Anders Blædel Gottlieb Hansen

The number of persons with alcohol problems in the Danish population

Aims: A) To qualify the existing estimates of the prevalence of heavy drinking, harmful alcohol use and alcohol dependency by applying adjustment for non-participation. B) To describe socio-demographic correlates of heavy drinkers. Methods: Data came from the Danish Health Interview Survey 2005, which included a personal interview of 14,566 individuals (response rate 66.7 %), and of 5,552 individuals who completed a self-administered questionnaire containing the Alcohol Use Disorder Test (AUDIT) (response rate 50.9%). Heavy drinkers were defined as consuming >14/21 drinks/week (women/men). Identification of harmful alcohol users and dependent drinkers was based on the score of specific AUDIT questions (harmful alcohol use a score of ≥4 in questions 7—10, dependent drinkers ≥4 in questions 4—6). Adjustment for non-participation was performed using data from the Danish National Patient Registry. Results: In the Danish population, 20% were heavy drinkers (862,876 persons 95% confidence interval (95% CI): 672,002—1,195,069), 14% had harmful alcohol use (620,301 persons 95% CI: 439,221—944,992), 3% were dependent drinkers (147,528 persons 95% CI: 118,196—188,384). Being male was associated with heavy drinking (odds ratio (OR): 1.70; 95% CI: 1.53—1.89), as was being a single male (OR: 1.27; 95% CI: 1.01—1.61) and being a smoker (men: OR: 1.96; 95% CI: 1.67—2.30 / women: OR: 2.08; 95% CI: 1.72—2.52). Conclusions: The number of heavy drinkers in the Danish population and the number of people with harmful alcohol use is considerably higher than earlier prevalence estimates. The number of dependent drinkers is similar to earlier estimates.

Internet-based brief personalized feedback intervention in a non-treatment-seeking population of adult heavy drinkers: a randomized controlled trial

Background Internet-based interventions for heavy drinkers show promising results, but existing research is characterized by few studies in nonstudent adult populations and few comparisons with appropriate control groups. Objective To test whether a fully automated Internet-based brief personalized feedback intervention and a fully automated Internet-based personalized brief advice intervention in a non-treatment-seeking population of heavy drinkers would result in a reduced alcohol intake. Methods We conducted a 3-arm parallel randomized controlled trial in a general population-based sample of heavy drinkers. The 54,157 participants (median age of 58 years) were screened for heavy drinking. Of the 3418 participants who had a weekly alcohol consumption above 14 drinks for women and 21 drinks for men, 1380 (619 women) consented to take part in the trial and were randomly assigned to an Internet-based brief personalized feedback intervention group (normative feedback, n = 476), an Internet-based personalized brief advice intervention group (n = 450), or a nonintervention control group (n = 454). Follow-up after 6 and 12 months included 871 and 1064 participants, respectively, of all groups combined. The outcome measure was self-reported weekly alcohol consumption. We analyzed the data according to the intention-to-treat principle. To examine changes over time and to account for the multiple time measurements, we used a multilevel linear mixed model. To take attrition into account, we used multiple imputation to address missing data. Results The intervention effect of the Internet-based brief personalized feedback intervention, determined as the mean additional difference in changes in alcohol consumption in the Internet-based brief personalized feedback intervention compared with the control group, was –1.8 drinks/week after 6 months and –1.4 drinks/week after 12 months; these effects were nonsignificant (95% confidence interval –4.0 to 0.3 at 6 months, –3.4 to 0.6 at 12 months). The intervention effect of the Internet-based personalized brief advice intervention was –0.5 drinks/week after 6 months and –1.2 drinks/week after 12 months; these effects were nonsignificant (95% confidence interval –2.7 to 1.6 at 6 months, –3.3 to 0.9 at 12 months). Conclusions In this randomized controlled trial we found no evidence that an Internet-based brief personalized feedback intervention was effective in reducing drinking in an adult population of heavy drinkers. Trial registration ClinicalTrials.gov NCT00751985; http://clinicaltrials.gov/ct2/show/NCT00751985 (Archived by WebCite at http://www.webcitation.org/68WCRLyaP)

Brief Alcohol Intervention by Newly Trained Workers Versus Leaflets: Comparison of Effect in Older Heavy Drinkers Identified in a Population Health Examination Survey: A Randomized Controlled Trial

AIMS To test if a brief motivational intervention (BMI) in a non-treatment seeking population of heavy drinkers results in a reduced alcohol intake. METHODS Screening of 12,364 participants in a Danish health examination survey led to 1026 heavy drinkers of whom 772 were included and randomized to a BMI group (n = 391) or a control group (n = 381) receiving two leaflets about alcohol. Follow-up took place after 6 and 12 months including 670 and 616 participants respectively. The outcome measure was self-reported weekly alcohol consumption. Data were analysed according to the intention-to-treat principle. We used the Motivational Interviewing Treatment Integrity 3.0 code (MITI) as a quality control of the interventions delivered. RESULTS The intervention effect of the BMI was -1.0 drinks/week, but the effect was not significant. The MITI analysis showed that the quality of the BMI delivered was sub-optimal, as only one of four aspects was above the recommended level for beginning proficiency. CONCLUSION We found no effect of a BMI in reducing alcohol consumption. The generalizability of the study is questionable, as individuals with the lowest level of education, low income and unmarried individuals are under-represented.

A 12-week interdisciplinary rehabilitation trial in patients with gliomas – a feasibility study

Abstract Purpose: This report aims to assess the safety and feasibility of using an interdisciplinary rehabilitation intervention for a future randomized controlled trial in patients with gliomas in the initial treatment phase. Method: We conducted an outpatient two-part rehabilitation intervention that involved six weeks of therapeutic supervised training (part one) and six weeks of unsupervised training in a local gym following a training protocol (part two). Results: Predefined feasibility objectives of safety (100%), consent rate (>80%), drop-out (<20%), adherence (>80%) and patient satisfaction (>80%) was achieved at part one. However, the failure to meet predefined feasibility objectives of drop-out, adherence and patient satisfaction of the unsupervised intervention at part two have led to a protocol revision for a future randomized controlled trial. Conclusion: This study demonstrates that an intensive rehabilitation intervention of physical therapy and occupational therapy in the initial treatment phase of patients with gliomas whose Karnofsky performance status is ≥70 is safe and feasible, if relevant inclusion criteria and precautionary screening are made. With the revised protocol, we are confident that the foundation for conducting a successful randomized controlled trial among these vulnerable patients has been established. Implications for rehabilitation Brain tumors constitute some of the most challenging cancer diagnoses presenting for rehabilitation intervention. Patients with gliomas experiences limitations in physical functioning, cognition, and emotional wellbeing. In a relatively small sample this study shows that supervised physical- and occupational therapy in patients with gliomas is safe and feasible in the initial treatment phase. Patients with gliomas can potentially improve functioning through interdisciplinary rehabilitation

Novel occupational therapy intervention in the early rehabilitation of patients with brain tumours

Statement of context The Danish Health Authority recommends that patients with brain tumours should have their rehabilitation needs evaluated prior to hospital discharge. Critical reflection on practice To our knowledge, no specific recommendations for specialised occupational therapy intervention in patients with glioma have been published. We rationalise how occupational therapy practices founded on shared decision-making and common goal-setting are implicated to patients with brain tumours and elaborate on how an occupation-centred approach with occupation-focused and based intervention has the potential to impact a patient’s performance ability and satisfaction in performing occupations established by the Canadian Occupational Performance Measure. This practice was embedded in a randomised controlled trial investigating the effectiveness of intensive rehabilitation efforts and involving occupational therapy compared with standard care in patients with glioma (ClinicalTrials.gov Identifier NCT02221986). Implications for practice Occupational therapy makes an important contribution in neurorehabilitation, which may also apply to patients with brain tumours.

Development of an exercise intervention as part of rehabilitation in a glioblastoma multiforme survivor during irradiation treatment: a case report

Abstract Introduction: This case report describes the rationale and development of an exercise intervention in a patient with glioblastoma multiforme (GBM ) and discusses potential relations of observed effects in functional performance and quality of life (QOL). Methods: A 54-year-old GBM survivor completed a supervised six-week exercise intervention during irradiation treatment beginning 42 d after resection. Exercise modalities of cardiorespiratory, resistance, and balance training were designed on generic recommendations of various cancer populations and literature review. Results: Our case attended all possible sessions without experiencing adverse effects, and improved in aerobe power (24%), muscle strength (0–38%), standing balance (71%), walking ability (9%), and QOL domains of “Global Health Status/QoL” and “Physical functioning.” Conclusions: Based on this single case, exercise rehabilitation has the ability to maintain or improve functional performance and QOL domains even during heavy treatments. It also implies that patients with GBM are capable and may be willing to participate in exercise rehabilitation if supervised by physical therapists. Implications for rehabilitation The use of exercise as part of rehabilitation still needs attention in strong methodology studies of patients with gliomas. Exercise rehabilitation may maintain or even improve functional performance and QOL domains during medical treatment regimens. Functional independent patients with GBM are capable to comply with generic exercise recommendations and may be willing to participate in exercise rehabilitation if supervised by physical therapists.