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  • 1
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    The long-term association between bilateral oophorectomy and depression: a prospective cohort study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Menopause Vol. 29, No. 3 ( 2022-01-24), p. 276-283
    Details
    In: Menopause, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 3 ( 2022-01-24), p. 276-283
    Abstract: Depression is a leading cause of disability globally and affects more women than men. Ovarian sex steroids are thought to modify depression risk in women and interventions such as bilateral oophorectomy that permanently change the sex steroid milieu may increase the risk of depression. This study aimed to investigate the associations between unilateral and bilateral oophorectomy and depression over a 25-year period (1993-2018) and whether this varied by age at oophorectomy or use of menopausal hormone therapy. Methods: Twenty-five thousand one hundred eighty-eight nurses aged ≥45 years from the Danish Nurse Cohort were included. Nurses with depression prior to baseline were excluded. Poisson regression models, with log-transformed person-years as offset, were used to assess the associations between oophorectomy and incident depression. Nurses who retained their ovaries were the reference group. Results: Compared with nurses with retained ovaries, bilateral oophorectomy was associated with a slightly higher rate of depression (rate ratio [RR], 1.08; 95% confidence interval [CI] , 0.95-1.23), but without statistical significance. However, when stratified by age at oophorectomy, compared with nurses with retained ovaries, bilateral oophorectomy at age ≥51 years was associated with higher rates of depression (RR 1.16; 95% CI, 1.00-1.34), but not bilateral oophorectomy at age 〈 51 years (RR 0.86; 95% CI, 0.69-1.07); P value for difference in estimates = 0.02. No association between unilateral oophorectomy and depression was observed. Conclusions: In this cohort of Danish female nurses, bilateral oophorectomy at age ≥51 years, but not at younger ages, was associated with a slightly higher rate of depression compared with those who retained their ovaries.
    Type of Medium: Online Resource
    ISSN: 1530-0374
    URL: Article
    DOI: 10.1097/GME.0000000000001913
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 2
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    In reply
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Menopause Vol. 29, No. 6 ( 2022-06), p. 756-758
    Details
    In: Menopause, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 6 ( 2022-06), p. 756-758
    Type of Medium: Online Resource
    ISSN: 1530-0374
    URL: Article
    DOI: 10.1097/GME.0000000000002009
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 3
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    Abstract 11: Community Interventions To Improve Out-of-hospital Cardiac Arrest Survival: Targeting Public Housing Could Be A Solution
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background: Identifying well-suited areas for community-targeted interventions to improve bystander interventions and OHCA survival, particularly in deprived communities, has been warranted by the AHA. Public housing projects are publicly subsidized, geographically well-defined, have local leadership, and residents typically have a high prevalence of OHCA predictors. To assess the potential reach of community interventions in public housing, we investigated the incidence of OHCA in public housing projects in Vienna (Austria) and Copenhagen (Denmark) and compared it with remaining residential areas. Methods: Non-EMS witnessed OHCAs occurring in residential areas in Vienna (2017-2021) and Copenhagen (2016-2020) were included from the Viennese and Danish Cardiac Arrest Registry, respectively. Population density and residential areas were obtained from Urban Atlas; public housing data from City of Vienna, and the Danish National Building Foundation. We compared OHCA/km 2 and OHCA/100,000 inhabitants between public housing projects and other residential areas using Poisson regression of rates. We calculated the proportion of OHCAs occurring within 100 meters of public housing projects. Results: In Vienna vs. Copenhagen, 32% (1,391/4,313) vs. 35% (817/2,335) of residential OHCAs occur in public housing areas. The relative ratio of OHCA/km 2 and OHCA/100,000 inhabitants is 3-fold and 1.5-fold higher in public housing than in other housing areas, respectively (Figure 1). Including the immediate surroundings, public housing covered 64.8% vs. 56.1% of all residential OHCAs in Vienna and Copenhagen. Conclusion: Public housing projects in Vienna and Copenhagen had a substantially higher incidence of OHCA than other residential areas covering 1/3 of all OHCAs in residential areas and ~60% when including nearby neighborhoods. Community initiatives targeting these areas may be an efficient strategy to improve bystander interventions and survival.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.11
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 4
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    Abstract 295: Availability Of Automatic Defibrillators And Volunteer Responders For Out-of-hospital Cardiac Arrest In Denmark
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Public automatic defibrillators (AEDs) and bystander resuscitation (CPR) are critical for cardiac arrest survival. We examined how availability of AEDs and volunteer responders that can be summoned with an app have developed following many national initiatives to improve survival. Methods: All OHCA (Out-of-Hospital Cardiac Arrest) registered with coordinates within the Danish Cardiac Arrest Registry (2016-2020) were included. This study assessed coverage of 1) AEDs and 2) volunteer responders at 12 noon for home and public OHCAs. Coverage was defined as ≥ 1 AED and ≥ 4 volunteer responders within 200, 500, or 1,800 meters using straight line distance from the OHCA. Results: A total of 22,330 OHCAs were included. At 12 noon, 33,180 volunteer responders (572/100,000 inhabitants) and 22,418 AEDs (387/100,000 inhabitants) were available. More OHCA were covered with AEDs compared to volunteer responders for all distances. A significant difference was found in AED coverage in public compared to home arrests for all distances (p for difference at all distances 〈 0.05). Opposite, no difference was found in volunteer responder coverage for home compared to public arrests at 1,800 and 500 meters (p for difference 〉 0.05). Figure 1 illustrates AED and volunteer responder coverage for home and public arrest. Conclusion: Following the implementation of a national volunteer responder program and strategic placement of AEDs in Denmark, most historical OHCAs were covered by AEDs and volunteer responders within 1,800 meters. Although we have more volunteer responders per 100,000 inhabitants compared to AEDs, we found more than half (53%) of all OHCA were covered with AEDs within 200 meters whereas only 16% of all OHCAs were covered by volunteer responders within 200 meters. These findings indicate strategic AED placement in Denmark, but further efforts regarding volunteer responder recruitment are needed to increase coverage of the historical OHCA in Denmark.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.295
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 5
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    Abstract 13237: Motivations and Barriers to Join an Automated External Defibrillator Network: A Nationwide Survey
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_2 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
    Abstract: Introduction: Since 2007, citizens have been able to register an automated external defibrillator (AED) with the Danish AED Network, which holds 〉 23,000 AEDs (394 AEDs/100,000 inhabitants) linked directly to the Emergency Medical Dispatch Centers. In 2019, 60.8% of sold AEDs were registered in the network. This study aimed to identify motivations and barriers for registration with the nationwide Danish AED Network. Methods: A cross-sectional survey among owners of newly registered AEDs in the Danish AED Network was carried out from September 2017 to December 2020. Each month, 30-50 random AED-owners participated. The survey included items on motivations and barriers to join the AED network and items on AED accessibility. Results: In total, 1,540 AED-owners were included (25.3 % of newly registered in the period (n=6087)). The time from AED-purchase to AED-registration was “ 〈 1week” in 25.7%, “ 〈 1month” in 23.4%, “1month-1year” in 28.6%, “ 〉 1year” in 20.4%, and “Do not know” in 1.9%. Knowledge about the AED network is illustrated in Figure 1. Over half of the AED-owners registered their AED because they felt it was a ‘good cause’ (64.0%), followed by ‘registering upon request’ (20.6%), and ‘after a first aid course’ (5.5%). Of newly registered AEDs, 73.8% (n=1137) were 24/7-accessible. The most frequent reason for choosing limited AED accessibility (AED placed indoors/not available 24/7, n=403) was “greater expenses” (26.8%), whereas “fear of theft/vandalism” only accounted for 12.4%. Conclusion: Among AED-owners registering their AED to the Danish AED Network, most heard about the registry through word of mouth, registered their AED within the first year of purchase, and registered primarily because they felt it was a good cause. Most newly registered AEDs were 24/7-accessible. The biggest expressed barrier to AED accessibility was increased expenses whereas fear of theft or vandalism was a minor issue.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_2.13237
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 6
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    Abstract 147: Volunteer Responders Often Provide Emotional Support To Relatives Of Out-of-hospital Cardiac Arrest Patients Even After Arrival Of The Emergency Medical Services
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Volunteer responders (VR) are dispatched to OHCA to fetch an AED and provide CPR. However, often more than one volunteer responder arrives, allowing additional responders to handle tasks beyond resuscitative efforts. We aimed to assess which tasks dispatched VR performed during resuscitation attempts and the proportion of VR providing emotional support to patient relatives. Method and Results: This was an observational study with prospectively collected data from Denmark's national volunteer responder cohort between April 2020 and May 2022. We included 18,489 VR who accepted an alarm and arrived at a presumed cardiac arrest. All VR who received an alarm received a survey 90 minutes after, which included questions regarding their handling of tasks (response rate 86.1%). Of 18,489 volunteers, 6,612 (35.8%) arrived before EMS. Among all VR who arrived at the cardiac arrest scene, 3,424 (18.5%) performed CPR, 1,851 (10.0%) attached an AED, and 3,447 (18.6%) provided support for relatives. In univariate logistic regression models, VR provision of CPR was significantly associated with being healthcare educated (OR: 1.76, 95% CI: 1.61-1.93), police or firefighter (OR: 3.28, 95% CI: 2.96-3.64). Further, odds for CPR provision increased with recent CPR course (OR: 2.48, 95% CI: 2.09-2.93). VR provision of CPR was significantly associated with an increasing number of VR arriving before EMS. Odds for the provision of CPR were doubled in cases where three or more VR arrived before EMS (OR:6.06, 95% CI: 5.29-6.94) compared to cases where one VR arrived (OR: 3.15, 95% CI: 2.70-3.69). When VR arrived after EMS, 14.9 % provided support for relatives (Fig 1). Conclusion: Volunteer responders’ engagement in OHCA is associated with educational background and the number of volunteers arriving before EMS. Provision of support for relatives is the most frequently handled task, even at arrival after the EMS.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.147
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 7
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    Cardiovascular mortality after bilateral oophorectomy: a prospective cohort study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Menopause Vol. 29, No. 1 ( 2021-11-01), p. 28-34
    Details
    In: Menopause, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 1 ( 2021-11-01), p. 28-34
    Abstract: Bilateral oophorectomy permanently reduces endogenous estrogen exposure and may increase cardiovascular mortality in women. This study aimed to investigate the association between bilateral oophorectomy and cardiovascular mortality and whether this association was conditional on hysterectomy or on the use of hormone therapy at the time of study entry. Methods: A prospective cohort study of 25,338 female nurses aged ≥ 45 years within the Danish Nurse Cohort. Nurses were enrolled in 1993 or 1999 and followed until death, emigration, or end of follow-up on December 31, 2018, whichever came first. Exposure was bilateral oophorectomy. Outcome was cardiovascular mortality. Associations were estimated using Poisson regression models with log person-years as the offset. Results: A total of 2,040 (8.1%) participants underwent bilateral oophorectomy. During a mean follow-up of 21.2 (SD: 5.6) years, 772 (3.0%) nurses died from cardiovascular disease. In adjusted analyses, a 31% higher rate of cardiovascular mortality was observed after bilateral oophorectomy (aMRR 1.31; 95% CI, 0.88-1.96) compared with women who retained their ovaries. No evidence of effect modification by use of hormone therapy at baseline or by hysterectomy on the association between bilateral oophorectomy and cardiovascular mortality was observed. Conclusion: Bilateral oophorectomy may be associated with cardiovascular mortality in women, but the estimate was not statistically significant. Additionally, we were unable to make firm conclusions regarding the possible modifying role of hormone therapy and hysterectomy on this potential association. Additional studies are needed to replicate this work.
    Type of Medium: Online Resource
    ISSN: 1530-0374
    URL: Article
    DOI: 10.1097/GME.0000000000001873
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 8
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    Innate immune cell infiltration in melanoma metastases affects survival and is associated with BRAFV600E mutation status
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Melanoma Research Vol. 29, No. 1 ( 2019-02), p. 30-37
    Details
    In: Melanoma Research, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 1 ( 2019-02), p. 30-37
    Abstract: Little is known about the infiltrative pattern of innate immune cells in primary melanoma compared with their paired metastases and in BRAF V600E -mutated tumors. Therefore, our aim was to characterize the inflammatory microenvironment in primary ulcerated and nonulcerated melanomas and paired metastases, to investigate the relation between inflammation and BRAF V600E mutation in primary melanoma and paired metastases, and to evaluate the effect of the analyzed biomarkers on melanoma-specific survival. A total of 385 primary tumors and 96 paired metastases were stained with immunohistochemistry for BRAF V600E , CD163+ macrophages, CD123+ plasmacytoid dendritic cells, CD66b+ neutrophils, and E-cadherin and estimated using objective computer-assisted image analysis. BRAF V600E was semiquantitatively scored as either present or absent. In metastases of nonulcerated melanomas, we observed higher neutrophil ( P =0.02) and macrophage ( P =0.01) numbers. In the metastases of ulcerated melanomas, we found a higher number of macrophages ( P 〈 0.0001). Increase in the neutrophil numbers in the metastases was associated with poor patient survival after first relapse (hazard ratio=1.19, 95% confidence interval: 1.03–1.38, P =0.02). BRAF V600E -positive primary tumors ( P =0.02) and metastases ( P =0.01) exhibited increased plasmacytoid dendritic cell numbers compared with BRAF V600E -negative tumors. Lastly, primary melanomas in men had higher neutrophil numbers than women ( P ≤0.0001), and men had worse melanoma-specific survival (hazard ratio=1.52, 95% confidence interval: 1.04–2.21, P =0.03). Our data show that melanoma metastases are densely infiltrated with neutrophils, which affects survival. Our results also highlight the importance of recognizing the presence of inflammatory cells in the metastases as a prognostic marker, and that they may potentially be used to improve the precision of immunotherapy and BRAF V600E targeted therapy.
    Type of Medium: Online Resource
    ISSN: 0960-8931
    URL: Article
    DOI: 10.1097/CMR.0000000000000515
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1095779-0
    detail.hit.zdb_id: 2030780-9
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  • 9
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    Association of Degree of Urbanization and Survival in Out‐of‐Hospital Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of the American Heart Association Vol. 12, No. 10 ( 2023-05-16)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 10 ( 2023-05-16)
    Abstract: Survival from out‐of‐hospital cardiac arrest (OHCA) varies across regions. The aim of this study was to evaluate the association between urbanization (rural, suburban, and urban areas), bystander interventions (cardiopulmonary resuscitation and defibrillation), and 30‐day survival from OHCAs in Denmark. Methods and Results We included OHCAs not witnessed by ambulance staff in Denmark from January 1, 2016, to December 31, 2020. Patients were divided according to the Eurostat Degree of Urbanization Tool in rural, suburban, and urban areas based on the 98 Danish municipalities. Poisson regression was used to estimate incidence rate ratios. Logistic regression (adjusted for ambulance response time) tested differences between the groups with respect to bystander interventions and survival, according to degree of urbanization. A total of 21 385 OHCAs were included, of which 8496 (40%) occurred in rural areas, 7025 (33%) occurred in suburban areas, and 5864 (27%) occurred in urban areas. Baseline characteristics, as age, sex, location of OHCA, and comorbidities, were comparable between groups. The annual incidence rate ratio of OHCA was higher in rural areas (1.54 [95% CI, 1.48–1.58] ) compared with urban areas. Odds for bystander cardiopulmonary resuscitation were lower in suburban (0.86 [95% CI, 0.82–0.96]) and urban areas (0.87 [95% CI, 0.80–0.95] ) compared with rural areas, whereas bystander defibrillation was higher in urban areas compared with rural areas (1.15 [95% CI, 1.01–1.31]). Finally, 30‐day survival was higher in suburban (1.13 [95% CI, 1.02–1.25] ) and urban areas (1.17 [95% CI, 1.05–1.30]) compared with rural areas. Conclusions Degree of urbanization was associated with lower rates of bystander defibrillation and 30‐day survival in rural areas compared with urban areas.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.122.028449
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2653953-6
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  • 10
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    Oophorectomy and rate of dementia: a prospective cohort study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Menopause Vol. 29, No. 5 ( 2022-01-31), p. 514-522
    Details
    In: Menopause, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 5 ( 2022-01-31), p. 514-522
    Abstract: Globally, dementia disproportionally affects women, which is not fully explained by higher female longevity. Oophorectomy at any age leads to the permanent loss of ovarian sex steroids, potentially increasing the risk of dementia. We aimed to investigate the association between oophorectomy and dementia and whether this was conditional on age at oophorectomy, hysterectomy or use of hormone therapy (HT). Methods: A prospective study of 24,851 female nurses from the Danish Nurse Cohort. Nurses were followed from age 60 years or entry into the cohort, whichever came last, until date of dementia, death, emigration or end of follow-up (December 31, 2018), whichever came first. Poisson regression models with log-transformed person-years as offset were used to estimate the associations. Results: During 334,420 person-years of follow-up, 1,238 (5.0%) nurses developed dementia and 1,969 (7.9%)/ 1,016 (4.1%) contributed person-time after bilateral-/unilateral oophorectomy. In adjusted analyses, an 18% higher rate of dementia was observed following bilateral oophorectomy (aRR 1.18: 95% CI, 0.89-1.56) and 13% lower rate (aRR 0.87: 95% CI, 0.59-1.23) following unilateral oophorectomy compared to nurses who retained their ovaries. Similar effects were detected after stratification according to age at oophorectomy. No statistically significant modifying effects of hysterectomy or HT were detected ( P interaction ≥0.60). Conclusions: Bilateral, but not unilateral, oophorectomy was associated with an increased rate of incident dementia. We were unable to establish whether this association was conditional on hysterectomy or HT use. Although an increase in dementia after bilateral oophorectomy is biologically plausible, limited statistical power hampers the precision of the estimates.
    Type of Medium: Online Resource
    ISSN: 1530-0374
    URL: Article
    DOI: 10.1097/GME.0000000000001943
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2071114-1
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