The association between long-distance migration and PTSD prevalence in Syrian refugees.

BACKGROUND: Refugees are forced migrants but there is a large variation in the distance that refugees cover and there is a paucity in the evidence of how this may affect refugees' health and health care needs. OBJECTIVE: We investigated the association between long-distance migration and post-traumatic stress disorder (PTSD), a serious psychiatric disorder associated with deteriorating mental and somatic health. METHODS: Included from 2016-2019 were adult Syrian refugees in Lebanon and Denmark that arrived up to 12 months prior to inclusion. PTSD was assessed using the Harvard Trauma Questionnaire and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience and general mental well-being, reporting the bootstrap 95-percentile confidence interval (95% CI). Additionally, a number of sensitivity analyses were performed. RESULTS: Included were 599 participants in Lebanon (mean age 35 years old, 73% being female) and 133 participants in Denmark (mean age 30 years old, 47% being female). After multiply imputing missing data and propensity score-weighted adjustment for confounding, migration to Denmark instead of Lebanon was associated with an increase in PTSD prevalence of 9 percentage point (95% CI [-1; 19] percentage point). CONCLUSIONS: Long-distance migration may be associated with an increase in PTSD prevalence in refugees. The migration could be an important factor to consider when assessing refugees' and asylum seekers' health. Practitioners should consider "long-distance migration" in refugee health screenings and in particular when assessing the risk of post-traumatic stress disorder. Future research should be designed to ultimately lead to studies of relevant interventions to lower the risk of post-traumatic stress disorder in refugees.

Is patient activation a mediator of the effect of a health promoting intervention in adults at high risk of type 2 diabetes? A longitudinal path model analysis within a randomised trial.

BACKGROUND: Exploring mediators of preventive intervention effects has important implications for the planning of complex interventions. Our aim was to assess the extent to which knowledge, skills and confidence to manage health, here measured as "patient activation", was a mediator of the effect of the intervention "Live your life without diabetes" on weight, waist circumference and systolic blood pressure at 12 months follow-up in adults at high risk of type 2 diabetes. METHODS: Autoregressive path models with three time points of measurement, and contemporaneous and constant b paths were used in a randomised controlled trial (RCT). The RCT took place in a Danish municipal healthcare center and included 127 individuals aged 28 to 70 years with fasting plasma glucose: 6.1-6.9 mmol/l and/or glycated haemoglobin (HbA1c): 42.0-47.9 mmol/mol. Participants were randomised to routine care (n = 64), or intervention (n = 63). The intervention group received an empirical and theory-based intervention delivered over four two-h group sessions during five weeks, and two further sessions after one and six months. The outcomes were weight, waist circumference and systolic blood pressure, and the mediator was patient activation, measured by the self-reported Patient Activation Measure (PAM). Data for the present study was derived from questionnaires and clinical measures from baseline, three- and 12-months follow-up. RESULTS: Mediated effects via PAM on: weight: - 0.09 kg (95% CI - 0.38 to 0.20) out of the total effect - 1.09 kg (95% CI - 3.05 to 0.87); waist circumference: - 0.04 cm (95% CI - 0.36 to 0.28) out of the total effect - 1.86 cm (95% CI - 4.10 to 0.39); and systolic blood pressure: - 0.31 mmHg (- 1.10 to 0.49) out of the total effect - 2.73 mmHg (95% CI - 6.34 to 0.87). CONCLUSION: We found no mediating effects of patient activation as a single variable of the intervention "Live your life without diabetes" on weight, waist circumference and systolic blood pressure at 12 months follow-up in adults at high risk of type 2 diabetes. Our study demonstrates an analytic approach for estimating mediating effects in complex interventions that comply with the criteria on temporal ordered data. Future studies should include possible interacting variables.

The effectiveness of mindfulness-based stress reduction for school teachers: a cluster-randomized controlled trial.

BACKGROUND: Teaching has been found to be one of the most stressful occupations. Hence, current interest in reducing stress and enhancing the well-being of teachers is strong. Mindfulness-based stress reduction (MBSR) is documented to be effective in reducing stress and increasing well-being. This study investigated the effectiveness of delivering MBSR to lower secondary school teachers as a part of a teacher-training programme. METHODS: This study was a nested trial within the parallel cluster-randomized controlled trial, Stress-free Everyday LiFe for Children and Adolescents REsearch (SELFCARE). Schools were recruited from all five geographical regions in Denmark between May 2018 and May 2019. One to three teachers from each school were allowed to participate. At baseline, 110 schools, representing 191 lower secondary school teachers, were cluster-randomized to intervention or a wait-list control group. The intervention group received MBSR during 2019 and the wait-list control group during 2020. Data were collected at baseline and after 3 and 6 months. The primary outcome was measured by Cohen's Perceived Stress Scale (PSS). Data were analyzed using a mixed-effect linear regression model and bootstrapped for cluster effects. RESULTS: At 3 months, the intervention group statistically significantly reduced their PSS score 1.7 [95% confidence interval (CI) 0.04-3.3] points more than did the wait-list control group. At 6 months, the intervention group had statistically significantly reduced their mean PSS score 2.1 (95% CI: 0.5-3.8) points more than the wait-list control group. CONCLUSION: It is possible to reduce perceived stress among lower secondary school teachers by delivering MBSR as part of a teacher-training programme.

Linoleic acid in adipose tissue and the risk of myocardial infarction: a case-cohort study.

PURPOSE: We investigated risk of myocardial infarction (MI) associated with the content of linoleic acid (LA) in adipose tissue, a biomarker of long-term dietary intake of LA and a marker of endogenous LA exposure. METHODS: Between 1993 and 1997, 57,053 middle-aged subjects were included in the Danish Diet, Cancer and Health cohort. We performed a case-cohort study that included a random sample of the full cohort (n = 3167) and all incident MI cases appearing during 16 years of follow-up (n = 2819). Information on incident MI cases was obtained by linkage with Danish nationwide registries. Adipose tissue biopsies were taken from the buttocks of the participants, and their fatty acid composition was determined using gas chromatography. HRs (hazard ratios) with 95% confidence intervals (CIs) were used to describe the associations between content of LA in adipose tissue and the risk of MI. HRs were calculated using weighted Cox proportional hazards regression with robust variance. RESULTS: After adjustment for established risk factors of MI, adipose tissue content of LA was not associated with the risk of MI in men and women combined (quintiles 5 versus 1, HR, 1.03 (95% CI, 0.85-1.25), P-trend = 0.970) or in men and women separately (quintiles 5 versus 1, HR, 1.05 (95% CI, 0.83-1.33), P-trend = 0.871 and quintiles 5 versus 1, HR, 0.99 (95% CI 0.72-1.37), P-trend = 0.928, respectively). Investigating the association between LA and MI with a shorter, 5- or 10-year duration of follow-up provided similar results. CONCLUSION: Content of LA in adipose tissue was not associated with the risk of MI.

Asthma and selective migration from farming environments in a three-generation cohort study.

Individuals raised on a farm appear to have less asthma than individual raised elsewhere. However, selective migration might contribute to this as may also the suggested protection from farm environment. This study investigated if parents with asthma are less likely to raise their children on a farm. This study involved three generations: 6045 participants in ECRHS/RHINE cohorts (born 1945-1973, denoted G1), their 10,121 parents (denoted G0) and their 8260 offspring participating in RHINESSA (born 1963-1998, denoted G2). G2-offspring provided information on parents not participating in ECRHS/RHINE. Asthma status and place of upbringing for all three generations were reported in questionnaires by G1 in 2010-2012 and by G2 in 2013-2016. Binary regressions with farm upbringing as outcome were performed to explore associations between parental asthma and offspring farm upbringing in G0-G1 and G1-G2. Having at least one parent with asthma was not associated with offspring farm upbringing, either in G1-G2 (RR 1.11, 95% CI 0.81-1.52) or in G0-G1 (RR 0.99, 0.85-1.15). G1 parents with asthma born in a city tended to move and raise their G2 offspring on a farm (RR 2.00, 1.12-3.55), while G1 parents with asthma born on a farm were less likely to raise their G2 offspring on a farm (RR 0.34, 0.11-1.06). This pattern was not observed in analyses of G0-G1. This study suggests that the protective effect from farm upbringing on subsequent asthma development could not be explained by selective migration. Intriguingly, asthmatic parents appeared to change environment when having children.

Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders.

We studied the risk of hypersensitivity pneumonitis and other interstitial lung diseases (ILDs) among pigeon breeders.This is a retrospective follow-up study from 1980 to 2013 of 6920 pigeon breeders identified in the records of the Danish Racing Pigeon Association. They were compared with 276 800 individually matched referents randomly drawn from the Danish population. Hospital based diagnoses of hypersensitivity pneumonitis and other ILDs were identified in the National Patient Registry 1977-2013. Stratified Cox regression analyses estimated the hazard ratios (HR) of hypersensitivity pneumonitis and other ILDs adjusted for occupation, residence and redeemed prescription of medication with ILDs as a possible side-effect. Subjects were censored at death, emigration or a diagnosis of connective tissue disease.The overall incidence rate of ILD was 77.4 per 100 000 person-years among the pigeon breeders and 50.0 among the referents. This difference corresponded to an adjusted HR of 1.56 (95% CI 1.26-1.94). The adjusted HRs of hypersensitivity pneumonitis and other ILDs for pigeon breeders were 14.36 (95% CI 8.10-25.44) and 1.33 (95% CI 1.05-1.69), respectively.This study shows an increased risk of ILD among pigeon breeders compared with the referent population. Protective measures are recommended even though ILD leading to hospital contact remains rare among pigeon breeders.

Fetal growth and cardio-metabolic risk factors in the 20-year-old offspring.

OBJECTIVE: To investigate the association between prenatal growth patterns as estimated by biparietal diameter and cardio-metabolic risk at 20 years. DESIGN: Follow-up study. SETTING: Denmark 1988-2009. POPULATION: Two cohorts of children born between 1988 and 1990 (n=707) and followed up in 2008-2009 (n=333-509). METHODS: We have access to biparietal diameter from early ultrasound scan and birthweight. For each gender, biparietal diameter and birthweight, gestational age-specific growth-z-scores were calculated. A change in growth trajectory was depicted as a shift in z-score for the two growth measures. Multiple linear regression modeling was used to estimate associations between biparietal diameter and birthweight z-scores and later cardio-metabolic risk factors as well as estimating whether changing growth trajectory was associated with later cardio-metabolic risk. MAIN OUTCOME MEASURES: Self-reported anthropometrics and clinically measured blood pressure, heart rate and biochemical measures associated with cardio-metabolic health. RESULTS: After adjustments, biparietal diameter was not associated with any of the outcomes. Birthweight was positively associated with both adult height and weight and inversely associated with insulin, triglyceride and insulin resistance. Also, the data indicated a U-shaped association between growth in the second half of pregnancy and adult body mass index among individuals with a low biparietal diameter in mid-pregnancy. CONCLUSION: Different patterns of intrauterine growth may be associated with later risk of cardio-metabolic disease.

Intensive care delirium - effect on memories and health-related quality of life - a follow-up study.

AIMS AND OBJECTIVES: To investigate the effects of delirium in the intensive care unit on health-related quality of life, healthcare dependency and memory after discharge and to explore the association between health-related quality of life and memories, patient diaries and intensive care unit follow-up. BACKGROUND: Up to 83% of intensive care unit patients experience delirium. In addition to increased risk of mortality, morbidity and cognitive impairment, the experience itself is unpleasant. A number of studies have focused on memories associated with delirium, but the association between delirium, memories and health-related quality needs further investigation. DESIGN: We used an observational multicentre design with telephone interviews. METHODS: Adult intensive care unit patients (n = 360) were consecutively recruited and interviewed using the intensive care unit-Memory Tool one week after intensive care unit. Interviews were repeated after two and six months and supplemented with Short Form-36 and the Barthel Index. RESULTS: Delirium was detected in 60% of the patients in our study, and delirious patients had significantly fewer factual memories and more memories of delusion than nondelirious patients up to six months postintensive care unit discharge. Delirium, memories and intensive care unit diaries with follow-up did not affect health-related quality of life and healthcare dependency. Memories of delusions might have an impact on patients assessed as nondelirious. CONCLUSIONS: More than half of the patients in intensive care unit experience delirium, which is associated with fewer factual memories and more memories of delusions. Short Form-36 might not be sensitive to delirium-related outcomes. Future research should include the development of better assessment tools to determine the long-term consequences of intensive care unit delirium. RELEVANCE TO CLINICAL PRACTICE: We recommend regular assessment to prevent, detect and treat delirium. We also recommend an intensive care unit follow-up programme providing an opportunity for postintensive care unit patients, particularly previously delirious patients, to discuss their memories and experiences with intensive care unit professionals.

Long-term criminal outcome of children with attention deficit hyperactivity disorder.

BACKGROUND: Long-term outcome studies of child psychiatric populations are often limited by attrition. Our study uses the Danish National Crime Register to report on the largest and most complete prospective study of adult criminality as an outcome for children with socioeconomic status attention deficit hyperactivity disorder (ADHD) and is the first to report on the adult criminal outcome of girls with ADHD. AIMS: To estimate the relative risk (RR) of adult criminal convictions of children with ADHD compared with the rate in the general population. METHODS: A clinical sample of 206 children who had attended a regional child and adolescent psychiatric clinic in Denmark between 1968 and 1989 and received a diagnosis of ADHD was identified. Official criminal conviction data were collected for all of them up to the year 2000 when their mean age was 31 years. Their rate of sustaining at least one criminal conviction was compared with that in an age-matched general population sample. RESULTS: Ninety-seven (47%) of the children with ADHD had criminal convictions in adulthood. Children with ADHD were about five times more likely to sustain convictions than their peers in the general population (rate ratio (RR) 5.6, 95% confidence interval 5.2-6.1) and twelve times more likely to have violent convictions (RR 12.0, 95% confidence interval 9.9-14.5). Fifty-four (26%) of the children with ADHD without any conduct problems in childhood were convicted in adulthood. Girls with ADHD were also at increased risk of criminal convictions. CONCLUSIONS: Children with ADHD have a higher risk of criminal convictions in adulthood than previously documented, and both girls and boys are at increased risk. Co-morbid conduct problems in childhood are highly predictive of criminal convictions in adulthood. Even in the absence of conduct problems, however, childhood ADHD is associated with increased risk of criminality.

On Top of Everything: a study protocol for a cluster-randomised controlled trial testing a teacher training programme to teach mindfulness among students in Danish upper secondary schools and schools of health and social care.

BACKGROUND: Mental health is decreasing among young people in Denmark. Our primary aim is to evaluate the effectiveness of a teacher training programme to teach mindfulness as part of regular classroom teaching in Danish upper secondary schools and schools of health and social care on students' self-reported mental well-being 6 months from baseline. Secondary aims are (1) to evaluate the effectiveness in a vulnerable subgroup as well as in the total population of students 3 and 6 months from baseline using other outcome measures on mental health and (2) to investigate the facilitators and barriers among teachers to implement mindfulness in schools. METHODS: This pragmatic cluster-randomised two-arm superiority trial includes 30 upper secondary schools, 13 schools of health and social care, 76 teachers, and approximately 1100 students aged 16 to 24 years. Our intervention is multi-level and consists of (a) a teacher training programme and (b) a mindfulness programme delivered to students. Students in control schools receive education as usual. Our primary study population is the total population of students. The primary outcome is changes in the short version of the Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). We also evaluate the effectiveness in a vulnerable subgroup (the 15% with the lowest SWEMWBS score), as well as in the total population of students 3 and 6 months from baseline using other outcome measures on mental health. Data will be analysed using repeated measurement models taking clusters into account. Facilitators and barriers among teachers to implement mindfulness in schools will be investigated through qualitative focus group interviews. DISCUSSION: The trial will estimate the effectiveness of a population-based strategy on mental health in Danish young people enrolled in education. TRIAL REGISTRATION: ClinicalTrials.gov NCT04610333 . Registered on October 10 2020.

SARS-CoV-2 Infection Rates Following Use of Regular Compared With Defective Respirators When Caring for COVID-19 Patients: A Retrospective Follow-up Study.

BACKGROUND: There is strong observational evidence that respirators are highly effective in protecting the users from being infected with Middle East respiratory syndrome and severe acute respiratory syndrome coronavirus (SARS-CoV), but the evidence for SARS-CoV-2 during daily work is limited. This study utilized a subset of healthcare workers' temporary use of a new brand respirator with frequent defects when caring for coronavirus disease 2019 (COVID-19) patients to assess the protective effect of regular respirators against SARS-CoV-2 infection. METHODS: We retrospectively followed 463 participants wearing a regular respirator and 168 wearing the new brand respirator day-by-day when caring for COVID-19 patients until testing polymerase chain reaction positive for SARS-CoV-2 between 27th December 2020 and 14th January 2021. RESULTS: We observed seven and eight incident SARS-CoV-2-infected cases. This corresponded with daily infection rates of 0.2 and 0.5%, an incidence rate ratio of 0.4 [95% confidence interval (CI) 0.1; 1.0], and an incidence rate difference of 0.3% (95% CI -0.1; 0.8) when comparing a regular with the new brand respirator. DISCUSSION: We regard the new brand respirator a sham intervention, and this study thus provides further evidence for the protective effect of respirators when exposed to SARS-CoV-2 virus.

Considerations for Using Multiple Imputation in Propensity Score-Weighted Analysis - A Tutorial with Applied Example.

Purpose: Propensity score-weighting for confounder control and multiple imputation to counter missing data are both widely used methods in epidemiological research. Combination of the two is not trivial and requires a number of decisions to produce valid inference. In this tutorial, we outline the assumptions underlying each of the methods, present our considerations in combining the two, discuss the methodological and practical implications of our choices and briefly point to alternatives. Throughout we apply the theory to a research project about post-traumatic stress disorder in Syrian refugees. Patients and Methods: We detail how we used logistic regression-based propensity scores to produce "standardized mortality ratio"-weights and Substantive Model Compatible-Full Conditional Specification for multiple imputation of missing data to get the estimate of association. Finally, a percentile confidence interval was produced by bootstrapping. Results: A simple propensity score model with weight truncation at 1st and 99th percentile obtained acceptable balance on all covariates and was chosen as our model. Due to computational issues in the multiple imputation, two levels of one of the substantive model covariates and two levels of one of the auxiliary covariates were collapsed. This slightly modified propensity score model was the substantive model in the SMC-FCS multiple imputation, and regression models were set up for all partially observed covariates. We set the number of imputations to 10 and number of iterations to 40. We produced 999 bootstrap estimates to compute the 95-percentile confidence interval. Conclusion: Combining propensity score-weighting and multiple imputation is not a trivial task. We present considerations necessary to do so, realizing it is demanding in terms of both workload and computational time; however, we do not consider the former a drawback: it makes some of the underlying assumptions explicit and the latter may be a nuisance that will diminish with faster computers and better implementations.

Quality of care and patient outcome in stroke units: is medical specialty of importance?

BACKGROUND: Specialized stroke unit care improves outcome in stroke patients. However, it is uncertain whether the units should be placed in a neurological or non-neurological (eg, internal medicine or geriatric) setting. OBJECTIVES: To assess whether stroke unit setting (neurological/non-neurological) is associated with quality of care and outcome among patients with stroke, and whether these associations depend on the severity of comorbidity. METHODS: In a nationwide population-based follow-up study, we identified 45,521 patients admitted to stroke units in Denmark between 2003 and 2008. Outcomes were quality of care (whether patients received evidence-based processes of acute stroke care), mortality, length of stay, and readmission. Charlson comorbidity index was used to assess comorbidity, and comparisons were adjusted for patient and hospital characteristics. RESULTS: Patients admitted to stroke units in neurological settings had higher odds for early antiplatelet therapy (odds ratio, 1.68; 95% confidence interval, 1.10-2.56) and early computed tomographic scan or magnetic resonance imaging (odds ratio, 1.77; 95% confidence interval, 1.29-2.45) compared with patients in non-neurological settings. No other differences were found when studying quality of care and patient outcomes. However, patients with moderate comorbidity admitted to stroke units in neurological settings had higher odds for 1-year mortality, but comparisons across strata of comorbidity were not statistical significant. CONCLUSIONS: Except for early antiplatelet therapy and early computed tomographic scan or magnetic resonance imaging, the medical setting was not associated with differences in processes of acute stroke care and patient outcome. No medical setting related differences were found according to comorbidity, although indications of a worse outcome in patients with moderate comorbidity in neurological settings warrant further investigation.

Long-term use of zopiclone, zolpidem and zaleplon among Danish elderly and the association with sociodemographic factors and use of other drugs.

PURPOSE: To estimate the degree of long-term use of zopiclone, zolpidem and zaleplon among Danes aged 65 and older and the association with sociodemographic factors and use of other drugs. METHODS: Danish register-based study of 5000 men and 5000 women aged 65 or older on 1 January 2004. Information on sociodemographic factors and drug redemptions were collected for 2003, with follow-up of zopiclone, zolpidem and zaleplon redemptions in 2004. Long-term use was defined as redemptions corresponding to a continuous daily use for more than 4 weeks (based on ½ DDD). The association between long-term use and sociodemographics and drug use was estimated by logistic regression. RESULTS: Ten per cent of all men and 16% of all women had a long-term use for minimum 4 weeks corresponding to 94% of the male and 93% of the female users. Four per cent of the men and 6% of the women had redeemed more than ½ DDD per day in 2004. Long-term use was associated with: Being a woman, high age, widowed or divorced, high education and high gross income. Long-term use was also associated with use of other drugs, the association with ATC group N being the strongest. Restricting the analyses to individuals who had minimum one zopiclone, zolpidem or zaleplon redemption gave similar results. CONCLUSION: The results indicate that the guidance for length of use is not followed. Long-term use of zopiclone, zolpidem and zaleplon is associated with sociodemographic factors and use of other drugs, particularly from ATC group N.

A cluster randomised pragmatic trial applying Self-determination theory to type 2 diabetes care in general practice.

BACKGROUND: Treatment recommendations for prevention of type 2 diabetes complications often require radical and life-long health behaviour changes. Observational studies based on Self-determination theory (SDT) propose substantial factors for the maintenance of behaviour changes and concomitant well-being, but experimental research is needed to develop and evaluate SDT-based interventions. The aims of this paper were to describe 1) the design of a trial assessing the effectiveness of a training course for practice-nurses in autonomy support on patient-perceived motivation, HbA1, cholesterol, and well-being among a diabetes population, 2) the actual intervention to a level of detail that allows its replication, and 3) the connection between SDT recommendations for health care-provider behaviour and the content of the training course. METHODS/DESIGN: The study is a cluster-randomised pragmatic trial including 40 Danish general practices with nurse-led diabetes consultations, and the associated diabetes population. The diabetes population was identified by registers (n = 4034).The intervention was a 16-hour course with interactive training for practice nurses. The course was delivered over 4 afternoons at Aarhus University and one 1/2 hour visit to the practice by one of the course-teachers over a period of 10 months (0, 2, 5, 10 mths.). The intervention is depicted by a PaT Plot showing the timeline and the characteristics of the intervention components.Effectiveness of the intervention will be assessed on the diabetes populations with regard to well-being (PAID, SF-12), HbA1c- and cholesterol-levels, perceived autonomy support (HCCQ), type of motivation (TSRQ), and perceived competence for diabetes care (PCD) 15-21 months after the core course; the completion of the second course afternoon. Data will be retrieved from registers and by questionnaires. DISCUSSION: Challenges and advantages of the pragmatic design are discussed. In a real-world setting, this study will determine the impact on motivation, HbA1c, cholesterol, and well-being for people with diabetes by offering a training course in autonomy support to practice-nurses from general practices with nurse-led consultations. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01187069.

Mediators for the Effect of Compassion Cultivating Training: A Longitudinal Path Analysis in a Randomized Controlled Trial Among Caregivers of People With Mental Illness.

Background: There is a paucity of research on mediators of change, within compassion training programs. The aim was to investigate the mediators, of an 8-week compassion cultivation training (CCT) program, on the effect of psychological distress on caregivers of people with a mental illness. Method: Longitudinal path models in a randomized controlled trial (RCT). One hundred ninety-two participants were assessed for eligibility, and 161 participants were included into the trial and randomized. The main outcome was psychological distress measured by the Depression, Anxiety and Stress scale at 6 months. Mediators included self-compassion (SC), mindfulness (FM), emotion regulation (ER), emotion suppression (ES), and cognitive reappraisal (CR). Baseline, post, and 3- and 6-month follow-up measurements were collected. Results: The mediated effects for CCT are as follows: depression at 6 months: SC: -1.81 (95% CI: -3.31 to -0.31); FM: -1.98 (95% CI: -3.65 to -0.33); ER: -0.14 (95% CI: -1.31 to 1.02); anxiety at 6 months: SC: -0.71 (95% CI: -1.82 to 0.40); FM: -1.24 (95% CI: -2.39 to -0.09); ER: 0.18 (95% CI: -1.04 to 1.40); stress at 6 months: SC: -1.44 (95% CI: -2.84 to -0.05); FM: -2.17 (95% CI: -3.63 to -0.71); ER: -0.27 (95% CI: -1.51 to 0.98). Conclusion: Mindfulness and self-compassion are important components in reducing psychological distress experienced by informal caregivers of people with a mental illness. Results contribute to the knowledge about the underlying mechanisms of CCT.

Stress-free Everyday LiFe for Children and Adolescents REsearch (SELFCARE): a protocol for a cluster randomised trial testing a school teacher training programme to teach mindfulness (".b").

BACKGROUND: There is a call for sustainable, evidence-based interventions in schools to promote mental health in schoolchildren. Our primary aim of this trial is to evaluate the effectiveness in vulnerable pupils of a school teacher training programme to teach mindfulness (".b" programme) as a part of compulsory class room teaching in Danish schools on the pupils' self-reported mental health at 6-month follow-up. Our secondary aim is to evaluate the effectiveness of the school teacher training programme to teach the ".b"-programme as a part of compulsory class room teaching among the total pupil population on the pupils' self-reported mental health at 3 and 6 months after baseline. METHODS: The pragmatic cluster two-armed randomised controlled trial includes 110 municipal or private schools from all five regions in Denmark; 191 school teachers and approximately 2000 pupils at 11-15 years of age. Exclusion criteria; for schools: < 100 pupils; for pupils: parental opt out. Our intervention consists of (A) a school teacher training programme and (B) the ".b"-programme delivered as part of compulsory class room teaching in schools to pupils at the age of 11-15 years. The pupils in the control schools receive education as usual. Our primary study population is the vulnerable subgroup with a Strengths and Difficulties Questionnaire (SDQ) total difficulties score > 80% percentile at baseline (approximately 400 pupils). The primary outcome is change in the SDQ total score by the pupils. We also evaluate the effectiveness among the total pupil study population and in girls and boys, respectively and use other measures on mental health. Data will be analysed with repeated measurement models taken clusters into account. DISCUSSION: This large-scale trial will estimate the effectiveness of a population-based strategy on mental health in Danish schoolchildren. The trial evaluates the effect of a school teacher training programme, where teachers are trained in teaching the ".b" programme. The ".b" programme will be taught as a part of compulsory class room teaching. The intervention takes implementation issues into account. Effectiveness will be evaluated both in a vulnerable subgroup and among the total population. Trial registration number ClinicalTrials.gov Identifier: NCT04208113, registered December 23 2019, https://clinicaltrials.gov/ct2/show/NCT04208113 .

Does parental farm upbringing influence the risk of asthma in offspring? A three-generation study.

BACKGROUND: A farm upbringing has been associated with lower risk of asthma and methylation of asthma-related genes. As such, a farm upbringing has the potential to transfer asthma risk across generations, but this has never been investigated. We aimed to study the generational effects from a parental farm upbringing on offspring asthma. METHODS: Our study involved three generations: 5759 participants from the European Community Respiratory Health Survey (ECRHS) study (born 1945-1971, denoted G1), their 9991 parents (G0) and their 8260 offspring (G2) participating in RHINESSA (Respiratory Health In Northern Europe, Spain and Australia). Questionnaire data were collected on G0 and G1 from G1 in 2010 and on G2 from themselves in 2013. The parental/grandparental place of upbringing was categorized: (i) both parents from farm; (ii) mother from farm, father from village/city; (iii) father from farm, mother from village/city; (iv) both parents from village or one parent from village and one from city; (v) both parents from city (reference group). Grandparental upbringing was equivalently categorized. Offspring asthma was self-reported and data were analysed using Cox-regression models with G2 age as the time scale. RESULTS: A parental farm upbringing was not associated with offspring asthma when compared with city upbringing [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.74-1.69]. Findings remained similar when stratified by offspring upbringing and asthma phenotypes. Quantitative bias analyses showed similar estimates for alternative data sources. A grandparental farm upbringing was not associated with offspring asthma in either the maternal (HR 1.05, 95% CI 0.67-1.65) or paternal line (HR 1.02, 95% CI 0.62-1.68). CONCLUSIONS: This multigenerational analysis suggests no evidence of an association between parental/grandparental farm upbringing and offspring asthma.

Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia.

BACKGROUND: Tunneled central venous catheters (CVCs) are inevitable in children with acute lymphoid leukemia (ALL). The aim of this study was to evaluate the risk of CVC-related complications in children with ALL in relation to timing of catheter placement and type of catheter. PROCEDURE: All children hospitalized from January 2000 to March 2008 with newly diagnosed ALL and with double-lumen total implantable devices (TIDs) or tunneled external catheters (TEs) were included retrospectively. We only used data related to the patient's first catheter. RESULTS: We included 98 children; 35 received a TID and the remaining 63 received a TE. A total number of 29,566 catheter days and 93 catheter-associated blood stream infections (CABSI) was identified. We found a CABSI rate of 3.1/1,000 catheter days (5.4/1,000 catheter days for TEs and 1.4/1,000 catheter days for TIDs, incidence rate ratio (IRR) 3.82 (95% CI 2.37-6.35) P = 0.0001). No difference was found in CABSI between neither early versus later placed TIDs (IRR = 0.99 (95% CI 0.41-2.45) P = 0.98) nor early versus later placed TEs (IRR = 0.81 (95% CI 0.40-1.86) P = 0.54). We found no difference between early and later placed catheters regarding non-elective removal (RR = 0.86 (95% CI 0.72-1.03) P = 0.09). TEs had a higher risk of non-elective removal compared with TIDs (RR = 3.95 (95% CI 1.88-8.29) P < 0.001). CONCLUSIONS: The study did not find that children with ALL and with early placed CVCs experienced significantly more complications compared with children with late placed catheters. This study found that children with ALL and TEs experienced more complications than children with TIDs.