Jan Alexis Nielsen

Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age

BackgroundIt is unclear to what extent spinal pain varies between genders and in relation to age. It was the purpose of this study to describe the self-reported prevalence of 1) pain ever and pain in the past year in each of the three spinal regions, 2) the duration of such pain over the past year, 3) pain radiating from these areas, and 4) pain in one, two or three areas. In addition, 5) to investigate if spinal pain reporting is affected by gender and 6) to see if it increases gradually with increasing age.MethodA cross-sectional survey was conducted in 2002 on 34,902 twin individuals, aged 20 to 71 years, representative of the general Danish population. Identical questions on pain were asked for the lumbar, thoracic and cervical regions.ResultsLow back pain was most common, followed by neck pain with thoracic pain being least common. Pain for at least 30 days in the past year was reported by 12%, 10%, and 4%, respectively. The one-yr prevalence estimates of radiating pain were 22% (leg), 16% (arm), and 5% (chest). Pain in one area only last year was reported by 20%, followed by two (13%) and three areas (8%).Women were always more likely to report pain and they were also more likely to have had pain for longer periods. Lumbar and cervical pain peaked somewhat around the middle years but the curves were flatter for thoracic pain. Similar patterns were noted for radiating pain. Older people did not have pain in a larger number of areas but their pain lasted longer.ConclusionPain reported for and from the lumbar and cervical spines was found to be relatively common whereas pain in the thoracic spine and pain radiating into the chest was much less common. Women were, generally, more likely to report pain than men. The prevalence estimates changed surprisingly little over age and were certainly not more common in the oldest groups, although the pain was reported as more long-lasting in the older group.

Heritability of Spinal Pain and Consequences of Spinal Pain: A Comprehensive Genetic Epidemiologic Analysis Using a Population-Based Sample of 15,328 Twins Ages 20-71 Years

OBJECTIVE To assess the relative contribution of genetic and environmental factors to different definitions of spinal pain and consequences of spinal pain. METHODS The Danish Twin Registry contains detailed survey information on spinal pain and its consequences in twins ages 20-71 years. A classic genetic epidemiologic analysis was performed in order to establish heritability for a number of phenotypes, including location of pain, radiation of pain in the extremities or chest, pain duration, and combinations of pain in >1 spinal area. Consequences included reduced physical activity, sick leave, care seeking, change of work, and disability pension. The analysis included a biometric analysis based on the effect of shared genetic and common environmental factors. Furthermore, a bivariate twin model was fitted to identify genetic and environmental correlations. RESULTS Altogether, data on 15,328 twin individuals (44% monozygotic and 56% dizygotic) from complete twin pairs were included. Genetic susceptibility explained approximately 38% of lumbar pain, 32% of thoracic pain, and 39% of neck pain. For patterns of pain, estimates were 7% for lumbar/thoracic, 24% for lumbar/cervical, 0% for thoracic/cervical, and 35% for pain in all 3 areas. Moderate to high genetic correlations indicated a common genetic basis for many spinal pain syndromes. In general, heritability was higher for women, and only a minor age effect was seen. CONCLUSION Heritability estimates for pain in different spinal regions are quite similar and there is a moderate to high genetic correlation between the phenotypes. This may indicate a common genetic basis for a high proportion of spinal pain.

The natural course of sensitization and allergic diseases from childhood to adulthood.

Longitudinal prospective population‐based birth cohort studies of the natural history of sensitization and allergic diseases from childhood to adulthood are few. The aim of the present prospective study was to investigate the natural course of sensitization and allergic diseases in a random population‐based sample of 276 children from a 1‐year birth cohort of unselected Danish children followed from birth to 26 years of age.

Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis - a nationwide cohort study

It is still controversial whether pre‐operative anti‐tumour necrosis factor‐alpha (anti‐TNF‐α) agents increase post‐operative complications in patients with ulcerative colitis (UC).

Pre‐operative use of anti‐TNF‐α agents and the risk of post‐operative complications in patients with Crohn's disease – a nationwide cohort study

A possible negative role of pre‐operative use of antitumour necrosis factor‐alpha (anti‐TNF‐α) agents on post‐operative outcomes in Crohns disease (CD) patients is still debated.

The incidence of ulcerative colitis (1995-2011) and Crohn's disease (1995-2012) — Based on nationwide Danish registry data

BACKGROUND AND AIMS The incidence of ulcerative colitis (UC) and Crohns disease (CD) has increased during the 20th century in North America and Western Europe. However, there are conflicting reports whether the incidence has declined, stabilized or even continued to increase. No nationwide Danish data on the incidence of UC and CD exist after 1992, and therefore we studied the incidence of UC (1995 through 2011) and CD (1995 through 2012). METHODS Based on data from the Danish National Patient Registry we identified patients recorded with a first time diagnosis of UC or CD in the study periods. Among these - patients were only included in the study as incident cases if they had at least one more discharge diagnosis of UC/CD or at least three subsequent outpatient visits. RESULTS We identified 17,500 patients with UC and 7863 patients with CD. The mean incidence rate for UC in 1995-1998 was 14.4 per 100,000 per year for women and 13.8 for men, increasing to 23.2 per 100,000 per year for women and 23.4 for men in the period of 2009-2011. The mean incidence rate for CD in 1995-1998 was 7.8 per 100,000 per year for women and 5.6 for men, increasing to 10.3 per 100,000 per year for women and 8.9 for men in the period of 2009-2012. CONCLUSIONS Based on nationwide Danish data from the last two decades, the incidence rates of UC and CD have continued to increase.

Co-opting Science: A preliminary study of how students invoke science in value-laden discussions

Letting students deliberate on socio-scientific issues is a tricky affair. It is yet unclear how to assess whether, or even support that, students weave science facts into value-laden socio-scientific deliberations without committing the naturalistic fallacy of deducing ‘ought’ from ‘is’. As a preliminary step, this study investigated how Danish upper secondary biology students actually interwove science facts and values in socio-scientific discussions. In particular, the focus was the argumentative effects of different ways of blurring the fact–value distinction. The data consisted of the transcriptions of three 45–60 minute discussions among 4–5 students about whether human gene therapy should be allowed. The data were analysed from a normative pragmatics perspective—with a focus on how the students designed and elicited messages to influence the decisions of others. It was found that the students regularly co-opted science to make it appear that their evaluative claims were more solidly supported than those of their opponents. Further, the students tended to co-opt science content so as to redefine what the issue or object of contention should be. The findings suggest that assessment of whether students properly used correct science facts in socio-scientific learning activities is very difficult. From the perspective of teachers, this means that much more work needs to be done in order to sort out how the fact–value distinction should be addressed appropriately. From the perspective of researchers, it means a continued negotiation of what they mean when they say that students should become able to use science on issues from outside science.

Genetic epidemiology of Scheuermann's disease

Background and purpose The genetic/environmental etiology of Scheuermanns disease is unclear. We estimated the heritability of the disease using an etiological model adjusted for sex and time of diagnosis, and examined whether the prevalence of Scheuermanns disease was constant over time. Methods 46,418 twins were sent a questionnaire about health and disease. Of these, 75% returned the questionnaire and 97% answered the question “Have you been diagnosed as having Scheuermanns disease by a doctor?” Results Responders included 11,436 complete pairs of twins. Data were analysed using classical twin modeling methods. Tetrachoric correlations were used to decide which etiological model to fit. The best-fitting model was the AE model. Heritability was 0.74 (95% CI: 0.65–0.81), while variance explained by environmental factors was 0.26 (95% CI: 0.19–0.35). A threshold of 2.1 (95% CI: 1.9–2.2) was calculated, corresponding to a prevalence of 1.9% (95% CI: 1.3–2.8) for women. Regression coefficients for age and sex were 0.000 (95% CI: –0.003 to 0.002) and –0.32 (95% CI: –0.42 to –0.23). Interpretation We found a heritability of 0.74 in Scheuermanns disease. The threshold in men was lower than in women, corresponding to a male prevalence that was almost twice that of females. We found no change in the prevalence of Scheuermanns disease throughout the 50-year age span that we examined.

Arguing from Nature: The role of 'nature' in students' argumentations on a socio-scientific issue

This paper explores how students invoked different conceptions of ‘nature’ in eight socio-scientific group discussions about human gene therapy. The paper illustrates and discusses how the students articulated nature and to what extent they elicited science factual content in the process. While the students in this study invoked nature at key places in a variety of dialectical contexts in the discussions, these invocations were often uncritical appeals and rarely involved science factual content. Even when an argument from nature was challenged, the author of that argument would often shift the sense of nature rather than elaborate upon the argumentation. It is argued that if students were properly introduced to the evaluative character of the term ‘nature’ it would not just be conducive to the quality of their argumentation, but also invite them to foreground science factual content at key places in their discussion.

The Effect of Disease Activity on Birth Outcomes in a Nationwide Cohort of Women with Moderate to Severe Inflammatory Bowel Disease

Background: Active inflammatory bowel disease (IBD) during conception and pregnancy may increase the risk of adverse birth outcomes. Former studies have examined heterogeneous groups of women with varying degrees of IBD severity. We aimed to examine the effect of active IBD on birth outcomes in a more homogeneous group of women with a moderate to severe disease course. Since in Denmark, moderate to severe IBD is an indication for use of anti-tumor necrosis factor-&agr; therapy, we examined all women who used anti-tumor necrosis factor therapy during pregnancy. Methods: We identified a nationwide cohort of 219 singleton pregnancies in women treated with anti-tumor necrosis factor-&agr; therapy during pregnancy (2005–2014). Pregnancies with clinical disease activity (65.8%) constituted the exposed cohort and pregnancies without disease activity constituted the unexposed (34.2%). Disease activity scores were supported by levels of fecal calprotectin. Outcomes included low birth weight, preterm birth, and congenital anomalies. Results: In women with IBD, disease activity was associated with adjusted odds ratio of low birth weight and preterm birth; 2.05 (95% confidence interval, 0.37–11.35) and 2.64 (95% confidence interval, 0.85–8.17), respectively. In those with clinical moderate to severe disease activity, the odds ratio for preterm birth was 3.60 (95% confidence interval, 1.14–11.36). In women with ulcerative colitis and disease activity, 19.5% had a child with low birth weight and 29.3% gave birth preterm. Conclusion: In women with moderate to severe IBD, 66% experienced disease activity during pregnancy. In those with the highest degree of disease activity, the risk of preterm birth was increased 3 to 4 folds. The proportion of adverse birth outcomes was high, particularly among women with ulcerative colitis and disease activity.