Cost of disorders of the brain in Denmark

The cost of brain disorders in Denmark is unknown and such information is important to decision makers. The aims of the study were to estimate the total number of subjects with brain diseases, and the associated direct and indirect expenses in Denmark. This was part of a larger pan-European study commissioned by the European Brain Council, which is an international collaboration of organizations within psychiatry, neurology, neurosurgery, neuro-research and patient organizations. The project provided the best possible estimates of the expenses for brain diseases based on available international scientific literature. The present study presents results for Denmark. There were an estimated 1.4 million Danish citizens who in 2004 had one of the selected 12 brain diseases, equivalent to one quarter of the total population. Anxiety disorders and migraine were the two most frequent diseases with 500,000 and 340,000 patients, respectively. The total expenses for all selected brain diseases were 37.3 billion DKR. Affective disorders, dependency, dementia and stroke were the most costly diseases. An estimated 12% of all direct costs in the Danish health system were spent on brain diseases; 9% of the total drug consumption was used for treatment of brain diseases. Expenses to brain diseases constituted 3% of the gross domestic product. Brain disorders are very prevalent in Denmark and they cause high societal and personal cost.     

Resource allocation to brain research in Denmark: an example for other European countries

This study represents a first attempt at estimating Danish resource allocation to brain research including both public and private spending. It appears that private spending is at a reasonable level because a highly developed Danish pharmaceutical industry invests significantly in this branch of science. However, public spending is at a low level compared with several other European countries with a similar economic status. As for other European countries the funding is very low compared with the USA. Dedicated national investigations of the resource allocation to different branches of biomedical research are warranted. Brain research should of course be an important part of such studies. The USA and the European Union have selected brain research as one of their priority areas within health-related research. The present figures indicate that this is highly justified and should be copied in Denmark and in all other European countries.     

The Feasibility of Cognitive Adaptation Training for Outpatients with Schizophrenia in Integrated Treatment

Cognitive adaptation training (CAT) has been tested as a psychosocial treatment, showing promising results. To date there are no reported tests of CAT treatment outside the United States. Thus, we decided to adjust CAT treatment and apply it to an Integrated Treatment setting in Denmark. In this article we describe and discuss the feasibility of using CAT treatment in a randomized clinical trial in Denmark. The treatment period was shorter and the patients were instructed in prompting for specific actions by using newer tools such as schedules in their mobile phones. Social functioning, symptoms and quality of life were assessed using instruments validated in a Danish context. It was judged that, after some adjustments to fit the Danish assertive community treatment, CAT treatment was feasible in a Danish setting.     

The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: Evidentiary Tables

A variety of technologies have been developed to assist decision-making during the management of patients with acute brain injury who require intensive care. A large body of research has been generated describing these various technologies. The Neurocritical Care Society (NCS) in collaboration with the European Society of Intensive Care Medicine (ESICM), the Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC) organized an international, multidisciplinary consensus conference to perform a systematic review of the published literature to help develop evidence-based practice recommendations on bedside physiologic monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews on physiologic processes important in the care of acute brain injury. In this article we provide the evidentiary tables for select topics including systemic hemodynamics, intracranial pressure, brain and systemic oxygenation, EEG, brain metabolism, biomarkers, processes of care and monitoring in emerging economies to provide the clinician ready access to evidence that supports recommendations about neuromonitoring.     

Is schizophrenia really on the decrease?

Summary Directly age standardized rates of first admission schizophrenia in Denmark (1991: 5.1 million inhabitants) decreased significantly with a slope of –0.16 and –0.13/100,000 inhabitants fifteen years and above for males and females respectively from 1971 to 1991 when examined by help of the Danish nation-wide psychiatric case register in the Institute of Psychiatric Demography, Aarhus. A control for changes in diagnostic delay/changing diagnostic patterns does not affect the findings. Various nosological factors might cause the decrease, e.g. changing structure in organization of treatment facilities, decreasing number of beds (50% in Denmark during the period investigated) and correlated with this: increasing suicide rates among pretreatment schizophrenics, increasing rates of schizophrenics not yet diagnosed in shelters for homeless and in institutions for criminals. The decrease might be genuine. In connection with this the theories about damage to the fetus during the gestation period are briefly discussed.     

Urbanicity during upbringing and bipolar affective disorders in Denmark

BACKGROUND: It has been suggested that known or suspected risk factors for schizophrenia may also be of importance for other psychoses, but the empirical evidence regarding this is limited. Urbanicity of place of birth and during upbringing has been shown to be related to the risk of schizophrenia. Few studies of urbanicity in relation to bipolar affective disorder exist. OBJECTIVE: To investigate the potential association between urbanicity at birth and during upbringing and the risk of bipolar affective disorder. METHOD: Using data from the Danish Civil Registration System, we established a population-based cohort of 2.04 million people born in Denmark during 1956-1986, which included information on place of residence during upbringing. Bipolar affective disorder in cohort members was identified by linkage with the Danish Psychiatric Central Register. RESULTS: Overall, 2232 people developed bipolar affective disorder during 1971-2001. We found evidence of an increased risk associated with residence in the provincial city; individuals, who at the 15th birthday lived in the provincial city, had a risk of 1.23 (1.08-1.41). This increased risk was explained solely by an increased risk associated with residence in Aarhus; at the 15th birthday, people residing in Aarhus - the largest of the three Danish provincial cities - had a 1.83 (1.56-2.14) increased risk of bipolar affective disorder (p < 0.001). Urbanicity during upbringing (p = 0.13) had no significant effects on the risk of bipolar affective disorder. CONCLUSIONS: We found no evidence of a dose-response relationship between urbanicity at birth (and during upbringing) and the risk of bipolar affective disorders in Denmark, but found some evidence that the diagnostic practices used in Aarhus differed from the rest of Denmark.     

Cost estimates of brain disorders in Belgium

This article presents the data on cost of the major brain disorders in Belgium which were retrieved from "Cost of Disorders of the Brain in Europe" study sponsored by the European Brain Council and performed by Stockholm Health Economics. The disorders selected were: addiction, depression, anxiety disorders, brain tumours, dementia, epilepsy, migraine and other headaches, multiple sclerosis, Parkinson's disease, psychotic disorders, stroke and trauma. Figures for prevalence of disorders and direct medical, direct non-medical and indirect costs are based on data coming from available electronic data bases, or when missing for Belgium, best possible estimates or extrapolated data were used. All economic data were transformed to Euro's for 2004 and adjusted for purchasing power parity (PPP). The results show that the total number of people with any brain disorder in Belgium amounts to 2.9 million in 2004, the most prevalent being anxiety disorders 1.1 million, migraine 860000, addiction (any) 800,000 and depression 500,000 cases. The total cost of all included brain disorders in Belgium was estimated at 10.6 billion Euros. Most costly per case are brain tumours, multiple sclerosis, stroke and dementia. Because of their higher prevalence, however depression, dementia, addiction, anxiety disorders and migraine have the highest total costs. Taken together brain disorders consume 4% of the gross national product and cost each citizen of Belgium 1029 Euros per year. The drug costs for brain disorders constitute only 10% of the total drug market in Belgium, and only 4% of the total cost of brain disorders in Belgium. This should be compared to the cost estimates and to a previous study which showed that brain disorders are responsible for 35% of the total burden of all disorders in Europe. This study suggests therefore that the direct healthcare resources, including expenses for drug therapies, allocated to brain disorders in Belgium are not leveled to the indirect costs and burden of these disorders. A comparison with data available from a direct prospective study in demented Belgian patients suggests that the mathematical estimates presented here reflect quite accurately the real average cost for dementia, although there are large variations depending on disease severity. As, in addition, subjects with brain disorders face collateral costs which have not been taken into associations, a complementary survey in the Belgian ecosystem to establish the cost profile of representative patients for the major brain disorders. Such a survey is being organized by a task force of the Belgian Brain Council.     

Therapeutic potential of brain stimulation techniques in the treatment of mental,psychiatric, and cognitive disorders

Treatment for brain diseases has been disappointing because available medications have failed to produce clinical response across all the patients. Many patients either do not respond or show partial and inconsistent effect, and even in patients who respond to the medications have high relapse rates. Brain stimulation has been seen as an alternative and effective remedy. As a result, brain stimulation has become one of the most valuable therapeutic tools for combating against brain diseases. In last decade, studies with the application of brain stimulation techniques not only have grown exponentially but also have expanded to wide range of brain disorders. Brain stimulation involves passing electric currents into the cortical and subcortical area brain cells with the use of noninvasive as well as invasive methods to amend brain functions. Over time, technological advancements have evolved into the development of precise devices; however, at present, most used noninvasive techniques are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), whereas the most common invasive technique is deep brain stimulation (DBS). In the current review, we will provide an overview of the potential of noninvasive (rTMS and tDCS) and invasive (DBS) brain stimulation techniques focusing on the treatment of mental, psychiatric, and cognitive disorders.     

Matching Spatial with Ontological Brain Regions using Java Tools for Visualization, Database Access, and Integrated Data Analysis

Brain atlases are widely used in experimental neuroscience as tools for locating and targeting specific brain structures. Delineated structures in a given atlas, however, are often difficult to interpret and to interface with database systems that supply additional information using hierarchically organized vocabularies (ontologies). Here we discuss the concept of volume-to-ontology mapping in the context of macroscopical brain structures. We present Java tools with which we have implemented this concept for retrieval of mapping and connectivity data on the macaque brain from the CoCoMac database in connection with an electronic version of “The Rhesus Monkey Brain in Stereotaxic Coordinates” authored by George Paxinos and colleagues. The software, including our manually drawn monkey brain template, can be downloaded freely under the GNU General Public License. It adds value to the printed atlas and has a wider (neuro-)informatics application since it can read appropriately annotated data from delineated sections of other species and organs, and turn them into 3D registered stacks. The tools provide additional features, including visualization and analysis of connectivity data, volume and centre-of-mass estimates, and graphical manipulation of entire structures, which are potentially useful for a range of research and teaching applications.     

Patterns of culture & power after ‘The Great Release’: the history of movements of subculture & empowerment among Danish people with learning difficulties

• • This article tells us about the history of self‐advocacy in Denmark.
• • It also gives some information about how services for people with learning difficulties in Denmark have changed over the past 100 years.
• • In this article, I talk about ‘movements’ of self‐advocacy, which means the different types of self‐advocacy groups that have grown in Denmark.
• • I also describe how these movements have developed in ‘generations’. Like families, I say that self‐advocacy goes through ‘generations’ where it has to change because the world around it is changing. Sometimes, self‐advocacy groups have helped to make these big changes.
• • I use theory in this article to help explain some of the very complicated developments that self‐advocacy groups in Denmark have been through during their history.

     

Changing brain connectivity dynamics: From early childhood to adulthood

Brain maturation through adolescence has been the topic of recent studies. Previous works have evaluated changes in morphometry and also changes in functional connectivity. However, most resting‐state fMRI studies have focused on static connectivity. Here we examine the relationship between age/maturity and the dynamics of brain functional connectivity. Utilizing a resting fMRI dataset comprised 421 subjects ages 3–22 from the PING study, we first performed group ICA to extract independent components and their time courses. Next, dynamic functional network connectivity (dFNC) was calculated via a sliding window followed by clustering of connectivity patterns into 5 states. Finally, we evaluated the relationship between age and the amount of time each participant spent in each state as well as the transitions among different states. Results showed that older participants tend to spend more time in states which reflect overall stronger connectivity patterns throughout the brain. In addition, the relationship between age and state transition is symmetric. This can mean individuals change functional connectivity through time within a specific set of states. On the whole, results indicated that dynamic functional connectivity is an important factor to consider when examining brain development across childhood.     

Electroconvulsive therapy in the Nordic countries, 1977-1987.

In 1977 a questionnaire was sent to all psychiatric departments in the Nordic countries: Sweden, Norway, Denmark, Finland and Iceland, concerning indications for electroconvulsive therapy (ECT) and the use of unilateral and bilateral treatment, respectively. The inquiry was repeated in 1987 and the answers compared with those obtained in 1977. In addition, the answers from Denmark were compared with previously performed inquiries. The use of exclusively unilateral treatment (U) and of both unilateral and bilateral treatment (UB) has increased in most of the countries and exclusively bilateral treatment (B) has decreased drastically. In Denmark the situation has not changed for ECT in endogenous depression and acute delirium, and the use in reactive psychosis, mania and schizophrenia decreased somewhat during the 1970s and then again stabilized or increased during the 1980s. Nearly all departments in the Nordic countries used ECT in endogenous depression in 1977 and were still doing it in 1987. In mania, about 50% of all departments have found ECT indicated occasionally or exceptionally both in 1977 and 1987. Manic-depressive mixed states have been regarded as an indication in somewhat more than two thirds of departments, increasing during the period. The use of ECT in schizophrenia has been rare and somewhat decreasing, but still about half of the departments apply it once in a while. In reactive psychosis the use of ECT decreased slightly, but in 1987 it was still in use for this indication in about 50% of all departments. In acute delirium there has been an overall increase in the use of ECT.(ABSTRACT TRUNCATED AT 250 WORDS)     

The schizophrenic patient in the somatic hospital

OBJECTIVE: There is an increased risk in schizophrenia for premature death from illnesses in almost all organic systems. The present study analyses the Rate Ratio (RR) for schizophrenic patients' admissions to somatic departments in Denmark. METHOD: 20000 schizophrenic patients were identified in the Danish Psychiatric Central Register and 200000 sex- and age-matched controls were identified in the Danish Central Person Register. Both groups were searched for in the Danish National Patient Register in which admissions to all somatic departments are registered. Pulmonary and cardiovascular diseases are used as examples. RESULTS: RR is increased for several diseases, especially infectious, up to a maximum of RR = 4.15 for severe heart failures and decreased to as low as RR = 0.35 for atherosclerotic diseases of the brain vessels. CONCLUSION: It seems that individuals with schizophrenia are rarely treated for their physical illness in its early, less severe phases, but more likely in its acute phases when the disease is severe, life-threatening or painful.     

Hospital Contacts With Infection and Risk of Schizophrenia: A Population-Based Cohort Study With Linkage of Danish National Registers

Infections and immune responses have been suggested to play an important role in the etiology of schizophrenia. Several studies have reported associations between maternal infections during pregnancy and the child’s risk of schizophrenia; however, infection during childhood and adolescence unrelated to maternal infection during pregnancy has not been studied to nearly the same extent and the results are far from conclusive. Data were drawn from 2 population-based registers, the Danish Psychiatric Central Register and the Danish National Hospital Register. We used a historical population-based cohort design and selected all individuals born in Denmark between 1981 and 1996 (n = 843 390). We identified all individuals with a first-time hospital contact with schizophrenia from 1991 through 2010. Out of the 3409 individuals diagnosed with schizophrenia, a total of 1549 individuals had had a hospital contact with infection before their schizophrenia diagnosis (45%). Our results indicate that individuals who have had a hospital contact with infection are more likely to develop schizophrenia (relative risk [RR] = 1.41; 95% CI: 1.32–1.51) than individuals who had not had such a hospital contact. Bacterial infection was the type of infection that was associated with the highest risk of schizophrenia (RR = 1.63; 95% CI: 1.47–1.82). Our study does not exclude that a certain type of infection may have a specific effect; yet, it does suggest that schizophrenia is associated with a wide range of infections. This association may be due to inflammatory responses affecting the brain or genetic and environmental risk factors aggregating in families.Key words: register, Denmark, cohort study, epidemiology     

Long-term risk factors for suicide mortality after attempted suicide--findings of a 14-year follow-up study

OBJECTIVE: The aims of this paper are (i) to describe the specific characteristics of suicide in China and compare it with that in a western country, Denmark: and (ii) to discuss the accuracy of suicide data and the possible explanations for suicide behaviour in China. METHOD: Data for the study are obtained from the World Health Statistics Annual based on official records in China and the Danish Cause-of-Death Register, and standardized according to the age-specified population of China in 1990. RESULTS: The specific characteristics of suicide in China differed strikingly from the general pattern of suicide in other western countries as well as in Denmark: suicide rates in females were higher than in males; rural rates were more than three times higher than urban rates; suicide rates peaked for those aged 75 + years, but with a minor peak in females for those aged 15-24 years old. CONCLUSION: These specific characteristics of suicide in China may possibly be interpreted in terms of traditional culture, social forces, political environment and economic status.     

脑不对称影响免疫功能

脑不对称是机体普遍存在的生物学现象。研究证实，大脑的不对称性可以影响免疫功能。通过动物实验以及临床观察发现，大脑左右两半球对免疫功能具有相反的调节作用，而且，动物及人类行为不对称与免疫系统间也存在密切的关系。新近的研究表明脑不对称亦可影响细胞因子的产生。总之，脑不对称对免疫功能的调控存在异质性，这一发现不仅丰富了神经-内分泌-免疫调节网络的知识，也为临床某些疾病的研究开拓了更为广阔的领域。     

Lifetime costs of cerebral palsy

This study quantified the lifetime costs of cerebral palsy (CP) in a register-based setting. It was the first study outside the US to assess the lifetime costs of CP. The lifetime costs attributable to CP were divided into three categories: health care costs, productivity costs, and social costs. The population analysed was retrieved from the Danish Cerebral Palsy Register, which covers the eastern part of the country and has registered about half of the Danish population of individuals with CP since 1950. For this study we analysed 2367 individuals with CP, who were born in 1930 to 2000 and were alive in 2000. The prevalence of CP in eastern Denmark was approximately 1.7 per 1000. Information on productivity and the use of health care was retrieved from registers. The lifetime cost of CP was about €860 000 for men and about €800 000 for women. The largest component was social care costs, particularly during childhood. A sensitivity analysis found that alterations in social care costs had a small effect, whereas lowering the discount rate from 5 to 3 per cent markedly increased total lifetime costs. Discounting decreases the value of costs in the future compared with the present. The high social care costs and productivity costs associated with CP point to a potential gain from labour market interventions that benefit individuals with CP.     

Psychiatric disease incidence among Danish Seventh-day Adventists and Baptists

Purpose

Previous studies suggest that religious practice can have a positive effect on mental health, but may also have potential for harm. In Denmark, unique possibilities are available for studying the influence of religious practice on mental health: Denmark is characterized as a secular society and it is possible to follow members of religious societies in nationwide registers. In this study, we follow a cohort of Danish Seventh-day Adventists (SDA) and Baptists in a nationwide psychiatry register and compare the incidence in this cohort with the general population.

Methods

We followed a cohort of 5,614 SDA and 3,663 Baptists in the Danish Psychiatric Central Register, which contained information on psychiatric hospitalizations from 1970 to 2009. Psychiatric disease incidence in the cohort was compared with that in the general Danish population as standardized incidence ratios and within-cohort comparisons were made with a Cox model.

Results

The cohort had decreased incidence of abuse disorders compared to the general population. Furthermore, among Baptists, decreased incidence of unipolar disorders among men and decreased incidence of schizophrenia among women were observed. Surprisingly, we observed an increased incidence rate of unipolar disorder among women.

Conclusions

In this nationwide cohort study with 40 years of follow-up, we observed increased incidence rates of unipolar disorders among women and decreased rates of alcohol- and drug-related psychiatric disorders compared to the general Danish population. We have no mechanistic explanation for the increased incidence of unipolar disorders among women, but discuss several hypotheses that could explain this observation.     

Brain network of semantic integration in sentence reading: Insights from independent component analysis and graph theoretical analysis

A set of cortical and sub‐cortical brain structures has been linked with sentence‐level semantic processes. However, it remains unclear how these brain regions are organized to support the semantic integration of a word into sentential context. To look into this issue, we conducted a functional magnetic resonance imaging (fMRI) study that required participants to silently read sentences with semantically congruent or incongruent endings and analyzed the network properties of the brain with two approaches, independent component analysis (ICA) and graph theoretical analysis (GTA). The GTA suggested that the whole‐brain network is topologically stable across conditions. The ICA revealed a network comprising the supplementary motor area (SMA), left inferior frontal gyrus, left middle temporal gyrus, left caudate nucleus, and left angular gyrus, which was modulated by the incongruity of sentence ending. Furthermore, the GTA specified that the connections between the left SMA and left caudate nucleus as well as that between the left caudate nucleus and right thalamus were stronger in response to incongruent vs. congruent endings. Hum Brain Mapp 35:367–376, 2014. © 2012 Wiley Periodicals, Inc.