Central Denmark Region Research Articles

Voldstedet Sallingholm

The Sallingholm castle mound – process, results and methodological considerationsThe investigations at Sallingholm castle mound were carried out as part of a study of four test localities in a pilot project called Middelalderborge i Region Midtjylland (Medieval Castles in Central Denmark Region). A joint project established for the region’s archaeologists, carried out in 2014-15.Prior to the archaeological survey executed in 2014, the Sallingholm castle mound lay relatively unnoticed in the Hinnerup river valley. Its banks were barely noticeable under the meadow vegetation, especially when compared with the impressive Skansehøj castle mound just 200 m to the east of Sallingholm, with its steep banks towering above the edge of the river valley. A causeway provided the only access to Sallingholm, and Skansehøj is located precisely at the point where the road from the castle mound meets the mainland. There has been speculation over time as to the connection, if any, there may have been between the two strongholds. In the study of Sallingholm, several aspects were clarified that have a bearing on an interpretation of the relationship between Sallingholm and Skansehøj.Sallingholm turned out to be a much larger structure than foreseen. In earlier submissions, the structure was recorded as consisting of two oval banks, together with a causeway. The project’s initial field survey, followed up by archaeological excavations, revealed that it consists of four discrete man-made turf banks and was extraordinarily well-constructed. Given its position, Skansehøj was able to control access to Sallingholm, the castle mound in the meadow, and Sallingholm’s interpretation as a refuge seems obvious. The locality was not excavated in its entirety, and it is possible that the picture that emerged, based on a relatively small number of finds and a limited occurrence of accumulated waste layers, is not fully comprehensive. The information currently available forms the basis for an interpretation of Sallingholm as a stronghold that was not in continuous use and perhaps only occupied quite briefly: This concurs with the theory that Skansehøj was built for a siege.One aim of the study was to obtain an accurate date for Sallingholm using dendrochronology. To this end, samples of well-documented, dateable wood were collected for analysis. Of these, ten samples produced reasonably reliable dates and one was particularly precise, specifying a felling date in the spring of 1372. The remaining dates were less precise and fell into two groups: One group dated remains associated with the construction of one of the banks to about 1372, the other group, comprised of samples from a presumed timber road by another bank, gave a date approximately 20 years later.A precise date for activities at the stronghold focussed the search for relevant historical sources. The date in the spring of 1372 proved to be particularly interesting in relation to the siege/refuge hypothesis: 1372 was the year when King Valdemar IV Atterdag concluded peace with the coalition of the southern counts who had ruled the kingdom since 1368. Not everyone wanted to surrender to Valdemar voluntarily, and some of the Jutland nobility, in particular, had to be persuaded by force and siege.The results presented here suggest that the owner of Sallingholm was one of the rebellious Jutland nobles who, in 1372, needed to defend themselves against the Danish king.With this study, Sallingholm, a previously unknown castle mound, has become part of Danish history.

Increased bystander intervention when volunteer responders attend out-of-hospital cardiac arrest

The primary aim was to investigate the association between alarm acceptance compared to no-acceptance by volunteer responders, bystander intervention, and survival in out-of-hospital cardiac arrest. This retrospective observational study included all suspected out-of-hospital cardiac arrests (OHCAs) with activation of volunteer responders in the Capital Region of Denmark (1 November 2018 to 14 May 2019), the Central Denmark Region (1 November 2018 to 31 December 2020), and the Northern Denmark Region (14 February 2020 to 31 December 2020). All OHCAs unwitnessed by Emergency Medical Services (EMS) were analyzed on the basis on alarm acceptance and arrival before EMS. The primary outcomes were bystander cardio-pulmonary resuscitation (CPR), bystander defibrillation and secondary outcome was 30-day survival. A questionnaire sent to all volunteer responders was used with respect to their arrival status. We identified 1,877 OHCAs with volunteer responder activation eligible for inclusion and 1,725 (91.9%) of these had at least one volunteer responder accepting the alarm (accepted). Of these, 1,355 (79%) reported arrival status whereof 883 (65%) arrived before EMS. When volunteer responders accepted the alarm and arrived before EMS, we found increased proportions and adjusted odds ratio for bystander CPR {94 vs. 83%, 4.31 [95% CI (2.43-7.67)] and bystander defibrillation [13 vs. 9%, 3.16 (1.60-6.25)]} compared to cases where no volunteer responders accepted the alarm. We observed a fourfold increased odds ratio for bystander CPR and a threefold increased odds ratio for bystander defibrillation when volunteer responders accepted the alarm and arrived before EMS.

Is laparoscopic excision for superficial peritoneal endometriosis helpful or harmful? Protocol for a double-blinded, randomised, placebo-controlled, three-armed surgical trial

IntroductionPlacebo-controlled surgical designs are recommended to ascertain treatment effects for elective surgeries when there is genuine doubt about the effectiveness of the surgery. Some elective surgeries for pain have been...

Influence of maternal body mass index on human milk composition and associations to infant metabolism and gut colonisation: MAINHEALTH – a study protocol for an observational birth cohort

IntroductionHuman milk provides all macronutrients for growth, bioactive compounds, micro-organisms and immunological components, which potentially interacts with and primes infant growth and, development, immune responses and the gut microbiota of...

Cost of non-communicable diseases in people living with HIV in the Central Denmark Region.

To estimate the economic burden of non-communicable diseases (NCDs) in people living with HIV (PLWH) in Denmark. We conducted a cohort study using population-based Danish medical registries including all adult residents of the Central Denmark Region registered with a first-time HIV-diagnosis during the period 2006-2017. For each PLWH, we matched 10 persons without HIV from the background population by birth year, sex and municipality of residence. Information on healthcare utilization and costs for the PLWH and non-HIV cohorts was retrieved from register data. For each cohort, we estimated the annual costs for major disease categories (HIV care, other somatic care, and psychiatric care) in the period from 3 years before to 9 years after diagnosis/matching date. We identified 407 PLWH and 4070 persons from the background population. The total healthcare costs during the study period were approximately three times higher for PLWH compared to the non-HIV cohort (€76 198 vs. €23 692). Average annual cost of hospital care, primary care and selected prescription medicine was estimated to be €6987 per year in the years after the diagnosis compared to €2083 per year in the non-HIV cohort. In PLWH, the cost of NCDs and psychiatric care was approximately two times higher than the cost of HIV care. PLWH have higher healthcare costs stemming from three areas: excess cost due to the HIV infection, the treatment of NCDs, and psychiatric care.

Treatment burden and associated factors: a population-based survey in Central Denmark Region 2017

Abstract Background Exploring treatment burden at a population level can provide evidence of the types of patients who need special attention and support. We aimed to determine factors associated with high perceived treatment burden in a population-based survey of adults living in the Central Denmark Region (23% of the Danish population). Methods The Danish Multimorbidity Treatment Burden Questionnaire (MTBQ) was included in the 2017 Danish population health survey. 28,627 individuals aged 25 years or over participated (64% response rate). Individuals who reported having one or more medical conditions or attending regular health check-ups were asked to complete the MTBQ. A global MTBQ score was calculated (range 0-100) and both the continuous scores and a four-category grouping of the scores into no, low, medium and high burden were used to statistically assess the association between treatment burden and sociodemographic and health-related factors. Results 13,407 individuals completed the Danish MTBQ (mean age 59 years). Treatment burden was negatively associated with self-related health (rs = -0.45, P < 0.0001), health-related quality of life (rs = -0.46/-0.51, P < 0.0001) and positively associated with the number of long-term conditions (rs = 0.26, P < 0.0001) and perceived stress (rs = 0.44, P < 0.0001). Higher treatment burden was associated with young age, male sex, high educational level, unemployment, not living with a spouse/cohabitant, living with child(ren) and specific long-term conditions, including heart disease, stroke, diabetes and mental illness. Conclusions This is the first known population-based study of treatment burden. The findings provide important evidence to policy makers and clinicians about sociodemographic groups at risk of higher treatment burden. We recommend that patient-perceived treatment burden is included when evaluating interventions targeting patients with long-term conditions and multimorbidity and health-care system reorganisations. Key messages • Treatment burden is associated with poor health and health-related quality of life and, among others, young age, male sex, unemployment, not living with a spouse, and specific long-term conditions. • We recommend that patient-perceived treatment burden is included when evaluating interventions targeting patients with long-term conditions and multimorbidity and health-care system reorganisations.

Representativeness of survey participants in relation to mental disorders: a linkage between national registers and a population-representative survey.

Surveys and registers have provided important insights into the mental health of the community. However, both sources have strengths and limitations. While participation in surveys has been shown to be lower among those with mental disorders, misclassification and limited information on confounders are typical issues for registers. To examine if participants of the Central Denmark Region's 2017 How are you? survey were representative of the general population in terms of mental disorder diagnoses. By linking data from the Central Denmark Region's 2017 How are you? survey with the Danish national registers, we compared the frequency of mental disorder diagnoses among (a) participants in the survey (n = 32,417), before and after applying non-response weights, and (b) the entire population who were eligible to participate (n = 1,063,082; 16 years of age or older on 10th January 2017 and registered as living in the Central Denmark Region). Using logistic regression models, we estimated associations between being diagnosed with any mental disorder and nine general medical conditions to assess whether selection into the survey appeared to bias these associations. Based on register data, 10.4% (n = 110,492) of the eligible population had received a diagnosis of any mental disorder prior to the date of this survey. Among the unweighted survey sample, 8.2% (n = 2,648) had received a diagnosis; once non-response weights were applied, this corresponded to 9.5%. Representativeness varied by sex, age and type of mental disorder. For example, people with organic disorders or substance use disorders were generally underrepresented among survey participants of all ages; however, representativeness of common disorders such as mood or neurotic disorders was generally good. With respect to the association of any mental disorder and general medical conditions, we found that estimates were similar for survey samples (both weighted and unweighted) compared to the entire eligible population. People with a previous diagnosis of a mental disorder are slightly underrepresented in the survey. However, this selection bias was minimized when non-response weights were applied. Associations between mental disorders and general medical conditions did not appear to be affected by selection bias. With the application of non-response weights, the survey provided a sample representative of the general population in terms of mental disorder diagnoses.

The incidence of Frey syndrome and treatment with botulinum toxin in the Central Denmark Region.

Frey syndrome (FS) is a common complication to large salivary glands surgery. This study primarily aims to describe the incidence of FS among parotid surgery patients in the Central Denmark Region. The secondary aim is to describe predisposing characteristics to syndrome development and the effect of treatment with botulinum toxin (Botox) injection. This is a retrospective qualitative study spanning the years 2015-2020. Data on patients diagnosed with FS after parotid surgery with symptoms severe enough to require Botox was extracted from electronic patient records. Incidence of FS development was calculated using data from all parotid gland surgeries in the same period and region. The incidence of treatment-requiring FS was 2.6% (20/775), with an annual incidence ranging from 0.8% (1/125) in 2017 to 4.5% (5/112) in 2016. Difference in FS development for men and women was not statistically significant (p=.07), although it was significantly more common after total parotidectomy compared to superficial resection (p=.003), and after malignant compared to benign diagnosis (p=.01). Complications in the postoperative period arose for 30% of FS patients. Repeated treatment with Botox was necessary after 6-12 months and at a median interval of 11 months. Forty-five percent of patients received only one injection. The average dose per injection was 48.3 IU. This study revealed a rather low incidence of FS in the Central Denmark Region compared to current international literature. Total parotidectomy and malignant diagnosis predisposed to syndrome development. Botox injection had a wide-ranging effective duration but typically lasted for around 1 year. Level IV.

Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

BackgroundAn increased prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in children was observed in various diabetes centres worldwide during the COVID-19 pandemic. We aimed to evaluate trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes before and during the COVID-19 pandemic, and to identify potential predictors of changes in diabetic ketoacidosis prevalence during the pandemic.MethodsFor this international multicentre study, we used data from 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA [Colorado], and Wales). The study population comprised 104 290 children and adolescents aged 6 months to younger than 18 years, who were diagnosed with type 1 diabetes between Jan 1, 2006, and Dec 31, 2021. The observed diabetic ketoacidosis prevalence in 2020 and 2021 was compared to predictions based on trends over the pre-pandemic years 2006–19. Associations between changes in diabetic ketoacidosis prevalence and the severity of the COVID-19 pandemic and containment measures were examined with excess all-cause mortality in the whole population and the Stringency Index from the Oxford COVID-19 Government Response Tracker.Findings87 228 children and adolescents were diagnosed with type 1 diabetes between 2006 and 2019, 8209 were diagnosed in 2020, and 8853 were diagnosed in 2021. From 2006 to 2019, diabetic ketoacidosis at diagnosis of type 1 diabetes was present in 23 775 (27·3%) of 87 228 individuals and the mean annual increase in the prevalence of diabetic ketoacidosis in the total cohort from 2006 to 2019 was 1·6% (95% CI 1·3 to 1·9). The adjusted observed prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes was 39·4% (95% CI 34·0 to 45·6) in 2020 and 38·9% (33·6 to 45·0) in 2021, significantly higher than the predicted prevalence of 32·5% (27·8 to 37·9) for 2020 and 33·0% (28·3 to 38·5) for 2021 (p<0·0001 for both years). The prevalence of diabetic ketoacidosis was associated with the pandemic containment measures, with an estimated risk ratio of 1·037 (95% CI 1·024 to 1·051; p<0·0001) per ten-unit increase in the Stringency Index for 2020 and 1·028 (1·009 to 1·047; p=0·0033) for 2021, but was not significantly associated with excess all-cause mortality.InterpretationDuring the COVID-19 pandemic, there was a marked exacerbation of the pre-existing increase in diabetic ketoacidosis prevalence at diagnosis of type 1 diabetes in children. This finding highlights the need for early and timely diagnosis of type 1 diabetes in children and adolescents.FundingGerman Federal Ministry for Education and Research, German Robert Koch Institute, German Diabetes Association, German Diabetes Foundation, Slovenian Research Agency, Welsh Government, Central Denmark Region, and Swedish Association of Local Authorities and Regions.

Bias in self-reported height and weight in a cohort of young adults – perspectives for cardio-metabolic risk prevention programmes

Abstract Background Precise assessment of obesity is essential in evaluating and applying preventive strategies to avoid adverse cardio-metabolic risk profiles later in life. Self-reported measures of height and weight is often used in cohort and cross-sectoral studies due to practical and financial reasons. However, bias due to self-reporting is well known with risk of overestimation of height and underestimation of weight. The latter is particular reported among women and persons with obesity. Little is known about the influence of educational factors in the self-reporting of height and weight. To gain insight into the extent to which different factors bias self-reporting, is important to assess the validity of self-reported body mass index (BMI) within groups of people with certain characteristics. Purpose The aim was to investigate the validity of self-reported height and weight versus objective measured height and weight. Additionally, the study aimed to examine if sex, measured BMI, and educational factors biased the self-reporting differenially. Methods The study included 264 participants, all aged 28 years who were a sub-sample from an ongoing cohort in Central Denmark Region. The participants attended a physical health examination, including measures of height and weight after having self-reported these not knowing they were to be objectively measured later. Data of their own and parental educational levels were drawn from registries. Paired t-tests were used to assess the descriptive differences between self-reported and measured values and linear regression was used to assess the independent effects of sex, education, and BMI on the differences. In model 1 adjustment for all other variables except for BMI was conducted and full adjustments were made in model 2. Results Overall, participants overestimated their height by 0.89 (0.67; 1.10) cm and underestimated their weight by 2.47 (1.78; 3.17) kg (Table 1). Female sex was found to independently bias underreporting of weight (β −1.51 (−2.86; −0.15)) and male sex overestimated height (β 0.83 (0.38; 1.27) (Table 2). Additionally, being overweight or obese also independently biased the underestimation of self-reported weight ((β 2.23 (0.64; 3.83) and β 5.22 (3.51; 6.94)) (Table 2). Additionally, participants with overweight were less likely to overestimate their height compared to those with normal weight. Without adjustments for BMI, low level of education also biased underestimation of weight significantly (Table 2). Conclusion Women and persons with obesity in particular underestimated weight. Participants with lower level of education also underestimated weight but this was explained by obesity. Men overestimated their height but participants with obesity were less likely to overestimate height compared to normal weighty. When screening for overweight and obesity to initiate interventions to prevent cardio-metabolic diseases, the lack of accuracy in self-reported values must be taken into account. Funding Acknowledgement Type of funding sources: None.

Three birds with one stone: a protocol for a randomised intervention study to increase participation in cervical and colorectal cancer screening among women attending breast cancer screening

IntroductionThe participation rate is higher in breast cancer screening than in cervical cancer (CCU) and colorectal cancer (CRC) screening. In this cluster-randomised study, we aim to evaluate an intervention offering...

Comparing exercise and patient education with usual care in the treatment of hip dysplasia: a protocol for a randomised controlled trial with 6-month follow-up (MovetheHip trial)

IntroductionSurgery is not a viable treatment for all patients with hip dysplasia. Currently, usual care for these patients is limited to a consultation on self-management. We have shown that an...

Progressive resistance training compared to neuromuscular exercise in patients with hip osteoarthritis and the additive effect of exercise booster sessions: protocol for a multicentre cluster randomised controlled trial (The Hip Booster Trial)

IntroductionThe primary aim of this randomised controlled trial is to investigate the effectiveness of 3 months of progressive resistance training (PRT) compared to neuromuscular exercise (NEMEX) on functional performance in...

Use of Personal Protective Equipment Among Healthcare Workers During the First and the Second Wave of the COVID-19 Pandemic.

IntroductionTo treat and properly care for COVID-19 patients it is vital to have healthy healthcare workers to ensure the continued function of the healthcare system and to prevent transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to patients, co-workers, and the community. Personal protective equipment (PPE) can prevent healthcare workers from being infected with and transmitting SARS-CoV-2. Experience and training are pivotal to ensure optimal protection. This study aims to examine the use and failure of PPE and compliance with PPE guidelines during the first and the second wave of the COVID-19 pandemic among Danish healthcare workers.MethodsHealthcare workers from the Central Denmark Region and the Capital Region of Denmark were invited to participate April–June 2020 during the first wave and November 2020–April 2021 during the second wave. Day-by-day, participants reported work procedures, use and failure of PPE, and compliance with PPE guidelines. Register-based information on sex, age, department, and profession was available for all participants.ResultsIn total, 21 684 and 10 097 healthcare workers participated during the first and the second wave, respectively. During the first wave, 1.7% used filtering face piece-2 or -3 (FFP2 or FFP3) respirators and 8.2% used face masks [fluid resistant (type IIR) masks, masks with visor (typically type IIR), and other unspecified face masks] during physical contact with patients. During the second wave, the corresponding figures increased to 17.8% and 80.7%. During respiratory procedures, the use of FFP2 or FFP3 respirators increased from 5.6 to 24.3%, and the use of face masks from 14.7 to 77.8%. The no PPE use decreased from 21.3% during the first wave to 0.4% in the second wave, during respiratory procedures. Total PPE failures decreased from 0.7 to 0.4% from the first to second wave. The proportion not complying with PPE guidelines declined from 3.6 to 2.2% during physical contact with patients and from 6.5 to 4.6% during respiratory procedures. PPE failure and non-compliance varied by age, sex and type of department. Frequent reasons for non-compliance were forgetfulness and lack of time, and during the first but not during the second wave, limited availability of PPE.ConclusionWe found a substantial increase in the use of PPE and a substantial decrease in PPE failures from the first to the second wave of COVID-19 in Denmark. However, there is still a need for continuous focus on compliance in use of PPE among healthcare workers.

Ten-year trends of adult trauma patients in Central Denmark Region from 2010 to 2019: A retrospective cohort study.

BackgroundTrauma causes significant economic and societal burdens, and the trauma patient population and their prognosis change over time. This study aims to analyze 10‐year trends of trauma patients at a major trauma center in Central Denmark Region.MethodsFive thousand three hundred and sixty‐six patients aged ≥16 years with Injury Severity Score (ISS) > 0 admitted by trauma team activation at a major trauma center between January 1, 2010, and December 31, 2019, were included. An annual percent change with a 95% confidence interval was used to estimate trends in the mechanism of injuries. Multiple logistic regression with mortality as the outcome was adjusted for age, sex, and ISS. Admission year was used as continuous variable in logistic regressions.ResultsThe median age increased from 37 in 2010 to 49 in 2019, and the proportion of patients aged ≥65 doubled. The annual incidence of minor injuries (ISS 1–15) decreased from 181.3/105 inhabitants in 2010 to 112.7/105 in 2019. Severe injuries (ISS > 15) increased from 10.1/105 inhabitants in 2010 to 13.6/105 in 2019. The proportion of patients with ISS > 15 increased from 18.1% in 2010 to 31.1% in 2019. Multivariable logistic regression indicates lower 30‐day mortality for all trauma patients over the study period when adjusting for age, sex, and ISS (odds ratio: 0.94, 95% CI: 0.90–0.99). The 30‐day mortality for severely injured patients with ISS > 15 seems to decrease during the study period when adjusting for age, sex, and ISS (Odds ratio: 0.92, 95% CI: 0.87–0.97). Fall injuries increased by 4.1% annually (95% CI: 2.3%–6.1%).ConclusionsTen‐year trends of trauma patients at a major trauma center show an increasing median age, injury severity, and number of fall injuries. The 30‐day mortality of trauma patients decreased slightly for both minor injuries and severe injuries when adjusting for age, sex, and injury severity.

Are progressive shoulder exercises feasible in patients with glenohumeral osteoarthritis or rotator cuff tear arthropathy?

BackgroundLittle is known about the feasibility of progressive shoulder exercises (PSE) for patients with glenohumeral osteoarthritis (OA) or rotator cuff tear arthropathy (CTA). The aim of this study was to investigate whether 12 weeks of PSE is feasible in patients with glenohumeral OA or CTA eligible for shoulder arthroplasty. Moreover, to report changes in shoulder function and range of motion (ROM) following the exercise program.MethodsTwenty patients were included. Eighteen patients (11 women, 15 with OA), mean age 70 years (range 57–80), performed 12 weeks of PSE with one weekly physiotherapist-supervised and two weekly home-based sessions. Feasibility was measured by dropout rate, adverse events, pain, and adherence to PSE. At baseline and end of intervention, patients completed the Western Ontario Osteoarthritis of the Shoulder (WOOS) score and Disabilities of the Arm, Shoulder and Hand (DASH). Data to assess feasibility were analyzed using descriptive statistics.ResultsTwo patients dropped out and no adverse events were observed. Sixteen of the eighteen patients (89%) had a high adherence (≥ 70%) to the physiotherapist-supervised sessions. Acceptable pain levels were reported; in 76% of all exercise sessions with no numeric rating scale (NRS) score over five for any exercise. WOOS improved with a mean of 23 points (95% CI 13;33), and DASH improved with a mean of 13 points (95% CI 6;19).ConclusionAdherence to PSE was high and dropout rates were low. PSE is feasible, safe and may relieve shoulder pain, improve function and ROM in patients with glenohumeral OA or CTA. The patient-experienced gains after PSE seem clinically relevant and should be compared to arthroplasty surgery in a RCT setting.Trial registrationAccording to Danish law, this study did not need an approval by the Central Denmark Region Committee on Health Research Ethics. Approval from The Danish Data Protection Agency (journal number 1-16-02-15-20) was obtained.

Increased shoulder pain across an exercise session and subsequent shoulder exercise: a prospective cohort study

BackgroundShoulder complaints are common and the recommended first-line treatment is exercise therapy. However, it remains unknown if increased shoulder pain after an exercise session is a barrier for subsequent exercise dose, particularly in people with high fear-avoidance beliefs. Such knowledge could indicate ways to optimise shoulder rehabilitation. The aim was to examine whether increased shoulder pain across an exercise session was associated with a lower subsequent exercise dose, and if high fear-avoidance beliefs exaggerated this association.MethodsWe conducted a prospective cohort study using data from a randomised controlled trial in Central Denmark Region 2017–2019. Participants were employees (n = 79) with shoulder complaints and high occupational shoulder exposures. The intervention was a home-based or partly supervised exercise programme lasting 2–3 months. Linear mixed models were used to examine the associations between change in shoulder pain and exercise dose (number of repetitions, progression level (1–3), resistance level (1–3), and time until next exercise session [days]).ResultsAt baseline, the participants had a median pain intensity at rest of 2 on a numerical rating scale (0–10). For a 1-cm increase in pain on a visual analogue scale (0–10 cm) during an exercise session, the subsequent number of repetitions, progression level and resistance level were − 1.3 (95% confidence interval [CI] − 3.4 to 0.9), 0.0 (95% CI − 0.1 to 0.0) and − 0.0 (95% CI − 0.1 to 0.0), respectively. Likewise, the time until next exercise session was − 0.6 (95% CI − 2.4 to 1.3) days for a 1-cm increase. There were no interactions with fear-avoidance beliefs.ConclusionIncreased pain across an exercise session was not associated with subsequent exercise dose, regardless of fear-avoidance beliefs, among employees with shoulder complaints and high occupational shoulder exposures.Trial registrationThe trial was registered at Clinicaltrials.gov 19/05/2017 (ID: NCT03159910).

Behavioural side effects of inhaled corticosteroids among children and adolescents with asthma

BackgroundInhalation corticosteroids (ICS) are prescribed for treatment of asthma in approximately 3% of all children in Denmark. Despite limited evidence, case reports suggest that ICS-related behavioural adverse drug events (ADEs) may be frequent. In general, underreporting of ADEs to official databases is common, and little is known about doctor’s clinical experiences with behavioural ADEs when prescribing ICS for children with asthma. The objective was to investigate the extent of behavioural ADEs in children with asthma treated with ICS by comparing database findings to experiences of specialist doctors.MethodsFirst, databases of the European Medicines Agency (EMA) and the Danish Medicines Agency (DKMA) were searched for reports made by healthcare professionals about behavioural ADEs in children from 2009 to 2018. Second, questionnaire data on behavioural ADEs were collected from eight of the 11 specialist doctors responsible for treating children with asthma at the six paediatric departments in Central Denmark Region and North Denmark Region.ResultsEMA and DKMA had registered 104 and 3 reports, respectively, on behavioural ADEs during the 10-year study period. In contrast, five of the eight specialist doctors (45.5%) had experienced patients who had developed behavioural changes during ICS treatment. However, none of the five specialist doctors had filed reports on these events to DKMA.ConclusionBehaviour-related ADEs to ICS in children with asthma are likely to be highly underreported in official databases and doctors treating children with ICS should be aware of potential ADEs and consider submitting ADE reports whenever appropriate.

Cohort profile: Health in Central Denmark (HICD) cohort - a register-based questionnaire survey on diabetes and related complications in the Central Denmark Region

PurposeThe Health in Central Denmark (HICD) cohort is a newly established cohort built on extensive questionnaire data linked with laboratory data and Danish national health and administrative registries. The aim...

Exploring the epidemiology of disseminated intravascular coagulation: protocol for the DANish Disseminated Intravascular Coagulation (DANDIC) Cohort Study

IntroductionSince disseminated intravascular coagulation (DIC) was first described, it has been considered a serious disease of the coagulation system and a major challenge to clinicians. Currently, several important knowledge gaps...