Biomedical subjects

J Søgaard

Publications and source records attributed to J Søgaard.

At least 19 recordsLinked to original sources

PubMed2000

[Socioeconomic costs due to tobacco smoking].

The objective of the study was to calculate costs attributable to smoking from both a societal and a public finance perspective. The Cost-of-Illness analysis was based on incidence data from 1995 and 1996, estimated with the attributable fraction, based on English and Danish RR-estimates respectively. The indirect costs are calculated with both the friction and the human capital method. In 1995, smoking attributable costs in Denmark amounted to 4100 million DKK with the friction method and based on Danish RR-estimates, including 3600 million in direct costs and 500 million in indirect costs. A public cash flow analysis showed a net revenue of about 3900 to 5600 million DKK. Compared with previous results for Denmark (1983), the annual costs to society increased by about 118%. It is suggested that similar Cost-of-Illness analyses are carried out at regular intervals to monitor the economic consequences of smoking in society.

Cardiovascular Diseases↗

PubMed2000

[Big differences in the frequency of polypharmacy between physicians].

Polypharmacy, the simultaneous use of multiple drugs, is associated with adverse drug reactions, medication errors, and increased risk of hospitalisation. When the number of drugs is five or more (major polypharmacy), a significant risk may be present. We analysed the prevalence of major polypharmacy among listed patients, and identified possible predictors of major polypharmacy related to the practice. Prescription data were retrieved from the Odense Pharmaco-epidemiological Database and the age and sex standardised prevalence rate of major polypharmacy was calculated for each practice (n = 173). Possible predictors of major polypharmacy related to the GPs were analysed by backward stepwise linear multiple regression. A six-fold variation between practices in the prevalence of major polypharmacy was found, i.e. from 16 to 96 per 1000 listed patients (median: 42). Predictors related to the practice structure, workload, clinical work profile, and prescribing profile could explain 56% of the variation.

Adult↗

PubMed2000

Do QOL instruments agree? A comparison of the 15D (Health-Related Quality of Life) and NHP (Nottingham Health Profile) in hip and knee replacements.

OBJECTIVES: Several instruments for measuring health-related quality of life (HRQOL) have been developed, and others are under construction. The problem is whether the different HRQOL measures show comparable results. We first compared the functional relationship of the Nottingham Health Profile (NHP) and the 15-dimensional measure of HRQOL (15D) in hip and knee replacement patients. The hypothesis was that condition or intervention does not affect the functional relationship between NHP and 15D changes. METHODS: We assessed the agreement of the instruments by comparing observed changes in the 15D and its fitted values derived by regressing the 15D by the NHP dimensions. Patients (n = 452) were recruited consecutively from seven Finnish orthopedic departments during April 1991-May 1992. HRQOL was measured prior to surgery and 6, 12, and 24 months postoperatively. RESULTS: There was a different functional relationship between the HRQOL instruments in hip and knee patients; they agreed upon the direction of changes in HRQOL in 84% and showed opposite signs in 12%. The NHP showed significantly more improvement in quality of life than the 15D. CONCLUSIONS: The two instruments were in slight but significant disagreement. Estimates of effectiveness can vary according to the instrument used. Comparisons of effectiveness in healthcare programs measured by differing instruments need information on the functional discrepancies between the instruments in the conditions and interventions in which they are applied.

Activities of Daily Living↗

PubMed2000

Randomized, double-blind comparison of venlafaxine and sertraline in outpatients with major depressive disorder. Venlafaxine 631 Study Group.

BACKGROUND: This 8-week, double-blind, randomized trial compared the efficacy and tolerability of venlafaxine and sertraline in patients with major depression. METHOD: Outpatients (N = 147) with DSM-IV major depressive disorder and a baseline 21-item Hamilton Rating Scale for Depression (HAM-D) score of at least 18 were randomly assigned to venlafaxine, 37.5 mg b.i.d., or sertraline, 50 mg once daily. From day 15, the doses could be increased to venlafaxine, 75 mg b.i.d., or sertraline, 50 mg b.i.d. Efficacy was assessed with the 21-item HAM-D, the Montgomery-Asberg Depression Rating Scale (MADRS), and the Clinical Global Impressions scale (CGI) using a modified intent-to-treat analysis. RESULTS: No significant differences were noted between treatments for mean HAM-D, MADRS, or CGI scores. At week 8, the HAM-D response rate was 83% with venlafaxine (N = 75) and 68% with sertraline (N = 72) (p = .05). A HAM-D score less than 10 was recorded in 68% of venlafaxine-treated and 45% of sertraline-treated patients at week 8 (p = .008). Among patients who increased their dose, the remission rate (HAM-D score < 10) was 67% with venlafaxine and 36% with sertraline at week 8 (p < .05). The overall discontinuation rate was 21% with venlafaxine and 17% with sertraline. The most common adverse events with venlafaxine were nausea, headache, and sweating and with sertraline were nausea, headache, and diarrhea. CONCLUSION: Among patients who increased their dose, approximately twice as many experienced a remission with venlafaxine, which is a more clinically relevant endpoint than response and represents the proportion of patients who have recovered or are well.

Adult↗

PubMed1999

Long-lasting improvement in general practitioners' prescribing of antibiotics by means of medical audit.

OBJECTIVE: To evaluate the usefulness of medical audit of GPs' antibiotic prescription habits. DESIGN: Medical audit according to the APO method. Registration of antibiotic prescriptions for respiratory tract infections during a 3 year period. Intervention with courses, visits to the laboratory, and distribution of recommendations concerning diagnosis and treatment of respiratory infections. SETTING: 24 Danish GPs in cooperation with Audit Project Odense (APO) and Department of Clinical Microbiology, Odense University Hospital. 207 GPs acted as controls. MAIN OUTCOME MEASURES: Changes in the number of antibiotic prescriptions and in the penicillin/broad-spectrum antibiotic ratio. RESULTS: The proportion of antibiotic prescriptions was reduced during the investigation period, but a similar reduction was found in the control groups. Only for acute sinusitis was a lasting decrease not found in the control groups recorded. The penicillin/broad-spectrum antibiotic ratio increased in the intervention group (1.33 in 1992, 1.94 in 1993 and 2.70 in 1995). This increase was significantly higher than in the control groups. The change was seen for acute sinusitis, bronchitis, and pneumonia, but not for acute otitis media or acute tonsillitis. The changes induced from 1992 to 1993 were maintained or increased from 1993 to 1995 although the educational measures had stopped. CONCLUSION: Medical audit according to the APO method is a useful tool for inducing and maintaining desirable changes in GPs' prescription habits.

Anti-Bacterial Agents↗

PubMed1999

Decision on influenza vaccination among the elderly. A questionnaire study based on the Health Belief Model and the Multidimensional Locus of Control Theory.

OBJECTIVE: To create an empirical model, describing factors of importance to the elderly in accepting influenza vaccinations. DESIGN: Epidemiologic study with two coupled questionnaires. In September 1996 a 46-item questionnaire was sent to 2147 elderly people (> or = 65 years). The questionnaire comprised questions about general health, and questions based on the Health Belief Model and the Multidimensional Locus of Control Theory. In February 1997 a postcard questionnaire was sent to the same elderly people asking whether they had been vaccinated against influenza in the past season. SETTING: All Danish counties. SUBJECTS: 2147 persons randomly sampled from the The Civil Registration System. MAIN OUTCOME MEASURE: Factors influencing the rate of influenza vaccine uptake in the elderly. Influenza vaccination rates. RESULTS: In the high-risk group 51% (95% confidence interval: 46-55%) were vaccinated compared to 29% (26-32%) in the low-risk group as regards influenza. By logistic regression the Health Belief Model dimensions "perceived barriers", "perceived benefits" and "perceived severity" were found to be significant predictors of acceptance of influenza vaccinations. CONCLUSIONS: An empirical model based on the Health Belief Model predicting acceptance of influenza vaccinations with a positive predictive value of 91% (87-94%) and a negative predictive value of 86% (83-88%) was obtained.

Aged↗

PubMed1999

A 12-week study comparing moclobemide and sertraline in the treatment of outpatients with atypical depression.

One hundred and ninety-seven outpatients with atypical depression [Atypical Depression Diagnostic Scale (ADDS) score=4] were randomized to 12 weeks of double-blind treatment with sertraline or moclobemide in a multicentre, parallel-group clinical trial. Patients were started on either 50 mg/day sertraline or 300 mg/day moclobemide. If the therapeutic response was not satisfactory after 4 weeks, the dose could be increased to either 100 mg/day sertraline or 450 mg/day moclobemide. Primary efficacy evaluations were the 29-item Hamilton Psychiatric Rating Scale for Depression (HAM-D) and the Clinical Global Impression of Improvement (CGI-I) response rate (much or very much improved) at study endpoint. Secondary efficacy evaluations included the ADDS, the Hamilton Anxiety Scale (HAMA), the Leeds Sleep Scale, and the Battelle Quality of Life Battery (BQOLB). In the analysis of the 172 patient efficacy-evaluable population, there was significant baseline to endpoint improvement in all primary and secondary efficacy assessments after treatment with either sertraline or moclobemide. At the endpoint, the proportion of responders on CGI-I, was 77.5% in the sertraline group and 67.5% in the moclobemide group (p=0.052). The baseline to endpoint mean 29-item HAM-D score decreased from 35.9 to 14.5 in the sertraline group and from 36.3 to 16.1 in the moclobemide group. Sertraline also resulted in a significantly (p < 0.05) greater degree of improvement at the endpoint, compared with moclobemide, in the proportion of remitters on the HAMA (total score < or = 7), ADDS Category IID (Rejection Sensitivity), Leeds Sleep Factor 4 (Integrity of Behaviour Following Awakening), and on three dimensions of the BQOLB (Energy/Vitality, Social Interaction and Life Satisfaction). There were no other significant differences between treatment groups. Overall, both medications were well tolerated. In this study, both sertraline and moclobemide improved the symptoms of atypical depression.

Adult↗

PubMed1999

Polypharmacy in general practice: differences between practitioners.

BACKGROUND: Polypharmacy, the simultaneous use of multiple drugs, is associated with adverse drug reactions, medication errors, and increased risk of hospitalization. When the number of concurrently used drugs totals five or more (major polypharmacy), a significant risk may be present. AIM: To analyse the interpractice variation in the prevalence of major polypharmacy among listed patients, and to identify possible predictors of major polypharmacy related to the practice. METHOD: Prescription data were retrieved from the Odense Pharmacoepidemiological Database, and individuals subject to major polypharmacy were identified. The age- and sex-standardized prevalence rate of major polypharmacy was calculated for each practice in the County of Funen in Denmark (n = 173), using the distribution of age and sex of the background population as a reference. The practice characteristics were retrieved from the Regional Health Insurance System. Possible predictors of major polypharmacy related to the general practitioners (GPs) were analysed using backward stepwise linear multiple regression. RESULTS: A six-fold variation between the practices in the prevalence of major polypharmacy was found (16 to 96 per 1000 listed patients; median = 42). Predictors related to the practice structure, workload, clinical work profile, and prescribing profile could explain 56% of the variation. CONCLUSION: A substantial part of the variation in major polypharmacy between practices can be explained by predictors related to practice.

Adult↗

PubMed1998

[Cost analysis of dialysis treatment at the Odense University Hospital and the Sønderborg Hospital].

The major purpose of this paper is to investigate the treatment costs of dialysis treatment by modality. In this study Odense University Hospital (OUH) and Sønderborg Hospital were chosen as cases. The costs of haemodialysis (HD) treatment are estimated to DKK 341-392,000 per patient during the first year, and DKK 328-379,000 per year the following years. The costs of continuous ambulatory peritoneal dialysis (CAPD) treatment are estimated to DKK 262-291,000 per patient during the first year, and DKK 251-277,000 per year the following years. The costs of CCPD (peritoneal dialysis with the aid of a machine), treatment are estimated to DKK 312-325,000 per patient during the first year, and DKK 296-308,000 per year the following years. The treatment costs of HD are lower than expected, while the treatment costs of PD are higher than expected. As a result of this the differences in treatment costs (HD versus PD) are much lower than expected, DKK 130,000 at the most.

Angioplasty, Balloon, Coronary↗

PubMed1998

[Occupational eczema in gardeners and greenhouse workers in the county of Funen].

The aims of the study were to assess the prevalence of and association between occupational dermatitis and possible risk factors in gardeners and greenhouse workers living on Funen, describe the distribution of different types of eczema and detect the allergens most commonly involved. A cross-sectional study, based on a postal questionnaire and subsequent patch testing of selected persons was carried out in 1958 gardeners. The response rate was 84.6%, and among 250 persons patch tested the most frequently sensitizing occupational allergens were plants of the Compositae family and the fungicide captan. Allergic occupational contact dermatitis was suspected in 43 persons (17%). Irritant eczemas outnumbered allergic eczemas and both were most often caused by plants. The lifetime prevalence of occupational dermatitis was 19.6%. Occupational mucosal symptoms, working with Compositae and training as a gardener in females were significantly associated with an increased prevalence of occupational eczema, whereas sex, age and personal atopy seemed to be of less importance.

Adult↗

PubMed1998

Colorectal cancer screening: efficiency and effectiveness.

The cost-effectiveness of a series of mutually exclusive colorectal cancer screening programmes with varying screening interval and target group are analysed. Costs and effects for 60 possible screening programmes are simulated on the basis of data collected from a randomized trial initiated in 1985 in Funen County, Denmark. The screening test applied is the unhydrated Hemoccult-II. The analysis identifies six efficient programmes with cost-effectiveness estimates ranging from 17000 to 42500 Danish kroner (DKK) per life-year.

Aged↗

PubMed1998

Discounting life-years: whither time preference?

If elicited time preferences are to be incorporated into economic evaluations, not only social but also individual preferences may be included. The view of this paper is that social intertemporal preferences should govern social intertemporal choices when prioritising between the saving of lives now or in the future. However, the present value of an individual's stream of future health benefits is a matter of private consumption and hence either individual time preferences or social interpersonal preferences could be applied when evaluating the value of extended life or improved quality of life. This paper shows that it is possible to incorporate both types of time preferences in an economic evaluation; using the individual time preference or the social interpersonal preference when discounting the remaining life expectancy and the social intertemporal time preference for discounting the health benefits from the time of the risk reduction to present time. Such a scenario could solve potential problems such as double discounting of QALYs, the paradox of intertemporal equity versus interpersonal equity, as well as include elements of quantity, risk and uncertainty which are otherwise ignored in evaluations of life-saving therapies.

Attitude to Health↗

PubMed1998

Counting and discounting gained life-years.

The life expectancy gain produced by a reduction in mortality can be determined by three different methods with respect to the timing of the gained life-years. One method adds the life expectancy gain to the expected end of life. Another method places the gain at the time of occurrence of the mortality reduction. A third method distributes the gained life-years over the maximum lifespan according to the differences in survival probabilities after and before the reduction in mortality. The three methods are all used in the literature together with a quasi-deterministic and a probabilistic approach to the notion of life expectancy. The counted numbers of gained life-years are the same, but due to different timing of life expectancy gains the discounted numbers are different. Several discounting models are identified when combining the three methods of counting with the deterministic and the probabilistic approaches to life expectancy. Some are symmetrical, some are not. However, most importantly, they come out with potentially very large differences in the discounted number of gained life-years. They differ by a factor of approximately (1 + r)e(a)-1, where r is a constant discount rate and e(a) is remaining life expectancy at age a, when the reduction of mortality occurs. For a new-born, discounting at 7% p.a., one discounting model provides a present value that is 150 times larger than another discounting model, the other models being in between. The various counting and discounting models for life expectancy gains are presented formally, graphically, and with numerical examples using Danish male mortality data. We show how three different discounting models provide large differences in discounted life expectancy gains and hence cost-effectiveness ratios in an economic evaluation of a colorectal cancer screening programme in Denmark. These different discounting models co-exist in the evaluation literature. Choice of method is rarely made explicit. Sensitivity analysis with respect to this choice is even rarer. We argue that one counting-discounting model is sufficient and that this should be to discount the differences between the two survival probability curves.

Adult↗

PubMed1998

Polypharmacy: correlations with sex, age and drug regimen. A prescription database study.

OBJECTIVE: To analyse the occurrence of multiple drug use (polypharmacy, PP) in the population and to identify individuals particularly prone to PP. METHODS: Data were derived from the Odense Pharmacoepidemiological Database (OPED) and covered all subsidised prescriptions during 1994 presented by inhabitants in the county of Funen (n = 466567). The number of individuals concurrently using two to four drugs (minor PP) and five or more drugs (major PP) was calculated on a random day in 1994. Drugs were classified according to the Anatomical Therapeutical Chemical (ATC) classification index. The main therapeutic class (second level of the ATC code) was used as an indicator for the type of health problem. A stepwise backwards logistic regression was used to identify predictors of major PP. Odds ratios were calculated for different drug classes, and the age and sex of all drug users. RESULTS: On a random day, 8.3% of the population were exposed to minor PP and 1.2% to major PP. The prevalence of PP increased with age, and from the age of 70 years, two thirds of all drug users were PP users. Drug use was 50% more prevalent among women than men, but over the age of 70, the sexes did not differ in the prevalence of major PP. Many different drug combinations were found, and among major PP users (n = 5443), two thirds had their own unique drug regimen, different from all other drug users. Cardiovascular drugs and analgesics were often involved in PP among the elderly, while asthma drugs, psychotropic drugs and anti-ulcer drugs were predominant among young individuals exposed to PP. The odds ratio (OR) for major PP was substantially increased for individuals treated for cardiovascular diseases (OR, 4.5), anaemia (OR, 4.1) and respiratory diseases (OR, 3.6). CONCLUSIONS: PP is widespread in the population. Clinicians and organisers who are responsible for quality assurance programmes should intensify their surveillance of the groups most prone to PP (the elderly and those using analgesics or drugs for cardiovascular disease, anaemia, asthma and diabetes).

Adolescent↗

PubMed1998

Occupational dermatitis in Danish gardeners and greenhouse workers (III). Compositae-related symptoms.

The clinical part of the study aimed at describing epidemiological and diagnostic aspects of occupational Compositae dermatitis. Patch testing with the sesquiterpene lactone (SL) and Compositae mixes, feverfew extract and supplementary allergens in 250 selected gardeners showed Compositae allergy in 25, 17 females and 8 males. 24 were possibly occupationally sensitized. The mean age was lower and the preponderance of women higher compared to classical Compositae dermatitis, and the distribution and course of the dermatitis most often did not differ from other occupational plant dermatoses. The Compositae mix detected 2x as many as the SL mix, and the overall detection rate with both was 76%, making aimed patch testing necessary. Chrysanthemum (Dendranthema), marguerite daisy (Argyranthemum frutescens) and lettuce (Lactuca sativa) were frequent sensitizers. Occupational type I allergy to Compositae comprised sensitization to Gerbera, chrysanthemum, lettuce, Senecio cruentus and Aster. Among 1657 respondents in the questionnaire part of the study, 824 had worked with Compositae, and 160 (19%) reported occupational Compositae-related symptoms of skin and mucous membranes. Possible risk factors for the development of these were assessed in a stepwise logistic regression model and a history of childhood eczema, hay fever and duration of exposure were significantly associated with Compositae-related irritant and allergic symptoms in both sexes.

Adult↗

PubMed1997

Analysis of screening data: colorectal cancer.

BACKGROUND: This paper illustrates how data gathered from an existing screening programme against colorectal cancer can be used to produce new information on the natural history of colorectal cancer as well as the characteristics of the unhydrated Hemoccult II screening test. METHODS: A mathematical model is used, which on the basis of prevalence and interval incidence data from a randomized screening project initiated in Funen County, Denmark, estimates the sensitivity of the screening test and the sojourn time of the disease. RESULTS: The sensitivity of the Hemoccult is estimated at 62.1% and the mean sojourn time is estimated to be 2.1 years. CONCLUSIONS: The short sojourn time indicates that overall effectiveness of a Hemoccult II screening programme can be improved significantly by more frequent screening.

Aged↗

PubMed1997

Occupational dermatitis in Danish gardeners and greenhouse workers (I). Prevalence and possible risk factors.

Floristry is considered a hazardous occupation from a dermatological point of view, but there are relatively few epidemiological studies to support this notion. The present investigation set out to assess the prevalence of and association between occupational dermatitis and possible risk factors in Danish gardeners and greenhouse workers. A cross-sectional study, based on a postal questionnaire and subsequent examination and patch testing of those who had occupational eczema from their present work or occupational problems with Compositae, was carried out in 1958 gardeners and greenhouse workers. The response rate was 84.6% and among 301 persons invited for further examination, 253 (84.1%) attended. The lifetime prevalence of occupational eczema in floristry, defined as dermatitis lasting more than 24 h, was 19.6% (95% confidence intervals 17.8-21.3%) among all potential respondents. Occupational mucosal symptoms, working with Compositae plants and a history of previous occupational eczema in floristry were significantly associated with an increased risk of occupational eczema. Sex, age and atopy did not seem to be important risk factors. The results confirm that floristry is a dermatologically hazardous occupation and emphasize the importance of eliciting agents in the working environment rather than personal inherent factors.

Adult↗

PubMed1997

The Danish approach to standards for economic evaluation methodologies.

Standards for economic evaluation have now been proposed in several countries. The background for this article is a report commissioned in 1994 by the Danish health authorities (the National Board of Health and the Danish Ministry of Health) on the state of the art of economic evaluation: are the methods ready to be used for systematic decision-making in the Danish healthcare sector? The themes of this article are the attitude towards economic evaluation of medical technologies and healthcare services in Denmark, the areas for application and the desirability and feasibility of a standard set of methods for conducting economic evaluations. In addition, the current state of methodologies in economic evaluation is briefly outlined. On the background of a roundtable discussion of interested parties, the Danish health authorities have decided to introduce economic evaluation of new pharmaceutical products, on a voluntary basis for 2 to 3 years, when application has been made for public reimbursement.

Denmark↗