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Analysing the length of care episode after hip fracture: a nonparametric and a parametric Bayesian approach.

https://arctichealth.org/en/permalink/ahliterature142186
Source
Health Care Manag Sci. 2010 Jun;13(2):170-81
Publication Type
Article
Date
Jun-2010
Author
Jaakko Riihimäki
Reijo Sund
Aki Vehtari
Author Affiliation
Department of Biomedical Engineering and Computational Science, Helsinki University of Technology-TKK, P.O. Box 2200, 02015 Helsinki, Finland. jaakko.riihimaki@tkk.fi
Source
Health Care Manag Sci. 2010 Jun;13(2):170-81
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Bayes Theorem
Episode of Care
Finland
Hip Fractures
Humans
Length of Stay
Models, Statistical
Registries
Abstract
Effective utilisation of limited resources is a challenge for health care providers. Accurate and relevant information extracted from the length of stay distributions is useful for management purposes. Patient care episodes can be reconstructed from the comprehensive health registers, and in this paper we develop a Bayesian approach to analyse the length of care episode after a fractured hip. We model the large scale data with a flexible nonparametric multilayer perceptron network and with a parametric Weibull mixture model. To assess the performances of the models, we estimate expected utilities using predictive density as a utility measure. Since the model parameters cannot be directly compared, we focus on observables, and estimate the relevances of patient explanatory variables in predicting the length of stay. To demonstrate how the use of the nonparametric flexible model is advantageous for this complex health care data, we also study joint effects of variables in predictions, and visualise nonlinearities and interactions found in the data.
PubMed ID
20629418 View in PubMed
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Antipsychotic Use and Risk of Hospitalization or Death Due to Pneumonia in Persons With and Those Without Alzheimer Disease.

https://arctichealth.org/en/permalink/ahliterature282670
Source
Chest. 2016 Dec;150(6):1233-1241
Publication Type
Article
Date
Dec-2016
Author
Anna-Maija Tolppanen
Marjaana Koponen
Antti Tanskanen
Piia Lavikainen
Reijo Sund
Jari Tiihonen
Sirpa Hartikainen
Heidi Taipale
Source
Chest. 2016 Dec;150(6):1233-1241
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alzheimer Disease - complications - drug therapy
Antipsychotic Agents - adverse effects
Comorbidity
Cross-Over Studies
Female
Finland - epidemiology
Hospitalization - statistics & numerical data
Humans
Incidence
Male
Middle Aged
Pneumonia - mortality
Propensity Score
Risk factors
Socioeconomic Factors
Abstract
The use of antipsychotic agents has been associated with increased pneumonia risk, but although people with dementia are particularly susceptible to pneumonia, only one small study has assessed the risk of pneumonia in relation to the use of antipsychotic agents among people with Alzheimer disease (AD).
We investigated whether the incident use of antipsychotic agents, or specific antipsychotic agents, are related to a higher risk of hospitalization or death due to pneumonia in the Medication and Alzheimer Disease (MEDALZ) cohort. The cohort includes all individuals with AD who received a clinically verified AD diagnosis in Finland in 2005 to 2011 (N = 60,584; incident pneumonia, n = 12,225). A matched comparison cohort without AD (N = 60,584; incident pneumonia, n = 6,195) was used to compare the magnitude of risk. Results were adjusted for a propensity score derived from comorbidities, concomitant medications, and sociodemographic characteristics. Sensitivity analyses with case-crossover design were conducted.
The use of antipsychotic agents was associated with a higher risk of pneumonia (adjusted hazard ratio [HR], 2.01; 95% CI, 1.90-2.13) in the AD cohort and a somewhat higher risk in the non-AD cohort (adjusted HR, 3.43; 95% CI, 2.99-3.93). Similar results were observed with case-crossover analyses (OR, 2.02; 95% CI, 1.75-2.34 in the AD cohort and OR, 2.59; 95% CI, 1.77-3.79 in the non-AD cohort). The three most commonly used antipsychotic agents (quetiapine, risperidone, haloperidol) had similar associations with pneumonia risk.
Regardless of applied study design, treatment duration, or the choice of drug, the use of antipsychotic agents was associated with a higher risk of pneumonia. With observational data, we cannot fully rule out a shared causality between pneumonia and the use of antipsychotic agents, but the risk to benefit balance should be considered when antipsychotic agents are prescribed.
PubMed ID
27298071 View in PubMed
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Cancer incidence in persons with type 1 diabetes: a five-country study of 9,000 cancers in type 1 diabetic individuals.

https://arctichealth.org/en/permalink/ahliterature279635
Source
Diabetologia. 2016 May;59(5):980-8
Publication Type
Article
Date
May-2016
Author
Bendix Carstensen
Stephanie H Read
Søren Friis
Reijo Sund
Ilmo Keskimäki
Ann-Marie Svensson
Rickard Ljung
Sarah H Wild
Joannes J Kerssens
Jessica L Harding
Dianna J Magliano
Soffia Gudbjörnsdottir
Source
Diabetologia. 2016 May;59(5):980-8
Date
May-2016
Language
English
Publication Type
Article
Keywords
Australia - epidemiology
Diabetes Mellitus, Type 1 - epidemiology
Diabetes Mellitus, Type 2 - epidemiology
Female
Finland - epidemiology
Humans
Incidence
Male
Neoplasms - epidemiology
Proportional Hazards Models
Risk factors
Scotland - epidemiology
Sweden - epidemiology
Abstract
An excess cancer incidence of 20-25% has been identified among persons with diabetes, most of whom have type 2 diabetes. We aimed to describe the association between type 1 diabetes and cancer incidence.
Persons with type 1 diabetes were identified from five nationwide diabetes registers: Australia (2000-2008), Denmark (1995-2014), Finland (1972-2012), Scotland (1995-2012) and Sweden (1987-2012). Linkage to national cancer registries provided the numbers of incident cancers in people with type 1 diabetes and in the general population. We used Poisson models with adjustment for age and date of follow up to estimate hazard ratios for total and site-specific cancers.
A total of 9,149 cancers occurred among persons with type 1 diabetes in 3.9 million person-years. The median age at cancer diagnosis was 51.1 years (interquartile range 43.5-59.5). The hazard ratios (HRs) (95% CIs) associated with type 1 diabetes for all cancers combined were 1.01 (0.98, 1.04) among men and 1.07 (1.04, 1.10) among women. HRs were increased for cancer of the stomach (men, HR 1.23 [1.04, 1.46]; women, HR 1.78 [1.49, 2.13]), liver (men, HR 2.00 [1.67, 2.40]; women, HR 1.55 [1.14, 2.10]), pancreas (men, HR 1.53 [1.30, 1.79]; women, HR 1.25 [1.02,1.53]), endometrium (HR 1.42 [1.27, 1.58]) and kidney (men, HR 1.30 [1.12, 1.49]; women, HR 1.47 [1.23, 1.77]). Reduced HRs were found for cancer of the prostate (HR 0.56 [0.51, 0.61]) and breast (HR 0.90 [0.85, 0.94]). HRs declined with increasing diabetes duration.
Type 1 diabetes was associated with differences in the risk of several common cancers; the strength of these associations varied with the duration of diabetes.
Notes
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PubMed ID
26924393 View in PubMed
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Cancer incidence of persons with Down syndrome in Finland: a population-based study.

https://arctichealth.org/en/permalink/ahliterature172392
Source
Int J Cancer. 2006 Apr 1;118(7):1769-72
Publication Type
Article
Date
Apr-1-2006
Author
Kristiina Patja
Eero Pukkala
Reijo Sund
Matti Iivanainen
Markus Kaski
Author Affiliation
National Public Health Institute, Helsinki, Finland. kristiina.patja@ktl.fi
Source
Int J Cancer. 2006 Apr 1;118(7):1769-72
Date
Apr-1-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Child, Preschool
Cohort Studies
Down Syndrome - complications
Female
Finland - epidemiology
Humans
Incidence
Infant
Infant, Newborn
Leukemia - epidemiology - etiology
Male
Middle Aged
Registries - statistics & numerical data
Testicular Neoplasms - epidemiology - etiology
Abstract
Individuals with Down syndrome (DS) have a predisposition to leukaemia and testicular cancer, but data on the incidence of cancers are yet sparse. A cohort of 3,581 persons with DS was identified from a National Registry of Finnish persons with intellectual disability collected between 1978 and 1986 and followed-up for cancer incidence until 2002. Standardised incidence ratios (SIRs) were defined as ratios of observed number of cancer cases to those expected from the national cancer incidence rates, by age and sex. The overall cancer risk was equal to that of the general population, but a significantly high risk of leukaemia (SIR 10.5, CI 95% 6.6-15.8) and testicular cancer (SIR4.8, CI 95% 1.8-10.4) was found.
PubMed ID
16231334 View in PubMed
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Cemented or uncemented hemiarthroplasty for the treatment of femoral neck fractures?

https://arctichealth.org/en/permalink/ahliterature105391
Source
Acta Orthop. 2014 Feb;85(1):49-53
Publication Type
Article
Date
Feb-2014
Author
Tero Yli-Kyyny
Reijo Sund
Mikko Heinänen
Petri Venesmaa
Heikki Kröger
Author Affiliation
Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio.
Source
Acta Orthop. 2014 Feb;85(1):49-53
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - adverse effects - methods - mortality
Cementation - adverse effects - methods - mortality
Databases, Factual
Female
Femoral Neck Fractures - mortality - surgery
Finland - epidemiology
Hemiarthroplasty - adverse effects - methods - mortality
Hip Prosthesis
Humans
Male
Prosthesis Failure
Registries
Reoperation - statistics & numerical data
Treatment Outcome
Abstract
Cemented hemiarthroplasty is preferred in treating displaced fractures of the femoral neck in the elderly. The cementing process may cause a fat embolism, leading to serious complications or death. In this study, we wanted to determine whether use of uncemented hemiarthroplasty (HA) would lead to reduced mortality and whether there are differences in the complications associated with these different types of arthroplasty.
From the PERFECT database, which combines information from various treatment registries, we identified 25,174 patients who were treated with hemiarthroplasty for a femoral neck fracture in the years 1999-2009. The primary outcome was mortality. Secondary outcomes were reoperations, complications, re-admissions, and treatment times.
Mortality was lower in the first postoperative days when uncemented HA was used. At 1 week, there was no significant difference in mortality (3.9% for cemented HA and 3.4% for uncemented HA; p = 0.09). This was also true after one year (26% for cemented HA and 27% for uncemented HA; p = 0.1). In patients treated with uncemented HA, there were significantly more mechanical complications (3.7% vs. 2.8%; p
Notes
Cites: Forensic Sci Int. 2003 Jan 28;131(2-3):113-2412590049
Cites: Stat Med. 2013 Aug 30;32(19):3388-41423508673
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Cites: Eur J Clin Pharmacol. 2007 Nov;63(11):1069-7417712552
Cites: Methods Inf Med. 2007;46(5):558-6617938779
Cites: Br J Anaesth. 2009 Jan;102(1):12-2219059919
Cites: Clin Orthop Relat Res. 2009 Sep;467(9):2426-3519130162
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Cites: Acta Orthop. 2010 Oct;81(5):588-9220860442
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Cites: Ann Med. 2011 Jun;43 Suppl 1:S39-4621639716
Cites: J Bone Joint Surg Br. 2011 Oct;93(10):1405-1021969443
Cites: J Orthop Trauma. 2012 Mar;26(3):135-4022198652
Cites: J Bone Joint Surg Am. 2012 Apr 4;94(7):577-8322488613
Cites: Injury. 2012 Jun;43(6):946-922209383
Cites: Scand J Public Health. 2012 Aug;40(6):505-1522899561
Cites: Acta Orthop. 2012 Oct;83(5):459-6622998529
Cites: Arch Orthop Trauma Surg. 2013 Jun;133(6):805-923532371
Cites: Eur J Cardiovasc Prev Rehabil. 2005 Apr;12(2):132-715785298
Comment In: Acta Orthop. 2014 Jun;85(3):33424847794
Comment In: Acta Orthop. 2014 Jun;85(3):334
PubMed ID
24397746 View in PubMed
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Changing patterns of secondary preventive medication among newly diagnosed coronary heart disease patients with diabetes in Finland: a register-based study.

https://arctichealth.org/en/permalink/ahliterature144891
Source
Scand J Public Health. 2010 May;38(3):317-24
Publication Type
Article
Date
May-2010
Author
Tuulikki Vehko
Kristna Manderbacka
Martti Arffman
Reijo Sund
Antti Reunanen
Ilmo Keskimäki
Author Affiliation
National Institute for Health and Welfare (THL), Helsinki, Finland. tuulikki.vehko@thl.fi
Source
Scand J Public Health. 2010 May;38(3):317-24
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - administration & dosage
Adult
Aged
Angiotensin II Type 1 Receptor Blockers - administration & dosage
Angiotensin-Converting Enzyme Inhibitors - administration & dosage
Coronary Disease - diagnosis - etiology - prevention & control
Diabetes Mellitus, Type 1 - complications - drug therapy
Diabetes Mellitus, Type 2 - complications - drug therapy
Drug Prescriptions - economics - statistics & numerical data
Drug Utilization - economics - statistics & numerical data
Female
Finland
Humans
Hypolipidemic Agents - administration & dosage
Male
Middle Aged
Practice Guidelines as Topic
Registries
Reimbursement Mechanisms
Secondary Prevention
Socioeconomic Factors
Abstract
Information on medicine use among coronary heart disease (CHD) patients with diabetes in unselected patient populations is scarce. This study examines the use of medication to prevent new cardiac events among newly diagnosed CHD patients with diabetes comparing them to patients without diabetes and examines socioeconomic differences in medicine use in these patient groups.
Data on CHD patients (43,501 men and 31,125 women) with or without diabetes were individually linked from nationwide registers (covering both patients treated in ambulatory and in hospital inpatient care). Age-standardised rates for medication use were calculated and differences between patient groups examined using Poisson regression.
beta-blocker use was high in all patient groups in 1997-2002, angiotensin-converting enzyme (ACE) inhibitor and angiotensin II antagonist use increased and remained higher among patients with diabetes. More than half of men and women with diabetes used ACE inhibitors and one out of five used angiotensin II antagonists in 2002. Lipid-lowering medication use increased, especially among women. In 1997-98 it was lower in lower socioeconomic groups; among men with diabetes the use remained lower than among others.
beta-blocker use was constant and ACE inhibitor and angiotensin II antagonist use increased. Lipid-lowering medication use increased considerably after a health insurance reform in 2000, in which elevated reimbursement of drug costs (75%) was extended to include all CHD patients with hyperlipidaemia.Socioeconomic differences in medication use disappeared after the reform. However, lipid-lowering medication use remained at a lower level among men with diabetes, suggesting that their treatment did not follow guidelines.
PubMed ID
20228159 View in PubMed
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Community mental-health services and suicide rate in Finland: a nationwide small-area analysis.

https://arctichealth.org/en/permalink/ahliterature153558
Source
Lancet. 2009 Jan 10;373(9658):147-53
Publication Type
Article
Date
Jan-10-2009
Author
Sami Pirkola
Reijo Sund
Eila Sailas
Kristian Wahlbeck
Author Affiliation
Mental Health Group, National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland.
Source
Lancet. 2009 Jan 10;373(9658):147-53
Date
Jan-10-2009
Language
English
Publication Type
Article
Keywords
Adult
Bayes Theorem
Community Mental Health Services - organization & administration - statistics & numerical data
Female
Finland
Humans
Male
Socioeconomic Factors
Suicide - prevention & control - statistics & numerical data
Abstract
In many countries, psychiatric services have been reformed by reducing the size of hospitals and developing community mental-health services. We investigated this reform by assessing the relation between suicide risk and different ways of organising mental-health services.
We did a nationwide comprehensive survey of Finnish adult mental-health service units between Sept 1, 2004, and March 31, 2005. From health-care or social-care officers of 428 municipalities, we asked for information, classified according to the European service mapping schedule, about adult mental-health services. For each municipality, we measured age-adjusted and sex-adjusted suicide risk, pooled between 2000 and 2004, and then adjusted for register-derived socioeconomic factors.
A wide variety of outpatient services (relative risk [RR] 0.92, 95% CI 0.87-0.96), prominence of outpatient versus inpatient services (0.93, 0.89-0.97), and 24-h emergency services (0.84, 0.75-0.92) were associated with decreased death rates from suicide. However, after adjustment for socioeconomic factors, only the prominence of outpatient services was associated with low suicide rate (0.94, 0.90-0.98). We replicated this finding even after adjustment for organisational changes and inpatient treatment.
Well-developed community mental-health services are associated with lower suicide rates than are services oriented towards inpatient treatment provision. These data are consistent with the idea that population mental health can be improved by use of multifaceted, community-based, specialised mental-health services.
Academy of Finland.
Notes
Comment In: Lancet. 2009 Jan 10;373(9658):99-10019097637
PubMed ID
19097638 View in PubMed
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Comparing the financial risk of bed-day and DRG based pricing types using parametric and simulation methods.

https://arctichealth.org/en/permalink/ahliterature185506
Source
Health Care Manag Sci. 2003 May;6(2):67-74
Publication Type
Article
Date
May-2003
Author
Hennamari Mikkola
Reijo Sund
Miika Linna
Unto Häkkinen
Author Affiliation
National R&D Centre for Welfare and Health, Helsinki, Finland. Hennamari.Mikkola@stakes.fi
Source
Health Care Manag Sci. 2003 May;6(2):67-74
Date
May-2003
Language
English
Publication Type
Article
Keywords
Benchmarking
Cost Allocation
Data Interpretation, Statistical
Diagnosis-Related Groups - economics
Financing, Government
Finland
Health Services Research
Hospital Costs - classification - statistics & numerical data
Hospitals, District - economics
Humans
Local Government
Models, Econometric
Rate Setting and Review - classification - statistics & numerical data
Reimbursement Mechanisms
Risk Sharing, Financial
Abstract
The extent of random financial risk involved in the Finnish bed-day and Diagnosis Related Groups (DRG) based hospital pricing systems were estimated and compared using parametric and simulation methods. DRG based payment schemes were found to provide significantly better protection against financial risk for municipalities, but municipality's size was the main determinant of financial risk. Small municipalities should use longer contracts between hospitals or form bigger purchaser-organisations for risk pooling. In addition, the current risk management system proved to be ineffective in decreasing the random variation in total costs.
PubMed ID
12733610 View in PubMed
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Cross-Validation of Arthroplasty Records Between Arthroplasty and Hospital Discharge Registers, Self-Reports, and Medical Records Among a Cohort of 14,220 Women.

https://arctichealth.org/en/permalink/ahliterature299873
Source
J Arthroplasty. 2018 12; 33(12):3649-3654
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Validation Studies
Date
12-2018
Author
Ville Turppo
Reijo Sund
Joonas Sirola
Heikki Kröger
Jukka Huopio
Author Affiliation
Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.
Source
J Arthroplasty. 2018 12; 33(12):3649-3654
Date
12-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Validation Studies
Keywords
Aged
Arthroplasty, Replacement, Hip - statistics & numerical data
Arthroplasty, Replacement, Knee - statistics & numerical data
Cohort Studies
Female
Finland
Humans
Knee Joint
Medical Records
Middle Aged
Patient Discharge
Prevalence
Registries - statistics & numerical data
Risk factors
Self Report - statistics & numerical data
Abstract
There are no actual validation studies of the Finnish Arthroplasty Register (FAR), and only a few studies about the accuracy of self-reported hip and knee arthroplasty exist. Therefore, we examine how reliably total hip (THA) and knee (TKA) arthroplasties can be identified from multiple data sources, including self-reports, the hospital discharge register, the arthroplasty register, and medical records.
Data from the FAR and from the Finnish Hospital Discharge Register (FHDR) during the years 1980-2010 were cross-checked to identify all THA and TKA events for the Kuopio Osteoporosis Risk Factor and Prevention Study cohort (n = 14,220). Unclear events were further checked from the medical records. After establishing a gold standard, by referring to confirmed THAs and TKAs, we examined the validity of self-reports in identifying the prevalent population with THA/TKA and in identifying incident THA/TKA.
Completeness of 2820 total arthroplasty events was 96.1% in FAR and 98.3% in FHDR. The self-reports had 95.1% sensitivity and 92.9% positive predictive value (PPV) to identify population with THA and for TKA sensitivity was 94.6% and PPV 95.2%. Self-reports' sensitivity of finding the actual surgery events was 65.3% and PPV 85.4% for THA and for TKA sensitivity was 62.9% and PPV 83.4%.
The best way to identify THAs and TKAs in Finland is to combine data from the FAR and the FHDR. Self-reports can be considered as suitable to identify the prevalent population with THA/TKA, and they do not work as well to identify the actual surgery events.
PubMed ID
30193880 View in PubMed
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Diabetes and depression? Secular trends in the use of antidepressants among persons with diabetes in Finland in 1997-2007.

https://arctichealth.org/en/permalink/ahliterature135839
Source
Pharmacoepidemiol Drug Saf. 2011 Apr;20(4):338-43
Publication Type
Article
Date
Apr-2011
Author
Kristiina Manderbacka
Reijo Sund
Sari Koski
Ilmo Keskimäki
Marko Elovainio
Author Affiliation
National Institute for Health and Welfare (THL), Service Systems Research, Helsinki, Finland. kristiina.manderbacka@thl.fi
Source
Pharmacoepidemiol Drug Saf. 2011 Apr;20(4):338-43
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Antidepressive Agents - therapeutic use
Case-Control Studies
Databases, Factual
Depression - drug therapy - etiology
Diabetes Mellitus, Type 1 - complications - epidemiology
Diabetes Mellitus, Type 2 - complications - epidemiology
Female
Finland - epidemiology
Humans
Male
Middle Aged
Prevalence
Registries
Sex Factors
Young Adult
Abstract
The association between diabetes and depression is well demonstrated. Less is known about the trends in use of antidepressants in the rapidly growing population of diabetics. We examined trends in antidepressant medication use during 1997-2007 in Finland among persons with or without diabetes using register-based data on both diabetes and antidepressant use.
The diabetes population was obtained from the FinDM II database including 50,027 persons with insulin treated (ITDM) and 346,290 persons with non-insulin treated diabetes (NITDM) identified from several administrative registers. Data on persons without diabetes were obtained from the yearly population statistics and their antidepressant use from the register for refunded prescription medicine costs covering all medicine purchases of non-institutionalised residents. Differences in trends and prevalence were examined using the binomial regression model.
Antidepressant use was more common among persons with diabetes in all age groups and each study year among both genders (prevalence ratios (RR) 1.4-2.2 for women and 1.7-2.2 for men). Prevalence was both higher (RR 2.0-2.2 women, 1.9-2.2 men), and increased more rapidly among younger persons with NITDM.
The use of register data linked using unique personal identifiers allowed us to identify a total cohort of persons with diabetes, to separate between ITDM and NITDM patients and to examine patterns of antidepressant use in populations with and without diabetes during an 11 year study period. Our results suggest that more attention should be focused on psychological well-being in those with diabetes and especially young people in risk of type 2 diabetes.
Notes
Comment In: Pharmacoepidemiol Drug Saf. 2011 Sep;20(9):1001-321919112
Comment In: Pharmacoepidemiol Drug Saf. 2012 Apr;21(4):45222495913
PubMed ID
21442683 View in PubMed
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48 records – page 1 of 5.