Capital Region Of Denmark Research Articles

The cumulative risk and severity of postoperative complications in patients with frailty undergoing major emergency abdominal surgery-A prospective cohort study.

Major emergency abdominal surgery (MEAS) has high morbidity and mortality rates. With an aging and frail population, understanding the impact of frailty on postoperative complications is crucial. This prospective cohort study was conducted at a major university hospital in Denmark from October 1, 2020, to January 1, 2024. A total of 733 patients undergoing MEAS were assessed for frailty using the clinical frailty scale (CFS) at admission and grouped into low (CFS 1-3), moderate (CFS 4-6), and high (CFS 7-9) frailty categories. Postoperative complications were classified by the Clavien-Dindo score and comprehensive complication index (CCI) until discharge. Patients with CFS one to three had 140 complications per 100 patients, CFS four to six had 267 complications per 100 patients, and CFS seven to nine had 297 complications per 100 patients (p<0.001). Increased frailty was associated with higher severity of complications (Clavien-Dindo score). Median CCI scores were 8.7 (CFS 1-3), 29.6 (CFS 4-6), and 38.2 (CFS 7-9) (p<0.001). The cumulative risk of complications was higher in patients with CFS four to six and seven to nine. Higher frailty scores correlate with an increased number and severity of complications as well as a greater overall burden of postoperative complications. The clinical frailty scale is effective for preoperative identification of high-risk patients. The study was approved by the Capital Region of Denmark (P-2020-1166 and R-21038079) and the Danish Data Protection Agency (P-2021-431).

Affective disorders: eliminate WArning signs And REstore functioning: AWARE. Results from a randomized controlled multimodular intervention study targeting functioning in patients with affective disorders.

There is a compelling need for innovative intervention strategies for patients with affective disorders, given their increasing global prevalence and significant associated disability and impaired functioning. This study aimed to investigate whether a comprehensive multimodule individualized intervention (AWARE), targeting known mediators of functioning, improves functioning in affective disorders. AWARE was a randomized, controlled, rater-blind clinical trial conducted at two centers in the Capital Region of Denmark (Clinicaltrials.gov, NCT04701827). Participants were adults with bipolar disorder or major depressive disorder and impaired functioning. Participants were randomized to the six-month AWARE intervention or treatment as usual (TAU). The AWARE intervention is based on the International Classification of Functioning, Disability and Health (ICF) Brief Core Set for Bipolar and Unipolar Disorder.The primary outcome was observation-based functioning using the Assessment of Motor and Process Skills (AMPS). Secondary outcomes were functioning, QoL, stress, and cognition. Between February 2021 and January 2023, 103 patients were enrolled; 50 allocated to AWARE treatment and 53 to TAU (96 included in the full analysis set). There was no statistically significant differential change over time between groups in the primary outcome (AMPS), however, both groups showed a statistically significant improvement at endpoint. The AWARE intervention had a statistically significant effect compared with TAU on secondary outcomes of patient-reported functioning, stress and cognition. Compared with TAU, the AWARE intervention was ineffective at improving overall functioning on the primary outcome, presumably due to the short duration of the intervention. Further development of effective treatments targeting functioning is needed.

Development of a PCR assay for rapid and accurate detection of an emerging vanB Enterococcus faecium clone in the Capital Region of Denmark.

To develop and validate a real-time PCR assay detecting the sequence bridging Tn1549 and the Enterococcus faecium chromosome in the emerging vanB vancomycin-resistant E. faecium (VREfm) clone (ST80/CT2406). The Tn1549 insertion site was determined on routinely sequenced VREfm isolates. The outer boundaries of Tn1549 and adjoining host bacterial sequences were determined using a BLAST search in the silent information regulator gene sir2. Next, the primers and probe were developed, targeting the sequence bridging Tn1549 and the E. faecium chromosome. Finally, the PCR assay was validated on well-characterized strains and prospectively performed on rectal screening samples submitted to our laboratory. The PCR assay proved to be accurate and provide rapid diagnosis of the emerging vanB VREfm in rectal screening samples.

Infertility in the Capital Region of Denmark: Prevalence and population characteristics

Abstract Background Infertility is a disease defined by failure to achieve a pregnancy within 12 months of trying. Infertility has-until now-not been monitored in Denmark for three decades. The aim of this study was to assess the prevalence of infertility in persons aged 25-44 years in the Capital Region of Denmark, and to describe characteristics of persons with infertility. Methods Life-long experience of infertility was assessed in the Danish Capital Region Health Survey 2021, including 56,245 participants from the general population aged ≥16 years (response rate 54.9%). In this study, only persons aged 25-44 years who had tried to have children (thus knowing their fertility) were included, resulting in 8,203 participants. Characteristics of persons with infertility were assessed using national registries (socio-demographics) and questionnaire data (health status). Descriptive analyses and multivariate logistic regression models weighted for survey design and non-response were performed. Results Among persons aged 25-44 years, who had tried to have children, 20% had experienced infertility. Among those, 44% did not achieve the children they wanted. Infertility was most common among women (22%) and persons aged 35-44 years (21%). No associations were observed between infertility and ethnicity, education, and employment status. Persons with infertility were more likely to have poor physical health, have higher level of stress symptoms and have obesity compared with persons in same age group, who had tried to have children but not experienced infertility. Conclusions Infertility is very common in the general population and is associated with unmet fertility desires as well as poor physical health and high stress level. These findings highlight the importance of focusing on and prioritizing treatment and prevention of infertility and emphasize the need for further research in and continued monitoring of infertility. Key messages • Infertility is very common in the general population and associated with unmet fertility desires and poor health highlighting the importance of prioritizing treatment and prevention of infertility. • Continuous monitoring of infertility in the general population is essential as well as further research into risk factors and consequences of infertility.

Experiences of access to care, diagnosis and rehabilitation among a multiethnic patient population with long-COVID in Denmark

Abstract Background and aim The aim of the study was to explore the experiences of accessing care, diagnosis, and rehabilitation among patients with long-COVID in a multiethnic population in Denmark. Methods Qualitative research using semi-structured interviews among a purposive sample of 18 people diagnosed with long-COVID, according to the NICE guideline, in the Capital Region of Denmark. Participants were sampled to secure variation in sex, age, ethnicity, migration status and education. Our interview guide was developed using the theoretical framework of candidacy. Interviews were transcribed verbatim, and member checked, and subsequently analyzed using thematic framework analysis and NVivo software. Results The analysis generated four categories: i) living with long-COVID, ii) access to care, iii) experiences in the healthcare system, and iv) experiences with rehabilitation. A main category was identified from these categories: limited knowledge of COVID resulting in uncertainty, which challenged nearly all aspects of access to diagnosis, care and rehabilitation among the informants. In particular, ethnic minorities experienced that their motives for seeking care were questioned or had the experience of differential treatment. In general, participants perceived to be themselves responsible of recovering, while also struggling with the mental, social and work-related consequences of their long-COVID. Conclusions Our study demonstrated how the emergence of a new viral disease with unknown long-term sequelae results in a group of patients who to a great extend carry the burden of getting better themselves. More research into relevant diagnosis, care and support for long-COVID patients is needed, especially among ethnic minorities.

High-sensitivity C-reactive protein is associated with cardiac dysfunction and morbidity in a community-based cohort

Abstract Background Inflammation is increasingly recognized as a risk factor for cardiac morbidity in the general population. Biomarkers like high-sensitivity C-reactive protein (hs-CRP) can aid in the detection of adverse systemic inflammation. The relationship between hs-CRP and cardiac structure and function is therefore a target of interest. Purpose The purpose of this study was to investigate the association of inflammation with cardiac structure and function in individuals free of overt cardiac disease. In addition, we examined if hs-CRP provided prognostic information regarding incident heart failure and myocardial infarction independent of echocardiographic measures. Methods In a community-based cohort study, participants were randomly selected for invitation from the Capital Region of Denmark. Echocardiography was performed on all the participants and measures of cardiac structure and function were obtained by blinded investigators. Participants with a history of cardiac disease were excluded from the analysis. Associations between log-transformed hs-CRP and echocardiographic measures were analyzed through uni- and multivariable linear regressions. Results A total of 3,379 individuals were included. Mean age was 55 years, 42% were female and the median hs-CRP was 1.13 (interquartile range: 0.65 - 1.47) mg/L. In the univariable analyses, increasing levels of hs-CRP were associated with worse left ventricular (LV) function including LV ejection fraction, global longitudinal strain (GLS), worse diastolic function (E/e’), worse right heart function (tricuspid regurgitation (TR) velocity and tricuspid annular plane systolic excursion (TAPSE)) and higher left ventricular (LV) mass index (p &amp;lt; 0.001 for all measures) (figure). When adjusting for sex, age, physical activity, smoking status, body mass index, blood pressure, hypercholesterolemia, diabetes, hypertension, creatinine, and heart rate, only LVEF (p &amp;lt; 0.001), GLS, (p &amp;lt; 0.001), E/e’ (p = 0.027), TAPSE (p = 0.008) and peak TR velocity (p = 0.015) remained significantly associated with increasing hs-CRP levels. In multivariable Cox regression adjusting for clinical characteristics and echocardiographic measures including LV ejection fraction, LV mass index, E/e’, TAPSE and GLS, higher hs-CRP was significantly associated with both heart failure and myocardial infarction (table) (HR for heart failure: 1.30, 95% CI: 1.03–1.66 p = 0.030; HR for acute myocardial infarction: 1.40, 95% CI: 1.04 – 1.89, p = 0.028, per doubling of hs-CRP). We did not find any interactions between hs-CRP and outcome among different types of echocardiographic phenotypes. Conclusion In the general population, higher levels of hs-CRP were associated with declining systolic, diastolic and right heart function. The associations persisted when adjusting for clinical characteristics. In addition, hs-CRP was associated with cardiac events independent of cardiac function as assessed by echocardiography.Linear regression splinesCox regressions

Characteristics of users of oral nicotine products according to smoking status in Denmark

Abstract Background Oral nicotine products e.g., snus, chewing tobacco, and tobacco-free nicotine pouches gain increasing popularity. The aim of the study was to estimate the prevalence of use of oral nicotine products in the Capital Region of Denmark in 2021, to describe associations with socio-demographic characteristics and to explore if smoking status moderated these associations. Methods The study was based on the Danish Capital Region Health Survey 2021 including 56,245 persons aged ≥16 years old (response rate 54.9%) which included self-reported information on use of oral nicotine products and smoking status. Information on socio-demographic characteristics were assessed in national registries. Descriptive analyses and multivariate logistic regression models including interaction terms with smoking status and weighted for survey-sampling and non-response were performed. Results In total, 3.5% used oral nicotine products. Men showed higher odds of using oral nicotine products compared with woman (OR = 3.70) while there were no associations with education and occupational affiliation when adjusted for sex and age. The associations with age and place of residence were moderated by smoking status. Among smoking participants, young persons aged 16-19 years showed the strongest association with use of oral nicotine products (sex-adjusted OR = 21.71) while persons aged 20-24 years showed the strongest association in non-smoking participants (OR = 11.08). Conclusions Especially men and young age were strongly associated with use of oral nicotine products. For age, the association was moderated by smoking status. Interventions should address these high-risk groups and pay attention to smoking status. Key messages • Sex and age play a siginificant role in use of oral nicotine products. • Interventions and public health campagins should adress high-risk groups

Overall survival after CDK4/6 inhibitor dose reduction in women with metastatic breast cancer

BackgroundBreast cancer is the most common cancer in women, and the first-line treatment for patients with hormone-receptor positive/HER2-negative metastatic breast cancer is CDK4/6 inhibitor plus endocrine therapy. Understanding the impact of CDK4/6 inhibitor dose reduction, which occurs in about half of the patients, is important.MethodsThis real-world cohort study is based on electronic health records from Capital Region of Denmark. All women with metastatic breast cancer initiating first-line treatment with CDK4/6 inhibitor between May 2017 and October 2022 were included.ResultsA total of 546 patients were eligible for inclusion in the 12-week landmark analysis and 192 (35%) experienced dose reduction. These patients were older, had worse ECOG PS, more received prior adjuvant endocrine treatment, and more received fulvestrant as the endocrine backbone. Dose reduction was associated with reduced overall survival (39.9 vs. 54.3 months) and shorter treatment duration (18.0 vs. 26.9 months). Adjusted hazard ratio for death was 1.38 (95% CI: 1.01–1.89).ConclusionsDose reduction of CDK4/6 inhibitors within the first 12 weeks of treatment was associated with significantly higher mortality and shorter treatment duration. These findings contrast with previous analyses showing no effect of dose reduction, likely due to considering immortal time bias in this study.

The chronic wound characterisation study and biobank: a study protocol for a prospective observational cohort investigation of bacterial community composition, inflammatory responses and wound-healing trajectories in non-healing wounds

IntroductionChronic wounds affect 1%–2% of the global population, with rising incidence due to ageing and lifestyle-related diseases. Bacterial biofilms, found in 80% of chronic wounds, and scattered single-cell bacteria may...

A register-based cohort study on the effectiveness and Safety of anti-PCSK9 treatment in persons with hyperlipidemia.

Dyslipidemia is a known risk factor for cardiovascular disease. While statins are the primary treatment, some individuals require additional lipid-lowering therapies, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Alirocumab and evolocumab have shown efficacy in reducing low-density lipoprotein cholesterol (LDL-C) levels and reduce the risk of major cardiovascular events (MACE) but have not been directly compared in clinical trials. This study aims to assess the effects of PCSK9 inhibitors on LDL-C levels and evaluate the impact of a mandated switch from alirocumab to evolocumab. Taking advantage of the mandated switch in PCSK9 treatment in Denmark, we conducted a register-based cohort study of 907 individuals with dyslipidemia treated with PCSK9 inhibitors in the Capital Region of Denmark from 2016 to 2022. We analyzed LDL-C levels, treatment retention, and MACE, adjusting for variables such as age, sex, dose, and concurrent lipid-lowering medications. We show that PCSK9 inhibitors treatment resulted in a 49% reduction in LDL-C levels. Following a mandated switch from alirocumab to evolocumab, no significant difference was observed in LDL-C levels or adverse clinical outcomes, including MACE. Treatment discontinuation was most likely within the first 100 days, and no significant difference in discontinuation rates was found between the two drugs. Our study demonstrates that both alirocumab and evolocumab are effective in significantly reducing LDL-C levels in individuals with dyslipidemia. The mandated switch from alirocumab to evolocumab did not result in significant changes in LDL-C or clinical outcomes, suggesting that these treatments can be used interchangeably. These findings support the clinical equivalence of the two PCSK9 inhibitors and may guide therapeutic decisions in lipid management.

Minimizing unnecessary proBNP blood tests: an evaluation of a pop-up form implementation in general practice

Objective To evaluate the impact of a compulsory pop-up form on the ordering pattern of proBNP blood tests by general practitioners in the Capital Region of Denmark. Design A follow-up study comparing the average number of proBNP tests ordered before and after the implementation of an intervention. Setting and subjects From 2016 to 2021, the average number of proBNP tests increased by over 300%. In March 2022, a compulsory pop-up form was introduced in the electronic request system (WebReq), requiring general practitioners to select one of three indications for ordering proBNP, as recommended by the Danish Society of Cardiology. The study included 528 general practitioners in the Capital Region of Denmark, with data available from January 2020 to 2023, encompassing 83,576 proBNP results from 56,645 patients. Main outcome measure The average number of proBNP tests ordered per month and the median level of proBNP before and after the intervention. Results Following the intervention, the average number of proBNP tests per month decreased by 60% over a 22-month follow-up period. The highest reduction was seen among general practitioners who previously ordered the most tests (≥3 per 1000 biochemical tests). In this group, the median proBNP level increased from 12.1 pmol/L before the intervention to 13.5 pmol/L after the intervention (p < 0.0001). Conclusions This study demonstrates a significant decrease in the number of proBNP requests from general practitioners in the Capital Region of Denmark after the introduction of a pop-up form in the requisition system containing the current guidelines.

Semaglutide treatment for PRevention Of Toxicity in high-dosE Chemotherapy with autologous haematopoietic stem-cell Transplantation (PROTECT): study protocol for a randomised, double-blind, placebo-controlled, investigator-initiated study

IntroductionCancer treatment with high-dose chemotherapy damages the mucosal barrier of the gastrointestinal (GI) tract and is associated with severe toxicity involving mucositis, severe inflammation and organ dysfunction. Currently, there is...

Correlation between illness perceptions and self-reported degree-of-worry in somatic ill patients in emergency care: a Danish cross-sectional study.

The study aimed to investigate the correlation between illness perceptions and self-reported degree-of-worry (DOW) in patients presenting to the emergency department with acute somatic illness. A cross-sectional survey study collected data from a survey on DOW, the Brief-illness Perception Questionnaire (B-IPQ) and demographics. An emergency department at a university hospital in the Capital Region of Denmark. 944 patients (≥18 years) presenting to the emergency department with acute somatic illness. Data collection was conducted during day and evening shifts on weekdays from 13 January to 19 December 2020. Correlations between B-IPQ scores and DOW, including (1) the total B-IPQ score, (2) emotional representations (emotion and illness concern combined) and (3) the single items, respectively. Secondary analysis: linear relationships between the single B-IPQ items and DOW. Analyses included the variables sex, age, reason for contact, self-reported comorbidity, employment, highest educational attainment, cohabitation status and region of origin. The study found moderate correlations between the total illness perceptions score and DOW of 0.47 (95% CI 0.42 to 0.52) and emotional representations and DOW of 0.57 (95% CI 0.52 to 0.61). Linear regression showed the largest and most significant changes in DOW with an increasing score of the B-IPQ items for consequence, illness concern and emotion. Illness perceptions overall and perceptions of consequences of symptoms, illness concern and emotional representations are correlated with patients' DOW, with increasing DOW related to more negative illness perceptions. This finding contributes to insight into how illness perceptions are related to illness worry when presenting to the emergency department. Incorporating the novel DOW scale may aid triage and clinical encounters in the emergency department. ClinicalTrails.gov reference: NCT04226040.

Prehospital Pulse-Dose Glucocorticoid in ST-Segment Elevation Myocardial Infarction

In patients with ST-segment elevation myocardial infarction (STEMI), acute inflammation is related to the extent of myocardial damage and may increase infarct size. Thus, administration of pulse-dose glucocorticoid in the very early phase of infarction may reduce infarct size. To determine the cardioprotective effect of prehospital pulse-dose glucocorticoid in patients with STEMI. This was a 1:1 investigator-initiated, blinded, placebo-controlled, randomized clinical trial conducted between November 14, 2022, and October 17, 2023, with last follow-up on January 17, 2024. Patients 18 years and older with less than 12 hours of acute chest pain and STEMI were included in the prehospital setting throughout the Region Zealand and Capital Region of Denmark and transferred to Rigshospitalet, Denmark. Patients were randomly allocated to intravenous glucocorticoid (methylprednisolone, 250 mg) or placebo in the prehospital setting. The primary outcome was final infarct size on cardiac magnetic resonance (CMR) at 3 months. The power calculation was based on an anticipated final infarct size of 13%. Secondary outcomes included CMR outcomes on acute scan and at 3 months, peak of cardiac biomarkers, clinical end points at 3 months, and adverse events. Of 530 included patients (median [IQR] age, 65 [56-75] years; 418 male [78.9%]) with STEMI, 401 (76%) were assessed for the primary outcome, with 198 patients treated with glucocorticoid and 203 with placebo. Median final infarct size was similar in the treatment groups (glucocorticoid, 5%; IQR, 2%-11% vs placebo, 6%; IQR, 2%-13%; P = .24). Compared with placebo, the glucocorticoid group had smaller acute infarct size (odds ratio, 0.78; 95% CI, 0.61-1.00), less microvascular obstruction (relative risk ratio, 0.83; 95% CI, 0.71-0.99), and greater acute left ventricular ejection fraction (mean difference, 4.44%; 95% CI, 2.01%-6.87%). Other secondary outcomes were similar in both groups. In patients with STEMI, treatment with prehospital pulse-dose glucocorticoid did not reduce final infarct size after 3 months. However, the trial was likely underpowered as the final infarct size was smaller than anticipated. The glucocorticoid group had improved acute parameters compared with placebo. ClinicalTrials.gov Identifier: NCT05462730.

How Do Nurses Experience Relational Work in the Emergency Department—Qualitative Study

IntroductionThis study aimed to explore how nurses experience relational work in the emergency department. MethodsA qualitative design with 34 focus group interviews using an abductive thematic analysis were completed for this study. Participants were recruited from an annual mandatory continuous learning program in 2020-2022 at 2 university hospitals in the Capital Region of Denmark. We applied semistructured interviews in an instructor-supported reflection session on the topic “relational nursing care.” Group discussion was supported by an interview guide addressing key elements of the nurse-patient relationship as described in the fundamentals of care framework. ResultsAcute care nurses’ attention was primarily directed toward the initial patient assessment, rather than toward the later stages of the patient trajectory. Forming a relationship with the patient was highly individual and done at the discretion of each nurse. The key elements of relational nursing were not mutually exclusive, but the findings could be separated into biomedical and relational care, where biomedical tasks took precedence. DiscussionRelational care in the emergency department is optional and individually performed. Moreover, emergency nurses lack a vocabulary to express this type of work. Consequently, there is a risk that patients’ psychosocial needs are not sufficiently met. According to the emergency nurses participating in this study, nurses fall short when performing and describing relational care. Nurses need more knowledge to address the psychosocial patient needs during short-term hospital admissions. Relational care and patient centeredness also need to be acknowledged by nursing leaders and further developed.

Non-participation in breast screening in Denmark: Sociodemographic determinants

BackgroundInternationally, non-participation in breast screening increased with decreasing level of education indicating importance of information campaigns to enhance awareness of screening. However, in Denmark in the 1990s the association between education and non-participation was U-shaped. We therefore analyzed recent Danish data.MethodsData derived from the Capital Region of Denmark, biennial, organized breast screening program 2008–2020, where women aged 50–69 were personally invited to screening. Non-participation was measured as number of women with no participation out of women eligible for at least three invitations. Sociodemographic determinants were identified by linkage to public registers. Results were reported as age adjusted odds ratios (OR) of non-participation including 95% confidence intervals (CI).ResultsAmong 196,085 women, 86% participated. Using women with low education as baseline, the OR for professional bachelors was 0.64; and for academics 0.75. The strongest determinants of non-participation were being non-married OR 2.03; born outside Denmark OR 2.04; being self-employed OR 1.67; retired OR 3.12; on public support OR 3.66; or having co-morbidity OR 1.56.ConclusionThe U-shaped association between education and non-participation in breast screening prevailed. The data further indicated that screening participation was low in women with pertinent health and social problems.

Discontinuing the recommendation of hip precautions does not increase the risk of early dislocation after primary total hip arthroplasty using 36-mm heads: a population-based study from the Danish Hip Arthroplasty Register.

Dislocation is a severe complication following total hip arthroplasty (THA). Hip precautions have been recommended in the initial postoperative period but evidence supporting this practice is limited. We therefore conducted a population-based study to evaluate the association between discontinuing recommending postoperative hip precautions and the risk of early dislocation. This is a cohort study with data from the Danish Hip Arthroplasty Register and the Danish National Patient Register. We included patients who underwent primary THA for osteoarthritis in 2004-2019 in public hospitals in the Capital Region of Denmark. The cohort was divided into the hip precautions group, comprising patients operated on between 2004 and 2009, and the no-precautions group operated on between 2014 and 2019. The primary outcome was the difference in the absolute risk of dislocation within 3 months post-surgery. The secondary outcome assessed the same risk within 2 years. We evaluated the difference in absolute risk using absolute risk regression (ARR). The cumulative incidence of dislocation within 3 months was 2.9% (confidence interval [CI] 2.5-3.3) in the hip precautions group and 3.5% (CI 3.1-3.9) in the no-precautions group. The risk of dislocation was higher in the no-precautions group but failed to reach statistical significance in the crude (ARR 1.2, CI 0.9-1.6) and multivariate model (ARR 1.4, CI 0.9-2.2). We found a higher but statistically insignificant increase in the risk of early dislocation in the no-precautions group. The lack of significance in the association may be explained by the increased use of 36-mm femoral heads after the guideline revision.

Evaluating risk factors in recurrent pregnancy loss: A prospective cohort study and its impact on live birth outcomes

Recurrent pregnancy loss (RPL) affects 1–2 % of all couples trying to conceive and is a challenging heterogeneous condition. This study aimed to evaluate the prevalence and impact of various risk factors in patients suffering from RPL. We performed a prospective cohort study including patients at the tertiary RPL Unit in the Capital Region of Denmark between 1st January 2000 and 1st January 2023. The main outcome of the study was the first pregnancy after referral and whether the pregnancy was ongoing at least to the 22nd gestational week. A total of 2555 patients were included in the study, out of whom 1892 patients achieved a pregnancy after referral to the RPL Unit. This resulted in 1103 live births (58.3 %) and 718 pregnancy losses (37.9 %). Maternal age, BMI, smoking status and the number of prior pregnancy losses were negatively correlated with the likelihood of achieving pregnancy. Furthermore, maternal age, prior pregnancy losses, antiphospholipid syndrome (APS) and uterine malformations were associated with reduced birth rates. Patients with secondary RPL had a higher birth rate compared to those with primary RPL, and patients with APS treated with low-molecular-weight heparin (LMWH) demonstrated a significantly increased birth rate compared to untreated APS patients. These findings suggest that certain risk factors significantly impact the likelihood of achieving pregnancy and live birth following RPL, which can be used in patient guidance.

Risk of intensive care unit admission and mortality in patients hospitalized due to influenza A or B and SARS‑CoV‑2 variants Omicron or Delta

AbstractBackgroundRespiratory viral infections have significant global health impacts. We compared 30‐day intensive care unit (ICU) admission and all‐cause mortality risks in patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) Delta and Omicron variants versus influenza A and B (A/B).MethodsData from two retrospective inpatient cohorts in Capital Region of Denmark were analyzed. Cohorts included hospitalized influenza A/B patients (2017–2018) and SARS‐CoV‐2 Delta/Omicron patients (2021–2022), aged ≥18 years, admitted within 14 days of a positive real‐time polymerase chain reaction test result. Cumulative ICU admission and mortality rates were estimated using the Aalen–Johansen estimator. Cox regression models calculated hazard ratios (HRs) for ICU admission and mortality.ResultsThe study encompassed 1459 inpatients (Delta: 49%; Omicron: 26%; influenza A: 6.4%; and influenza B: 18%). Cumulative incidence of ICU admission was 11%, 4.0%, 7.5%, and 4.1%, for Delta, Omicron, influenza A, and B, respectively. For ICU admission, adjusted HRs (aHRs) were 3.1 (p &lt; .001) and 1.5 (p = .34) for Delta and Omicron versus influenza B, and 1.5 (p = .36) and 0.71 (p = .48) versus influenza A. For mortality, aHRs were 3.8 (p &lt; .001) and 3.4 (p &lt; .001) for Delta and Omicron versus influenza B, and 2.1 (p = .04) and 1.9 (p = .11) versus influenza A.ConclusionDelta but not Omicron inpatients had an increased risk for ICU admission compared to influenza B; however, both variants were associated with higher risks of mortality than influenza B. Only Delta inpatients had a higher risk of mortality than influenza A inpatients.

A survey of emergency medical service providers' perspectives regarding relatives influence on acute prehospital treatment of adult patients.

In the field of prehospital emergency medicine, specialized emergency medical service (EMS) providers interact with acutely ill patients and their relatives. The influence of family presence during in-hospital resuscitation is well described. However, no studies have previously assessed the influence of relatives' presence in the acute prehospital setting. The aim of this study was to investigate EMS providers' perspectives on relatives' impact on the acute prehospital treatment of adult patients. An online anonymous survey was distributed to all prehospital EMS providers in the Capital Region of Denmark. The survey included 25 research questions on a 5-point Likert scale, investigating relatives' influence on treatment in three different domains: positive, negative, and resuscitation. A higher domain score indicates a high level of agreement or frequency. Two hundred forty-six EMS providers completed the survey (84 ambulance technicians, 87 paramedics, and 75 physicians). There were no significant differences in the positive domain across professions (p = .175). Physicians had a statistically significant lower median score in the negative domain, compared with ambulance technicians and paramedics (2.50 vs. 2.63 and 2.63, p = .024). In the resuscitation domain, paramedics and physicians had a significant lower median score compared with ambulance technicians (3.00 and 3.00 vs. 3.14, p = .003). All professions were equally positive towards the relatives' presence and involvement in the acute prehospital setting. Physicians were less likely to be negatively influenced by the presence of relatives compared with ambulance technicians and paramedics. In all professions, increased experience led to improved comfort with handling relatives.