Existing data sources for clinical epidemiology: The North Denmark Bacteremia Research Database

Bacteremia is associated with high morbidity and mortality. Improving prevention and treatment requires better knowledge of the disease and its prognosis. However, in order to study the entire spectrum of bacteremia patients, we need valid sources of information, prospective data collection, and complete follow-up. In North Denmark Region, all patients diagnosed with bacteremia have been registered in a population-based database since 1981. The information has been recorded prospectively since 1992 and the main variables are: the patient’s unique civil registration number, date of sampling the first positive blood culture, date of admission, clinical department, date of notification of growth, place of acquisition, focus of infection, microbiological species, antibiogram, and empirical antimicrobial treatment. During the time from 1981 to 2008, information on 22,556 cases of bacteremia has been recorded. The civil registration number makes it possible to link the database to other medical databases and thereby build large cohorts with detailed longitudinal data that include hospital histories since 1977, comorbidity data, and complete follow-up of survival. The database is suited for epidemiological research and, presently, approximately 60 studies have been published. Other Danish departments of clinical microbiology have recently started to record the same information and a population base of 2.3 million will be available for future studies

Does Aerobic Exercise Increase 24-Hour Ambulatory Blood Pressure Among Workers With High Occupational Physical Activity?-A RCT.

ObjectiveHigh occupational physical activity (OPA) increases cardiovascular risk and aerobic exercise has been recommended for reducing this risk. This paper investigates the effects of an aerobic exercise intervention on 24-hour ambulatory blood pressure (ABP) among cleaners with high OPA.MethodsHundred and sixteen cleaners between 18 and 65 years were randomized. During the 4-month intervention period, the aerobic exercise group (AE) (n = 57) performed worksite aerobic exercise (2 × 30 minutes/week), while the reference group (REF) (n = 59) attended lectures. Between-group differences in 4-month ABP changes were evaluated by intention-to-treat analysis using a repeated-measure 2 × 2 multiadjusted mixed-models design.ResultsRelative to REF, 24-hour ABP significantly increased in AE: systolic 3.6 mm Hg (95% confidence interval (CI) 1.6-5.7) and diastolic 2.3 mm Hg (95% CI 0.9-3.8). Cleaners with high aerobic workload exhibited particularly high 24-hour ABP increases: systolic 6.0 mm Hg (95% CI 2.4-9.6), and diastolic 3.8 mm Hg (95% CI 1.3-6.4).ConclusionAerobic exercise increased 24-hour ABP among cleaners. This adverse effect raises questions about the safety and intended benefits of aerobic exercise, especially among workers with high OPA and a demanding aerobic workload. http://www.controlled-trials.com/ISRCTN86682076. Unique identifier ISRCTN86682076.Clinical trial registrationTrial Number ISRCTN86682076

Nationwide trends in pneumonia hospitalization rates and mortality, Denmark 1997–2011

SummaryObjectiveTo provide up-to-date population-based data on nationwide trends in pneumonia hospitalization rates and associated 30-day mortality.MethodsUsing medical databases we identified all in-hospital episodes of pneumonia between 1997 and 2011. We computed age- and sex-standardized hospitalization rates of total and first-time pneumonia-related hospitalization and adjusted 30-day mortality rates by calendar year.ResultsAmong 552,528 pneumonia-related hospitalizations in Denmark between 1997 and 2011, 385,985 (69.9%) were first-time events. Total pneumonia hospitalizations increased by 63%, from 4.96 per 1000 population in 1997 to 8.09 in 2011. Rates of first-time pneumonia per 1000 population increased by 33%, from 3.99 in 1997 to 5.31 in 2011. Pneumonia rates stabilized in the mid-00s but primary pneumonia rates increased 16% from 2008 to 2011, most notably among children and young adults. In patients aged ≥80 years the rate of hospitalizations with secondary pneumonia more than doubled during the study period. Average 30-day mortality remained stable at 13%, but increased slightly over time in patients aged ≥80 years.ConclusionsIn an era of smoking cessation and vaccination efforts, pneumonia hospitalization rates are continuously increasing, largely driven by secondary diagnoses and recurrent pneumonia episodes in elderly patients. Thirty-day mortality remains persistently high

Modulating Heart Rate Variability through Deep Breathing Exercises and Transcutaneous Auricular Vagus Nerve Stimulation:A Study in Healthy Participants and in Patients with Rheumatoid Arthritis or Systemic Lupus Erythematosus

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are associated with an impaired autonomic nervous system and vagus nerve function. Electrical or physiological (deep breathing—DB) vagus nerve stimulation (VNS) could be a potential treatment approach, but no direct comparison has been made. In this study, the effect of transcutaneous auricular VNS (taVNS) and DB on vagal tone was compared in healthy participants and RA or SLE patients. The vagal tone was estimated using time-domain heart-rate variability (HRV) parameters. Forty-two healthy participants and 52 patients performed 30 min of DB and 30 min of taVNS on separate days. HRV was recorded before and immediately after each intervention. For the healthy participants, all HRV parameters increased after DB (SDNN + RMSSD: 21–46%), while one HRV parameter increased after taVNS (SDNN: 16%). For the patients, all HRV parameters increased after both DB (17–31%) and taVNS (18–25%), with no differences between the two types of VNS. DB was associated with the largest elevation of the HRV parameters in healthy participants, while both types of VNS led to elevated HRV parameters in the patients. The findings support a potential use of VNS as a new treatment approach, but the clinical effects need to be investigated in future studies

Investigating the Dose-Response Relationship between Deep Breathing and Heart Rate Variability in Healthy Participants and Across-Days Reliability in Patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus

Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE) are associated with autonomic dysfunction, potentially through reduced vagus nerve tone. Vagus nerve stimulation has been proposed as an anti-inflammatory treatment, and it can be performed through deep breathing (DB) exercises. In this study, the dose-response relationship between DB exercises and heart rate variability (HRV) was investigated in healthy participants and reliability across days in patients with RA and SLE. On three separate days, 41 healthy participants performed DB for: 5, 15, or 30 min. On two separate days, 52 RA or SLE patients performed DB with the dose associated with the highest HRV increase in healthy participants. The HRV was estimated from ECG-recordings recorded prior and post the DB exercises. Increases in dose led to larger HRV-responses. Thirty minutes led to the largest HRV-response. In the RA and SLE patients, this dose increased the HRV-parameters consistently across the two days, indicating reliability. DB increases HRV in healthy participants and RA or SLE patients, which indicates stimulation of the vagus nerve. Of the tested durations, 30 min of DB was the optimal period of stimulation. A potential anti-inflammatory effect of DB exercises should be investigated in future studies

Potentiale for flere uheldsdata på baggrund af fejlklassificeringer af ekstrauheld

Af tidligere studier vides det, at der er stor usikkerhed forbundet med den officielle uheldsdatabase, der er grundlag for trafiksikkerhedsarbejdet. Usikkerheden er ikke ønskelig, og lægger op til, at undersøge om der på andre måder kan opnås yderligere kendskab til flere uheldsdata. Andre måder at indsamle data på er ved selvrapportering, forsikringsdata og sygehusdata, dog kan ingen af de nævnte benyttes direkte i trafiksikkerhedsarbejdet, da uheldene ikke stedfæstes. Men hvilke muligheder er der så for flere uheldsdata? Hvis uheld skal indgå i det stedbestemte trafiksikkerhedsarbejde, skal de være stedfæstede. Uheld registreret af politiet stedfæstes. Dette omfatter person- og materielskadeuheld samt ekstrauheld, der alle er en del af den officielle uheldsstatistik. Generelt indgår ekstrauheld sjældent i trafiksikkerhedsarbejdet, og udviklingen i antal ekstrauheld præsenteres sjældent. Imidlertid er udviklingen i antal ekstrauheld interessant, da den afviger fra uheldsudviklingen generelt. Antallet af registrerede ekstrauheld er steget fra år 2000 til 2015, ligesom uheldsarten udgør en større og større andel af de samlede registrerede uheld. En stigning i ekstrauheld er ikke et problem i sig selv, men hvis stigingen skyldes, at uheldene ikke er korrekt registrerede, og uheldet dermed burde indgå i den officielle statistik, går værdifulde uheldsdata tabt. Det er således undersøgt, om der ligger et potentiale for flere uheldsdata i de registrerede ekstrauheld, grundet fejlklassificeringer

Temporal changes in incidence of hospital-diagnosed acute pyelonephritis: A 19-year population-based Danish cohort study

Objectives: To examine temporal changes in the incidence of hospital-diagnosed acute pyelonephritis (APN) and characterize associated demographics. Methods: Cohort study including Danish patients with hospital-diagnosed APN during 2000-2018, identified by International Classification of Diseases, 10th Revision codes. Annual sex- and age-standardized incidence rates per 10,000 person years with 95% confidence intervals (CIs) were stratified by sex, age group, diagnosis code, and region of residence. Incidence rates for selected urinary tract infections and sepsis diagnoses were also computed. Results: We included 66,937 hospital-diagnosed APN episodes in 57,162 patients. From 2000 to 2018, the incidence increased from 6.8 (95% CI: 6.8-6.8) to 15.4 (95% CI: 15.4-15.4) in women and from 2.7 (95% CI: 2.7-2.7) to 4.5 (95% CI: 4.5-4.5) in men. Among infants, the rate rose from 7.4 (95% CI: 7.4-7.4) to 64.8 (95% CI: 64.7-64.9) in girls and from 17.1 (95% CI: 17.1-17.2) to 52.5 (95% CI: 52.4-52.6) in boys. Concomitant declines were observed in incidences of hospital-diagnosed unspecified urinary tract infections and sepsis. Conclusion: The APN incidence roughly doubled during 2000-2018. The increase was largely driven by a prominently increasing incidence among young children which was not explained by the enlarging prevalence of congenital anomalies of the kidney and urinary tract.</p