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S Kreiner

Publications and source records attributed to S Kreiner.

At least 37 records · Page 2Linked to original sources
PubMed1992

Functional ability of community dwelling elderly. Criterion-related validity of a new measure of functional ability.

Criterion-related validity of a new measure of functional ability was conducted according to a causal model based on conceptual models employed in the area of rehabilitative and geriatric medicine. The criteria variables included concurrent diagnosed diseases, global self-rated health, drug consumption and general practitioner (GP) consultations. The measure of functional ability was developed with the intention of achieving a high degree of discrimination among a group of community dwelling elderly. Data were derived from a sample survey of 70-year-old men and women conducted in 1984 in the county of Copenhagen (Denmark). Altogether 366 men and 368 women participated in each of the two phases of the study--a comprehensive medical examination at the county hospital at Glostrup followed by a home visit conducted by an occupational therapist 1-2 weeks later. The analysis included four different unidimensional index scales of functional ability divided into two types, with reduced speed and tiredness as subdimensions. The two scale types were mobility function and lower limb function. Early losses of ability together with global self-rated health were treated as outcome measures of diagnosed chronic diseases. At the same time these outcome measures together with diagnosed diseases were considered to predict drug consumption and GP consultations. It was shown that functional ability as measured by the new index scales were strongly influenced by diagnosed diseases: arteriostenosis and osteoarthrosis in lower extremities, obesity, shoulder impairments and bronchitis among women, and glucose intolerance, arteriostenosis in lower extremities and shoulder impairments among men. Global self-rated health was strongly associated with the new functional ability rating system. Early losses of ability but not self-rated health was a strong predictor for drug consumption and frequent contacts with GP. It is concluded that the new measure of functional ability is suitable for health studies of community dwelling elderly, in particular as a summary statement of the individual's health status.

Activities of Daily Living↗
PubMed1992

Interpretation of the electrocardiogram in suspected myocardial infarction: a randomized controlled study of the effect of a training programme to reduce interobserver variation.

We examined the effect of a training programme to reduce interobserver variation in interpretation of electrocardiography in suspected myocardial infarction. Sixteen doctors with 6-24 months of clinical training in internal medicine read serial electrocardiographic recordings in 107 patients and assessed whether signs indicative of acute myocardial infarction were present. There was disagreement in approximately 70% of cases. Eight of the doctors were randomly allocated to attend an 8-h intensive course on interpretation of electrocardiography in myocardial infarction. The remaining eight participants were allocated to a control group, received no training, and were not told about the subject of the study. All the doctors then reviewed another series of electrocardiographic recordings. No difference was found in the level of agreement within the two groups before and after the training programme, or between the two groups before and after the training. The raters' ability to discriminate between electrocardiograms with a high and low indication of infarction remained unaffected. We conclude that the training programme did not increase agreement regarding the interpretation of electrocardiographic data in suspected myocardial infarction. Our results suggest that the diagnostic approach of physicians is established at a very early stage in their clinical training. The effect of training programmes should be evaluated by the use of randomized clinical studies.

Education, Medical, Continuing↗
PubMed1992

Incidence and prevalence of Crohn's disease in the county of Copenhagen, 1962-87: a sixfold increase in incidence.

The incidence of Crohn's disease increased sixfold from 1962 to 1987 in the county of Copenhagen. The mean annual incidence for 1979-87 was 4.1 per 10(5) inhabitants. The increase was found equally in both sexes, with an approximately 40% higher incidence in women. The maximal incidence was found in the 15- to 24-year age group, being 12.8 per 10(5) per year for women and 6.0 per 10(5) per year for men, as mean of the period 1979-87. The prevalence at the end of the study was 54 per 10(5) inhabitants, 46 per 10(5) in men and 63 per 10(5) in women. The clinical appearance of the disease at the time of diagnosis was remarkably similar during the study period with regard to both the localization of disease and the clinical symptoms and signs. A slightly higher percentage of the patients, however, were in high disease activity at diagnosis in the later years of the study.

Adolescent↗
PubMed1991

Incidence and prevalence of ulcerative colitis in Copenhagen county from 1962 to 1987.

The incidence of ulcerative colitis was estimated during the period 1962 to 1987 in the county of Copenhagen. Within this area of approximately 550,000 inhabitants, 1161 patients were diagnosed. The mean annual incidence for the period was 8.1 per 10(5) inhabitants. There were significant increases in incidence in the early 1970s and in the early 1980s, both of which were followed by significant decreases. A bimodal age distribution was found in men, with incidence peaks in young adult life and late in life. In women a peak incidence was found in the young adult age group. The interval from onset of symptoms to diagnosis in terms of years remained unchanged over the period, with a median of 1 year (range, 0-37 years). The extent of disease at diagnosis was total colon in 18% of the patients, a substantial part of the colon in 36%, and distal colon in 44%--with no changes during the study period. The distribution of different localizations did not differ among age groups except for a tendency towards more extensive disease in young patients, below 20 years of age. The disease activity in the 1st year was fulminant in 9.1% of the cases, moderate to high in 70.7%, and low in 20.2%, with a tendency towards higher activity in patients diagnosed late in the study period. The prevalence of ulcerative colitis increased steadily during the study period, reaching a value at the end of the study (31 December 1987) of 161 per 10(5) inhabitants.

Adult↗
PubMed1990

[Study of the quality of measurement by the Sickness Impact Profile. Assessment of the reliability of a method to determine the functional level of psychiatric patients].

The Sickness Impact Profile (SIP) is a questionnaire method of assessing the functional level within 12 fields which together provide a generalized measurement of the level of health in agreement with the definition of health by WHO. In the present investigation, the method was employed for the first time occasion for 58 suitable psychiatric patients and the result of Rasch's item-analysis of the replies to the individual questions showed altogether scales of good measurement quality. A single question, however, appeared to be unsuitable. The item-analysis is a demanding measurement for the internal validity and homogeneity and it supplements foreign investigations of the criteria-related validity of SIP.

Adolescent↗
PubMed1989

Statistical analysis of complex health and social data.

The selection of appropriate statistical models is a vital aspect of the analysis of complex health and social data. This paper examines issues related to model selection. It is concluded that the range of methods now available makes old controversies less relevant. Researchers may now look for strategies that combine the advantages of non-parametric and parametric approaches without automatically accepting the limitations of either. Examples of new directions are provided.

Analysis of Variance↗
PubMed1987

Proteinuria: value as predictor of cardiovascular mortality in insulin dependent diabetes mellitus.

The relation between diabetic microangiopathy and macroangiopathy was studied by analysing the relative mortality from cardiovascular disease in patients with insulin dependent diabetes mellitus with and without persistent proteinuria. The study group comprised 2890 diabetics diagnosed between 1933 and 1972 before the age of 31, and the study was conducted by using the linear logistic discrete failure time model. In patients with proteinuria the relative mortality from cardiovascular disease was 37 times that in the general population; in patients without proteinuria it was 4.2 times that in the general population. In both groups women had a relative mortality twice to 2.6 times that of men. In neither group was relative mortality correlated with duration of diabetes, suggesting that the association between diabetes and cardiovascular disease may be conferred by factors other than hyperglycaemia and hyperinsulinaemia. The high relative mortality from cardiovascular disease in diabetics with proteinuria indicates a strong association between diabetic microangiopathy and macroangiopathy, suggesting a common (pathogenetic?) mechanism for these two late diabetic complications.

Adult↗
PubMed1987

Declining incidence of persistent proteinuria in type I (insulin-dependent) diabetic patients in Denmark.

The decreasing relative mortality among type I (insulin-dependent) diabetic patients during the last 50 years might be related to the incidence of clinical diabetic nephropathy. We therefore followed 2890 type I diabetic patients (1607 males and 1283 females) diagnosed between 1933 and 1972 and before the age of 31, from admission to death, emigration, or January 1, 1984. All patients had been admitted to the Steno Memorial Hospital. Information on development of proteinuria was obtained in 2658 patients (92%). Five hundred twenty-five patients developed proteinuria due to diabetes and 49 developed nondiabetic proteinuria. When comparing patients diagnosed between 1933 and 1942 with those diagnosed between 1953 and 1962, the incidence of proteinuria decreased by 30% (P less than .03). This might explain the decrease of relative mortality in type I diabetic patients. The incidence decreased with increasing age at onset but was always highest in males. Insulin dose (U/kg) and diabetes duration at admission did not influence the incidence of proteinuria. The incidence peaked after 15-17 yr of diabetes duration independent of sex, age at diagnosis, or calendar year of diagnosis. However, the majority of patients did not develop proteinuria during 40 yr of diabetes. This suggests individual renal susceptibility to the deleterious effect of hyperglycemia.

Denmark↗
PubMed1986

Mortality of type 1 (insulin-dependent) diabetes mellitus in Denmark: a study of relative mortality in 2930 Danish type 1 diabetic patients diagnosed from 1933 to 1972.

This study included 2930 (1642 male, 1288 female) Type 1 (insulin-dependent) diabetic patients diagnosed before the age of 31 years and between 1933 to 1972. The patients were followed from first admission to Steno Memorial Hospital until death, emigration, or until 1 January 1983. Relative mortality was studied, and the influence of calendar year of diagnosis, diabetes duration, age at diagnosis, current age and sex were studied. Relative mortality decreased continuously during the period, and patients diagnosed after 1956 had a relative mortality 30-40% lower than patients diagnosed from 1933 to 1946. Relative mortality increased with increasing diabetes duration until about 20 years of duration, after which it declined. It also increased with increasing age until 31-40 years. It decreased with increasing age at diabetes onset. Factors like calendar year of diabetes onset, age at diagnosis, current age and sex had no influence on relative mortality within the first 15 years of duration, although the relative mortality increased with diabetes duration. In the interval of 16 to 40 years of diabetes duration, the relative mortality decreased with increasing calendar year of diagnosis and age at diagnosis. In patients with a diabetes duration of more than 40 years, the relative mortality decreased with increasing age and diabetes duration. These results show that the prognosis of Type 1 diabetic patients has improved considerably during the last 40 years. Furthermore, they show that diabetes duration is the most important determinant of relative mortality.

Adult↗
PubMed1986

Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients.

The mortality following surgical correction of upper femoral fractures was investigated in 578 patients, over the age of 50 yr, randomly allocated to receive spinal (bupivacaine) or general (enflurane or neurolept) anaesthesia. Thirty days after surgery the mortality was 6% after spinal and 8% after general anaesthesia (ns). Six months to 2 years after surgery the mortality was identical in the two groups. There were no differences with respect to ambulation and discharge. The estimated blood loss was smaller (P less than 0.05) in patients receiving spinal anaesthesia. Regardless of the anaesthetic technique, a high short-term mortality was related to age, male sex, and trochanteric fracture, whereas excess long-term mortality was related to male sex and high ASA scores.

Aged↗
PubMed1986

Diabetic nephropathy--susceptible to care? A cohort-study of 641 patients with type 1 (insulin-dependent) diabetes.

The aim of the study was to investigate the influence of diabetes care on the incidence and course of clinical nephropathy in patients with Type 1 (insulin-dependent) diabetes mellitus. After hospitalization at a diabetes care unit within 15 yr after diabetes onset, 246 patients were followed at the care unit, whereas 395 patients were non-attenders. The 2 groups were comparable with regard to age and calendar year at diagnosis, insulin dose and body weight. After 40 yr of diabetes duration the cumulative incidence of persistent proteinuria was significantly lower among patients treated at the unit (31.9% vs 44.8%, p less than 0.003). The median survival after onset of persistent proteinuria was significantly longer among patients followed at the diabetes care unit (p less than 0.003). Among patients not developing diabetic nephropathy, no difference in survival was found between the 2 groups, since 72% of the patients in each group survived 40 yr with Type 1 diabetes. It is concluded that patient care seems to be highly important for the incidence and the course of clinical nephropathy, whereas no such influence could be demonstrated in patients not developing clinical nephropathy.

Body Weight↗
PubMed1985

Relative mortality of type 1 (insulin-dependent) diabetes in Denmark: 1933-1981.

The relative mortality of Type 1 (insulin-dependent) diabetes in Denmark during the period 1933-1981 was studied using a modification of Cox's regression model on the basis of two patient populations, ascertained in different ways and independently of each other. Initial analysis showed that the two groups could be combined completely into one common analysis. Relative mortality was the same for both sexes. The additional variables studied were age at diagnosis, current age, calendar year at diagnosis and calendar time during follow-up. All these interrelated variables were accounted for in the analysis. The analysis showed that relative mortality decreased with increasing age at diagnosis; increased from 1933 to a maximum in about 1965, after which it decreased; increased with increased duration of diabetes to a maximum at 15-25 years, after which it declined.

Adolescent↗
PubMed1985

Death and relapse in anorexia nervosa: survival analysis of 151 cases.

The traditional historic-prospective follow-up study of anorexia nervosa patients may be well served by recent methods of statistical analysis, the so-called models for the analysis of survival data. These models are particularly suited to the sort of incomplete observations usually produced a longitudinal studies. They include methods for estimating the probability of death and relapse as a function of time. This makes possible powerful comparisons among studies and among subsamples in single studies. In the present study, 151 patients were followed-up after 4-22 yrs. The hazard of death was on average 0.5% per year, the hazard of relapse 3% per year. With both measures, the risk declined steadily after therapeutic contact.

Adolescent↗
PubMed1985

Prognosis in Crohn's disease--based on results from a regional patient group from the county of Copenhagen.

All patients in the county of Copenhagen (approximately 500 000 inhabitants) with Crohn's disease, n = 185 were followed regularly between 1960 and 1978. The survival, the course of disease, the frequency of surgery, and the working capacity were estimated for the first 10 years of disease on the basis of the follow up results. The observation time ranged from 1-18 years with a median of 5.5 years for clinical observations, 5.8 years for survival, and 9.5 years for the occurrence of gastrointestinal cancer. The follow up was 100% concerning survival and cancer. The survival did not differ from that of the age- and sex-matched background population. Cancer was seen in only one of 185 patients corresponding to an annual risk of 0.06% and a cumulated risk after 10 years of 0.56, 95% confidence limits: 0.1-3.1%. The cancer was localised in the ileum. For all years, about 45% of the patients were without clinical symptoms of their disease, in 30% the clinical disease activity was low, and in 25% moderate to high. Among the patients with active disease, the course within the individual year was continuous in about one third and intermittent in about two thirds. After 10 years, 99% of the patients had experienced at least one relapse. The operation rate was 33% in the year of diagnosis, 13% in the following year, and then about 3% per year independent of whether or not the patient had been treated surgically in the past. After 10 years, 45% of the patients had not been treated surgically, 42% had had only one operation, and 13% had had two or more operations for their Crohn's disease. The working capacity was normal in about 75% of the patients for all years except the year of diagnosis. About 15-20% of the patients who had had the disease for more than five years were disabled as compared with about 4.4% of the background population. These results indicate that some of the patients with Crohn's disease run a more serious course with continuing symptoms despite of medical treatment and frequent surgical interventions. Most patients, however, remained capable for work and were able to lead a normal life.

Adolescent↗