Abstract:
:The overall aim of this thesis was to validate the new concept of the Fertility Assessment and Counselling (FAC) Clinic at Rigshospitalet. The intention was to: explore the prognostic value of fertility risk factors by a risk score and provide an estimate of female fecundity, to quantify the impact of oral contraception (OC) on ovarian reserve parameters defined as Anti Müllerian Hormone (AMH), Antral Follicle Count (AFC) and ovarian volume, and to gain knowledge of attitudes and considerations toward family formation in women of advanced age. The thesis is based on the following four manuscripts: Manuscript I describes the predictive value of individual fertility assessment and counselling in terms of subsequent time to pregnancy within two years after the initial consultation at the FAC Clinic. The follow up study comprised 519 women, of which 352 had tried to conceive. At the time of follow-up, 259/352 had achieved a pregnancy, 74/352 were still trying and 19/352 had given up. The remaining 167 women had no attempts to conceive. The risk assessment provided a score based on the appearance of fertility risk factors: green (low), yellow (low), orange (medium) and red (high). Two-thirds of the women with only low risk scores conceived spontaneously within 12 months (65%), while this figure was only 32% for women with at least one high risk score (n=82). Accordingly, presence of at least one high risk score reduced the odds of achieving a pregnancy within 12 months by 73% (OR 0.27, 95%CI 0.13-0.57). The FAC Clinic concept seems as a usable tool for fertility experts to guide women on how to fulfil their reproductive life-plan, but longer follow-up studies are needed. Manuscript II describes the impact of OC on ovarian reserve parameters in 887 women at the FAC Clinic. Of the 887 women, 244 (27.5%) used OC. The 244 users of OC were significantly younger than non-users with a mean age of 31.5 (SD 4.3) vs. 34.1 (SD 4.3) years (p < 0.001). Overall, there was no difference between the two groups in relation to bodyweight, BMI, smoking habits, gestational age at birth, prenatal exposure to maternal smoking or maternal age at menopause. In linear regression analyses adjusted for age, ovarian volume was 50% lower, AMH was 19% lower, and AFC was 18% lower in OC-users compared to non-users. Among the OC users there was a significant decrease in antral follicles sized 5-7 and 8-10 mm and an increase in the number of small follicles sized 2-4 mm. Physicians have to be aware of the impact of OC use on ovarian reserve parameters and possible concealment of premature ovarian insufficiency, when assessing the fertility status and estimating the reproductive lifespan in OC users. Manuscript III describes the family intentions and personal considerations on postponing childbearing in 340 childless women of advanced age. The study comprised 140 cohabiting and 200 single women aged 35-43 seeking fertility assessment and counselling at the FAC Clinic. The majority (82%) was well-educated and in employment. Despite their mean age of 37.4 years, the main reasons for attending the FAC Clinic were to gain knowledge on the possibility of postponing pregnancy (63%) and due to a concern about their fecundity (52%). Both the cohabiting and single women expressed a wish for two or more children (60%). The most important benefits were "personal development" (89%) and "to give and receive love" (86%). The main concerns about childbearing were "less time to myself" (82%) and "less time to job and career" (76%). The single women were more positive regarding the use of donor sperm (70%) compared to the cohabiting women (25%). Our results indicated a general overestimation of the women´s own reproductive capacity and an underestimation of their risk of future infertility and childlessness with continuous postponement of pregnancies. Manuscript IV describes attitudes toward family formation in ten single and ten cohabiting childless women of advanced age. The women were interviewed one week before their consultation at the FAC Clinic about their family formation intentions, considerations and concerns. The interviews were analysed and condensed into four categories: ''The biological clock'', ''The difficult choice'', ''The dream of the nuclear family'', and ''Mother without a father''. The categories were condensed into two subthemes; `Fear´ and `Expectations´ and gathered into one main theme 'The conflict of choosing', which reflected the women's attitudes toward family formation prior to individual fertility counselling. The women attended the FAC Clinic due to a concern about their fecundity and a fear for infertility. Overall, the women expressed a dream of the nuclear family and finding "Mr. Right" and many with the wish of buying more time. Both groups would consider solo motherhood due to their advanced age, although it was considered to be Plan B, as it was not "natural".
journal_name
Dan Med Jjournal_title
Danish medical journalauthors
Petersen KBsubject
Has Abstractpub_date
2016-10-01 00:00:00issue
10issn
2245-1919pii
B5292journal_volume
63pub_type
杂志文章,评审abstract:INTRODUCTION:This prospective cohort study in consecutive shoulder patients sought to determine the minimal, clinically important difference of the Danish version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and to evaluate patient responsiveness to it. The study was undertaken at the Outpatie...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2014-04-01 00:00:00
abstract:INTRODUCTION:Clinical practice does not reflect current clinical guidelines recommending an early multimodal non-surgical treatment for knee and hip osteoarthritis (OA). The purpose of this study was to examine the feasibility of such an initiative (Good Life with osteoArthritis in Denmark (GLA:D) in persons with mild ...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2012-12-01 00:00:00
abstract:INTRODUCTION:The aim of the study is to identify how disease management programmes for patients with a chronic disease work. This issue is explored from the patients' perspective. Specifically, we study how transition and coordination are related to the patient's perception of quality of care, with a particular focus o...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2016-03-01 00:00:00
abstract:INTRODUCTION:Adjuvant treatment of early-stage breast cancer has been associated with bone loss in randomised trials, but evidence from unselected populations is needed. In a single-center study, we assessed the annual percentage change in bone mineral density (∆BMDt) and risk of osteoporosis from two to five years aft...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2020-10-20 00:00:00
abstract:INTRODUCTION:Fine-needle aspiration biopsy (FNAB) is the cornerstone of thyroid nodule evaluation. In most cases, FNAB can discriminate between benign and malignant disease. In other cases, it is only indicative of malignancy and the results are considered "suspicious". In Denmark, thyroid FNAB results are categorised ...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2017-02-01 00:00:00
abstract:INTRODUCTION:Superficial CNS siderosis was previously almost unknown but is now diagnosed with increasing frequency owing to magnetic resonance imaging. Patients may present with sensory deafness, gait ataxia, various sensorimotor signs and, eventually, cognitive decline. They typically have a history of traumatic brai...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2015-05-01 00:00:00
abstract:INTRODUCTION:The widespread use of computed tomography (CT) improves detection of pulmonary lesions, which are not only detected at an increased rate but also at a smaller size. CT-guided lung biopsies are now more frequently used than fluoroscopy-guided lung biopsies. The main aim of the present paper was to investiga...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2016-06-01 00:00:00
abstract::Difficulties with airway management in relation to general anaesthesia have been a challenge for the anaesthesiologist since the birth of anaesthesia. Massive landmark improvements have been made and general anaesthesia is now regarded as a safe procedure. However, rare, difficult airway management still occurs and it...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2016-05-01 00:00:00
abstract::Strategies to reduce the burden of blood pressure attributable diseases require knowledge of secular trend in PBP and its determinants. The issues were investigated in the Copenhagen City Heart Study. The design of CCHS is a repeated measures study. Such designs are uniquely suited to studying changes of an outcome an...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2017-03-01 00:00:00
abstract:INTRODUCTION:Patients' non-attendance is a significant problem in modern healthcare. Non-attendance delays treatment, reduces efficiency and increases healthcare costs. For several years, the introduction of financial incentives such as a non-attendance fee has been discussed in Denmark. Set in the context of a tax-fin...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2016-07-01 00:00:00
abstract:INTRODUCTION:Severely painful or dysfunctional destroyed wrists can be reconstructed by fusion, interposition of soft-tissue or by arthroplasty using artificial materials. Total and partial wrist arthroplasty (T/PWA) has been used on a regular basis since the 1960's. The objective of this study was to review the litera...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2014-05-01 00:00:00
abstract:INTRODUCTION:(99m)Tc-pertechnetate scintigraphy is much used in the evaluation of patients with nodular goitre. We investigated the ability of experienced observers to estimate the thyroid 24-h (131)I uptake (RAIU) and the thyroid volume by visual evaluation of the scintigram. MATERIAL AND METHODS:Two endocrinologists...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2014-02-01 00:00:00
abstract:INTRODUCTION:The treatment strategy for appendiceal mass is controversial, ranging from operation or image-guided drainage to conservative treatment with or without antibiotics. The aim of this study was to assess the various treatment modalities with respect to complications and treatment failure. METHODS:The analysi...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2014-08-01 00:00:00
abstract:INTRODUCTION:Patients with bronchiectasis suffer from breathlessness, cough and sputum production, which impairs quality of life. The Bronchiectasis Health Questionnaire (BHQ), a short and disease-specific questionnaire, has previously been developed and validated in English. The aim of this study was to translate and ...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2020-03-01 00:00:00
abstract:INTRODUCTION:The health authorities have recommended that face-to-face consultations be substituted by telephone consultations to reduce the risk of virus transmission in out-patient clinics during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the present study was to assess the frequency of such telepho...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2020-06-23 00:00:00
abstract:INTRODUCTION:The aim of this study was to examine the use of quantitative fluorescein angiographic analysis as a means of estimating rates of perfusion of the retina in eyes with a circulatory deficit secondary to carotid artery stenosis. MATERIAL AND METHODS:The study included 21 eyes with ocular ischaemic syndrome (...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2013-10-01 00:00:00
abstract::Excessive health anxiety, still designated as hypochondriasis in ICD-10, refers to worries and anxiety about harbouring serious illness. It is common in both primary and secondary health care with prevalence rates up to 9% and causes great suffering for the individual as well as high health care costs when untreated. ...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2017-05-01 00:00:00
abstract::Critically ill acute high-risk abdominal surgery patients represent a major challenge to health care providers, with the typical patient being elderly and frail, and with severe and multiple comorbidities. The mortality rate in this population is high, and the postoperative course is characterized by complications, pr...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2018-02-01 00:00:00
abstract:INTRODUCTION:This is a systematic review of existing literature on the diagnostic modalities and treatment of traumatic abdominal wall hernia caused by bicycle handlebar injury in children. METHODS: A systematic literature search was conducted covering incidents involving children below 17 years of age. Data were extr...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2018-01-01 00:00:00
abstract:INTRODUCTION:In Copenhagen, Denmark, patients in need of prehospital emergency assistance dial 112 and may then receive evaluation and treatment by physicians (from the Mobile Emergency Care Unit (MECU)). ST-elevation myocardial infarction (STEMI) is a severe condition leaving only a limited time frame to deliver optim...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2012-04-01 00:00:00
abstract:INTRODUCTION:A routine follow-up urine sample (FUS) in the form of a midstream urine sample (MSU) is recommended after treatment for urinary tract infection (UTI) according to the Danish Paediatric Society (DPS) and "Lægehåndbogen" published by Danish Regions. We studied the effect of FUS with a focus on patients witho...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2015-01-01 00:00:00
abstract:INTRODUCTION:The Lewinnek and Callanan "safe zones" have been widely used to minimise the dislocation fre-quency in total hip arthroplasty (THA), but recent studies have questioned the association between "safe zones" and lower dislocation rates. The purpose of this study was to investigate: 1) if hip surgeons agree on...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2017-04-01 00:00:00
abstract:INTRODUCTION:Despite rehabilitation programmes offered to all patients with newly diagnosed type 2 diabetes in Denmark, a number of patients either never accomplish good diabetes regulation or the regulation deteriorates with time. Therefore, new approaches are needed. The aim of the present study is to examine whether...
journal_title:Danish medical journal
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2013-12-01 00:00:00
abstract::Hip dysplasia and hip joint deformities in general are recognized as possible precursors of osteoarthritic development. Early and correct identification of hip dysplasia is important in order to offer timely joint preserving treatment. In the contemporary literature, several controversies exist, and some of these were...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2012-06-01 00:00:00
abstract::The epidemiology and prognosis of ''fainting'' or syncope has puzzled physicians over the years. Is fainting dangerous? This is a question often asked by the patient--and the answer is ''it depends on a lot of things''. The diverse pathophysiology of syncope and the underlying comorbidites of the patients play an esse...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2013-09-01 00:00:00
abstract:INTRODUCTION:Age and comorbidity are associated with length of stay (LOS) and mortality. Our aim was to compare acutely ill elderly medical patients in geriatric care with general medical care, and to examine the effects of comprehensive geriatric assessment (CGA). MATERIAL AND METHODS:In an observational study, we us...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2012-06-01 00:00:00
abstract:INTRODUCTION:The prevalence of children and adolescents with overweight and obesity has tripled over the past 30 years. One in five children in Denmark is overweight, a condition which is accompanied by serious medical and psychosocial complications. So far, an overview of the Danish treatment of childhood overweight a...
journal_title:Danish medical journal
pub_type: 杂志文章,多中心研究
doi:
更新日期:2016-09-01 00:00:00
abstract::Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by pain, swelling and progressive destruction of the joints leading to loss of function and invalidity. The bone destruction in RA is characterised by two distinct features: structural joint damage and hand bone loss, and their prevention is an im...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2018-03-01 00:00:00
abstract:INTRODUCTION:Abdominal auscultation is a part of the clinical examination of patients, but the determining factors in bowel sound evaluation are poorly described. The aim of this study was to assess inter- and intra-observer agreement in physicians' evaluation of pitch, intensity and quantity in abdominal auscultation....
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2013-05-01 00:00:00
abstract:INTRODUCTION:The objective was to search the literature with a view to providing a general description of critical illness myopathy/polyneuropathy (CIM/CIP), including its genesis and prevention. Furthermore, it was our aim to determine whether new treatments have occurred in the past five years. MATERIAL AND METHODS:...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2012-10-01 00:00:00