Characteristics, interventions, and longer term outcomes of COVID-19 ICU patients in Denmark-A nationwide, observational study.

BACKGROUND: Most data on intensive care unit (ICU) patients with COVID-19 originate in selected populations from stressed healthcare systems with shorter term follow-up. We present characteristics, interventions and longer term outcomes of the entire, unselected cohort of all ICU patients with COVID-19 in Denmark where the ICU capacity was not exceeded. METHODS: We identified all patients with SARS-CoV-2 admitted to any Danish ICU from 10 March to 19 May 2020 and registered demographics, chronic comorbidities, use of organ support, length of stay, and vital status from patient files. Risk factors for death were analyzed using adjusted Cox regression analysis. RESULTS: There were 323 ICU patients with confirmed COVID-19. Median age was 68 years, 74% were men, 50% had hypertension, 21% diabetes, and 20% chronic pulmonary disease; 29% had no chronic comorbidity. Invasive mechanical ventilation was used in 82%, vasopressors in 83%, renal replacement therapy in 26%, and extra corporeal membrane oxygenation in 8%. ICU stay was median 13 days (IQR 6-22) and hospital stay 19 days (11-30). Median follow-up was 79 days. At end of follow-up, 118 had died (37%), 15 (4%) were still in hospital hereof 4 in ICU as of 16 June 2020. Risk factors for mortality included male gender, age, chronic pulmonary disease, active cancer, and number of co-morbidities. CONCLUSIONS: In this nationwide, population-based cohort of ICU patients with COVID-19, longer term survival was high despite high age and substantial use of organ support. Male gender, age, and chronic co-morbidities, in particular chronic pulmonary disease, were associated with increased risk of death.

Assessment of acute pain in trauma-A retrospective prehospital evaluation.

OBJECTIVE: To elucidate pain treatment with analgesics in a prehospital trauma population. DESIGN: Retrospective database study. SETTING: Prehospital data from the anesthesiologist-manned Mobile Emergency Care Unit (MECU) in Odense, Denmark, were extracted and subjected to analysis. PATIENTS: During the period of January 1, 2013 to December 31, 2014, patients with the diagnoses "unspecified multiple injuries," "examination and observation following traffic accident," "examination and observation following other accident," and "commotio cerebri" were included in the analysis. MAIN OUTCOME MEASURES: Evaluation of the application of the pain scale Numeric Rating Scale (NRS). Furthermore, the authors performed a characterization of the patients with mild pain and severe pain according to specific parameters such as pharmacological interventions, opioid consumption, intubation, and others. RESULTS: Nine hundred eighty-five cases were analyzed. NRS was documented only in one case. In all, 787 patients experienced no pain or mild pain (no pain, n = 242; mild pain, n = 545) and 168 patients severe pain or worse (severe pain, n = 155; intolerable pain, n = 13). In the severe pain group, 138 were treated with opioid analgesics or S-ketamine, while no pharmacological intervention was documented in 30 cases. Eight of the 138 cases with severe pain needed endotracheal intubation, whereas nine cases in the patients with mild or no pain needed endotracheal intubation; odds ratio (OR) 4.3 (p = 0.003). CONCLUSIONS: Effect was only documented in one patient after administering opioids in a patient with trauma population, where approximately 17 percent of patients experienced severe pain. Severe pain was correlated to male gender, respiratory intervention, opioid administration, and the diagnosis unspecified multiple injuries.

Patterns of brain activation in foster children and nonmaltreated children during an inhibitory control task.

Children in foster care have often encountered a range of adverse experiences, including neglectful and/or abusive care and multiple caregiver transitions. Prior research findings suggest that such experiences negatively affect inhibitory control and the underlying neural circuitry. In the current study, event-related functional magnetic resonance imaging was employed during a go/no go task that assesses inhibitory control to compare the behavioral performance and brain activation of foster children and nonmaltreated children. The sample included two groups of 9- to 12-year-old children: 11 maltreated foster children and 11 nonmaltreated children living with their biological parents. There were no significant group differences on behavioral performance on the task. In contrast, patterns of brain activation differed by group. The nonmaltreated children demonstrated stronger activation than did the foster children across several regions, including the right anterior cingulate cortex, the middle frontal gyrus, and the right lingual gyrus, during correct no go trials, whereas the foster children displayed stronger activation than the nonmaltreated children in the left inferior parietal lobule and the right superior occipital cortex, including the lingual gyrus and cuneus, during incorrect no go trials. These results provide preliminary evidence that the early adversity experienced by foster children impacts the neural substrates of inhibitory control.

Marital hostility and child sleep problems: direct and indirect associations via hostile parenting.

The current study examined two family process predictors of parent-reported child sleep problems at 4.5 years in an adoption sample: marital hostility and hostile parenting. Participants were 361 linked triads of birth parents, adoptive parents, and adopted children. We examined direct and indirect pathways from marital hostility to child sleep problems via hostile parenting. Mothers' marital hostility at 9 months was associated with child sleep problems at 4.5 years. Fathers' marital hostility at 9 months evidenced an indirect effect on child sleep problems at 4.5 years via fathers' hostile parenting at 27 months. Findings were significant even after controlling for genetic influences on child sleep (i.e., birth parent internalizing disorders). The findings suggest targets for prevention and intervention programs that are potentially modifiable (e.g., hostile parenting, marital hostility), and inform theory by demonstrating that relations among marital hostility, hostile parenting, and child sleep problems are significant after accounting for genetic influences.

Foster placement disruptions associated with problem behavior: mitigating a threshold effect.

OBJECTIVE: Placement disruptions have adverse effects on foster children. Identifying reliable predictors of placement disruptions might assist in the allocation of services to prevent disruptions. There were two objectives in this study: (a) to replicate a prior finding that the number of daily child problem behaviors at entry into a new foster home predicts subsequent placement disruptions in foster preschoolers and (b) to determine whether this association is mitigated by a treatment foster care intervention. METHOD: Problem behavior and placement disruptions were examined in 60 children in regular foster care (age range = 3.10-5.91 years [M = 4.34, SD = 0.83], 58.3% male, 93.4% Caucasian) and 57 children in a treatment foster care program (age range = 3.01-6.78 years [M = 4.54, SD = 0.86], 49.1% male, 82.5% Caucasian). Using the Parent Daily Report Checklist (Chamberlain & Reid, 1987), a brief telephone interview, foster caregivers reported problem behavior 6 times over 3 months. Placement disruptions were tracked over 12 months. RESULTS: The regular foster care children with 5 or fewer problem behaviors were at low risk for disruption, but their risk increased 10% for each additional behavior (p = .013). The intervention appeared to mitigate this "threshold effect"; number of problem behaviors did not predict risk of placement disruption in the treatment foster care group (p = .63). CONCLUSIONS: These findings replicate previous evidence linking child problem behavior to placement disruptions and further highlight the need for early preventative interventions.

Longitudinal associations between marital instability and child sleep problems across infancy and toddlerhood in adoptive families.

This study examined the longitudinal association between marital instability and child sleep problems at ages 9 and 18 months in 357 families with a genetically unrelated infant adopted at birth. This design eliminates shared genes as an explanation for similarities between parent and child. Structural equation modeling indicated that T1 marital instability predicted T2 child sleep problems, but T1 child sleep problems did not predict T2 marital instability. This result was replicated when models were estimated separately for mothers and fathers. Thus, even after controlling for stability in sleep problems and marital instability and eliminating shared genetic influences on associations using a longitudinal adoption design, marital instability prospectively predicts early childhood sleep patterns.