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T Lauritzen

Publications and source records attributed to T Lauritzen.

At least 37 records · Page 2Linked to original sources
PubMed2001

Use and validation of public data files for identification of the diabetic population in a Danish county.

INTRODUCTION: This study aims to describe the process of identifying people known to have diabetes through public data files, to validate this method, and to describe models for optimization of such identification processes. PATIENTS AND METHODS: In a study population of 303,250 citizens, the diabetics were identified by combining information from public data files with information from general practitioners. Data validity was checked by comparing the results of data searches in public data files against information from general practitioners and a random sample of diabetics. Two models were defined to optimize the use of public data files for identification of diabetics. In model A the minimum number of parameters needed to obtain a sensitivity as high as possible was identified. In model B the optimal combination of parameters needed to obtain a high positive predictive value combined with a high sensitivity was identified. RESULTS: A total of 5449 diabetics were identified. Of those 4438 (81%) were classified as Type 2 diabetics and 1011 (19%) were classified as Type 1 diabetics. The data validation revealed that one person was misclassified as a diabetic and 93 persons were misclassified as non-diabetics. In model A the identification parameters included: "prescription", "HbA1c", "chiropodist service" and "glucose service". In model B the optimal combination of parameters was identified as: minimum two HbA1c measurements, minimum one visit to a chiropodist, minimum one prescription or minimum one abnormal HbA1c during one year. CONCLUSION: Public data files are suitable for identification of both Type 1 and Type 2 diabetics. Models have been developed to identify diabetics and to promote the possibilities of long-term follow-up and quality assessment in an unselected diabetic population in a region.

Adult↗
PubMed2001

A randomised controlled trial of screening for adult hearing loss during preventive health checks.

BACKGROUND: Prophylactic strategies to counter acquired hearing impairment may involve routine audiometric screening of asymptomatic working-age adults attending general practice for regular health checks. AIM: To evaluate the effect of adult hearing screening on subsequent noise exposure and hearing. DESIGN OF STUDY: A randomised controlled population-based study of health checks and health discussions in general practice. SETTING: The project was initiated in the district of Ebeltoft, Aarhus county, Denmark. METHOD: Intervention group participants' hearing thresholds were determined audiometrically at 0.5, 1, 2, 3, and 4 kHz in each ear. Participants were advised to get their ears checked if the average hearing loss exceeded 20 dB hearing level (dBHL) in either ear. Noise avoidance was emphasised when thresholds exceeded 25 dBHL bilaterally at 4 kHz. Follow-up included questionnaires and audiometry. RESULTS: Hearing loss was observed among 18.9% of the study sample at baseline. At the five-year follow-up we recorded no significant differences between the control and the intervention groups regarding subjective or objective hearing, or exposure to occupational noise. However, there was a tendency towards reduction in exposure to leisure noise among intervention participants (P = 0.045). Approximately 20% reported hearing problems; 16.5% reported tinnitus-related complaints; 0.8% used hearing aids; 35.0% reported frequent noise exposure; and occluding wax was suspected in 2.1%. CONCLUSION: Preventive health checks with audiometry did not significantly affect hearing, but leisure noise exposure tended to become less frequent. The poor effect may be ascribed to inadequate audiological counselling or a higher priority to other advice, e.g. on cardiovascular risk or lifestyle.

Adult↗
PubMed2000

[How do patients evaluate the newly introduced system of substituting prescriptions?].

In 1997 a new prescription system was introduced in Denmark. The pharmacist must now substitute the prescribed drug with a cheaper version either by a generic prescription (G-substitution) or by an original prescription (O-substitution) unless the prescribing doctor indicates that substitution is not allowed in the specific case. The purpose of this study was to obtain the patients' view on the new prescription system and to identify any related problems. The investigation was based on structured interviews. The interview guide was designed as a questionnaire, which was validated and tested before use. The response rate was 82%. The study showed that 84% of the patients were satisfied with the system and 85% of the patients thought that it should continue. Eighty-three percent of the patients had tried another version of the substituted medicine earlier. Out of these, 6% had experienced more side-effects from the substituted medicine, and 10% felt that the substituted medicine had a weaker effect. There was one case of erroneous medical treatment as a consequence of the substitution system. Only few problems such as more side-effects or less effect of the substituted medicine was experienced by the patients. It can be concluded that the patients in general are satisfied with the new prescription system.

Adult↗
PubMed2000

[How do practitioners evaluate the newly introduced system of substituting prescriptions?].

AIMS: In 1997 a new prescription system was introduced in the Danish health care system. The pharmacist must now substitute a prescribed drug with a cheaper version, either generic (G-substitution) or original (O-substitution) unless the general practitioner (GP) indicates that substitution is not allowed. The purpose of this study was to obtain the GPs' views on the system and evaluate the problems related to the system. METHODS: The study was based on questionnaires to GPs developed via qualitative interviews with the GPs and afterwards pilot tested. RESULTS: Out of 300 GPs the response rate was 80%. The study showed that 61% of the GPs were dissatisfied with the system and thought that it should be removed. There were several reasons for this: the system was incomprehensible, the introduction and information about the system was insufficient and the extra workload was too heavy. All the GPs agreed that analogue substitution (substitution between drugs with the same effect obtained by different means) was medically unjustifiable and should not be introduced.

Adult↗
PubMed2000

[How do pharmacists evaluate the newly introduced system of substituting prescriptions?].

In 1997 a new prescription system was introduced in the Danish health care system. The pharmacist must now substitute a prescription with a cheaper version of the drug (either generic or original) unless the prescribing doctor indicates that substitution is not allowed in the specific case. The purpose of this study was to evaluate problems of the system and obtain the pharmacists' views on the system. The study was based on questionnaires to a representative sample of 75 pharmacists (a quarter of Denmark's pharmacists). The response rate was 72%. Half of the pharmacists were dissatisfied with the system, which primarily was due to the excessive workload imposed. In spite of this, about half the pharmacists wanted the system to be continued, because the overall purpose of finding the cheapest drug for the patient is good. Nearly all pharmacists thought that analogue substitution (substitution between drugs with the same overall effects but obtained by different means) should not be introduced.

Adult↗
PubMed2000

The ADDITION study: proposed trial of the cost-effectiveness of an intensive multifactorial intervention on morbidity and mortality among people with Type 2 diabetes detected by screening.

OBJECTIVE: The overall aims of the ADDITION study are to evaluate whether screening for prevalent undiagnosed Type 2 diabetes is feasible, and whether subsequent optimised intensive treatment of diabetes, and associated risk factors, is feasible and beneficial. DESIGN: Population-based screening in three European countries followed by an open, randomised controlled trial. SUBJECTS AND METHODS: People aged 40-69 y in the community, without known diabetes, will be offered a random capillary blood glucose screening test by their primary care physicians, followed, if equal to or greater than 5.5 mmol/l, by fasting and 2-h post-glucose-challenge blood glucose measurements. Three thousand newly diagnosed patients will subsequently receive conventional treatment (according to current national guidelines) or intensive multifactorial treatment (lifestyle advice, prescription of aspirin and ACE-inhibitors, in addition to protocol-driven tight control of blood glucose, blood pressure and cholesterol). Patients allocated to intensive treatment will be further randomised to centre-specific interventions to motivate adherence to lifestyle changes and medication. Duration of follow-up is planned for 5 y. Endpoints will include mortality, macrovascular and microvascular complications, patient health status and satisfaction, process-of-care indicators and costs.

Adult↗
PubMed2000

Review of prandial glucose regulation with repaglinide: a solution to the problem of hypoglycaemia in the treatment of Type 2 diabetes?

Type 2 diabetes mellitus is characterised by abnormal beta-cell function (present at the time of diagnosis) that is often associated with insulin resistance. An important and consistent pathophysiological finding is the failure to produce adequate increments in insulin secretion in response to carbohydrate intake. Therefore, insulin secretagogue therapy, particularly when focused on prandial glucose regulation, is a logical approach to treatment because it addresses one of the most fundamental pathophysiological aspects of the disease. However, the traditional secretagogues-the sulphonylureas--have long been associated with the unwanted effect of hypoglycaemia. This is particularly likely to occur when drugs with lengthy plasma half-lives, prolonged drug-receptor interactions, active metabolites or a reliance on renal clearance are used. The problem is most prevalent in elderly patients, where sulphonylurea-induced hypoglycaemia may be related to failure to comply with strict mealtimes or the need for supplementary food intake, often in the context of compromised renal function. Data from large-scale outcome studies demonstrate that when tight glycaemic control is achieved through aggressive antidiabetic therapy, late diabetic complications can be significantly reduced. However, the pursuit of stricter HbA1c targets with more aggressive interventions may increase the risk of hypoglycaemia. This is an irony because the clinical need to avoid hypoglycaemia and patients' apprehension of it present barriers to the achievement of beneficial glycaemic targets. However, an increased risk of hypoglycaemia may not be inevitable with insulin secretagogue therapy. The recently introduced carbamoylmethyl benzoic acid derivative, repaglinide, has pharmacological properties that are well suited to its intended role as a prandial glucose regulator. When taken prior to main meals, the rapid onset and relatively short duration of action of repaglinide aid disposal of the mealtime glucose load, without continued stimulation of pancreatic beta-cells in the postprandial fasting period. Repaglinide is also characterised by hepatic metabolism and elimination, which is an advantage in the context of impaired renal function. Prandial glucose regulation with repaglinide selectively increases insulin secretion, and hence limits glucose excursions, in the prandial phase. If a meal is omitted, so too is the corresponding dose. This more flexible approach to the management of Type 2 diabetes has a number of advantages when compared with the fixed daily dosing regimens of sulphonylureas, among them a reduced risk of hypoglycaemia--a benefit that is particularly marked in the context of missed or irregular meals.

Blood Glucose↗
PubMed2000

Fetal growth and blood pressure in a Danish population aged 31-51 years.

During the past decade, studies have shown an inverse association between birth weight and blood pressure and risk of coronary heart disease in adult life. From old public archives we were able to trace the birth records of 545 out of 905 persons (60.2%) aged 31-51 years who participated in the Ebeltoft Health Promotion Project in Denmark. We examined the associations between birth weight, length at birth, Ponderal Index and systolic and diastolic blood pressure. No associations were found for women. For men, the mean systolic blood pressure fell from 131.1 mmHg with a birth weight of less than 3300 g to 129.6 mmHg with a birth weight of more than 4000 g, and for diastolic blood pressure 81.6 mmHg to 80.3 mmHg, respectively. For men, the mean systolic blood pressure fell from 135.7 mm Hg with a birth length of 30-51 cm to 131.6 with a birth length of 55-62 cm, and for diastolic blood pressure 83.0 mmHg to 78.8 mmHg, respectively. The associations may reflect organ programming in fetal life.

Adult↗
PubMed2000

Inverse association between birth weight, birth length and serum total cholesterol in adulthood.

OBJECTIVES: To investigate whether impaired fetal growth, measured by low birth weight and short birth length, is linked with raised levels of serum lipids and increased risk and mortality of coronary heart disease. DESIGN: The association between birth length, birth weight, Ponderal Index and total serum cholesterol was examined in 545 Danish men and women aged 31 to 51 years who participated in the Ebeltoft Health Promotion Project in Denmark. RESULTS: No associations were found in women. For men, a negative association was found between birth weight and serum total cholesterol, with a fall in mean serum total cholesterol from 6.03 mmol/l at birth weight below 3300 g to 5.64 mmol/l at birth weight above 4000. A similar association was found between birth length and serum cholesterol, with a mean value of 6.23 mmol/l at birth length below 51 cm and a mean value of 5.56 mmol/l at birth length above 54 cm. No associations were found for Ponderal Index. Between 3% and 8% of the variance in serum total cholesterol could be explained by the statistical models used in this study. CONCLUSION: Our findings support the hypothesis of a negative association between birth weight, birth length and elevated serum cholesterol in adult life, but only in men.

Adult↗
PubMed2000

A five-year longitudinal study of hearing in a Danish rural population aged 31-50 years.

This paper aims to report changes in hearing sensitivity over five years in a rural population aged 31-50 years and to identify risk factors associated with hearing deterioration. The study is prospective and based on data from pure tone audiometry and questionnaires in the Ebeltoft Health Promotion Project in Denmark. A representative sample of 705 subjects had a complete follow-up, including audiometry. The median hearing deterioration was 2.5 dB at 3-4 kHz and 0 dB at 0.5-2 kHz. There was a high degree of individual variability in deterioration. The overall deterioration of hearing sensitivity of the population was largely predicted from the cross-sectional findings reported previously. In the analysis of risk factors, hearing deterioration was defined as an average deterioration 10 dB/5 years at 3-4 kHz in at least one ear. Deterioration was present in 23.5% of the sample. The 41-50-year-olds had a relative risk of deterioration of 1.32 (95% CI 1.01-1.73) compared with the 31-40-year-olds. Males had a relative risk of 1.35 (1.03-1.76) compared with females. The risk was not significantly elevated for a range of other possible risk factors confirmed by logistic regression analysis. In conclusion, deterioration in hearing sensitivity on population level can be predicted on the basis of cross-sectional findings. Hearing sensitivity deteriorated mainly at 3-4 kHz. The deterioration increased with age and was higher in males than in females. Other risk factors were not found. The present study does not support the hypothesis that hypertension or tobacco smoking is associated with deterioration in hearing.

Adult↗
PubMed1999

[Quality assessment of diabetes care in a large general practice. Identification and biomedical status].

The aims of this study were to describe the diabetic population and to evaluate the routine diabetic care in one general practice. All patients with recognized diabetes were included. Information was collected from each patient's record and from patients' and doctors' questionnaire. One hundred an fourty (1.8%) of the patients had recognized diabetes and 81% of these diabetes had non-insulin-dependent diabetes (NIDDM). According to the records, HbA1c had been monitored in 85% of the NIDDM patients in the preceding year and in 76% of the IDDM patients. The corresponding figures for albuminuria were 84% vs. 76%, for S-creatinine 74% vs. 81%, for S-cholesterol 37% vs. 24%, for weight 47% vs. 43%, for blood pressure 60% vs. 48%, for foot care 67% vs. 62% and for eye examination 76% vs. 75%. International targets for good control were obtained for HbA1c in 42% of cases, for weight in 23%, for blood pressure in 30% and for S-cholesterol in 40% at the last control. The results of the study indicate that there is a continuous demand for quality monitoring and improvement of diabetic care in general practice.

Adolescent↗
PubMed1999

Changes in liver-derived enzymes and self-reported alcohol consumption. A 1-year follow-up study in Denmark.

BACKGROUND: The association between alcohol intake and liver disease is well known, but little is known about alcohol consumption and changes in liver-derived enzymes within 1 year. In a 1-year follow-up study we examined changes in liver-derived enzymes and their association with self-reported alcohol consumption. METHODS: We recorded liver-derived enzyme values, self-reported alcohol consumption, and potential confounder variables at base line and at a 1-year follow-up in a representative sample of 822 persons (aged 30-50 years) from the survey of The Ebeltoft Health Promotion Project in Denmark, by using questionnaires, health examinations, and blood samples. RESULTS: The prevalence of increased liver-derived enzyme values was 11.1% at base line and 11.8% at the 1-year follow-up. The incidence rate of increased liver-derived enzyme values was 5.1 per 100 person-years, and 34% of the cases of increased liver-derived enzyme values returned to normal within I year. We found an odds ratio of 4.0 for men and 8.0 for women of developing increased liver-derived enzyme values if alcohol consumption was more than 21 units a week. The risk seemed to be dose-dependent. CONCLUSIONS: The prevalence of increased liver-derived enzyme values in the population was high and increased slightly during the study period. There was a strong association between the incidence rate of increased liver-derived enzyme values and self-reported alcohol consumption in a dose-dependent relationship, also when adjusted for confounding by smoking and obesity. The persons with persistently increased enzyme values had a higher weekly alcohol consumption than the rest of the study population.

Adult↗
PubMed1999

From science to everyday clinical practice. Need for systematic evaluation of research findings.

This paper focuses on problems attached to using scientific results in everyday clinical practice. Based on examples we raise the question: Are research results obtained under ideal scientific conditions, presented to health professionals and the public in a way that creates unrealistic expectations of the health services? We suggest that the clinical researcher, when reporting scientific results, should be obliged to consider technological aspects, i.e. the human and monetary cost, effectiveness, compliance, the expected consequence for the patient, professionals and society, and resources needed to accomplish it. Presented with these considerations, actors of the health care scene in terms of professionals, administrators, politicians and patients should be better suited to decide if implementation of a new treatment should take place. Such procedures will give the population and the politicians more realistic expectations of the contributions of medical science and the health services in general.

Adult↗
PubMed1999

Prevalence of hearing impairment and subjective hearing problems in a rural Danish population aged 31-50 years.

The objective of the present study was to describe the prevalence of subjective hearing problems and hearing impairment and to evaluate the relation between subjective hearing problems and audiometric thresholds, in a random sample of subjects aged 31-50 years. The study is cross-sectional and based on data from questionnaires (N = 1397) and pure tone audiometry (N = 905) in the Ebeltoft Health Promotion Project in Denmark. Hearing problems were significantly more prevalent in males than females. Males had significantly poorer average audiometric thresholds (0.5, 1, 2 and 4 kHz) in the better hearing ear (BE) and worse hearing ear (WE) than females. Average audiometric thesholds were poorer in the 41-50-year-old age group compared with the 31-40-year-old age group, the difference being most marked in males. Overall prevalence of hearing impairment (at least two threshold levels >25 dB HL) was 7.4% (95% confidence interval: 5.7-9.1%) in BE and 15.9% (13.5-18.3%) in WE. Prevalence of impairment > or = 25, > or = 35 and > or = 45 dB HL (average across 0.5-4 kHz): (BE) 3.4% (2.2-4.6%), 1.0% (0.3-1.6%) and 0.2% (0.0-0.5%); (WE) 11.6% (9.5-13.7%), 3.6% (2.4-4.9%) and 1.7% (0.8-2.5%). An interesting sex difference was noted as females were aware of hearing problems at an earlier stage of impairment than males. In conclusion, hearing impairment is fairly prevalent in this young rural population, less prevalent, however, than in the British National Study of Hearing. It is proposed that general practitioners should take a more active part in primary prevention, early detection of hearing impairment and early referral for rehabilitation.

Adult↗
PubMed1999

Near-patient test for C-reactive protein in general practice: assessment of clinical, organizational, and economic outcomes.

BACKGROUND: The benefits of near-patient, point-of-care tests have not been fully examined. We have assessed the clinical, organizational, and economic outcomes of implementing a near-patient test for C-reactive protein (CRP) in general practice. METHODS: In a randomized crossover trial during intervention periods, general practitioners (GPs) were allowed to measure CRP within 3 min, using NycoCard(R) CRP. During control periods, they had to mail blood samples for CRP measurements to the hospital laboratory and received test results 24-48 h later. Twenty-nine general practice clinics participated (64 GPs), and 1853 patients were included in the study. Results were evaluated at both the level of participating GPs and the level of included patients. RESULTS: For participating GPs, the overall use of erythrocyte sedimentation rates (ESRs) decreased by 8% (95% confidence interval, 1-14%) during intervention periods, and the number of blood samples mailed to the hospital laboratory decreased by 6% (1-10%). No reduction in the prescription of antibiotics was seen. The proportion of study patients having a follow-up telephone consultation was reduced from 63% to 53% (P = 0. 0001), and patients with CRP concentrations >50 mg/L had their antibiotic treatments started earlier when CRP was measured in general practices (P = 0.0161). CONCLUSION: The implementation of the near-patient CRP test was cost-effective mainly on the basis of a reduction in the use of services from the hospital laboratory by GPs. If the implementation is followed by education and clinical guidelines, opportunities exist for additional reduction in the use of ESR and for a more appropriate use of antibiotics.

Anti-Bacterial Agents↗
PubMed1999

Waist circumference and body mass index as predictors of elevated alanine transaminase in Danes aged 30 to 50 years.

INTRODUCTION: We examined whether waist circumference and waist-to-hip circumference ratio were a better predictor for elevated alanine transaminase level than body mass index. METHODOLOGY: In a cross-sectional survey we examined body mass index, waist circumference, waist-to-hip ratio, alcohol consumption, and alanine transaminase level in a random sample of 903 men and women aged 30 to 50 years from The Ebeltoft Health Promotion Project in Denmark. RESULTS: Body mass index, waist circumference and waist-to-hip ratio explained an approximate 12% variation in alanine transaminase in men and 4% in women, whereas waist-to-hip circumference ratio explained a 2% variation in women. The risk of elevated alanine transaminase level in men, calculated as odds ratio, with a body mass index (kg/m2) above 30, or a waist circumference above 102 cm, or a waist-to-hip circumference ratio above 0.9 was 9.3 (95% confidence interval [CI], 3.6-24.1), 5.6 (95% CI, 2.5-12.5) and 2.7 (95% CI, 1.3-5.3) respectively, but there was no elevated risk among women. CONCLUSIONS: Waist circumference and body mass index were both predictors in men. Waist-to-hip ratio was also a predictor in men, but not as strong a predictor as waist circumference and body mass index. No association was found in women. This difference is probably explained by differences in the accumulation of intra-abdominal adipose tissue among men and women with the same degree of obesity.

Adult↗