Central Denmark Research Articles

Integrating primary care in a specialized forensic psychiatric setting: predictors of program adherence

AimThis study investigates patient adherence to an integrated primary care intervention within medium secure forensic psychiatric services.MethodsUsing a prospective cohort design, we evaluated the implementation of a 1-year integrated primary care intervention across seven medium secure wards in the Central Denmark Region. Using descriptive statistics, baseline data were analyzed to compare completers and non-completers, with a focus on somatic health indicators and preexisting attitudes toward primary care services.ResultsOf the 75 patients included in the intervention, almost 40% did not complete it. Baseline data demonstrated a high burden of health risk factors, with 75% of patients being daily smokers and 58% meeting the criteria for metabolic syndrome. Negative preexisting perceptions of primary care services were particularly prevalent among non-completers (42%). Those who completed the intervention had a greater illness burden (p = 0.02) and tended to have more favorable attitudes toward primary care, although this was not statistically significant. Notably, over 30% of eligible inpatients either declined or were deemed unable to participate in the intervention.ConclusionsHigh rates of health risk factors were identified, highlighting the sensibility of integrating primary care services in forensic psychiatric settings. Such integration may represent a necessary standard of care, aligning Denmark with international practices. The high rates of non-adherence underscore the serious issue of negative preexisting perceptions of primary care. The results emphasize the need to strengthen relationships between forensic psychiatric patients and primary care services, both within and beyond forensic settings.

Initial experience and results of robotic lateral pelvic lymph node dissection in locally advanced rectal cancer—a single center experience of 17 consecutive procedures

PurposeWe have evaluated lateral pelvic lymph node dissection (LPLND) in combination with rectal resection in the treatment of locally advanced rectal cancer in a specialized colorectal surgical department with a focus on safety and feasibility.MethodsThe study analyzed surgical-pathologic outcomes in 17 consecutive patients who underwent robotic LPLND and rectal resection between May 2018 and June 2024 at a high-volume colorectal cancer center in Denmark. Patients were selected for the procedure based on lateral lymph node (LLN) diameter ≥ 8 mm before and ≥ 5 mm after neoadjuvant treatment.ResultsOut of 17 patients (15 men and 2 females) included in this study, 13 patients (76%) had undergone neoadjuvant therapy. The median age was 63 years (range 35–79) with a median BMI of 25.6 kg/m2 (range 19.4–34.5). The total median operation time was 335 min (range 182–526 min) with no conversions necessary. Additional resection of structures beyond the total mesorectal excision plane was performed in eight patients (47%). The median hospital stay was 4 days (range 2–14) and one patient was readmitted within 30 days. Seven patients experienced postoperative complications within 30 days, with only one CD complication ≥ grade 3. The median number of resected LLNs was 4 (range 0–11) per patient and malignant LLNs were verified in three patients (17.6%).ConclusionThis study shows that simultaneous robot-assisted LPLND and rectal resection can be performed safely and effectively in selected patients with locally advanced rectal cancer, with a short hospital stay and few readmissions and postoperative complications.

Assessment of a colposcopic scoring system (Swedescore) to reduce the number of cervical biopsies: a protocol for a clinical multicentre non-randomised intervention study in Denmark

IntroductionColposcopy is a standard procedure for evaluating cervical abnormalities and collecting cervical biopsies. The procedure is associated with intra- and inter-observer variation. A colposcopic scoring system, Swedescore, has been designed...

A comprehensive review of biomarker research in diabetic nephropathy from a global bibliometric and visualization perspective.

Diabetic nephropathy (DN) is a common complication of diabetes, which is prone to develop into end-stage renal disease, and early diagnosis and treatment is the key to effective management of DN. Biomarkers have important clinical significance in the diagnosis and treatment of DN and have attracted extensive attention from researchers in recent years. The aim of this study was to visualize the field of biomarker research in DN through bibliometric analysis, to summarize the current status and predict future trends of this field, with a view to providing valuable insights for scholars and policy makers. Literature search and data collection from Web of Science Core Collection. Calculations and visualizations were performed using Microsoft Excel, VOSviewer, Bibliometrix R-package, and CiteSpace. We identified 1274 publications about biomarker research in DN from 1995 to November 01, 2023, with a steady increase in annual publications. China, Steno Diabetes Center in Denmark, and Frontiers in Endocrinology were the most productive country, institution, and journal, respectively; Mischak, Harald was both the most productive and highly cited author, and Kidney International was the most cited journal. The high frequency keywords were "albuminuria," "chronic kidney disease" and "expression." In addition, "macrophage," "fibrosis" and "omics" are potentially promising topics. Our study comprehensively and visually summarized the important findings of global biomarker research in DN and revealed the structure, hotspots, and evolutionary trends in this field. It would inspire subsequent studies from a macroscopic perspective and provide a basis for rational allocation of resources and identification of collaborations among researchers.

Sex-specific temporal trends in incidence and prevalence of chronic kidney disease: a Danish population-based cohort study.

Rates of chronic kidney disease (CKD) may change with ageing populations, rising metabolic and cardiovascular disease prevalence, increasing CKD awareness and new treatments. We examined sex-specific temporal trends in CKD incidence and prevalence from 2011 through 2021. We conducted a population-based cohort study among adults residing in the North and Central Denmark Regions (population ∼1.5 million in 2021), utilizing routinely collected individual-level laboratory data. We identified individuals with incident or prevalent CKD, using data on plasma creatinine and urine albumin-creatinine ratios from samples performed in outpatient hospital settings or primary care. We estimated annual sex-specific crude and age-standardized incidence and prevalence and tabulated clinical characteristics. Throughout 2011-2021, CKD incidence and prevalence remained higher among females than males. A transient increase in the crude incidence was observed during 2011-2013, followed by a decrease from 11.8 per 1000 person-years in 2013 [95% confidence interval (CI) 11.5-12.1] to 10.7 in 2021 (95% CI 10.5-11.0) among females and from 10.9 (95% CI 10.7-11.2) to 10.6 (95% CI 10.3-10.8) among males. During 2011-2021, the crude prevalence increased among females from 85.1 per 1000 individuals (95% CI 84.4-85.8) to 99.9 (95% CI 99.2-100.6), and among males from 55.3 (95% CI 54.7-55.9) to 82.4 (95% CI 81.8-83.0). After age standardization, declines in incidence persisted, while the prevalence was stable among females, and the increase persisted among males. The CKD incidence and prevalence remained higher among females than males during 2011-2021. Despite a notable decline in incidence rates from 2013 onwards, the crude prevalence increased during 2011-2021.

Predicting involuntary admission following inpatient psychiatric treatment using machine learning trained on electronic health record data

Abstract Background Involuntary admissions to psychiatric hospitals are on the rise. If patients at elevated risk of involuntary admission could be identified, prevention may be possible. Our aim was to develop and validate a prediction model for involuntary admission of patients receiving care within a psychiatric service system using machine learning trained on routine clinical data from electronic health records (EHRs). Methods EHR data from all adult patients who had been in contact with the Psychiatric Services of the Central Denmark Region between 2013 and 2021 were retrieved. We derived 694 patient predictors (covering e.g. diagnoses, medication, and coercive measures) and 1134 predictors from free text using term frequency-inverse document frequency and sentence transformers. At every voluntary inpatient discharge (prediction time), without an involuntary admission in the 2 years prior, we predicted involuntary admission 180 days ahead. XGBoost and elastic net models were trained on 85% of the dataset. The models with the highest area under the receiver operating characteristic curve (AUROC) were tested on the remaining 15% of the data. Results The model was trained on 50 634 voluntary inpatient discharges among 17 968 patients. The cohort comprised of 1672 voluntary inpatient discharges followed by an involuntary admission. The best XGBoost and elastic net model from the training phase obtained an AUROC of 0.84 and 0.83, respectively, in the test phase. Conclusion A machine learning model using routine clinical EHR data can accurately predict involuntary admission. If implemented as a clinical decision support tool, this model may guide interventions aimed at reducing the risk of involuntary admission.

The Added Value of Using Video in Out-of-Hours Primary Care Telephone Triage Among General Practitioners: Cross-Sectional Survey Study.

Many countries have introduced video consultations in primary care both inside and outside of office hours. Despite some relational and technical limitations, general practitioners (GPs) have reported the benefits of video use in the daytime as it provides faster and more flexible access to health care. Studies have indicated that video may be specifically valuable in out-of-hours primary care (OOH-PC), but additional information on the added value of video use is needed. This study aimed to investigate triage GPs' perspectives on video use in GP-led telephone triage in OOH-PC by exploring their reasons for choosing video use and its effect on triage outcome, the decision-making process, communication, and invested time. We conducted a cross-sectional questionnaire study among GPs performing telephone triage in the OOH-PC service in the Central Denmark Region from September 5, 2022, until December 21, 2022. The questionnaire was integrated into the electronic patient registration system as a pop-up window appearing after every third video contact. This setup automatically linked background data on the contact, patient, and GP to the questionnaire data. We used descriptive analyses to describe reasons for and effects of video use and GP evaluation, stratified by patient age. A total of 2456 questionnaires were completed. The most frequent reasons for video use were to assess the severity (n=1951, 79.4%), to increase the probability of self-care (n=1279, 52.1%), and to achieve greater certainty in decision-making (n=810, 33%) (multiple answers were possible for reasons of video use). In 61.9% (n=1516) of contacts, the triage GPs anticipated that the contact would have resulted in a different triage outcome if video had not been used. Use of video resulted in a downgrading of severity level in 88.3% (n=1338) of cases. Triage GPs evaluated the use of video as positive in terms of their decision-making process (n=2358, 96%), communication (n=2214, 90.1%), and invested time (n=2391, 97.3%). Triage GPs assessed that the use of video in telephone triage did affect their triage outcome, mostly by downgrading the level of care needed. The participating triage GPs found video in OOH-PC to be of added value, particularly in communication and the decision-making process.

Diabetes distress and depression in type 2 diabetes. A cross-sectional study in 18,000 individuals in the Central Denmark region.

Type 2 diabetes is linked to psychological distress and a doubled risk of depression. This study aims to characterize individuals with type 2 diabetes experiencing diabetes distress and/or depression in relation to lifestyle and metabolic outcomes. A population-based survey in 2020 targeted individuals with type 2 diabetes (aged 18-75 years) in the Central Denmark Region. This cross-sectional study assessed diabetes distress (using Problem-Area-in-Diabetes-scale) and depression (via hospital diagnosis and prescribed medication) as exposures. Logistic regression, adjusting for potential confounders, compared exposed and non-exposed groups on lifestyle habits, metabolic factors and medication usage related to cardio-metabolic risks. Of 18,222 respondents with type 2 diabetes (46% response rate), 11% had depression, 14% had diabetes distress and 4% had both. Compared to those with neither condition, those with depression were more often smokers (OR: 2.0, 95% CI: 1.8; 2.3) and sedentary in leisure time (OR: 2.0, 95% CI: 1.8; 2.2). Diabetes distress was associated with elevated HbA1c (OR: 1.8, 95% CI: 1.5; 2.0) and treatment with insulin (OR: 1.8, 95% CI: 1.6; 2.0). Half with diabetes distress displayed stable blood glucose levels. Those with both conditions had a higher risk of sedentary behaviour (OR: 2.7, 95% CI: 2.3; 3.2), clinical insomnia (OR: 6.5, 95% CI: 5.5; 7.7) and low self-rated health (OR: 7.5, 95% CI: 6.3; 9.0) than those with either psychological condition in isolation. This study emphasizes the importance of recognizing distinct features and risk factors associated with diabetes distress and depression in individuals with type 2 diabetes. Tailored care strategies for comorbid mental health issues are crucial for comprehensive management.

Final diagnoses and mortality rates in ambulance patients administered nebulized β2-agonists bronchodilators.

To assess final diagnoses and mortality rates (30day and 1year) in patients treated with the inhaled bronchodilator salbutamol by ambulance personnel, and to establish its role as an identifier of moderate to severe respiratory distress in the prehospital phase of treatment. In a descriptive retrospective observational study, patients experiencing respiratory distress and treated with inhaled bronchodilators, specifically salbutamol, in the prehospital setting within the Central Denmark Region during 2018-2019 were included. The study included 6318 ambulance transports, comprising 3686 cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), 234 with community-acquired pneumonia (CAP), 320 with heart disease (HD), 233 adults with asthma, 1674 with various other primary ICD-10 diagnoses (other ≥ 18years), and 171 patients under 18years. The 30day mortality rate for all patients was 10.7% (95% CI 9.8-11.6), with zero deaths within 30days among adults with asthma and those under 18. Excluding low mortality groups, AECOPD patients had the lowest 30day mortality at 10.2% (95% CI 9.1-11.3), and HD patients the highest at 15.3% (95% CI 10.6-19.9). The 1-year overall mortality rate increased to 32.1% (95% CI 30.2-34.0), with mortality staying low for asthma and under-18 groups, while differences between other groups lessened and became insignificant. Patients requiring inhaled bronchodilator treatment in ambulances exhibit notably high mortality rates at 30days and 1year, except for those with asthma or under 18. The need for prehospital bronchodilators could serve as a clear and unmistakable marker for moderate to severe respiratory distress, enabling early intervention.

A window of opportunity for ICU end-of-life care-A retrospective multicenter cohort study.

The "window of opportunity" for intensive care staff to deliver end-of-life (EOL) care lies in the timeframe from "documenting the diagnosis of dying" to death. Diagnosing the dying can be a challenging task in the ICU. We aimed to describe the trajectories for dying patients in Danish intensive care units (ICUs) and to examine whether physicians document that patients are dying in time to perform EOL care and, if so, when a window of opportunity for EOL care exists. From the Danish Intensive Care Database, we identified patients ≥18 years old admitted to Danish ICUs between January and December 2020 with an ICU stay of >96 h (four days) and who died during the ICU stay or within 7 days after ICU discharge. A chart review was performed on 250 consecutive patients admitted from January 1, 2020, to ICUs in the Central Denmark Region. In most charts (223 [89%]), it was documented that the patient was dying. Of those patients who received mechanical ventilation, 171 (68%) died after abrupt discontinuation of mechanical ventilation, and 63 (25%) died after gradual withdrawal. Patients whose mechanical ventilation was discontinued abruptly died after a median of 1 h (interquartile range [IQR]: 0-15) and 5 h (IQR: 2-15) after a diagnosis of dying was recorded. In contrast, patients with a gradual withdrawal died after a median of 108 h (IQR: 71-189) and 22 h (IQR: 5-67) after a diagnosis of dying was recorded. EOL care hinges on the ability to diagnose the dying. This study shows that there is a window of opportunity for EOL care, particularly for patients who are weaned from mechanical ventilation. This highlights the importance of intensifying efforts to address EOL care requirements for ICU patients and those discharged from ICUs who are not eligible for readmission.

Motivations for and experience with labor induction at 39 weeks in women with obesity-A qualitative study.

Timing of induction of labor (IOL) at term has been investigated in multiple settings. In Denmark, the 'When to INDuce for OverWeight' (WINDOW) study compares IOL at 39 weeks of gestation versus expectant management in low-risk women with obesity. However, knowledge on women's expectations of and experience with IOL is sparse. The aim of this study was to explore women's motivation to join the WINDOW study and their experience when randomized to IOL at 39 gestational weeks. A qualitative interview study of 25 pregnant women with obesity randomized in the WINDOW study to IOL at 39 weeks of gestation was conducted. Participants were recruited from four hospitals in Central Denmark Region and were interviewed four to six weeks after giving birth. A thematic analysis was performed using a phenomenological approach. The analysis resulted in three main themes, (1) Motivation for IOL, (2) The IOL process, and (3) IOL in recollection and in the future. Participants perceived inclusion into the WINDOW study as a "great opportunity," as they hoped to be randomized to IOL at 39 weeks of gestation. Their main motivation for participating was physical discomfort in late pregnancy and a wish for "knowing" the timing of the birth. BMI-related risk factors were mentioned by few as a motivating factor. Some participants described the IOL process as a team effort between the couple and the midwives and were positive towards future IOL. Others associated the IOL process with prolonged labor or described the body as "reluctant" to respond to the induction regime. A desire to experience spontaneous onset of labor in a future pregnancy was mentioned. Physical discomfort and wanting to "control" the onset of labor were main motivations for women's decision to participate in the WINDOW study, hoping they would be allocated for IOL. Comprehensive information and being supported by midwives through the IOL process was crucial for a positive IOL experience. Some participants were positive towards a future IOL. Others speculated if their body was not ready for birth in 39 weeks of gestation and/or associated the IOL process with a challenging labor.

“You’re dealing with the bottom here…” understanding reasons for reduced utilisation: a qualitative study on colorectal cancer screening among vulnerable men at a drop-in centre in Denmark

BackgroundColorectal cancer (CRC) screening can reduce both CRC incidence and mortality, and faecal immunochemical testing (FIT)-based screening programmes are therefore now being implemented in many countries. However, social inequality in FIT-based screening participation is well documented, and initiatives to address this challenge are understudied. We explored the perceptions of CRC screening and the perceived barriers and facilitators towards FIT-based CRC screening among men visiting a drop-in centre for people with severe social problems in Denmark.MethodsThe study was a qualitative interview study. Participants were sixteen men visiting a drop-in centre in Denmark. A local staff member provided supplementary information and assisted with the recruitment process. The interviews were transcribed verbatim, followed by an inductive content analysis.ResultsThe men were often dealing with health and social problems, and they often had low self-esteem. At first, they stated that they did not think much about cancer and their own risk of being diagnosed with it. They argued that they had little time, energy, and resources to participating in, for example, CRC screening programmes, and barriers to participating were facts of life such as comorbidity and cognitive difficulties. Further, they were not sure how to participate, and some misunderstood the concept of screening. However, during the interviews, the main part of the participants became very keen to participate, and they suggested that in the future, they could receive regular information about cancer screening in face-to-face interactions with someone who cared and was interested in helping them.ConclusionMen in a vulnerable position visiting a drop-in centre were interested in CRC screening. If we intervene in a way that meets the needs among these vulnerable citizens, it may contribute to reducing social inequality in FIT-based CRC screening programmes.

Dis-continuity in Continuity-of-Care: a pathway for more equal access to mental health care services?

Abstract Background Access to healthcare is core to achieving universal health coverage. Reaching and obtaining appropriate health care services requires engagement by health care organizations and users. For people with mental illness, access emerges as a continuous process, reflecting oscillating health conditions. This challenges aspirations of continuity of care (COC), but we know little about the experiences of users. Methods We carried out observations of interactions between professionals and users (n = 18) and semi-structured interviews with users, professionals, and managers (n = 33) in the specialised mental health services in Central Denmark Region and FACT-inspired teams in three municipalities. We also conducted 3 focus groups with regional and municipal professionals from these teams. Data was analysed through a qualitative thematic analysis. Results From the perspective of users, COC builds on the acknowledgment of their entire life situation. For users, this is about making connections between their past, present and future lives. Past experience affect their present abilities to follow treatment and influence future hopes and expectations. The acknowledgment of these connections often translates into spaces of discontinuity in continuity, where users need occasional breaks from treatment but worry about being excluded from treatment. Crucially, the organization of the FACT-inspired teams allows for flexibility in the intensity of visits and treatment. The norms of professionals also support users’ perspectives on COC, as the norms focus on building trust in the relations between users and professionals. Conclusions One important step to achieve more equal access is to integrate the social world of users. This requires organizational and professional approaches that allow for user needs for dis-continuity in COC. Key messages • For mental health service users, continuity-of-care includes breaks from treatment (discontinuity). • More equal health access requires adapting continuity-of-care to needs as perceived by users.

Tackling health inequalities by creating new practices of integrated health access

Abstract Background Health inequalities often emerge in-between health and social care sectors, as part of transitions between providers across the two sectors. Integrated health access is important for addressing these inequalities. Therefore, we need to understand processes of organising integrated health access and how these shape pathways of accessing care. We draw on sociological understandings of organising as practice that emerges as part of interactions between professionals and users. Methods We did observations of interactions between professionals and users (n = 18 days) and semi-structured interviews with users, professionals, and managers (n = 33) in the specialised mental health services in Central Denmark Region and FACT-inspired teams in 3 municipalities. We also conducted 3 focus groups with regional and municipal professionals from these teams. Data was analysed through a qualitative thematic analysis. Results Each team had distinct cultures of collaboration and different levels of cross-sectoral collaboration. Creating new, more integrated practices seemed to rely on both, supportive organisational structures and committed engagement in inter-sectoral spaces to change professional meaning systems. When teams were able to collaborate closely, it was easier to retain hard-to-reach users in treatment. However, professional differences could easily create division and therefore maintaining and building relationships were highly important. These mechanisms illustrate the importance of ensuring meaningful spaces for cross-sectoral work, where professionals can interact and create the needed changes. Conclusions Organising integrated health access is not merely about providing structures but is also highly dependent on interactions between professionals and users. Analysing interactions between professionals from across sectors, is important to understand the sustainability of integrated health access. In turn, this could help to tackle social inequalities in health. Key messages • Introducing integrated health access is highly dependent on interactions among professionals. • Integration of professional practices across sectors helps retain hard-to-reach users in treatment.

7.M. Round table: A new lens on loneliness: leveraging the built environment for social health

Abstract Loneliness is a global issue impacting a third of all adults, with young adults (15-25 years) disproportionately affected. Prolonged loneliness has serious consequences for mental and physical health and should be addressed as a matter of urgency. The built environment, where we live, work, and socialise, is increasingly recognised as a significant factor influencing loneliness. However, existing interventions often focus on older adults and neglect the role of the built environments in promoting connectedness across the life course. To bridge this gap, we need interdisciplinary collaboration to understand how our environments and communities can mitigate loneliness. This workshop will explore the critical intersection of place and loneliness interventions. The three panellists bring unique interdisciplinary expertise on loneliness ranging from policy to intervention implementation. These three talks (10min each) will set the stage for a dynamic discussion (30min): 1. Nina Goldman, commissioned by the World Health Organization to undertake a global overview of national loneliness policies, will present findings on how national strategies integrate place-based strategies across sectors such as housing, transportation, and urban planning. 2. Mathias Lasgaard, leading researcher on loneliness interventions, will present the innovative ‘More Together’ (MoTo) project - a multifaceted intervention addressing loneliness in both young and older adults within the Silkeborg Municipality, Denmark. This presentation will contextualize MoTo within the broader landscape of targeted loneliness interventions. 3. Eric Schoenmakers, advisor of the national loneliness action program in the Netherlands, will introduce the “I BELONG” project, an international network dedicated to understanding the relationship between public spaces, loneliness, and effective interventions for young adults in the Netherlands. Key messages • We aim to stimulate a paradigm shift in the way we address loneliness by moving beyond individual-centred solutions to develop a more holistic and community-based approach. • We need more interdisciplinary collaboration to understand how our environments and communities can mitigate loneliness. Speakers/Panelists Nina Goldman University of Manchester, Manchester, UK Mathias Lasgaard Defactum, Central Denmark Region, Aarhus, Denmark Eric Schoenmakers Fontys University of Applied Sciences, Eindhoven, Netherlands

Strengthening the quality of primary healthcare services and interdisciplinary collaboration

Abstract Background Political organisations stress the need for preventive strategies to reduce the amount of avoidable hospital admissions, i.e. admissions that could have been avoided given timely and adequate care in the primary healthcare setting. Interdisciplinary collaboration has been suggested as a means to prevent hospitalizations, but effective implementation remains a challenge. Thus, there is a need for evidence-based strategies to prevent avoidable admissions and support interdisciplinary collaboration. The aim was to develop an evidence-based framework for preventive and coordinated interventions strengthening the quality of primary healthcare services and supporting interdisciplinary collaboration. Methods The project consists of three sub-studies: 1) a mixed methods systematic review following the JBI methodology; 2) a focus group study with primary healthcare providers in the Central Denmark Region, including general practitioners, physiotherapists, occupational therapists, home care providers, registered nurses and nurse specialists; and 3) a study using participatory design, where a framework for coordinated interventions were developed based on the results from study 1 and 2, supported by all stakeholders. Results Findings suggest that some hospitalizations can be prevented by intervening on mental factors, e.g., through trustful relations, and social factors, e.g., living situation. Also, a strong collaboration between healthcare providers from different disciplines and healthcare services is needed to improve the care pathway and prevent hospitalization. The collaboration may be strengthened if the health providers share a common language regarding the citizens’ health status. Conclusions Stakeholders at all levels should be informed about the relevance of considering mental, social and physical factors to improve the quality and responsiveness of primary healthcare services and to develop initiatives to support interdisciplinary collaboration. Key messages • By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately to prevent some admissions. • Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration.

A remotely delivered intervention targeting adults with persisting mild-to-moderate post-concussion symptoms (GAIN Lite): a study protocol for a parallel group randomised trial

BackgroundWorldwide, mild traumatic brain injury, synonymous with concussion, affects more than 30–50 million each year. The incidence of concussion in Denmark is estimated to be about 20,000 yearly. Although complete resolution normally occurs within a few weeks, up to a third develop persistent post-concussion symptoms (PPCS) beyond 3 months. Evidence for effective treatment strategies is scarce. The objective of this study is to evaluate the efficacy of the novel intervention GAIN Lite added to enhanced usual care (EUC) for adults with mild-to-moderate PPCS compared to EUC only.MethodsAn open-label, parallel-group, two-arm randomised controlled superiority trial (RCT) with 1:1 allocation ratio. Potential participants will be identified through the hospital’s Business Intelligence portal of the Central Denmark Region or referred by general practitioners within 2–4 months post-concussion. Participants with mild-to-moderate PPCS will be randomly assigned to either (1) EUC or (2) GAIN Lite added to EUC. GAIN Lite is characterised as a complex intervention and has been developed, feasibility-tested and process evaluated before effect evaluation in the RCT. GAIN Lite contains an initial remote interview, self-administrated e-learning videos and voluntary remote counselling with an allocated occupational- or physiotherapist. Sixty-six participants will be recruited to each group. Primary outcomes are mean changes in PPCS and limitations in daily life from baseline to 24 weeks after baseline.DiscussionGAIN Lite is a low-intensity intervention for adults with mild-to-moderate PPCS. Offering a remote intervention may improve access to rehabilitation and prevent chronification for individuals with mild-to-moderate PPCS. Moreover, GAIN Lite will facilitate access to healthcare, especially for those with transportation barriers. Overall, GAIN Lite may provide an accessible, flexible and convenient way to receive treatment based on sound theories and previous evidence of effective interventions for adults with mild-to-moderate PPCS.Trial registrationClinicalTrials.gov NCT05233475. Registered on February 10, 2022.

Patient trust in the use of machine learning-based clinical decision support systems in psychiatric services: A randomized survey experiment.

Clinical decision support systems (CDSS) based on machine-learning (ML) models are emerging within psychiatry. If patients do not trust this technology, its implementation may disrupt the patient-clinician relationship. Therefore, the aim was to examine whether receiving basic information about ML-based CDSS increased trust in them. We conducted an online randomized survey experiment in the Psychiatric Services of the Central Denmark Region. The participating patients were randomized into one of three arms: Intervention=information on clinical decision-making supported by an ML model; Active control=information on a standard clinical decision process, and Blank control=no information. The participants were unaware of the experiment. Subsequently, participants were asked about different aspects of trust and distrust regarding ML-based CDSS. The effect of the intervention was assessed by comparing scores of trust and distrust between the allocation arms. Out of 5800 invitees, 992 completed the survey experiment. The intervention increased trust in ML-based CDSS when compared to the active control (mean increase in trust: 5% [95% CI: 1%; 9%], p=0.0096) and the blank control arm (mean increase in trust: 4% [1%; 8%], p=0.015). Similarly, the intervention reduced distrust in ML-based CDSS when compared to the active control (mean decrease in distrust: -3%[-1%; -5%], p=0.021) and the blank control arm (mean decrease in distrust: -4% [-1%; -8%], p=0.022).No statistically significant differences were observed between the active and the blank control arms. Receiving basic information on ML-based CDSS in hospital psychiatry may increase patient trust in such systems.

Impact of CCR5Δ32 on the risk of infection, Staphylococcus aureus carriage, and plasma concentrations of chemokines in Danish blood donors

The CC chemokine receptor 5 (CCR5) is a suggested receptor for Staphylococcus aureus leukotoxin ED. Homozygosity for the Δ32 deletion (CCR5Δ32) protects against human immunodeficiency virus infection and possibly also against leukotoxin ED. We examined the impact of CCR5Δ32 on the susceptibility to S.aureus infection, all-cause infections, and S.aureus nasal carriage, respectively, and on the concentrations of circulating chemokines in blood donors. We included 95,406 participants from the Danish Blood Donor Study (DBDS) genotyped for >650,000 single nucleotide polymorphisms. The CCR5Δ32 (rs333, MAF: 0.12) was imputed from a reference panel and validated. Infectious outcomes were identified by diagnosis codes and redeemed prescription of antibiotics in national health registers. Data on S.aureus nasal carriage and forty-seven inflammatory biomarkers were available for 6721 and 7811 participants, respectively. Cox, logistic, and linear regression models adjusted for relevant confounders were used to explore said associations. During more than 700,000 person-years of observation, we found that CCR5Δ32 was associated with neither an increased risk of redeemed dicloxacillin, hospital-treated S.aureus-associated infection (replicated in 345,996 Icelanders), redeemed antibiotics, all-cause infection, and nor with S.aureus nasal carriage. We discovered an association between CCR5Δ32 and elevated CCL4 concentrations, which were 1.26-fold higher in Δ32-heterozygotes (95%-CI: 1.23-1.30) and 2.64-fold higher in Δ32-homozygotes (95%-CI: 2.41-2.90) compared with wildtype homozygotes. Conversely, concentrations of CCL2, CXCL-10, and CCL11 were slightly lower among Δ32-heterozygotes. Results from this CCR5Δ32 high-prevalent cohort do not support the idea that CCR5Δ32 affects the risk of S.aureus carriage or infection to any relevant degree, in this northern European context. CCL4 was the main chemokine affected by CCR5Δ32 and was observed in higher concentration among Δ32-carriers. This study cannot rule out that S.aureus is a previous driver of CCR5Δ32 selection. The Health Research Fund of Central Denmark Region, Aarhus University, Danish Administrative Regions, Bio- and Genome Bank Denmark, Danish Blood Donor Research Foundation, Aase & Ejnar Danielsens Foundation, Højmosegård Grant, National Institute of Allergy and Infectious Diseases, and A.P. Møller Foundation for the Advancement of Medical Science.

The role of health literacy in the association between social support and self-rated health: a Danish population-based study in 10,787 individuals with a long-term condition.

Managing a long-term condition requires higher health literacy. Social networks may play a crucial role for self-management. However, the pathway is not entirely understood. This study aimed to examine whether the association between social support and self-rated health is mediated by health literacy among individuals with a long-term condition. This cross-sectional study used data from the "How are you?" 2021 survey in Central Denmark Region. Social support was assessed using a single question, health literacy with two dimensions from the Health Literacy Questionnaire (HLQ): 'Understanding health information' and 'Engaging with healthcare providers', and self-rated health with a single question from SF-36. Multiple logistic regression analyses were used to examine the associations, and multiple mediation analyses were performed using the Karlson-Holm-Breen method. A total of 10,787 individuals with a long-term condition were included in the study, whereas 6% (n = 595) reported a low level of social support. Both health literacy scales mediated the association between social support and self-rated health, particularly the ability to engage with healthcare providers, accounting for 25% of the variance. After adjustment for sociodemographic factors, individuals with a low level of social support had significantly higher odds of reporting difficulties in understanding health information (OR 2.53 (95% CI: 1.84-3.48)) and engaging with healthcare providers (OR 3.77 (95% CI: 2.96-4.79)). Health literacy, particularly the ability to engage with healthcare providers, was a mediator between social support and self-rated health. Additionally, a low level of social support was associated with higher odds of reporting lower health literacy. These findings suggest that strategies to enhance health literacy, improve health outcomes, and reduce health inequities may benefit from strengthening individuals' social network, particularly focusing on those with limited support.