[Danish influence on global health].

Health for all has been a central global goal for years. Today, sustainable development goals (SDGs), the primary health care strategy and universal health coverage are the main strategies. In recent years, the focus has shifted to global health thus indicating a need for joint focus on transnational health problems. The SDGs and global health are highlighting the need for partnerships between countries in order to share knowledge, ideas and approaches. Danish national authorities, civil society organisations and research institutions could in collaboration play a more central role in global health.

The 12-month effects of structured lifestyle advice and pelvic floor muscle training for pelvic organ prolapse.

INTRODUCTION: We evaluated the 12-month effects of adding pelvic floor muscle training to a lifestyle advice program in women with symptomatic pelvic organ prolapse stage II-III and the number of women who had sought further treatment. MATERIAL AND METHODS: This study was a 12-month follow up of a randomized controlled trial comparing a structured lifestyle advice program alone (lifestyle group) or in combination with pelvic floor muscle training (training and lifestyle group). Both programs consisted of six separate group sessions within 12 weeks. RESULTS: Data were available from 83 (76%) of the 109 originally included women. At the 12-month follow up, 34/83 (41%) had not sought further treatment, 13/43 (30%) in the lifestyle group and 21/40 (52%) in the training and lifestyle group, and these could be included for analysis. The lifestyle group had significantly improved bladder symptoms compared with baseline on single-item analysis (p = 0.01). The training and lifestyle group had significantly improved pelvic organ prolapse symptoms on single-item analysis (p = 0.02) and of bowel-related quality of life (p = 0.04). No significant between-group differences were found in the symptom and quality of life scores. All together 49 women (59%) had sought further treatment, 70% in the lifestyle group, and 48% in the training and lifestyle group (p = 0.05). Twenty-six in the lifestyle group, and 15 in the training and lifestyle group had sought conservative treatment. Four women in each group had received surgery. More severe anterior prolapse and more bladder symptoms at the 3-month follow up were significantly associated with having sought further treatment in both groups. CONCLUSIONS: At 12-month follow up, the effects of adding pelvic floor muscle training to a structured lifestyle advice program were limited.

Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: We evaluated the effect of adding pelvic floor muscle training (PFMT) to a structured lifestyle advice program. METHODS: This was a single-blinded randomized trial of women with symptomatic pelvic organ prolapse (POP) stage ≥ II. Participants were randomized to a structured lifestyle advice program with or without PFMT. Both groups received similar lifestyle advice in six separate group sessions. The combined group performed group PFMT after an individual assessment. Primary outcome was a global improvement scale at six-month follow-up. Secondary outcomes were the global scale and objective POP at three-month follow-up, symptoms and quality of life including sexuality, at three and six-month follow-up. A clinically relevant change of symptoms was defined as ≥ 15 %. RESULTS: We included 109 women. Eighty-nine women (82 %) completed three months follow-up; 85 (78 %) completed six-month follow-up. At both follow-ups, significantly more women in the combined group reported improvement in the global scale. At the three-month follow-up, the combined group only had significant improvement of POP symptoms while only the lifestyle advice group had significant improvement of quality of life. Change in objective POP and sexuality was nonsignificant. The symptom score improved 17 % in the combined group and 14 % in the lifestyle advice group (P = 0.57). Significantly more women in the lifestyle advice group had sought further treatment at the six-month follow-up. CONCLUSION: Adding PFMT to a structured lifestyle advice program gave superior results in a global scale and for POP symptoms. Overall effect of either intervention barely reached clinical relevance.

Use of antibiotics for urinary tract infection in women undergoing surgery for urinary incontinence: a cohort study.

OBJECTIVE: To describe the use of antibiotics for urinary tract infection (UTI) before and after surgery for urinary incontinence (UI); and for those with use of antibiotics before surgery, to estimate the risk of treatment for a postoperative UTI, relative to those without use of antibiotics before surgery. DESIGN: A historical population-based cohort study. SETTING: Denmark. PARTICIPANTS: Women (age ≥18 years) with a primary surgical procedure for UI from the county of Funen and the Region of Southern Denmark from 1996 throughout 2010. Data on redeemed prescriptions of antibiotics ±365 days from the date of surgery were extracted from a prescription database. MAIN OUTCOME MEASURES: Use of antibiotics for UTI in relation to UI surgery, and the risk of being a postoperative user of antibiotics for UTI among preoperative users. RESULTS: A total of 2151 women had a primary surgical procedure for UI; of these 496 (23.1%) were preoperative users of antibiotics for UTI. Among preoperative users, 129 (26%) and 215 (43.3%) also redeemed prescriptions of antibiotics for UTI within 0-60 and 61-365 days after surgery, respectively. Among preoperative non-users, 182 (11.0%) and 235 (14.2%) redeemed prescriptions within 0-60 and 61-365 days after surgery, respectively. Presurgery exposure to antibiotics for UTI was a strong risk factor for postoperative treatment for UTI, both within 0-60 days (adjusted OR, aOR=2.6 (95% CI 2.0 to 3.5)) and within 61-365 days (aOR=4.5 (95% CI 3.5 to 5.7)). CONCLUSIONS: 1 in 4 women undergoing surgery for UI was treated for UTI before surgery, and half of them had a continuing tendency to UTIs after surgery. Use of antibiotics for UTI before surgery was a strong risk factor for antibiotic use after surgery. In women not using antibiotics for UTI before surgery only a minor proportion initiated use after surgery.

Use of symptom-relieving drugs before and after surgery for urinary incontinence in women: a cohort study.

OBJECTIVE: To describe the use of symptom-relieving drugs (antimuscarinic drugs or duloxetine) before and after surgery for urinary incontinence (UI); and for those with use of antimuscarinic drugs or duloxetine before surgery, to estimate the risk of being a postoperative user, relative to those without use before surgery. DESIGN: A historical population-based cohort study. SETTING: Denmark. PARTICIPANTS: Women ≥18 years with a first-time surgical procedure for UI from the county of Funen, Denmark between 1 January 1996 and 31 December 2006, extended to the Region of Southern Denmark from 1 January 2007 to the end of 2010. For these women, data on redeemed prescriptions ±365 days of date of surgery were extracted. MAIN OUTCOME MEASURES: Effect of preoperative use of antimuscarinic drugs or duloxetine on the risk of being a postoperative user of these drugs. RESULTS: Of 2151 women with a first-time surgical procedure for UI, 358 (16.6%) were preoperative users of antimuscarinic drugs or duloxetine and 1793 were not (83.4%). A total of 110 (30.7%) of the preoperative users also redeemed prescriptions for these drugs within 0-60 days after surgery, and 152 (42.5%) of the preoperative users redeemed prescriptions for these drugs within 61-365 days after surgery. Among preoperative non-users, 25 (1.4%) and 145 (8.1%) redeemed prescriptions within 0-60 and 61-365 days after surgery, respectively. Presurgery exposure to antimuscarinic drugs or duloxetine was a strong risk factor of postoperative drug use, both within 0-60 days (adjusted OR=33.0, 95% CI 20.0 to 54.7) and 61-365 days (OR=7.2, 95% CI 5.4 to 9.6). CONCLUSIONS: A substantial number of women will continue to be prescribed symptom-relieving drugs after surgery for UI within a year of follow-up. Only a minority of preoperative non-users initiated usage of symptom-relieving drugs after surgery. Compared with other factors included in the regression model, preoperative use of antimuscarinic drugs or duloxetine was the strongest risk factor for postoperative use.

Validation of the Pelvic Floor Distress Inventory-20 and the Pelvic Floor Impact Questionnaire-7 in Danish women with pelvic organ prolapse.

OBJECTIVE: To translate the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and to evaluate their psychometric properties in Danish women with symptomatic pelvic organ prolapse. DESIGN AND SETTING: Cross-sectional, university hospital setting. SAMPLE: Women with symptomatic pelvic organ prolapse (n = 132). METHODS: A panel of gynecologists performed three independent translations, which were combined and psychometrically evaluated through interviews and pretesting. MAIN OUTCOME MEASURES: Construct, content and convergent validity. Internal consistency and reliability. Sensitivity to change, responsiveness and minimal clinical important difference. RESULTS: After two revisions PFDI-20 demonstrated good construct and content validity but PFIQ-7 showed major ceiling effect and lacked items describing affection of health-related quality of life. Convergent validity was moderate with only single items of PFDI-20 correlating with the pelvic organ prolapse quantification system (POP-Q) and only weak to moderate correlations between PFDI-20 and PFIQ-7 scores. Cronbach's alpha and inter-item-total correlation analysis were satisfactory overall. Intra-class correlation coefficient demonstrated good reliability for all but one subscale (r = 0.701-0.894 p < 0.001). Wilcoxon signed rank test showed significant sensitivity to change. Effect size and standardized response mean was good in pelvic organ prolapse subscales and correlated with the Patient Global Index of Improvement scale (PGI-I). Minimal clinical important difference could not be clearly demonstrated. CONCLUSION: The Danish version of PFDI-20 is valid while the PFIQ-7 has a major ceiling effect and lacks items about health-related quality of life. The subscales of PFDI-20 and PFIQ-7 demonstrate good internal consistency and reliability. Pelvic organ prolapse subscales show good responsiveness.

The Danish Urogynaecological Database: establishment, completeness and validity.

INTRODUCTION AND HYPOTHESIS: The Danish Urogynaecological Database (DugaBase) is a nationwide clinical database established in 2006 to monitor, ensure and improve the quality of urogynaecological surgery. We aimed to describe its establishment and completeness and to validate selected variables. This is the first study based on data from the DugaBase. METHODS: The database completeness was calculated as a comparison between urogynaecological procedures reported to the Danish National Patient Registry and to the DugaBase. Validity was assessed for selected variables from a random sample of 200 women in the DugaBase from 1 January 2009 to 31 October 2010, using medical records as a reference. RESULTS: A total of 16,509 urogynaecological procedures were registered in the DugaBase by 31 December 2010. The database completeness has increased by calendar time, from 38.2 % in 2007 to 93.2 % in 2010 for public hospitals. All medical records were retrievable for the validation study. The overall percent agreement was at least 90 % for the following variables: surgical procedure code, hospital department, date of surgery, use of antibiotic prophylaxis, prior gynaecological surgery, height, weight, parity and smoking. CONCLUSIONS: The database completeness of the DugaBase has improved over time, now with a nearly complete registration from all public hospitals in Denmark. The overall percent agreement between selected variables and medical records is high. We conclude that due to the high degree of database completeness and data of high validity the DugaBase offers a unique possibility for continuing quality assessment of urogynaecological surgery in Denmark and future research.

Patient reported outcome measures in women undergoing surgery for urinary incontinence and pelvic organ prolapse in Denmark, 2006-2011.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the impact of urogynecological surgery on quality of life based on patient reported outcome measures (PROMs). METHODS: Data were retrieved from the Danish Urogynaecological Database. Inclusion criteria were Danish women undergoing surgery for urinary incontinence (UI) or pelvic organ prolapse (POP) from 2006 to 2011. Using frequency of symptoms and a visual analogue scale (VAS) both pre- and postoperatively, their severity of symptoms and quality of life were measured by questionnaires. RESULTS: During the study period, 20,629 urogynecological procedures were performed. The questionnaires on severity of symptoms and the VAS had been completed both pre- and postoperatively for approximately one third of women undergoing surgery. For UI surgery, 83% had improved symptoms, 13% were unchanged, and 4% had worse symptoms postoperatively. For POP surgery, 80, 17, and 3% were improved, unchanged, and worsened, respectively. The postoperative bother of symptoms and interference in everyday life evaluated by VAS were significantly reduced for both UI [preoperative median VAS score 9, postoperative median score 1 (p < 0.001)] and POP [8 preoperatively and 0 postoperatively (p < 0.001)]. CONCLUSIONS: Based on PROMs, surgery for UI and POP is effective in alleviating symptoms associated with UI or POP, and it can improve quality of life in symptomatic women. Pre- and postoperative questionnaires are useful tools in assessing symptomatic outcome measures after surgery.

[Pelvic floor muscle training in pregnant and parturient women--a survey of a Cochrane review]. / Baekkenbundstraening til gravide og barslende kvinder--en gennemgang af et Cochrane-review.

Urinary and anal incontinence are prevalent in pregnant and parturient women. Pelvic floor muscle training is frequently employed for prevention and treatment. A recent Cochrane review is discussed. Fifteen studies with a total of 6,181 women were included. Pregnant women without urinary incontinence experienced a reduction of the risk of developing urinary incontinence in later pregnancy or post partum. Peripartum patients with urinary and anal incontinence experienced a reduction of their symptoms following training.

[Oestrogen for prevention of recurrent urinary tract infections in postmenopausal women--a survey of a Cochrane review]. / Østrogen til forebyggelse af recidiverende urinvejsinfektioner hos postmenopausale kvinder--gennemgang af et Cochrane-review.

Recurrent urinary tract infections (UTIs) are common in postmenopausal women. While the pathophysiology is often complex, it is evident that the urogenital atrophy due to the decrease of endogenous oestrogen production is a key factor. Two small randomized controlled studies have proven the efficacy of local (vaginal) oestrogen therapy in the prevention of recurrent UTIs. Conversely, four randomized trials, reviewed in a weighted meta-analysis with pooled data from 2,798 women, have shown the lack of efficacy of systemic oestrogen-progesterone therapy. Local oestrogen therapy is recommended, if the predominant indication is urogenital symptoms.

Persistence of antimuscarinic drug use.

PURPOSE: Evidence suggests antimuscarinic drugs for the overactive-bladder syndrome only confer modest improvements in quality of life. We wanted to describe the persistence of therapy, including an extended analysis beyond the 1-year follow-up employed in other studies. METHODS: All prescriptions for drugs in ATC category G04BD were retrieved for the period 1999-2006 from a regional database with complete capture of all reimbursed prescriptions. Kaplan-Meyer curves were generated for duration of treatment for each substance and analyzed for determinants of termination. RESULTS: With the exception of trospium chloride, all drugs had continuation rates of less than 50% at 6 months, less than 25% at 1 year, and less than 10% at 2 years and longer. Trospium chloride, however, exhibited continuation rates of 46% at 6 months, 36% at 1 year, 22% at 2 years, and 16% at 3 years. CONCLUSIONS: In a setting of socialized medicine, we found higher continuation rates than previously published. Interestingly, we found that one of the older drugs on the market, trospium chloride, had a strikingly longer retention rate than other drugs.