Biomedical subjects

David Gaist

Publications and source records attributed to David Gaist.

At least 19 recordsLinked to original sources

PubMed2006

Intensive community pharmacy intervention had little impact on triptan consumption: a randomized controlled trial.

OBJECTIVE: To evaluate the impact of an intensive pharmaceutical care campaign targeting inappropriate use of triptans. DESIGN: Randomized controlled trial. SETTING: 22 community pharmacies in the County of Funen, Denmark. SUBJECTS: A total of 1123 triptan users at intervention pharmacies and 1340 at control pharmacies. INTERVENTION: Intervention pharmacy staff received information on migraine and other types of headache, detection of inappropriate triptan use and other drug-related problems, and techniques for establishing a dialogue with patients. Intervention consisted of a folder and a structured dialogue with the pharmacy staff. The folder included questions aimed at detecting overuse and inappropriate triptan use. MAIN OUTCOME MEASURES: Change in average triptan consumption in doses per month measured by means of a prescription database with information on all purchases of reimbursed drugs at the level of the individual patient. RESULTS: Overall, intervention had no statistically significant short-term impact on patients' consumption of triptans either among incident users (intervention/control ratio 1.02; 95% confidence interval 0.95 to 1.12), or among prevalent users (1.02; 0.97 to 1.08). No effects were observed after 6 and 9 months, apart from a possible borderline effect after 9 months among prevalent users with intermediate triptan consumption (0.93; 0.87 to 1.00). CONCLUSION: The pharmaceutical care campaign did not reduce the use of triptans.

Adult↗

PubMed2005

Time trends in waiting time to pregnancy among Danish twins.

BACKGROUND: Little is known about time trends in fecundity because few population-based data are available. In a survey among female twins born from 1953 to 1976, their time to pregnancy did not differ from singletons and can be considered to represent the fecundity of the general population. METHODS: Information was collected by interview about waiting time to first pregnancy (TTP) and any periods of subfecundity among both male and female twins born between 1931 and 1952. Trends were analysed by considering the year of birth of the index person (birth cohort effect) or year at which the first attempt started (period effect). RESULTS: Eighty-five percent of male and 81.3% of female eligible twins participated. A total of 1598 male twins and 1653 female twins reported a TTP value and 1671 men and 1715 women had a value for their first attempt to conceive including unsuccessful attempts. No overall trends in either male or female TTP were observed with increasing year of birth or of starting time, after adjustment for confounders, but for attempts fecundity increased among female twins by year of birth or of starting the attempt. A decreasing risk of severe infertility with increasing year of birth or year for start of the attempt was observed among male twins, but this observation was based on only 81 men and was not seen among female twins. CONCLUSION: No decreasing trend in fecundity was observed among Danish twins born between 1931 and 1952 who had completed their reproduction. Female twins had a slight increase in fecundity, and men a decrease in severe infertility. In addition, TTP was apparently well reported and recalled for up to 50 years among both male and female twins.

Adult↗

PubMed2005

Characteristics of middle-aged and elderly women with urinary incontinence.

OBJECTIVE: To describe the prevalence of urinary incontinence and to find characteristics useful in general practice for identifying middle-aged and elderly women with the problem. DESIGN: Cross-sectional interview study. SETTING: Population-based samples of Danes. SUBJECTS: A total of 5795 women older than 45 years (46+ years). MAIN OUTCOME MEASURES: Prevalence of incontinence and clinical characteristics assessed by standardized interview questions. RESULTS: The overall prevalence of urinary incontinence was 20% among women less than 60 years of age and 44% among those older than 80 years. Increasing age was highly associated with both forms of incontinence (stress and urge). High body mass index (BMI), chronic lung disease, and stroke were also associated with both forms, while number of children was associated with stress incontinence only. Predictive models show that 56% of women characterized by high age (older than 80 years) and overweight (BMI higher than 30) will suffer from urinary incontinence. The low-risk group defined by these two parameters (aged 46-60 years and not overweight) still had a 19% prevalence in the last month. CONCLUSION: The prevalence of urinary incontinence increased with age. Even in the low-risk groups the problem was very common in old age. Questions about incontinence should, therefore, be asked in relevant consultations with all elderly female patients.

Age Factors↗

PubMed2004

Seasonal variation in hospitalization and case fatality of subarachnoid hemorrhage - a nationwide danish study on 9,367 patients.

Seasonal variation in the occurrence of cerebrovascular disease has been reported, but data about subarachnoid hemorrhage (SAH) are few and inconclusive. We conducted a nationwide population-based study in Denmark to examine any seasonal pattern of hospitalization and case fatality of SAH. We identified 9,367 patients with SAH and found a modest indication of overall seasonal variation for the risk of hospitalization with this diagnosis. The seasonal pattern, with the highest incidence in January and the nadir in July, was mostly apparent for subjects aged >65 years (peak-to-trough ratio = 1.18; 95% CI 1.04-1.32). There was little difference by sex. The overall 30-day case fatality rate was 38% and showed less seasonal variation. We found evidence of weak seasonal variation in hospitalization for SAH and almost no seasonal variation in a 30-day case fatality rate after SAH.

Age Factors↗

PubMed2004

Does appendectomy reduce the risk of ulcerative colitis?

BACKGROUND: Persons who have had an appendectomy are less prone to develop ulcerative colitis than those who have not. The underlying mechanism and the clinical use of this finding are unknown. METHODS: Two competing hypotheses were examined: (1) the inverse association between appendectomy and ulcerative colitis is conferred by a mutual determinant such as genes, and (2) the appendix itself has biologic effects that promote the development of ulcerative colitis. We performed a population-based cohort study of all 234,559 persons who had an appendectomy performed in Denmark 1977 through 1999. We used a bidirectional cohort design, calculating the standardized incidence rate of ulcerative colitis both before and after the appendectomy. If the hypothesis of a constant, confounding factor were true, incidence rates of ulcerative colitis would be equal before and after appendectomy. If the incidence of ulcerative colitis were lower after appendectomy than before, it would support the second hypothesis and a true protective effect of the appendectomy. We controlled confounding by age and sex using direct standardization. RESULTS: Of 234,559 persons who had an appendectomy, 559 developed ulcerative colitis during a mean follow up of 17.5 years. The standardized incidence rate of ulcerative colitis was lower in the postappendectomy period than in the preappendectomy period (incidence rate ratio = 0.74; 95% confidence interval = 0.62-0.88). CONCLUSIONS: The inverse association between appendectomy and ulcerative colitis is not explained by time-stable factors such as genes. Appendectomy might have a genuine protective effect toward development of ulcerative colitis.

Adolescent↗

PubMed2004

Genetic and environmental influences on urinary incontinence: a Danish population-based twin study of middle-aged and elderly women.

BACKGROUND: Familial clustering has been reported for urinary incontinence (stress and urge), but different etiologies for the two types of incontinence have been suggested. OBJECTIVE: The aim of this study was to estimate the relative influence of genetic and environmental factors on stress, urge, and mixed incontinence among elderly and middle-aged women. METHODS: This is a population-based classical twin study of 1168 female twin pairs [548 monozygotic (MZ) and 620 dizygotic (DZ)] from a middle-aged (46-68 years) and an old (70-94 years) cohort identified in the Danish Twin Registry. Urinary incontinence was assessed with the help of two validated questions identifying stress and urge incontinence in interviews. RESULTS: For urge incontinence, the tetrachoric correlation was significantly higher for MZ twins, compared to that for DZ twin pairs in both middle-aged [0.51 (95% CI: 0.26-0.71) versus -0.22 (95% CI: -0.59-0.18)] and elderly [0.50 (95% CI: 0.27-0.68) versus 0.28 (95% CI: 0.02-0.42)], indicating genetic effects. The heritability of urge incontinence was 42% (95% CI: 16-63%) among middle-aged women and 49% (95% CI: 29-65%) among the elderly. Moreover, mixed incontinence had a substantial genetic component. The role of genetic factors was less clear in stress incontinence. CONCLUSIONS: Genetic factors play a substantial role in the development of urge and mixed incontinence, whereas the role of genetic factors in stress incontinence is less prominent.

Aged↗

PubMed2003

Parity and risk of subarachnoid hemorrhage in women: a nested case-control study based on national Swedish registries.

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) is the only type of stroke with female predominance, suggesting that reproductive factors may play a role in the etiology. We conducted a population-based study to examine the influence of parity on the risk of SAH in women. METHODS: We linked data from 3 national Swedish registries to identify first-ever hospitalizations for SAH in a cohort of women followed up since first childbirth during 1973-1997. Within this cohort, we conducted a nested case-control study and estimated the odds ratio (OR) and 95% CI of SAH by parity adjusted for age, calendar period, and length of follow-up. Information on smoking habits before the subject's first childbirth was available in a subset of the data (women with first childbirths during 1982-1997). RESULTS: Of the 887 cases identified, 70% had suffered from SAH > or =5 years after giving birth to their last child. The OR declined with increasing parity (1 child: reference; 2: OR=0.83 [95% CI, 0.70 to 0.99]; 3: OR=0.72 [95% CI, 0.58 to 0.91]; 4: OR=0.72 [95% CI, 0.48 to 1.08]; > or =5: OR=0.67 [95% CI, 0.32 to 1.41]). Adjusting for daily cigarette consumption before first childbirth in the subsample in which this information was available reduced but did not eliminate the association of the disorder with parity. CONCLUSIONS: Parity may confer a moderate long-term protective effect on the risk of SAH. The biological mechanism underlying this association is currently unknown.

Adolescent↗

PubMed2003

Angiotensin I-converting enzyme (ACE) gene polymorphism in relation to physical performance, cognition and survival--a follow-up study of elderly Danish twins.

PURPOSE: Studies of younger individuals have suggested an association between ACE genotype and physical and cognitive performance. Using a longitudinal study of elderly twins we studied the association between ACE genotype and physical and cognitive functioning and survival in old age. METHODS: Participants were 684 twins aged 73+ years from the 1997 and 1999 surveys of the Longitudinal Study of Aging Danish Twins. Cognitive skills were assessed by the MMSE, while physical abilities were determined through self-report in 1997 and through both self-report and measurement of performance in two physical tasks in 1999. Survival status was obtained through linkage with a national death register. RESULTS: Neither physical nor cognitive performance was associated with ACE genotype at baseline in 1997, or at follow-up in 1999. For participants in both surveys longitudinal changes in these skills did not depend on ACE genotype. The relative risk of dying was increased in II compared with the DI and DD genotype with relative risks of 1.6 (95 percent confidence intervals 1.1-2.5) and 1.3 (0.8-2.1), respectively. CONCLUSION: We found no substantial effects of ACE genotype on physical and cognitive performance, or rate of change among elderly. Persons with the D allele may have a lower mortality at older ages.

Aged↗

PubMed2003

Predictors of mortality in 2,249 nonagenarians--the Danish 1905-Cohort Survey.

OBJECTIVES: : To elucidate whether well-known predictions of mortality are reduced or even reversed, or whether mortality is a stochastic process in the oldest old. DESIGN: : A multidimensional survey of the Danish 1905 cohort conducted in 1998 with follow-up of vital status after 15 months. SETTING: : Denmark. PARTICIPANTS: : All Danes born in 1905, irrespective of physical and mental status were approached. Two thousand two hundred sixty-two persons of 3,600 participated in this survey. MEASUREMENTS: : Professional interviewers collected data concerning sociodemographic factors, smoking, alcohol consumption, body mass index, physical and cognitive performance, and health during a visit at the participant's residency. Cox regression models were used to evaluate predictors of mortality. RESULTS: : Five hundred seventy-nine (25.7%) of the 2,249 participants eligible for the analysis died during the 15 months follow-up. Multivariate analyses showed that marital status, education, smoking, obesity, consumption of alcohol, and number of self-reported diseases were not associated with mortality. Disability and cognitive impairment were significant risk factors in men and women. In addition poor self-rated health was associated with an increase in mortality in women. CONCLUSION: : In the oldest old, several known predictors of mortality, such as sociodemographic factors, smoking, and obesity, have lost their importance, but a high disability level, poor physical and cognitive performance, and self-rated health (women only), predict mortality, which shows that mortality in the oldest old is not a stochastic process.

Activities of Daily Living↗

PubMed2003

Genetic and environmental influences on migraine: a twin study across six countries.

Migraine is a common neurovascular brain disorder that is manifested in recurrent episodes of disabling headache. The aim of the present study was to compare the prevalence and heritability of migraine across six of the countries that participate in GenomEUtwin project including a total number of 29,717 twin pairs. Migraine was assessed by questionnaires that differed between most countries. It was most prevalent in Danish and Dutch females (32% and 34%, respectively), whereas the lowest prevalence was found in the younger and older Finnish cohorts (13% and 10%, respectively). The estimated genetic variance (heritability) was significant and the same between sexes in all countries. Heritability ranged from 34% to 57%, with lowest estimates in Australia, and highest estimates in the older cohort of Finland, the Netherlands, and Denmark. There was some indication that part of the genetic variance was non-additive, but this was significant in Sweden only. In addition to genetic factors, environmental effects that are non-shared between members of a twin pair contributed to the liability of migraine. After migraine definitions are homogenized among the participating countries, the GenomEUtwin project will provide a powerful resource to identify the genes involved in migraine.

Adolescent↗

PubMed2003

Stroke research in GenomEUtwin.

Stroke is one of the leading causes of severe disability and death in the world. In the present article we outline possibilities and limitations for future stroke research within the GenomEUtwin. The combined sample of twins born before 1958 from Denmark, Finland, and Sweden, and available for follow-up into the second millennium for non-fatal and fatal stroke events through national inpatient and death registers exceeds 70,000 twin pairs. This sample size will enable the study of genetic influences on stroke and major stroke subtypes. Large samples of twins in GenomEUtwin have been followed up repeatedly through interviews and questionnaires concerning a variety of exposures and potential risk factors for stroke. We briefly outline how this information can be combined with the health register information for epidemiologic and genetic epidemiologic studies of stroke. We also present the number of twin pairs concordant and discordant for stroke in Denmark, Finland and Sweden, and time lags between events for twins concordant for stroke. This information illustrates that the number of affected sib pairs for linkage studies is relatively limited, but the sample sizes are promising for association studies.

Denmark↗

PubMed2003

Risk of stroke associated with nonsteroidal anti-inflammatory drugs: a nested case-control study.

BACKGROUND AND PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with bleeding complications and may affect the risk of hemorrhagic stroke through inhibition of platelet cyclooxygenase-1. We performed a population-based case-control study to estimate the risk of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in users of NSAIDs. METHODS: We used a population-based patient registry to identify all patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999. All diagnoses were validated according to predefined criteria. We selected 40 000 random controls from the background population. Information on drug use for cases and controls was retrieved from a prescription registry. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors. RESULTS: The cases were classified as intracerebral hemorrhage (n=659), subarachnoid hemorrhage (n=208), and ischemic stroke (n=2717). The adjusted odds ratio of stroke in current NSAID users compared with never users was 1.2 (95% CI, 0.9 to 1.6) for intracerebral hemorrhage, 1.2 (95% CI, 0.7 to 2.1) for subarachnoid hemorrhage and 1.2 (95% confidence interval, 1.0 to 1.4) for ischemic stroke. The survey data indicated that additional confounder control would not have led to an increase in relative risk estimates. CONCLUSIONS: Current exposure to NSAIDs is not a risk factor for intracerebral hemorrhage or subarachnoid hemorrhage. Furthermore, NSAIDs probably offer no protection against first-ever ischemic stroke.

Adult↗

PubMed2002

[Do children of long-lived parents age more successfully?].

INTRODUCTION: Long-lived individuals are rare and may be selected in part for the genetic factors that promote successful ageing. The children of long-lived parents may therefore age more successfully than the children of short-lived parents. MATERIAL AND METHODS: We used three major cross-sectional, population-based surveys to study the association of parental longevity with successful ageing in offspring. The measures of ageing were hand-grip strength, cognitive performance (mini mental state examination (MMSE) and a cognitive composite score), self-reported diseases, and self-rated health. RESULTS: For every additional ten years the parents lived, grip strength increased by 0.32 kg (95% CI = 0.00-0.63), the MMSE score by 0.20 points (95% CI = 0.03-0.37), and cognitive composite score by 0.24 points (95% CI = 0.07-0.40). A ten-year increment of parental life was associated with a reduction by approximately 0.20 in the adjusted OR for having each of the following conditions: diabetes, hypertension, ischaemic heart disease, heart failure, stroke, or fair, poor or very poor self-rated health. Almost all the effects were seen solely in the cohort of 70+ year-olds, but not in the middle-aged or nonagenarians. DISCUSSION: Parental life span is positively associated with physical and cognitive functioning and avoidance of some of the common chronic diseases. However, overall the effects are small and are seen in the elderly, but not in the middle-aged or the very old.

Adult Children↗

PubMed2002

Genetic contribution to rate of change in functional abilities among Danish twins aged 75 years or more.

In a previous cross-sectional study of twins, the authors found evidence of a substantial genetic influence on functional abilities among elderly women. It has been suggested that rate of change in functional abilities over time could underlie such findings and that rate-of-change phenotypes may have an even larger genetic component than "level" phenotypes (e.g., functional abilities per se). If so, rate-of-change phenotypes could be more powerful than level phenotypes in studies aimed at identifying specific polymorphisms of importance for aging. In 1995, the authors assessed a population-based sample of 2,401 Danish twins aged 75 years or more. The survivors were recontacted after 2 years and again after 4 years. Consistent mean-level declines, high within-person correlations over time, and substantial heritability in the female sample were observed for functional abilities. Nonetheless, structural-equation analyses revealed only a very modest and nonsignificant heritability for rate of change in functional abilities: 16% (95% confidence interval: 0, 35) for women and 9% (95% confidence interval: 0, 44) for men. This study had a large initial sample size, high participation rates, and a valid and reliable measure of rate of change in a phenotype that had previously shown substantial heritability in cross-sectional analyses in the same twin population. Still, the present study revealed only a modest and nonsignificant genetic influence on rate of change, which suggests that detection of polymorphisms influencing rate of change in functional abilities among the elderly may prove to be difficult.

Activities of Daily Living↗

PubMed2002

Hand grip strength: a phenotype suitable for identifying genetic variants affecting mid- and late-life physical functioning.

Physical functioning late in life has been shown to be affected by genetic factors. Only a few genetic variants have been suggested to be associated with physical functioning, and this only in selected populations (e.g., young healthy males and elite athletes). Declining physical functioning late in life is a major problem in terms of prevalence, morbidity, functional limitations, and quality of life. It is therefore of interest to find a phenotype reflecting physical functioning which has a relatively high heritability and which can be measured in large samples. Hand grip strength is known to be associated with muscular functioning in other muscle groups and with activities of daily living (ADL) functioning, and it predicts incident disability. We studied 1,757 Danish twin pairs aged 45-96 years, and found that this phenotype has a heritability of 52% (95% confidence interval (CI), 48-55%). A powerful design to detect genes associated with a phenotype is obtained using the extreme discordant and concordant sib pairs, of whom 28 and 77 dizygotic twin pairs, respectively, were found in this study. Hence grip strength is a suitable phenotype for identifying genetic variants of importance to mid- and late-life physical functioning.

Activities of Daily Living↗

PubMed2002

Do children of long-lived parents age more successfully?

BACKGROUND: Long-lived individuals are rare and may be selected in part for the genetic factors that promote successful aging. The children of long-lived parents may therefore age more successfully than the children of short-lived parents. METHODS: We used three major cross-sectional population-based surveys to study the association of parental longevity with successful aging in offspring. The measures of aging were hand-grip strength, cognitive performance (Mini Mental State Examination and a cognitive composite score), self-reported diseases, and self-rated health. RESULTS: For every additional 10 years the parents lived, their children's grip strength increased by 0.32 kg (95% CI = 0.00-0.63), Mini Mental State Examination score by 0.20 points (95% CI = 0.03-0.37), and cognitive composite score by 0.24 points (95% CI = 0.07-0.40). A 10-year increment of parental life was associated with a reduction by approximately 0.20 in the adjusted odds ratio for their children having each of the following conditions: diabetes; hypertension; ischemic heart disease; heart failure; stroke; or fair, poor, or very poor self-rated health. Almost all the effects were seen solely in the cohort of 70+-year-olds, but not among middle-aged or nonagenarian subjects. CONCLUSIONS: Parental life span is positively associated with the children's physical and cognitive functioning and avoidance of some of the common chronic diseases. However, the effects are small and are seen among offspring who are elderly, but not among the middle-aged or the oldest old.

Age Distribution↗

PubMed2002

Cognitive impairment and mortality among nonagenarians: the Danish 1905 cohort survey.

Cognitive impairment has been associated with increased mortality. Most studies, however, have only included small numbers, if at all, of the very old. In a large nationwide survey of all Danes born in 1905 and still alive in 1998, where the baseline examination was conducted, we examined the impact of cognitive impairment on mortality over a 2-year period. No cognitive impairment was defined as a score of 24-30 points on the Mini Mental State Examination, mild cognitive impairment was defined as a score of 18-23 points, and severe impairment was defined as a score of 0-17 points. Cox regression analysis was applied to adjust for a number of known and suspected factors known or suspected of being associated with cognition and mortality (e.g. sociodemographic factors, sex, smoking, alcohol consumption, depressive symptoms, and physical abilities), and yielded hazard ratios (95% confidence interval) of 1.24 (1.00-1.55) for mildly impaired and 1.73 (1.37-2.20) for severely impaired Danes compared to individuals with no impairment. Cognitive impairment predicts mortality among the very old, even after controlling for most known predictors of mortality.

Aged↗

PubMed2002

Selective serotonin reuptake inhibitors and the risk of stroke: a population-based case-control study.

BACKGROUND AND PURPOSE: Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of bleeding complications, possibly as a result of inhibition of platelet aggregation. Little is known about the risk of intracerebral hemorrhage in users of SSRIs and whether the effect on platelet aggregation reduces the risk of ischemic stroke. We used population-based data to estimate the risk of hemorrhagic and ischemic stroke in users of SSRIs. METHODS: We performed a nested case-control study in Funen County (465 000 inhabitants), Denmark. All patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999 were identified, and a validated diagnosis of stroke was reached in 4765 cases. In all, 40 000 controls were randomly selected from the background population. Information on drug use for cases and controls was retrieved from a prescription registry with full coverage of the county. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register data, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors. RESULTS: Of 659 patients with hemorrhagic stroke, 21 were current users of SSRIs. The adjusted odds ratio of hemorrhagic stroke in current SSRI users compared with never users was 1.0 [95% confidence interval (CI), 0.6 to 1.6]. Of 2717 patients with ischemic stroke, 100 were current users of SSRIs, and the adjusted odds ratio of ischemic stroke in cases compared with controls was 1.1 (95% CI, 0.9 to 1.4). The survey data indicated that additional confounder control would not have led to an increase in the relative risk estimates. CONCLUSIONS: Current exposure to SSRIs is not associated with increased risk of intracerebral hemorrhage and is probably not associated with a decreased risk of ischemic stroke.

Adult↗