary rehabilitation programme for patients with newly implanted first time ICD Method: The model was implemented as a pilotstudy in a regional hospital through 12 months, and all patients were invited to the programme after first ICD implant. Participation rate was 43% (44/102). Mean age was 67 years, and 91% (n=40) were male. The evaluation was conducted as a self-reported questionnaire, with content, method and benefits for the patients as main topics. The questions were based on literature and response from patients and the multidisciplinary team. Descriptive statistics were used. Results: Among the patients, 63% (n=28) experience that the programme made them less worried about the function of the ICD, 58% (n=26) experience being less nervous about physical activity, 98% (n=43) find the programme relevant, and 100% (n=44) experience that the programme have given them sufficient knowledge about daily life with an ICD. Also 60% (n=26) experience that the programme have made them less worried about getting a shock, 98% (n=43) report having sufficient knowledge about what to do in case of getting a shock, and 86% (n=38) report having sufficient knowledge about the possibility of deactivating the ICD after attending the programme. All (n=44) experience contact with others in a comparable situation, as positive. Of 44 patients, 36% have had cardiac arrest (n=16). Data shows a tendancy that these patients benefits more from the programme, but the study doesn't have enough statistical power to show significant differences. Waitingtime for starting the programme was assessed too long for 23% (n=10). These participants waited mean time 5½ weeks longer compared to the rest of the patients, who all assessed waitingtime appropriate. Conclusion: The programme created valuable benefits for the patients. Based on the evaluation the patients should start the programme within 3 months after ICD implant. Further research is needed in relation to benefits for ICD patients with vs without cardiac arrest.
Nordic Journal of Psychiatry, 2006
Restriction of means for suicide is an important part of suicide preventive strategies in differe... more Restriction of means for suicide is an important part of suicide preventive strategies in different countries. All suicides in Denmark between 1970 and 2000 were examined with regard to method used for suicide. Overall suicide mortality and method-specific suicide mortality was compared with official information about availability of medical compounds (barbiturates, benzodiazepines, analgesics, antidepressants) and carbon monoxide in vehicle exhaust and household gas. Restrictions on the availability of carbon monoxide, barbiturates and dextropropoxyphen was associated with a decline in the number of suicides by self-poisoning with these compounds. Restricted access occurred concomittantly with a 55% decrease in suicide rate. Acetaminophon, epidemiology, overdose, poisoning, suicide.
BMC Public Health, 2012
Background: Comparisons of mortality patterns between different migrant groups, and between migra... more Background: Comparisons of mortality patterns between different migrant groups, and between migrants and natives, are relevant to understanding, and ultimately reducing, inequalities in health. To date, European studies on migrants' mortality patterns are scarce and are based solely on country of birth, rather than migrant status. However, mortality patterns may be affected by implications in relation to migrant status, such as health hazards related to life circumstances before and during migration, and factors related to ethnic origin. Consequently, we investigated differences in both all-cause and cause-specific mortality from cancer and cardiovascular disease among refugees and immigrants, compared with the mortality among native Danes. Methods: A register-based, historical prospective cohort design. All refugees (n = 29,139) and family-reunited immigrants (n = 27,134) who, between 1 January1993 and 31 December1999, were granted right of residence in Denmark were included and matched 1:4 on age and sex with native Danes. To identify deaths, civil registration numbers were cross-linked to the Register of Causes of Death (01.01.1994-31.12.2007) and the Danish Civil Registration System (01.01.1994-31.12.2008). Mortality rate ratios were estimated separately for men and women by migrant status and region of birth, adjusting for age and income and using a Cox regression model, after a median follow-up of 10-13 years after arrival. Results: Compared with native Danes, all-cause mortality was significantly lower among female (RR = 0.78; 95%CI: 0.71;0.85) and male (RR = 0.64; 95%CI: 0.59-0.69;) refugees. The rates were also significantly lower for immigrants: women (RR = 0.44; 95%CI: 0.38;0.51) and men (RR = 0.43; 95%CI: 0.37;0.51). Both migrant groups also had lower cause-specific mortality from cancer and cardiovascular diseases. For both all-cause and cause-specific mortality, immigrants generally had lower mortality than refugees, and differences were observed according to ethnic origin. Conclusions: Mortality patterns were overall advantageous for refugees and immigrants compared with native Danes. Research should concentrate on disentangling the reasons behind migrants' health advantages, in order to enlighten future preventive public-health efforts, for the benefit of the entire population.
Aging Clinical and Experimental Research, 2008
This review examines sex differences in health and survival, with a focus on the Nordic countries... more This review examines sex differences in health and survival, with a focus on the Nordic countries. There is a remarkable discrepancy between the health and survival of the sexes: men are physically stronger and have fewer disabilities, but have substantially higher mortality at all ages compared with women: the so-called male-female health-survival paradox. A number of proposed explanations for this paradox are rooted in biological, social, and psychological interpretations. It is likely to be due to multiple causes that include fundamental biological differences between the sexes such as genetic factors, immune system responses, hormones, and disease patterns. Behavioral differences such as risk-taking and reluctance to seek and comply with medical treatment may also play a role. Another consideration is that part of the difference may be due to methodological challenges, such as selective non-participation and under-reporting of health problems, and delayed seeking of treatment by men. The Nordic countries provide a unique opportunity for such studies, as theyhave good-quality data in their national health registers, which cover the whole population, and a long tradition of high participation rates in surveys.
The Lancet, 2014
Background-The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction ... more Background-The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods-We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61
Lancet (London, England), Jan 10, 2015
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a s... more The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental...
Lancet (London, England), Jan 7, 2015
Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and year... more Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally...
The National Danish Death Register contains information on 1.88 million deaths during the period ... more The National Danish Death Register contains information on 1.88 million deaths during the period 1943–83. The information in the register is derived from the death certificates and is filed on magnetic tape. The organization of the register and its content will be described in the following. Furthermore, examples of applications of the register will be shown.
Ugeskrift for laeger, Jan 21, 1987
European Heart Journal, 2017
Heart and mind / Novel methods for atrial fibrillation screening economical groups using EQ-5D, t... more Heart and mind / Novel methods for atrial fibrillation screening economical groups using EQ-5D, to assess the relation of QOL and treatment status, associated with QOL factors in hypertensive subjects. Material and methods: A cross-sectional study ESSE-RF (Epidemiology of cardiovascular diseases in Russian Federation) was carried out in 14 regions. Randomly selected males and females aged 25-64 years (N=21 923, response rate>80%) were included. Arterial hypertension (AH) defined as SBP≥140 mmHg, DBP≥90 mmHg, or if the person had taken antihypertensive medications (AM). The AH subjects were divided into the 3 groups by blood pressure (BP) levels and AH treatment: 1-treated and controlled hypertensives (TCH), 2-hypertensives never treated (HNT), and 3-treated but not achieved target BP level (TNA). Health-related quality of life was measured by EuroQol questionnaire (EQ-5D)-1) no decline; 2) mild decline; 3) significant decline and the EuroQol visual analogue scale (EQ-VAS). Age-standardized parameters were calculated using computer-based statistic software SAS. We calculated the prevalence of problems for each dimensions and index scale EQ-5D. Results: EQ-5D index of Russian population was 0,88 and declined with age. The negative association between wealth level and QOL was found. Most common (p<0,0005) were disorders by the components pain/discomfort and anxiety/depression. Educational gradient of QOL was significant only in EQ-VAS (p<0,05).Regional specifics of QOL by EQ-5D index: from 0,82 (Vladikcaucas) to 0,95 (Orenburg), p<0,0005. The significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in RF was found. The AH prevalence in RF was 43.5%. The results showed that AH subjects had worse quality of life in all dimensions and EQ-5D index scale compared with non-hypertensive: mean EQ-VAS score for AH subjects self-reporting was 66.4 (males-69.0 > females 63.8, p<0.0005) compared with those with no AH (70.1, p<0.0005). EQ-5D index score was 0.86, better among HNT-group of hypertensive subjects compared with TCH and TNA groups-89.1 vs 83.1 and 84.8 accordingly, p<0,0005. Similar to EQ-5D index score, EQ-VAS score was higher among HNT (69.4) vs 63.8 and 63.7 among TCH and TNA groups (p<0.0005). Conclusion: EQ-5D index of Russian population was declined with age; wealth level negatively associated with QOL. In general hypertension population has worse quality of life compared with normotensive subjects and mainly because the TCH and TNA group. In HNT group QOL was almost the same as in the normal BP group. Treatment of hypertension, but not hypertension can be associated with quality of life decreasing and it is important to consider it in adherenceimproving strategies.
Ugeskrift for Læger, 1986
Ugeskrift for Læger, 1981
The study quantifies the influence of smoking on mortality in Denmark and computes measures for t... more The study quantifies the influence of smoking on mortality in Denmark and computes measures for the individual risk. Mortality due to lung cancer among Danish women is now the highest in Europe. Smoking-attributable deaths among men amounted to 3% in 1945, 26% in 1985, and 25% in 1995; the proportion is lower among women, but is increasing considerably. In 1995 in the age-group 35-69 years such deaths make up the same proportion among men and women. The risk that a 35-year old Dane dies before attaining the age of 70 due to other than smoking-attributable causes has decreased since 1945, most significantly among women. Women have experienced a considerable increase in smoking-attributable mortality over the last 20 years, increasing the total risk of a 35 year-old of dying before reaching the age of 70. In 1995 a little over 13,000 of a total of a little less than 63,000 deaths could be attributed to smoking. Smoking is responsible for a significant part of the adverse development i...