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Objective Danish departments of occupational medicine currently receive about 9,000 patients each year referred due to suspected work-related disorders. In Denmark and internationally there is a lack of follow-up studies investigating the long-term prognosis of employees with work-related disorders. The purpose of this cohort is to facilitate long-term prognostic studies.Methods The cohort was created through The Danish National Patient Register and comprises all patients seen in Danish Departments/units of Occupational Medicine from 2000–2018 (N= 145,390). Numerous register data are included in the database from five years prior to time of inclusion until 2018. Examples of register data are; information on work, sickness absence and disability as well as number and type of contacts to health services, hospital admissions, income, education, type of occupation, social status, death and cause of death. Job Exposure Matrices (JEMs) on physical and psychosocial work exposure, life styles and other matrices are also available. The cohort will be updated with new patients regularly.Results Currently the cohort comprises seven major groups: musculoskeletal (n=51.056), mental health (n=28.212), lung (N=12.274), skin (N=6.544), nervous system (N=5.513), cancer (N=1.566), and others (n=40.225). Preliminary analyses across groups suggest that the labor market attachment has been high among the majority (about 75%) of patients during the years prior to the year of inclusion. However, results indicate that the main diagnostic groups, with the exception of skin patients, do not return to comparable levels of labor market attachment during the years following referral and diagnosis.Conclusions The Danish Occupational Medicine Cohort is an open source dataset available to researchers interested in long-term follow-up on patients with work-related disorders. Preliminary analyses indicate most diagnostic groups do not return to prior levels of labor market attachment during the years following referral and diagnosis from a department of occupational medicine.

Introduction The health care system of Denmark is currently undergoing major centralizations. Relocation of workplaces as well as mergers and split-ups may impact both health and productivity among employees and managers. The unification of all hospital units in Aarhus, Denmark, poses an opportunity to study the short- and long-term consequences of different degrees of organizational change during a fixed event.Objectives The primary aims are to: 1) investigate the consequences of major organizational changes on absenteeism and mental health of employees and workplace productivity and staff turnover, and 2) identify risk factors for negative consequences on mental health, sickness absence, productivity, and staff turnover, in order to identify risk groups for targeted prevention.Methods Using national and regional registers we will establish a cohort of 10,000 individuals employed at Aarhus University Hospital in the period from 2011–2020. Hospital units moving at different time points through 2016–2019 will be aligned on the index date defined by their relocation and followed up to 5 years after and prior to this.Results Based on the life event literature we expect to find a delayed effect of major organisational change on sickness absence and mental health, and an immediate effect on staff turnover and productivity. We hypothesize these effects as more pronounced for units which in addition to relocating also merge/split, representing greater organisational change. We also expect to identify risk factors for the chosen outcomes based on job titles, age, seniority, and work unit characteristics such as number of employees, patient centred vs. service/administrative, and out-patient vs. in-patient wards.Conclusion This project is expected to produce valuable knowledge about the mental health and/or economic consequences of major organizational changes in the health care system. This can inform preventive actions targeting specific employee groups in future centralization projects.

Objective Little is known about the long-term prognosis for employees with suspected work-related mental health problems. Are they employed 5 years after consulting a department of occupational medicine in Denmark, or do they have no or low labor-market attachment? The aim of the study was to examine long-term employment status among patients referred to Danish departments of occupational medicine in the period 2000–2013 due to suspected work-related mental health problems.Methods The study includes data from the Danish Occupational Medicine Cohort. 17,900 patients aged 16–67 were included. All patients were referred to a department of occupational medicine in Denmark from 2000–2013 due to suspected work-related mental health problems. Register data was extracted 5 years prior to study inclusion and until 5 years after study inclusion. Information on 13 potential risk factors for negative labor market attachment was included. The primary outcome of this study was positive work status, defined as being at work or at education, maternity or parental leave.Results Preliminary results showed that approximately 85% of all patients from 2–5 years prior to study inclusion had positive work status. The proportion declined to 30% at the year of study inclusion and increased to approximately 50% of the patients 1 year after inclusion after which practically no further increase was seen. Within the subgroups of patients diagnosed with depression or PTSD only 40% and 30% had positive work status 5 years after study inclusion respectively. Besides, preliminary results indicated that diagnosis, sick leave status at inclusion time and previous work participation, were strong independent prognostic markers of work participation at 5-years of follow up.Conclusion We found a profoundly reduced long-term employment status among patients referred to departments of occupational medicine in Denmark due to suspected work-related mental health problems, particularly among patients diagnosed with PTSD or depression. AbstractObjective Little is known about the long-term prognosis for employees with suspected work-related mental health problems. Are they employed 5 years after consulting a department of occupational medicine in Denmark, or do they have no or low labor-market attachment? The aim of the study was to examine long-term employment status among patients referred to Danish departments of occupational medicine in the period 2000–2013 due to suspected work-related mental health problems.Methods The study includes data from the Danish Occupational Medicine Cohort. 17,900 patients aged 16–67 were included. All patients were referred to a department of occupational medicine in Denmark from 2000–2013 due to suspected work-related mental health problems. Register data was extracted 5 years prior to study inclusion and until 5 years after study inclusion. Information on 13 potential risk factors for negative labor market attachment was included. The primary outcome of this study was positive work status, defined as being at work or at education, maternity or parental leave.Results Preliminary results showed that approximately 85% of all patients from 2–5 years prior to study inclusion had positive work status. The proportion declined to 30% at the year of study inclusion and increased to approximately 50% of the patients 1 year after inclusion after which practically no further increase was seen. Within the subgroups of patients diagnosed with depression or PTSD only 40% and 30% had positive work status 5 years after study inclusion respectively. Besides, preliminary results indicated that diagnosis, sick leave status at inclusion time and previous work participation, were strong independent prognostic markers of work participation at 5-years of follow up.Conclusion We found a profoundly reduced long-term employment status among patients referred to departments of occupational medicine in Denmark due to suspected work-related mental health problems, particularly among patients diagnosed with PTSD or depression.

Objective The long-term prognosis for employees with work-related stress, depression or PTSD is unclear. We aim to investigate if these conditions represent a temporary setback or a decline towards long-term poor health.Methods From the Danish Occupational Medicine Cohort we included patients referred 2000–2012 with mental disorders (N=17.900) to Departments of Occupational Medicine across Denmark. From nation-wide registries we obtained data on general health care service utilization (GP contacts) and specialized mental health care (incident private practice psychiatrist/psychologist care and psychiatric hospital care) for five years after/before the index-date of referral. Results are presented as utilization 5 years before referral (index-year -5), the year on either side of referral (index-year -1 and +1) and five years after referral (index-year +5).Results General health care utilization increased from 7 median GP contacts in index-year -5 rising sharply to 12 in index-year -1 and 10 in index-year +1, then declining gradually to 8 in index-year +5. Incident private practice psychiatrist/psychologist care was 4.5% among patients in index-year -5 rising to 13.6% in index-year -1, 19.8% in index-year +1, declining to 7.4% in index-year +5. Incident psychiatric hospital care was 1.4% in index-year -5 rising to 5.6% in index-year -1, 8.6% in index-year +1, then declining to 4.7% in index-year +5.Conclusions General health care utilization was elevated in the years surrounding referral, then declined to levels comparable to five years prior to referral. From a relatively low incidence, mental health care utilization increased 4–6 fold in the years around referral, then declined to levels 2–3 fold higher than five years before referral. This could indicate that work-related mental disorders represent a temporary setback for most patients, but for some becomes a decline towards long-term poor mental health. Further analyses will seek to identify at-risk groups from demographic, occupational and health-related prognostic factors.

Purpose To examine the importance of estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER-2), and constructed subtypes in a large study randomly assigning patients to receive or not receive postmastectomy radiotherapy (PMRT). Patients and Methods The present analysis included 1,000 of the 3,083 high-risk breast cancer patients randomly assigned to PMRT in the Danish Breast Cancer Cooperative Group (DBCG) protocol 82 trials b and c. Tissue microarray sections were stained for ER, PgR, and HER-2. Median follow-up time for patients alive was 17 years. End points were locoregional recurrence as isolated first event, distant metastases, and overall survival. For statistical analyses four subgroups were constructed from hormonal receptors (Rec). Rec+ was defined as ER+ and/or PgR+. Rec–as both ER–and PgR–. The four subgroups were Rec+/HER-2–, Rec+/HER-2+, Rec–/HER-2–(triple negative), and Rec–/HER-2+. Results A significantly improved overall survival after PMRT was seen only among patients characterized by good prognostic markers such as hormonal receptor–positive and HER-2− patients (including the two Rec+ subtypes). No significant overall survival improvement after PMRT was found among patients with an a priori poor prognosis, the hormonal receptor–negative and HER-2+ patients, and in particular the Rec–/HER-2+ subtype. Furthermore, comparing hazard ratios and 95% CIs, significantly smaller improvements in locoregional recurrence control after PMRT were found for ER–and PgR–tumors compared with the ER+ and PgR+ tumors (P = .003 and .04, respectively), and for the triple-negative (P = .02), and the Rec–/HER-2+ subtypes (P = .003) compared with the Rec+/HER-2–subtype. Conclusion Hormonal receptor status, HER-2, and the constructed subtypes may be predictive of locoregional recurrence and survival after postmastectomy radiotherapy.

Udgivelsesdato: 2008-null INTRODUCTION: A significant survival improvement after postmastectomy radiotherapy was identified in the Danish Breast Cancer Cooperative Group (DBCG82) b and c studies and in the British Columbia Randomized Radiation Trial. Recently, potential predictive value regarding response to postmastectomy radiotherapy was reported for carbonic anhydrase (CA) IX in a study (reported in abstract form) that included 160 patients. The purpose of the present study was to examine the importance of CA IX to response to postmastectomy radiotherapy in the larger scaled DBCG82 b and c studies. METHODS: The DBCG82 b and c studies included 3,083 high-risk Danish breast cancer patients. The women were randomly assigned to postmastectomy radiotherapy plus systemic therapy (cyclophosfamide, methotrexate and fluorouracil in premenopausal women; and tamoxifen in postmenopausal women) or to systemic therapy alone. Cores from invasive tumour-containing paraffin blocks from 1,000 patients (more than seven nodes surgically removed) were transferred to tissue microarrays. Tissue microarray sections were stained immunohistochemically for CA IX (M75). The median follow up for patients remaining alive was 17 years. Clinical end-points were loco-regional recurrence, distant metastases, disease-specific survival and overall survival. Statistical analyses included kappa statistics, chi2 or exact tests, Kaplan-Meier probability plots, Log-rank test and Cox regression analyses. RESULTS: CA IX was assessable in 945 cores. The percentage of tumours positive for CA IX was 16% (> or = 10% invasive tumour staining). CA IX was not an independent prognostic marker for survival, distant metastases, or locoregional recurrence in the subgroup of 945 patients or within either of the two randomization arms. In subgroup analyses, however, CA IX was an independent prognostic marker for overall survival among postmenopausal women (P = 0.001), women with one to three positive nodes (P = 0.02) and hormone receptor positive women (P = 0.001). Fifteen-year probabilities of overall survival were improved by 9% and 7% after postmastectomy radiotherapy for the subgroups of CA IX negative and CA IX positive patients, respectively. CONCLUSION: Within this series of 945 high-risk premenopausal and postmenopausal women, positivity for CA IX was not overall an independent prognostic marker for survival; only in subgroup analyses was it found to have prognostic value. The improvement in 15-year survival after postmastectomy radiotherapy was of similar magnitude in the two subgroups of CA IX positive and CA IX negative patients.