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Biomedical subjects

Henrik Toft Sørensen

Publications and source records attributed to Henrik Toft Sørensen.

At least 19 recordsLinked to original sources
PubMed2007

Survival of persons with and without HIV infection in Denmark, 1995-2005.

BACKGROUND: The expected survival of HIV-infected patients is of major public health interest. OBJECTIVE: To estimate survival time and age-specific mortality rates of an HIV-infected population compared with that of the general population. DESIGN: Population-based cohort study. SETTING: All HIV-infected persons receiving care in Denmark from 1995 to 2005. PATIENTS: Each member of the nationwide Danish HIV Cohort Study was matched with as many as 99 persons from the general population according to sex, date of birth, and municipality of residence. MEASUREMENTS: The authors computed Kaplan-Meier life tables with age as the time scale to estimate survival from age 25 years. Patients with HIV infection and corresponding persons from the general population were observed from the date of the patient's HIV diagnosis until death, emigration, or 1 May 2005. RESULTS: 3990 HIV-infected patients and 379,872 persons from the general population were included in the study, yielding 22,744 (median, 5.8 y/person) and 2,689,287 (median, 8.4 years/person) person-years of observation. Three percent of participants were lost to follow-up. From age 25 years, the median survival was 19.9 years (95% CI, 18.5 to 21.3) among patients with HIV infection and 51.1 years (CI, 50.9 to 51.5) among the general population. For HIV-infected patients, survival increased to 32.5 years (CI, 29.4 to 34.7) during the 2000 to 2005 period. In the subgroup that excluded persons with known hepatitis C coinfection (16%), median survival was 38.9 years (CI, 35.4 to 40.1) during this same period. The relative mortality rates for patients with HIV infection compared with those for the general population decreased with increasing age, whereas the excess mortality rate increased with increasing age. LIMITATIONS: The observed mortality rates are assumed to apply beyond the current maximum observation time of 10 years. CONCLUSIONS: The estimated median survival is more than 35 years for a young person diagnosed with HIV infection in the late highly active antiretroviral therapy era. However, an ongoing effort is still needed to further reduce mortality rates for these persons compared with the general population.

Adult↗
PubMed2007

Use of phenytoin, phenobarbital, or diazepam during pregnancy and risk of congenital abnormalities: a case-time-control study.

PURPOSE: Case-control studies are often used to examine putative teratogenic drug effects during organogenesis but these studies are subject to confounding by indication, recall, and participation bias. The case-time-control approach is less susceptible to these sources of bias. We studied congenital abnormalities following exposure to phenytoin, phenobarbital, and diazepam in early pregnancy, i.e., second and third month, compared to mid-pregnancy, i.e., fifth and sixth month of pregnancy. METHODS: We analyzed data from the Hungarian Case-Control Surveillance of Congenital Abnormalities (1980-1996) in a case-time-control study. RESULTS: The study included 22 843 children with congenital abnormalities (cases) and 38 151 children with no abnormalities (controls). Overall, odds ratio (OR) for congenital abnormalities after exposure to one of the three drugs in early pregnancy was 1.2 (95% confidence interval (CI): 1.0-1.4). Among children exposed to phenytoin OR for congenital abnormalities was 3.7 (95%CI: 0.3-49.6), for children exposed to phenobarbital the OR was 1.1 (95%CI 0.7-1.7), and for diazepam, OR for congenital abnormalities was 1.2 (95%CI: 1.0-1.4). CONCLUSIONS: The associations we found between the drugs examined and congenital abnormalities were either only borderline significant or not statistically significant. The case-time-control study provides an interesting way of using existing case-control data to study rare side effect of drugs taken during pregnancy.

Abnormalities, Drug-Induced↗
PubMed2006

[Surgical risk for patients with liver disease].

Liver disease increases surgical risk. Thus, in patients with cirrhosis, the mortality after abdominal or heart surgery is 50-75% in Child-Pugh C, 20-30% in B and near normal in Child-Pugh A. Stable autoimmune hepatobiliary disease and steatosis without inflammation do not increase surgical risk, but the mortality after major abdominal surgery is increased in patients with fulminant hepatic failure (>90%), alcoholic hepatitis (50%) and acute viral hepatitis (10-15%).

Elective Surgical Procedures↗
PubMed2006

Maternal use of oral contraceptives and risk of hypospadias - a population-based case-control study.

The aim of this population-based case-control study was to examine the risk of isolated hypospadias in boys born to mothers who have used oral contraceptives in early pregnancy. The study was based on data from the Hungarian Case-Control Surveillance of Congenital Abnormalities from 1980 to 1996, and included 3,038 boys with hypospadias (cases), 24,799 boys without congenital abnormalities (CA-free controls), and 11,881 boys with abnormalities other than hypospadias. We used unconditional logistic regression to adjust for birth order, maternal age, maternal employment status, maternal diabetes, and pre-eclampsia. When comparing cases with CA-free controls the OR for maternal use of OC was 1.21 (95% CI: 0.67-2.17). When comparing cases with boys with other abnormalities, the OR for maternal use of OC was 0.83 (95% CI: 0.46-1.50). Our data showed that self-reported maternal use of oral contraceptives during pregnancy was not associated with an increased risk of hypospadias in the offspring.

Abnormalities, Drug-Induced↗
PubMed2006

[Self-management versus conventional management of oral anticoagulant therapy: a randomized controlled trial].

The efficacy of self-managed oral anticoagulant therapy has been addressed in few randomized controlled trials, which have provided inconsistent results. The aim of this study was to compare the quality of self-managed oral anticoagulant therapy with conventional management. One hundred patients were randomly assigned to the two treatment regimens, and it was found that the quality of self-management of oral anticoagulant therapy was at least as good as the treatment provided by conventional management. Self-management is therefore a valid management option in selected patients.

English Abstract↗
PubMed2006

Delay of treatment is associated with advanced stage of rectal cancer but not of colon cancer.

BACKGROUND: Dukes' stage is the most important predictor of prognosis of colorectal cancer, but the association between delay of treatment (DT) and Dukes' stage is still controversial. METHODS: From 1 January 2001 to 31 July 2002, we conducted a population-based prospective observational study based on 733 Danish colorectal cancer patients. DT was determined through questionnaire-interviews, and Dukes' stage was obtained from medical records and pathological forms. DT was classified into three groups: short (0-60 days), intermediate (61-150 days) and long (>150 days) DT. Dukes' stage was classified into two groups: non-advanced (Dukes' stage A or B) and advanced (Dukes' stage C or D) cancer. Using relative risk (RR) the association between DT and stage was estimated, with short delay as the reference group. RESULTS: The RR of advanced cancer was 1.0 (95% confidence intervals (CI): 0.8-1.3) for colon cancer patients with an intermediate DT, and 1.1 (95% CI: 0.9-1.4) for patients with a long DT. For rectal cancer patients the RR of advanced cancer was 1.9 (95% CI: 1.1-3.1) for patients with an intermediate DT and 2.1 (95% CI: 1.3-3.4) for patients with a long DT. CONCLUSION: DT was strongly associated with advanced stage of rectal cancer, but not of colon cancer.

Adenocarcinoma↗
PubMed2006

Fracture risk in patients with monoclonal gammopathy of undetermined significance.

Little information is available on the risk of fractures in patients with monoclonal gammopathy of undetermined significance (MGUS). We identified 1535 patients with MGUS between 1978 and 2003 in North Jutland County, Denmark. The population control group consisted of 15 350 persons selected from the Danish Central Population Registry, matched by age and sex. Data on fractures in the two groups were obtained from the regional Hospital Discharge Registry. In the MGUS cohort, 187 first-time fractures were identified during 9754 person-years of follow-up, corresponding to an incidence rate of 19/1000 person-years. The adjusted relative risk for fractures among MGUS patients compared with population controls was 1.4 [95% confidence interval (CI), 1.2-1.6]. After 5 years of follow-up, the risk difference was 1.8% (95% CI, 0.5-3.0). Six of the 187 MGUS patients with fractures were later diagnosed with malignant transformation. Relative risks for fractures were increased in IgG-type MGUS [1.3 (95% CI,1.1-1.6)], IgM-type MGUS [1.6 (95% CI, 1.1-2.2)] and MGUS with kappa light chain [1.4 (95% CI, 1.1-1.7)]. MGUS patients had an increased risk of fractures, which could not be explained by comorbidity, advanced age, gender or malignant transformation.

Aged↗
PubMed2006

Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand.

BACKGROUND: No data currently exist about use of antibiotics to prevent surgical site infections (SSI) among patients undergoing appendectomy in Thailand. We therefore examined risk factors, use, and efficacy of prophylactic antibiotics for surgical site infection SSI among patients with uncomplicated open appendectomy. METHODS: From July 1, 2003 to June 30, 2004 we conducted a prospective cohort study in eight hospitals in Thailand. We used the National Nosocomial Infection Surveillance (NNIS) system criteria to identify SSI associated with appendectomy. We used logistic regression analysis to obtain relative risk estimates for predictors of SSI. RESULTS: Among 2139 appendectomy patients, we identified 26 SSIs, yielding a SSI rate of 1.2 infections/100 operations. Ninety-two percent of all patients (95% CI, 91.0-93.3) received antibiotic prophylaxis. Metronidazole and gentamicin were the two most common antibiotic agents, with a combined single dose administered in 39% of cases. In 54% of cases, antibiotic prophylaxis was administered for one day. We found that a prolonged duration of operation was significantly associated with an increased SSI risk. Antibiotic prophylaxis was significantly associated with a decreased risk of SSI regardless of whether the antibiotic was administered preoperatively or intraoperatively. Compared with no antibiotic prophylaxis, SSI relative risks for combined single-dose of metronidazole and gentamicin, one-day prophylaxis, and multiple-day antibiotic prophylaxis were 0.28 (0.09-0.90), 0.30 (0.11-0.88) and 0.32 (0.10-0.98), respectively. CONCLUSION: Single-dose combination of metronidazole and gentamicin seems sufficient to reduce SSIs in uncomplicated appendicitis patients despite whether the antibiotic was administered preoperatively or intraoperatively.

Adolescent↗
PubMed2006

Maternal use of Loratadine during pregnancy and risk of hypospadias in offspring.

To examine the risk of hypospadias after exposure to loratadine and other antihistamines during pregnancy, we conducted a population-based case-control study in four Danish counties, which account for 30% of the Danish population (approximately 1.6 M). We obtained data on maternal use of antihistamines from prescription databases, and data on birth outcomes from the Danish Medical Birth Registry (MBR) and the Hospital Discharge Registry (HDR). A total of 65,383 male births with a full prescription history of the mother in the study period from 1989-2002 were available for analysis. Within this cohort, we identified cases with a diagnosis of hypospadias, and 10 selected controls per case without such a diagnosis (matched on birth month, gender and year of birth). We identified 227 cases of hypospadias recorded in the HDR within six months postpartum and 2270 controls. One case (0.4%) and eight (0.4%) controls were exposed to loratadine in the first trimester and up to 30 days before the time of conception. The adjusted odds ratio (OR) for hypospadias among users of loratadine relative to non-users was 1.4 (95% CI: 0.2-11.2) and the corresponding OR for other antihistamines was 1.9 (95% CI: 0.7-5.7). In this study, maternal exposure to loratadine did not appear to be associated with an increased risk of hypospadias when compared with other antihistamines, although it should be noted that the statistical precision of the risk estimates might be limited.

Journal Article↗
PubMed2006

[Long-term survival rate of patients transfused with leucocyte-depleted and buffy-coat-poor blood during colorectal surgery--secondary publication. An eight-year post-trial follow-up study].

This study investigated the long-term survival rate of 589 patients enrolled in a trial in 1992-1995 who underwent colorectal surgery. The patients were randomised to receive leucocyte-depleted or buffy-coat-poor blood when transfusion was indicated. Significantly more of the non-transfused patients (59%) were alive seven years later compared to patients transfused with leucocyte-depleted blood (41%) and to patients transfused with buffy-coat-poor blood (45%).

Adult↗
PubMed2006

Beyond randomized controlled trials: a critical comparison of trials with nonrandomized studies.

Observational analogs of randomized clinical trials (RCTs) are well accepted in the study of disease risk factors, diagnosis, and prognosis. There is controversy about observational studies when the focus is on the intended benefit due to lack of blinding and poor control for unmeasured confounding. Well-designed randomized clinical trials are costly both in time and money. Therefore, existing databases are used increasingly and are often the only feasible source with which to examine delayed health effects. We reviewed the reasons for possible discrepancies between RCTs and observational studies. There can be different patient populations, differences in therapeutic regimen, control of confounding, follow-up, measuring outcome, and differences arising from the intention-to-treat analysis. Observational studies cannot replace trials, nor do trials make observational studies unnecessary. Both designs are susceptible to particular bias, so neither provides perfect information.

Observation↗
PubMed2006

Thirty-day mortality after peptic ulcer bleeding in hospitalized patients receiving low-dose aspirin at time of admission.

BACKGROUND: Use of low-dose aspirin increases the risk for peptic ulcer bleeding (PUB) by approximately 60%. However, whether use of low-dose aspirin influences the outcome of PUB is not known. OBJECTIVE: The aim of this study was to examine the effect of low-dose aspirin use at the time of hospital admission on 30-day mortality among hospitalized PUB patients. METHODS: This population-based study was conducted using data from the hospital discharge registries in the Danish counties of North Jutland, Aarhus, and Viborg. We identified all hospitalized patients with a first-time diagnosis of PUB and their comorbidities between 1991 and 2003. This information was linked with data from the counties' prescription databases and the Danish Civil Registration System to determine the preadmission use of low-dose aspirin (75 or 150 mg) and mortality within 30 days after admission. We calculated mortality ratios (MRs) according to the use of low-dose aspirin, adjusted for age, sex, comorbidity, alcoholism, and use of other PUB-associated or antiulcer drugs. RESULTS: We identified 7204 patients with a discharge diagnosis of PUB (3751 men, 3453 women; median age, 71 years [interquartile range, 62-82 years]). The overall mortality within 30 days after admission with PUB was 10.7%. Among all patients with PUB, 1029 (14.3%) were current (ie, at the time of admission) users of low-dose aspirin and 709 (9.8%) were former low-dose aspirin users, respectively. Compared with those who never used lowdose aspirin, current users had an adjusted 30-day MR of 0.83 (95% CI, 0.68-1.01). CONCLUSION: The results of this follow-up study suggest that current use of low-dose aspirin was not associated with increased mortality in these hospitalized patients with PUB.

Aged↗
PubMed2006

Maternal use of selective serotonin reuptake inhibitors and risk of congenital malformations.

BACKGROUND: Human data on the teratogenicity of selective serotonin reuptake inhibitors (SSRIs) are limited. We examined the association between SSRI use during early pregnancy and the risk of congenital malformations in the offspring. METHODS: In a population-based cohort study from Denmark, we identified 1051 women who filled prescriptions for SSRIs from 30 days before conception to the end of the first trimester; of those, 453 filled the prescription during the second or third pregnancy month. We included 150,780 women with no SSRI prescriptions as a reference cohort. Drug use data were extracted from prescription databases. Data on congenital malformations and potential confounders were extracted from hospital discharge registries and the National Birth Registry. RESULTS: The 150,780 women with no SSRI prescriptions gave birth to 5112 (3.4%) children with congenital malformations. The 1051 women with SSRI prescriptions any time during early pregnancy gave birth to 51 (4.9%) children with congenital malformations. The corresponding adjusted relative risk (aRRs) was 1.34 (95% confidence interval = 1.00-1.79). The 453 women with prescriptions during the second or third month of pregnancy gave birth to 31 (6.8%) children with congenital malformations. The corresponding aRR was 1.84 (1.25-2.71). CONCLUSIONS: We found an increased risk of congenital malformations after exposure to SSRIs in early pregnancy. It is unclear whether the effects were causal or due to factors related to the underlying disease. There was no evidence that the association was specific to particular malformations.

Abnormalities, Drug-Induced↗
PubMed2006

Short-term prognosis of community-acquired bacteremia in patients with liver cirrhosis or alcoholism: A population-based cohort study.

BACKGROUND: Liver cirrhosis is associated with an increased risk of infection and a poor prognosis, but the role of alcoholism in these outcomes is uncertain. This study looks at the short-term prognosis for bacteremia in patients with alcoholic liver cirrhosis, nonalcoholic liver cirrhosis, and alcoholism, compared with the prognosis for other bacteremia cases. METHODS: All patients who were hospitalized with their first community-acquired bacteremia in North Jutland County, Denmark, in the period 1992 to 2002 were retrieved from a population-based bacteremia registry. Denmark's Hospital Discharge Registry then allowed us to disaggregate these patients into the following groups: 47 patients with alcoholic liver cirrhosis, 19 with nonalcoholic liver cirrhosis, 190 with alcoholism, and a comparison group of 3,535 other bacteremia cases. Using logistic regression, we estimated odds ratios (ORs) for 30-day case fatality for the main study variable, adjusted for gender, age, focus of infection, and comorbidity. RESULTS: The case fatality rate (CFR) was 43% for patients with alcoholic liver cirrhosis, 32% for patients with nonalcoholic liver cirrhosis, 24% for patients with alcoholism, and 15% for other bacteremia patients. The adjusted OR estimates for patients with alcoholic liver cirrhosis, nonalcoholic liver cirrhosis, and alcoholism compared with other bacteremia cases were 6.3 (95% CI 3.3-11.7), 2.4 (95% CI 0.9-6.7), and 2.5 (95% CI 1.7-3.7), respectively. Focus of infection and group of bacteria did not noticeably affect the increased CFR. CONCLUSION: Liver cirrhosis and alcoholism were associated with a poor short-term prognosis for community-acquired bacteremia. Liver cirrhosis and alcoholism may have independent effects on the prognosis for patients with liver cirrhosis and bacteremia.

Adult↗
PubMed2006

Effect of selective serotonin reuptake inhibitors on requirement for allogeneic red blood cell transfusion following coronary artery bypass surgery.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) inhibit platelet function, and use of these drugs has been associated with bleeding events. The objective of this study was to examine whether the requirement for red blood cell transfusion was increased following preoperative use of SSRIs among patients undergoing coronary artery bypass grafting (CABG). METHODS: A population-based cohort study of transfusion requirements (red blood cells, fresh frozen plasma, and/or platelets) was conducted among patients undergoing CABG at either Aalborg or Skejby Hospitals between 1 January 1998 and 31 December 2003. All prescriptions for antidepressants, including SSRIs, filled before the date of admission for CABG were identified using prescription databases. Patients were categorized according to use of antidepressants (never users, current users [<90 days before admission for CABG], and former users). Antidepressants were classified according to their action on serotonin and norepinephrine reuptake mechanisms. Relative risk (RR) for transfusion were adjusted for: age; sex; preoperative use of platelet inhibitors (low-dose aspirin [acetylsalicylic acid], clopidogrel, and dipyridamole), NSAIDs and oral anticoagulants; place of surgery; extracorporeal circulation; concomitant valve surgery; and Charlson comorbidity index score. RESULTS: There were 124 (3.5%) current users of SSRIs among 3454 patients. Adjusted RRs for transfusion among current users of SSRIs, users of nonselective serotonin reuptake inhibitor antidepressants, and users of other antidepressants were 1.1 (95% CI 0.9, 1.3), 0.9 (95% CI 0.6, 1.3), and 1.0 (95% CI 0.7, 1.5), respectively, when compared with never users of any type of antidepressant. The adjusted RR among former SSRI users was 1.0 (95% CI 0.7, 1.4). Risk of re-exploration for bleeding and mortality within 30 days did not differ according to the examined drug-exposure categories. CONCLUSION: Preoperative use of SSRIs was not associated with any substantially increased requirement for allogeneic red blood cell transfusion among patients undergoing CABG. The main strengths of this study are its relatively large size, the use of prospectively collected data obtained from population-based databases with complete follow-up, and the ability to examine specific types of antidepressants. The limitations include a lack of detailed clinical data regarding other factors that may influence transfusion requirements.

Adult↗
PubMed2006

Declining prevalence of HIV-infected individuals at risk of transmitting drug-resistant HIV in Denmark during 1997-2004.

BACKGROUND: Transmission of drug-resistant HIV is a potential threat to the substantial clinical benefit of highly active antiretroviral therapy (HAART). To explore the background for the low rates of drug resistance transmission (2.5%) in our population, we estimated acquisition of HIV drug resistance and examined temporal trends in the prevalence of patients at risk of transmitting drug-resistant HIV. METHODS: The study population included all 4,025 patients from The Danish HIV Cohort Study seen during the period 1995-2004. Virological failure to a given drug class was defined as a viral load (VL) > 1,000 copies/ml for 120 days while on a HAART regimen including that drug class. In addition, receiving nucleoside reverse transcriptase inhibitors (NRTIs) for 180 days before HAART counted as NRTI failure irrespective of VL. Having experienced failure was considered a proxy for harbouring drug-resistant virus in subsequent observation time. Patients with a current VL > 1,000 copies/ml were considered at risk of transmitting HIV. RESULTS: We found a decrease from 1997 to 2004 in the prevalence of potential transmitters of drug-resistant HIV. The number of these patients with previous NRTI failure decreased from 429 (24% of all patients) in 1998 to 213 (8.0% of all patients) in 2004. Previous protease inhibitor (PI) failure peaked at 279 (14%) in 1999, declining to 142 (5.3%) in 2004. Previous NNRTI failure peaked at 121 patients (4.7%) in 2002, and occurred in 113 patients (4.2%) in 2004. Of all 686 potential transmitters in 2004, 31% had previously experienced NRTI failure, 21% PI failure, and 16% non-NRTI failure. CONCLUSION: In the population of HIV-infected individuals in Denmark with complete follow-up, the number at risk of transmitting drug-resistant virus declined over time.

Antiretroviral Therapy, Highly Active↗