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Biomedical subjects

Gunnar Lauge Nielsen

Publications and source records attributed to Gunnar Lauge Nielsen.

15 recordsLinked to original sources
PubMed2005

Rates of lumbar disc surgery before and after implementation of multidisciplinary nonsurgical spine clinics.

STUDY DESIGN: Correlation study. OBJECTIVES: To assess the rates of lumbar disc surgery in North Jutland County, Denmark, before and after implementation of two nonsurgical spine clinics, and to compare the observed rates with those for the rest of Denmark in the same time periods. SUMMARY OF BACKGROUND DATA: Few studies have addressed initiatives to reduce high rates of lumbar disc surgery by improving nonsurgical care offered to patients with sciatica and low back pain. METHODS: The study was conducted in North Jutland County, Denmark with 500,000 inhabitants (10% of the Danish population). In 1997, two nonsurgical spine clinics were established, along with an educational program for general practitioners. The clinics targeted patients with sciatica of 1 to 3 months' duration, with or without low back pain. Data on rates of lumbar disc surgery were obtained from the National Registry of Patients. RESULTS: The annual rate of lumbar disc operations for patients in North Jutland County decreased from approximately 60 to 80 per 100,000 before 1997 to 40 per 100,000 in 2001 (P = 0.00), and the rate of elective, first-time disc surgeries decreased by approximately two thirds (P = 0.00). In contrast, the annual rate of lumbar disc operations for patients in the rest of Denmark remained unchanged during the same period. CONCLUSIONS: The implementation of multidisciplinary, nonsurgical spine clinics coincided closely with a significant reduction in the rate of lumbar disc surgery. The observed reduction seems most likely to be causally associated with educational activities and improved patient care provided by the clinics.

Ambulatory Care Facilities↗
PubMed2004

Skin cancers and non-hodgkin lymphoma among users of systemic glucocorticoids: a population-based cohort study.

Patients treated with glucocorticoids may have an increased risk of skin cancer. Using data from the population-based North Jutland Prescription Database and the Danish Cancer Registry, we compared observed and expected numbers of cases of skin cancer and non-Hodgkin lymphoma among 59 043 individuals who received prescriptions for glucocorticoids, a common immunosuppressive therapy, during an 8-year period from January 1, 1989, through December 31, 1996. The overall risks for squamous cell carcinomas and basal cell carcinomas of the skin were increased, particularly among persons who had 15 or more prescriptions (standardized incidence ratio [SIR] for squamous cell carcinomas = 2.45, 95% confidence interval [CI] = 1.37 to 4.04; SIR for basal cell carcinomas = 1.52, 95% CI = 1.09 to 2.07). An elevated risk was also found for non-Hodgkin lymphoma among those with 10-14 prescriptions (SIR = 2.68, 95% CI = 1.16 to 5.29). Our data suggest that use of glucocorticoids may be a shared risk factor for certain skin cancers and lymphomas.

Adult↗
PubMed2004

Hospital discharges and 30-day case fatality for drug poisoning: a Danish population-based study from 1979 to 2002 with special emphasis on paracetamol.

OBJECTIVE: To examine the number of hospital discharges and 30-day case fatalities due to drug poisoning based on data from a Danish County Hospital Discharge Registry from 1979 to 2002. METHODS: All patients with a hospital discharge diagnosis of drug poisoning were identified and separated into groups taking: (1) opioid analgesics; (2) non-opioid analgesics; (3) anxiolytics; (4) antidepressants; (5) antipsychotics; or (6) non-specified. Paracetamol and salicylate were analysed separately. From 1994 to 2001, the total amount of drugs sold in the county was identified from a national drug database. RESULTS: A total of 13,432 patients with a median age 41.5 years at discharge of whom 59% were females accounted for 20,249 discharges for drug poisoning. The overall number of discharges remained essentially stable around 170 discharges per 100,000 inhabitants per year. From the mid-1990's, paracetamol became the most frequently used drug in poisoning with the largest increase in female teenagers. Thirty-day case fatality in poisoning with opioids was 3.6% compared with around 1% in other drug categories. For most drug categories, a sale of around 80,000 defined daily doses was associated with one hospital discharge due to drug poisoning. CONCLUSION: The overall number of hospital discharges remained stable and seems primarily related to amount of drugs available. With almost 10 years delay, the easier access to paracetamol was followed by an increase in hospitalisation due to poisoning with paracetamol. However, although the majority of hospitalisations were found in the younger age group, the highest mortality was seen among the elderly.

Acetaminophen↗
PubMed2004

Outcome of upper gastro-intestinal bleeding and use of ibuprofen versus paracetamol.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to increase the risk of upper gastrointestinal bleeding (UGIB). Whether the severity of outcome of UGIB associated with NSAIDs differs from non-NSAID-related UGIB is less clear. METHOD: Medical records of 228 patients hospitalized for UGIB in the Danish county of North Jutland were evaluated. Preadmission characteristics and clinical outcomes were compared between 112 patients who had been prescribed ibuprofen and 116 patients who had been prescribed paracetamol within 90 days of the hospitalization. RESULTS: The baseline characteristics of UGIB patients prescribed ibuprofen tended to differ from those prescribed paracetamol. The ibuprofen group significantly less often had histories of ulcer (11% vs 36%) and dyspepsia (19% vs 44%), or had been prescribed medications for these or other conditions, and had lower co-morbidity indices. Ibuprofen users also were somewhat less likely (31% vs 37%) to report GI pain at admission, but among hospitalized patients with endoscopic examinations were more likely (75% vs 58%) to be diagnosed with ulcer or hematemesis vs normal or gastritis/dyspepsia/reflux. For the clinical outcomes, 30 days case fatality rates were 12% for both ibuprofen and paracetamol users. The ibuprofen-related cases of UGIB more often required surgery (11% vs 3%) or transfusions (66% vs 57%), and those prescribed ibuprofen averaged 11 days in hospital, 4 days longer than those prescribed paracetamol. Adjustment for baseline characteristics and underlying conditions, or analyses eliminating patients with unconfirmed diagnoses and prior ulcers or restricted to patients with current hospital diagnoses of ulcer or hematemesis, did not materially alter the ibuprofen vs paracetamol differences in outcome measures. Generally similar results were obtained when restricting the analyses to patients prescribed ibuprofen or paracetamol within 30 days of UGIB hospitalization, except for a reduction in the 30 days case fatality rate among those prescribed ibuprofen. CONCLUSIONS: UGIB patients with antecedent ibuprofen prescriptions experienced about the same case fatality rates, but more surgery and longer hospital stays, than patients prescribed paracetamol. The differences appear in part due to differing characteristics among those prescribed ibuprofen compared with those prescribed paracetamol, but also raise the possibility of drug-related effects.

Acetaminophen↗
PubMed2004

Risk of acute pancreatitis in users of finasteride: a population-based case-control study.

GOALS: To examine the risk of acute pancreatitis in > or = 60-year-old male users of finasteride in a case-control study from a population of 490,000 persons in North Jutland County, Denmark, from 1993 to 2000. STUDY: We identified all men age 60 and over with incident acute pancreatitis from the County Hospital Discharge Registry in North Jutland, 1993 to 2000, and selected 10 age-matched controls per case from the Danish Civil Registration System based on incidence density sampling. All prescriptions for finasteride within 90 days prior to admission with acute pancreatitis were identified from the population-based North Jutland Prescription Database. Data on potential confounding factors were also extracted from registries. We used conditional logistic regression to estimate the relative risk of acute pancreatitis, adjusted for these potential confounders. RESULTS: There were 302 men age 60 and older with incident acute pancreatitis, of whom 3 were exposed to finasteride, and 2994 controls, of whom 37 were exposed to finasteride. The crude odds ratio for having reimbursed prescriptions for finasteride was 0.8 (95% confidence interval, 0.2-2.6). After adjustment for alcohol-related diseases, gallstone disease, hyperlipidemia, hypercalcemia, and hyperparathyroidism, the odds ratio was slightly decreased to 0.5 (95% confidence interval, 0.1-2.5). CONCLUSION: We did not find any increased risk of acute pancreatitis in users of finasteride.

5-alpha Reductase Inhibitors↗
PubMed2003

[DANAMI-2].

Explore the source record for details and available documents.

Angioplasty, Balloon, Coronary↗
PubMed2003

Risk of acute pancreatitis in users of azathioprine: a population-based case-control study.

OBJECTIVE: Azathioprine has been linked to subsequent acute pancreatitis in several case reports and small case series. We examined the risk for acute pancreatitis in users of azathioprine in North Jutland County, Denmark, with about 490,000 inhabitants. METHODS: We identified patients with incident cases of acute pancreatitis from the Hospital Discharge Registry of the county from 1991-2000, and selected 10 controls per case, matched by age and sex, from the Central Personal Registry using incidence density sampling technique. All prescriptions of azathioprine within 90 days before admission were likewise collected from the population-based North Jutland Prescription Database. Data on potential confounders were extracted from registries. We used conditional logistic regression to adjust for confounding. RESULTS: A total of 1,388 patients and 13,836 controls were included in the study. We found that 1,317 persons in the entire population redeemed a total of 15,811 prescriptions of azathioprine in the county. The incidence rate for acute pancreatitis among all users of azathioprine was one per 659 treatment year. The crude OR of having redeemed prescriptions for azathioprine within 90 days before admission for acute pancreatitis was 7.5 (95% CI = 2.6-21.6). After adjustment for gallstone disease, alcohol-related diseases, inflammatory bowel disease, and use of glucocorticoids, the OR increased to 8.4 (95% CI = 2.4-29.4). The population-attributable risk, which measures the proportion of all cases of pancreatitis that are attributable to the use of azathioprine in our study population, was 0.4%. CONCLUSIONS: There was a substantially increased relative risk of acute pancreatitis in users of azathioprine.

Acute Disease↗
PubMed2002

Thirty-day postoperative mortality after hysterectomy in women with liver cirrhosis: a Danish population-based cohort study.

BACKGROUND: Women with liver cirrhosis have a higher incidence of hysterectomy than the general population, generally because of abnormal bleeding. They may also have an increased risk of postoperative mortality and morbidity. METHODS: In the nationwide Danish National Patients Register (NPR) we identified all women diagnosed with liver cirrhosis from 1977 to 1993. From this cohort we selected all women undergoing hysterectomy. A random sample of women without liver cirrhosis undergoing hysterectomy was selected as controls. Outcome was defined as mortality within the first 30 days after discharge. Logistic regression analysis was used to estimate the association between liver cirrhosis and 30-day postoperative mortality, adjusted for age, comorbidity, and type of admission. RESULTS: Out of 8539 women with liver cirrhosis 105 underwent hysterectomy. We found a 30-day postoperative mortality of 7.6% (95% confidence interval (CI) 2.5-12.7%) and 0.6% (95% CI 0.5-0.7%) in women with and without liver cirrhosis, respectively. The crude odds ratio was 14 (95% CI 6.5-29) and the adjusted odds ratio was 11 (95% CI 4.8-24) for 30-day postoperative mortality in women with liver cirrhosis compared with non-cirrhotic controls. CONCLUSION: Hysterectomy in women with liver cirrhosis is associated with an 11-fold increased risk of death within the first 30 days after discharge.

Cohort Studies↗
PubMed2002

Cancer risk in persons receiving prescriptions for paracetamol: a Danish cohort study.

The use of paracetamol has been associated with increased risks for urinary tract cancers and decreased risk for ovarian cancer, although results have been inconsistent. We conducted a population-based cohort study using data from the Prescription Database of North Jutland County and the Danish Cancer Registry. Cancer incidence among 39,946 individuals receiving prescriptions for paracetamol was compared with expected incidence based on the North Jutland population who did not receive paracetamol prescriptions, during a 9-year follow-up period. Standardized incidence ratios (SIRs) with corresponding 95% confidence intervals (95% CIs) were calculated for cancers overall and at selected sites. Overall, 2,173 cancers were observed with 1,973 expected, yielding a SIR of 1.10 (95% CI, 1.06-1.15). Significantly elevated SIRs were found for cancers of the esophagus (1.9; 95% CI, 1.3-2.8) and lung (1.6; 95% CI, 1.4-1.7). Nonsignificantly increased SIRs were observed for cancers of the liver (1.5; 95% CI, 0.96-2.2), renal parenchyma (1.3; 95% CI, 0.9-1.7) and renal pelvis/ureter (1.6; 95% CI, 0.96-2.6), whereas the SIR for cancer of the urinary bladder was close to unity (1.1; 95% CI, 0.9-1.4). For ovarian cancer, the SIR was close to expectation (0.9; 95% CI, 0.6-1.2) with no evidence of trends with duration of follow-up or number of prescriptions. A similar risk pattern was observed after exclusion of person-time experience following prescription for aspirin or other nonsteroidal antiinflammatory drugs in the study cohort and reference population. Our results do not support a major role for paracetamol in the development of cancers of the urinary tract, and we found little evidence of a protective effect of paracetamol against ovarian cancer. The elevated risks for cancers of the esophagus, lung and liver are most likely a result of confounding variables, but may warrant further investigation.

Acetaminophen↗
PubMed2002

Short-term complications after surgically induced abortions: a register-based study of 56 117 abortions.

BACKGROUND: Performing an induced abortion is a rather simple medical procedure which is frequently done and side-effects will have public health implications unless they are very rare. We estimated the incidence of side-effects detected during the stay at the hospital and 2 weeks after the discharge. We only include side-effects reported by clinics or hospitals. METHODS: Altogether 56 117 induced abortions performed by public hospitals in Denmark from 1980 to 1994 were analyzed in this study. The study combined results from the mandatory reporting of side-effects to the National Induced Abortion Registry and all diagnoses reported to the Hospital Discharge Registry. RESULTS: Side-effects in the form of bleeding, infections or re-evacuation were recorded for about 5%. We found more side-effects in teenage women and for abortions performed late in pregnancy. We found nothing to indicate that the frequency of side-effects following an abortion changed over time. CONCLUSIONS: About 5% have side-effects registered by hospitals following an induced abortion. The long-term consequences of this are not known.

Abortion, Induced↗
PubMed2002

Pregnancy outcome after suicide attempt by drug use: a Danish population-based study.

BACKGROUND: It is important to study the side-effects of drugs taken during pregnancy, however the findings are difficult to interpret because of a low exposure level, uncertainty of actual drug consumption and confounding by indication. Experience from accidental or intended drug intoxications may bypass some of these methodological shortcomings. Our aim was to examine reproductive failures and child health following a single drug overdose taken prior to or during pregnancy. METHODS: Women diagnosed with a drug intoxication during pregnancy were identified in the Regional Hospital Discharge Registry of North, Jutland from 1977 to 1999 by linkage of diagnoses for abortion and delivery with diagnoses for intoxication. Hospital medical records were reviewed to obtain data on drug use, dosage, and pregnancy outcome (legally induced abortion/miscarriages/data on birth outcome). The hospitalization history of the children was followed for a mean of 9 years with a maximum of 20 years. RESULTS: Of 122 women studied, 44 wanted an elective abortion, 17 experienced miscarriage, and 61, exposed mainly to weak analgesics and psychotropic drugs, gave birth to 62 infants. We estimated the proportion of miscarriage to be almost doubled, whereas there was no increased risk of congenital abnormalities or prematurity in women exposed to a drug overdose compared with the background population. CONCLUSIONS: A drug overdose shortly before or during pregnancy seems to be associated with a substantially increased risk of miscarriage, but there was no increase in fetal pathology at birth among fetuses surviving till birth.

Abortion, Spontaneous↗
PubMed2002

Upper gastrointestinal bleeding among users of NSAIDs: a population-based cohort study in Denmark.

AIMS: It is well-known that use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of upper gastrointestinal bleeding (UGIB), but characteristics of the association and quantification of excess risk at the population level require clarification. METHODS: All users of nonaspirin prescription NSAIDs in North Jutland County, Denmark during 1991-95 were identified in the regional Pharmaco-Epidemiologic Database. Using the Hospital Discharge Register, all hospitalizations for UGIBs were identified among the 156,138 users of NSAIDs and compared with the number of expected based on the North Jutland population who did not receive NSAID prescriptions. RESULTS: During periods of NSAID use without use of other drugs associated with UGIB, we observed 365 UGIBs, a number 3.6 times higher than expected (95% CI = 3.3, 4.0). The excess risk varied by sex, type of NSAID and form and route of administration of the NSAID, but not by age at first NSAID prescription or number of prior prescriptions. Risk declined sharply following cessation of use. For ibuprofen and naproxen, there was a clear trend in rising risk by increasing dose, although the lowest doses were also associated with an excess of UGIB. Concurrent use of corticosteroids, anticoagulants and aspirin further increased the risk of UGIB. CONCLUSIONS: All types and formulations of NSAIDs appear to increase the risk of UGIBs, but the effect appear not to be cumulative and diminish rapidly with discontinue of use. Up to 15% of the UGIBs in the entire population of the North Jutland County may be explained by use of this drug.

Aged↗
PubMed2002

How do we best detect toxic effects of drugs taken during pregnancy? A EuroMap paper.

It is a major clinical and public health problem that there is no clear strategy as to how we best make use of information obtained when pregnant women take drugs. For this reason, some pregnant women are not treated as they should be and some are given drugs they should not use. We suggest a monitoring system that combines some of the available datasets in Europe. Using these sources as a starting point, one can develop a system that has sufficient power to detect even rare diseases like congenital malformations and sufficient diversity to detect several possible outcomes from spontaneous abortions to childhood disorders. We also suggest that case-crossover designs should be used in case-control monitoring systems that carry a high risk of recall bias. These considerations are based upon our results from a European Union-funded concerted action called EuroMaP (Medicine and Pregnancy).

Abnormalities, Drug-Induced↗