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1.
Dan Med J ; 68(5)2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33870886

RESUMEN

INTRODUCTION Prompted by reports of thromboembolic events - some with fatal outcomes - among people who had received the ChAdOx1 nCoV-19 (AZD1222) vaccine from Oxford-AstraZeneca against COVID-19, a number of European countries paused vaccination with this vaccine in early and mid-March 2021. Prior studies have suggested that vaccine willingness is highly dependent on public trust in the safety of vaccines. We therefore investigated whether vaccine willingness dropped in the wake of the reported cases of thromboembolic events in relation to the Oxford-AstraZeneca COVID-19 vaccine. METHODS Using longitudinal survey data from Denmark, we compared vaccine willingness shortly before and after the reported cases of thromboembolic events, as well as the perceived safety of the two most widely used COVID-19 vaccines in Denmark - those from Pfizer-BioNTech and Oxford-AstraZeneca - in the wake of these events. RESULTS We found sustained vaccine willingness after the reported cases of thromboembolic events (89% both before and after). However, the safety of the Oxford-AstraZeneca COVID-19 vaccine was perceived to be significantly and substantially lower than the safety of the vaccine from Pfizer-BioNTech, and this difference was particularly pronounced among those who were vaccine-hesitant. CONCLUSIONS The vaccine willingness of Danes does not seem to have been affected by the reports of thromboembolic events in relation to the Oxford-AstraZeneca COVID-19 vaccine. FUNDING The study was funded by a grant from the Novo Nordisk Foundation (grant number: NNF20SA0062874). TRIAL REGISTRATION not relevant.


Asunto(s)
/efectos adversos , Aceptación de la Atención de Salud/psicología , Tromboembolia/inducido químicamente , Tromboembolia/epidemiología , Anciano , Dinamarca/epidemiología , Europa (Continente)/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Encuestas y Cuestionarios , Confianza
2.
Sensors (Basel) ; 21(5)2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33807527

RESUMEN

PURPOSE: We aimed to investigate the influence of wearing a ballistic vest on physical performance in police officers. METHODS: We performed a cross-over study to investigate the influence of wearing a ballistic vest on reaction and response time, lumbar muscle endurance and police vehicle entry and exit times. Reaction and response time was based on a perturbation setup where the officers' pelvises were fixed and EMG of lumbar and abdominal muscles was recorded. We used a modified Biering-Sørensen test to assess the lumbar muscle endurance and measured duration of entry and exit maneuvers in a variety of standard-issue police cars. RESULTS: There was a significant difference of 24% in the lumbar muscle endurance test (no vest: 151 s vs. vest: 117 s), and the police officers experienced higher physical fatigue after the test when wearing a vest. Furthermore, officers took longer to both enter and exit police cars when wearing a vest (range: 0.24-0.56 s) depending on the model of the vehicle. There were no significant differences in reaction and response times between the test conditions (with/without vest). DISCUSSION AND CONCLUSION: Wearing of a ballistic vest significantly influenced the speed of movement in entry and exit of police cars and lumbar muscle endurance, although it does not seem to affect reaction or response times. The ballistic vest seems to impair performance of tasks that require maximal effort, which calls for better designs of such vests.


Asunto(s)
Vehículos a Motor , Policia , Estudios Cruzados , Dinamarca , Humanos , Rendimiento Físico Funcional
3.
Nat Commun ; 12(1): 2009, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33790294

RESUMEN

Microorganisms play crucial roles in water recycling, pollution removal and resource recovery in the wastewater industry. The structure of these microbial communities is increasingly understood based on 16S rRNA amplicon sequencing data. However, such data cannot be linked to functional potential in the absence of high-quality metagenome-assembled genomes (MAGs) for nearly all species. Here, we use long-read and short-read sequencing to recover 1083 high-quality MAGs, including 57 closed circular genomes, from 23 Danish full-scale wastewater treatment plants. The MAGs account for ~30% of the community based on relative abundance, and meet the stringent MIMAG high-quality draft requirements including full-length rRNA genes. We use the information provided by these MAGs in combination with >13 years of 16S rRNA amplicon sequencing data, as well as Raman microspectroscopy and fluorescence in situ hybridisation, to uncover abundant undescribed lineages belonging to important functional groups.


Asunto(s)
Genoma Bacteriano/genética , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Metagenoma/genética , Metagenómica/métodos , ARN Ribosómico 16S/genética , Aguas del Alcantarillado/microbiología , Bacterias/clasificación , Bacterias/genética , Reactores Biológicos/microbiología , Dinamarca , Microbiota/genética , Filogenia , ARN Ribosómico 23S/genética , ARN Ribosómico 5S/genética , Aguas Residuales/microbiología , Purificación del Agua/métodos
4.
PLoS One ; 16(4): e0249733, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33836034

RESUMEN

BACKGROUND: Initially, the relative sizes of the asymptomatic and the symptomatic infected populations were not known for the COVID-19 pandemic and neither was the actual fatality rate. Therefore it was not clear either how the pandemic would impact the healthcare system. As a result it was initially predicted that the COVID-19 epidemic in Denmark would overwhelm the healthcare system and thus both the diagnosis and treatment of other hospital patients were compromised for an extended period. AIM: To develop a mathematical model, which includes both asymptomatic and symptomatic infected persons, for early estimation of the epidemic's course, its Infection Fatality Rate and the healthcare system load in Denmark, both retrospectively and prospectively. METHODS: The SEIRS (Susceptible-Exposed-Infected-Recovered-Susceptible) model including deaths outside hospitals and separate assessments of symptomatic and asymptomatic cases (based on seroprevalence) with different immunological memories. Optimal model parameters are in part identified by Monte Carlo based Least Square Error methods while micro-outbreaks are modeled by noise and explored in Monte Carlo simulations. Estimates for infected population sizes are obtained by using a quasi steady state method. RESULTS: The calculations and simulations made by the model were shown to fit with the observed development of the COVID-19 epidemic in Denmark. The antibody prevalence in the general population in May 2020 was 1.37%, which yields a relative frequency of symptomatic and asymptomatic cases of 1 to 5.2. Due to the large asymptomatic population, the Infection Mortality Rate was only 0.4%. However, with no non-pharmacological restrictions the COVID-19 death toll was calculated to have more than doubled the national average yearly deaths within a year. The transmission rate ℜ0 was 5.4 in the initial free epidemic period, 0.4 in the lock-down period and 0.8-1.0 in the successive re-opening periods through August 2020. The large asymptomatic population made the termination of the epidemic difficult and micro-outbreaks occurred when the country re-opened. The estimated infected population size July 15 to August 15 was 2,100 and 12,200 for October 1-20, 2020. CONCLUSIONS: The results of the model show, that COVID-19 has a low Infection Fatality Rate because the majority of infected persons are either asymptomatic or with few symptoms. A minority of the infected persons, therefore, requires hospitalization. That means that for a given infection pressure of both symptomatic and asymptomatic infected there will be a lower pressure on the capacity of the health care system than previously predicted. Further the epidemic will be difficult to terminate since about 84% of the infected individuals are asymptomatic but still contagious. The model may be useful if a major infection wave occurs in the autumn-winter season as it could make robust estimates both for the scale of an ongoing expanding epidemic and for the expected load on the healthcare system. The simulation may also be useful to evaluate different testing strategies based on estimated infected population sizes. The model can be adjusted and scaled to other regions and countries, which is illustrated with Spain and USA.


Asunto(s)
Modelos Biológicos , Pandemias , Estaciones del Año , /epidemiología , Dinamarca/epidemiología , Femenino , Humanos , Masculino
5.
BMC Infect Dis ; 21(1): 386, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-33902487

RESUMEN

BACKGROUND: Congenital cytomegalovirus disease (cCMV) is common and can be fatal or cause severe sequelae. Circulating strains of cytomegalovirus carry a high number of variable or disrupted genes. One of these is UL146, a highly diverse gene with 14 distinct genotypes encoding a CXC-chemokine involved in viral dissemination. UL146 genotypes 5 and 6 lack the conserved ELR motif, potentially affecting strain virulence. Here, we investigate whether UL146 genotypes 5 and 6 were associated with congenital CMV infection. METHODS: Viral DNA was extracted and UL146 sequenced from 116 neonatal dried blood spots (DBS) stored in the Danish National Biobank since 1982 and linked to registered cCMV cases through a personal identifier. These sequences were compared to UL146 control sequences obtained from CMV DNA extracted from 83 urine samples from children with suspected bacterial urinary tract infections. RESULTS: Three non-ELR UL146 genotypes (5 and 6) were observed among the cases (2.6%) and two were observed among the controls (2.4%; P > 0.99). Additionally, no significant association with cCMV was found for the other 12 genotypes in a post-hoc analysis, although genotype 8 showed a tendency to be more frequent among cases with 12 observations against three (P = 0.10). All fourteen genotypes were found to have little intra-genotype variation. Viral load, gender, and sample age were not found to be associated with any particular UL146 genotype. CONCLUSIONS: No particular UL146 genotype was associated with cCMV in this nationwide retrospective case-control study. Associations between CMV disease and disrupted or polymorph CMV genes among immunosuppressed people living with HIV/AIDS and transplant recipients should be investigated in future studies.


Asunto(s)
Quimiocinas CXC/química , Quimiocinas CXC/genética , Infecciones por Citomegalovirus/epidemiología , Citomegalovirus/genética , Genotipo , Enfermedades del Recién Nacido/epidemiología , Proteínas Virales/química , Proteínas Virales/genética , Secuencias de Aminoácidos , Secuencia de Aminoácidos , Secuencia de Bases , Estudios de Casos y Controles , Infecciones por Citomegalovirus/sangre , Infecciones por Citomegalovirus/orina , Infecciones por Citomegalovirus/virología , ADN Viral/sangre , ADN Viral/genética , Dinamarca/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/sangre , Enfermedades del Recién Nacido/orina , Enfermedades del Recién Nacido/virología , Masculino , Polimorfismo Genético , Estudios Retrospectivos , Carga Viral
6.
Eur Neuropsychopharmacol ; 46: 39-48, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33823427

RESUMEN

The ongoing Coronavirus Disease 2019 (COVID-19) pandemic has affected more than 100 million people and clinics are being established for diagnosing and treating lingering symptoms, so called long-COVID. A key concern are neurological and long-term cognitive complications. At the same time, the prevalence and nature of the cognitive sequalae of COVID-19 are unclear. The present study aimed to investigate the frequency, pattern and severity of cognitive impairments 3-4 months after COVID-19 hospital discharge, their relation to subjective cognitive complaints, quality of life and illness variables. We recruited patients at their follow-up visit at the respiratory outpatient clinic, Copenhagen University Hospital, Bispebjerg, approximately four months after hospitalisation with COVID-19. Patients underwent pulmonary, functional and cognitive assessments. Twenty-nine patients were included. The percentage of patients with clinically significant cognitive impairment ranged from 59% to 65% depending on the applied cut-off for clinical relevance of cognitive impairment, with verbal learning and executive functions being most affected. Objective cognitive impairment scaled with subjective cognitive complaints, lower work function and poorer quality of life. Cognitive impairments were associated with d-dimer levels during acute illness and residual pulmonary dysfunction. In conclusion, these findings provide new evidence for frequent cognitive sequelae of COVID-19 and indicate an association with the severity of the lung affection and potentially restricted cerebral oxygen delivery. Further, the associations with quality of life and functioning call for systematic cognitive screening of patients after recovery from severe COVID-19 illness and implementation of targeted treatments for patients with persistent cognitive impairments.


Asunto(s)
/epidemiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicología , Alta del Paciente/tendencias , Índice de Severidad de la Enfermedad , Anciano , Dinamarca/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo
7.
Bone Joint J ; 103-B(4): 762-768, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789482

RESUMEN

AIMS: To compare the functionality of adults with displaced mid-shaft clavicular fractures treated either operatively or nonoperatively and to compare the relative risk of nonunion and reoperation between the two groups. METHODS: Based on specific eligibility criteria, 120 adults (median age 37.5 years (interquartile range (18 to 61)) and 84% males (n = 101)) diagnosed with an acute displaced mid-shaft fracture were recruited, and randomized to either the operative (n = 60) or nonoperative (n = 60) treatment group. This randomized controlled, partially blinded trial followed patients for 12 months following initial treatment. Functionality was assessed by the Constant score (CS) (assessor blinded to treatment) and Disability of the Arm, Shoulder and Hand (DASH) score. Clinical and radiological evaluation, and review of patient files for complications and reoperations, were added as secondary outcomes. RESULTS: At 12 months, 87.5% of patients (n = 105) were available for analysis. The two groups were well balanced based on demographic and fracture-related characteristics. At six weeks of follow-up a significant difference in DASH score (p < 0.001) was found in favour of operative treatment. The functionality at 12 months of follow-up based on CS and DASH was excellent in both groups (CS > 90 points and DASH < 10 points) with no significant difference (p = 0.277 for DASH and p = 0.184 for CS) between the two groups. The risk of symptomatic nonunion was significantly higher in the nonoperative group (p = 0.014), with a relative risk of 9.47 (95% confidence interval (CI) 1.26 to 71.53) in this group compared to the operative group. The number-needed-to-treat to avoid one symptomatic nonunion was 6.2. Initial treatment and age were factors significantly associated with nonunion in a logistic analysis. There were 26% in both groups (n = 14 in operative group and n = 15 in nonoperative group) who required secondary surgery, with most indications in the nonoperative group mandatory due to nonunion compared to most relative indications in the operative group requiring intervention due to implant irritation. CONCLUSION: Superiority was not identified with either an all-operative or all-nonoperative approach. The functionality at short term (within six weeks) seems igreater following operative treatment but was not found at one year. The risk of nonunion is significantly higher with nonoperative treatment. However, an all-operative approach to lower the nonunion risk may result in unnecessary surgery and is not recommended. Cite this article: Bone Joint J 2021;103-B(4):762-768.


Asunto(s)
Clavícula/lesiones , Fijación de Fractura/métodos , Fracturas Óseas/terapia , Fracturas no Consolidadas/terapia , Adolescente , Adulto , Dinamarca , Evaluación de la Discapacidad , Femenino , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Recuperación de la Función , Reoperación
8.
J Headache Pain ; 22(1): 22, 2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33832438

RESUMEN

Headache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organized in Denmark. This description is followed by sections on the characteristics, diagnosis and treatment of each of the most common primary and secondary headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular challenges regarding migraine and female hormones as well as headache in children are addressed.


Asunto(s)
Trastornos de Cefalalgia , Cefalea , Niño , Dinamarca , Europa (Continente) , Dolor Facial/diagnóstico , Dolor Facial/terapia , Femenino , Cefalea/diagnóstico , Cefalea/terapia , Trastornos de Cefalalgia/diagnóstico , Trastornos de Cefalalgia/terapia , Humanos
9.
Occup Ther Int ; 2021: 8893345, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33824631

RESUMEN

Current research shows that children with sensory processing (SP) difficulties have limited participation and enjoyment in their daily activities at school. The aim of this study was to explore the prevalence of SP difficulties among Danish children and to explore possible associated factors. Since SP difficulties can affect children's prerequisites for participation in school activities and learning possibilities, this study focused on primary school children. Method. The study was designed as a cross-sectional survey. The sample consisted of 1723 children age 5 to 11 years, who were attending Danish public school (45.5% girls, 53.2% boys). The parents or caregivers of the child completed a Short Sensory Profile (SSP) questionnaire and a demographic questionnaire. One-way ANOVA was used to examine differences between girls and boys regarding sports, geographic area, and parental level of education. Chi-square analysis was used to explore the relationship between sex and SPP scores in the different behavioral sections. Logistic regression analysis was used to investigate possible associations between SP difficulties and sex and the included demographics. Results. A total of 21.3% of the children had SSP scores suggesting SP difficulties. Boys had a higher probability of having SP difficulties than girls (odds ratio (OR) = 1.55, confidence level (Cl): 1.22, 1.97). An association was found between participating in sports outside of school and SP difficulties (OR = 0.55, Cl: 0.47, 0.65 (p ≤ 0.001)). Additionally, a slight association between SP difficulties and parental education level (OR = 0.80) was found. No association was found regarding geographic area, i.e., where in Denmark the children attended school (OR = 1.00). Conclusion. The study results suggest that approximately 20% of the children in Danish public schools might have SP difficulties and over 20% might be at risk of having SP difficulties. The results suggest that Danish schools should focus on both identifying children with SP difficulties and implement interventions such as sensory integration through occupational therapy to help children with SP difficulties, in order to improve their ability to participate and learn from school activities.


Asunto(s)
Trastornos de la Sensación , Estudiantes , Niño , Preescolar , Estudios Transversales , Dinamarca/epidemiología , Femenino , Humanos , Masculino , Terapia Ocupacional , Instituciones Académicas , Trastornos de la Sensación/epidemiología , Trastornos de la Sensación/rehabilitación , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios
10.
BMC Psychiatry ; 21(1): 190, 2021 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-33849472

RESUMEN

BACKGROUND: Randomised controlled trials suggest that family therapy has a positive effect on the course of depression, schizophrenia and anorexia nervosa. However, it is largely unknown whether a positive link also exists between caregiver involvement and patient outcome in everyday psychiatric hospital care, using information reported directly from patients, i.e. patient-reported experience measures (PREM), and their caregivers. The objective of this study is to examine whether caregiver-reported involvement is associated with PREM regarding patient improvement and overall satisfaction with care. METHODS: Using data from the National Survey of Psychiatric Patient Experiences 2018, we conducted a nationwide cross-sectional study in Danish psychiatric hospitals including patients and their caregivers who had been in contact with the hospital (n = 940 patients, n = 1008 caregivers). A unique patient identifier on the two distinct questionnaires for the patient and their caregiver enabled unambiguous linkage of data. In relation to PREM, five aspects of caregiver involvement were analysed using logistic regression with adjustment for patient age, sex and diagnosis. RESULTS: We consistently find that high caregiver-reported involvement is statistically significantly associated with high patient-reported improvement and overall satisfaction with care with odds ratios (OR) ranging from 1.69 (95% confidence interval (CI) 0.95-2.99) to 4.09 (95% CI 2.48-6.76). This applies to the following aspects of caregiver-reported involvement: support for the patient-caregiver relationship, caregiver information, consideration for caregiver experiences and the involvement of caregivers in decision making. No statistically significant association is observed regarding whether caregivers talk to the staff about their expectations for the hospital contact. CONCLUSION: This nationwide study implies that caregiver involvement focusing on the patient-caregiver relationship is positively associated with patient improvement and overall satisfaction with care in everyday psychiatric hospital care.


Asunto(s)
Hospitales Psiquiátricos , Satisfacción Personal , Cuidadores , Estudios Transversales , Dinamarca , Humanos , Satisfacción del Paciente , Encuestas y Cuestionarios
11.
BMC Geriatr ; 21(1): 269, 2021 04 21.
Artículo en Inglés | MEDLINE | ID: mdl-33882868

RESUMEN

The Clinical Frailty Scale, which provides a common language about frailty, was recently updated to version 2.0 to cater for its increased use in areas of medicine usually involved in the care and treatment of older patients. We have previously translated the Clinical Frailty Scale 1.2 into Danish and found inter-rater-reliability to be excellent for primary care physicians, community nurses, and hospital doctors often involved in cross-sectoral collaborations. In this correspondence we present the Danish translation and cultural adaption of the Clinical Frailty Scale 2.0. Our recent findings on cross-sectoral inter-rater reliability for the Clinical Frailty Scale 1.2 are likely also applicable for the Clinical Frailty Scale 2.0.


Asunto(s)
Fragilidad , Dinamarca/epidemiología , Fragilidad/diagnóstico , Fragilidad/epidemiología , Humanos , Lenguaje , Reproducibilidad de los Resultados , Traducciones
12.
Nat Commun ; 12(1): 2301, 2021 04 16.
Artículo en Inglés | MEDLINE | ID: mdl-33863885

RESUMEN

The molecular landscape in non-muscle-invasive bladder cancer (NMIBC) is characterized by large biological heterogeneity with variable clinical outcomes. Here, we perform an integrative multi-omics analysis of patients diagnosed with NMIBC (n = 834). Transcriptomic analysis identifies four classes (1, 2a, 2b and 3) reflecting tumor biology and disease aggressiveness. Both transcriptome-based subtyping and the level of chromosomal instability provide independent prognostic value beyond established prognostic clinicopathological parameters. High chromosomal instability, p53-pathway disruption and APOBEC-related mutations are significantly associated with transcriptomic class 2a and poor outcome. RNA-derived immune cell infiltration is associated with chromosomally unstable tumors and enriched in class 2b. Spatial proteomics analysis confirms the higher infiltration of class 2b tumors and demonstrates an association between higher immune cell infiltration and lower recurrence rates. Finally, the independent prognostic value of the transcriptomic classes is documented in 1228 validation samples using a single sample classification tool. The classifier provides a framework for biomarker discovery and for optimizing treatment and surveillance in next-generation clinical trials.


Asunto(s)
Biomarcadores de Tumor/genética , Carcinoma de Células Transicionales/genética , Recurrencia Local de Neoplasia/epidemiología , Neoplasias de la Vejiga Urinaria/genética , Anciano , Vacuna BCG/administración & dosificación , Carcinoma de Células Transicionales/inmunología , Carcinoma de Células Transicionales/mortalidad , Carcinoma de Células Transicionales/terapia , Inestabilidad Cromosómica , Cistectomía/métodos , Dinamarca/epidemiología , Femenino , Estudios de Seguimiento , Regulación Neoplásica de la Expresión Génica , Genómica , Humanos , Estimación de Kaplan-Meier , Masculino , Mutación , Recurrencia Local de Neoplasia/genética , Pronóstico , Supervivencia sin Progresión , RNA-Seq , Vejiga Urinaria/inmunología , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/inmunología , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/terapia
13.
Epidemiol Psychiatr Sci ; 30: e28, 2021 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-33820580

RESUMEN

AIMS: Antipsychotics are primarily labelled for the treatment of severe mental illness and have documented clinical utility in certain neurological disorders or palliative care. However, off-label use of antipsychotics is common and increasing, and prior studies on antipsychotic utilisation have not specifically assessed users in neurology, palliative care or general practice. We aimed to explore diagnoses associated with antipsychotic use, treatment patterns and characteristics of users without diagnoses relevant to antipsychotic treatment. METHODS: Population-based study identifiying all users of antipsychotics in Denmark (pop 5.7 mio.) 1997-2018 in the Danish National Prescription Register (DNPR). Possible indications for antipsychotic therapy were evaluated using in- and outpatient contacts from the DNPR. Users were divided hierarchically into six groups: severe mental disorders (schizophrenia, bipolar-spectrum disorders), chronic mental disorders (dementias, mental retardation, autism), other mental disorders (depression-spectrum, anxiety and personality disorders, etc.), selected neurological diseases, cancer and antipsychotic users without any of these diagnoses. This last group was characterised regarding demographics, antipsychotic use, health care utilisation and likely antipsychotic treatment initiator in 2018. RESULTS: Altogether, 630 307 antipsychotic users were identified, of whom 127 649 had filled prescriptions during 2018. Users without diagnoses relevant to antipsychotic treatment comprised of the largest group (37%), followed by schizophrenia and bipolar-spectrum disorders (34%), other mental disorders (15%), dementia, autism and mental retardation (11%), cancer (2.2%) and neurological diagnoses (2.0%). Of 37 478 incident users in 2018, 39% had no diagnosis relevant to antipsychotic treatment, 7.9% had major depression, 7.7% neurotic/stress-related disorders and 7.5% dementia. Quetiapine was most commonly used, both overall (51%) and among users without diagnoses relevant to antipsychotic treatment (58%). Of 14 474 incident users in 2018 without diagnoses relevant to antipsychotic treatment, treatment was most likely initiated by a general practitioner (65%), with only 17% seeing a psychiatrist during the following year. As many as 18% of patients with adjustment disorders and 14% of those without relevant diagnoses for antipsychotic use, remained on antipsychotic treatment 5 years after their first prescription. CONCLUSIONS: Over one-third of antipsychotic users in Denmark did not have psychiatric, neurological or cancer diagnoses as possible indications for antipsychotic therapy. Many antipsychotics are initiated or prescribed in general practice, and a concerningly large subgroup without documented diagnoses relevant for antipsychotics continued to receive them. Rational prescribing, adequate side effect monitoring and further research into reasons for the observed antipsychotic use patterns and their risk-benefit ratio are needed.


Asunto(s)
Antipsicóticos , Utilización de Medicamentos , Trastornos Mentales , Uso Fuera de lo Indicado , Antipsicóticos/uso terapéutico , Dinamarca/epidemiología , Utilización de Medicamentos/estadística & datos numéricos , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Uso Fuera de lo Indicado/estadística & datos numéricos
14.
Dan Med J ; 68(3)2021 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-33660609

RESUMEN

INTRODUCTION: Mortality due to COVID-19 is higher among elderly patients with comorbidities. Even so, prognostication in COVID-19 remains limited. METHODS: We assessed 90-day mortality stratified by comorbidities, routine biochemical markers and oxygen need in a consecutive single-centre cohort from 2 March to 2 June 2020. RESULTS: We included 263 hospitalised patients with laboratory-confirmed COVID-19. On admission, fitness for intensive care was determined in 254 patients including 98 (39%) with a do-not-resuscitate order. Ninety-day overall mortality was 29%, whereas intensive care unit (ICU) mortality was 35% (14/40). Alcohol abuse, liver disease and elevated urea were strongly associated with mortality in univariable analyses. In a mutually adjusted multivariable analysis, we found an independent incremental increase in 90-day mortality with each increasing age by decade (hazard ratio (HR) = 1.5; 95% confidence interval (CI): 1.2-1.9), Charlson Comorbidity Index (CCI) score (HR = 1.2; 95% CI: 1.0-1.4), number of abnormal blood tests (HR = 1.2; 95% CI: 1.1-1.3) and l/min. of supplemental oxygen (HR = 1.1; 95% CI: 1.1-1.2). CONCLUSIONS: The overall mortality was similar to that of other hospitalised patients, whereas the ICU mortality was lower than expected. On admission, each additional age by decade, CCI score, number of abnormal blood tests and magnitude of supplemental oxygen were independently associated with increased mortality. FUNDING: none. TRIAL REGISTRATION: not relevant.


Asunto(s)
/diagnóstico , Hospitalización , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Estudios de Cohortes , Cuidados Críticos , Dinamarca , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Tasa de Supervivencia , Adulto Joven
15.
Dan Med J ; 68(3)2021 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-33660610

RESUMEN

INTRODUCTION: The aim of this study was to explore changes in medical therapy and document the level of COVID-19-specific worries in patients with inflammatory bowel disease (IBD) during the COVID-19 epidemic in Denmark. METHODS: A cross-sectional survey including 619 IBD patients was conducted. Patients answered questionnaires regarding IBD, IBD medicine, sociodemographic information, mental health, and COVID-19-specific worries (response rate = 64.6%). RESULTS: In total, 14.3% of patients using IBD medication had paused or stopped their IBD treatment during the initial phase of the COVID-19 epidemic, the majority (61.4%) either due to remission or because of side-effects. Only five patients stated that COVID-19 contributed to their decision. The majority of patients (70.5%) expressed worries about an increased risk of infection with coronavirus-2 and worries that their IBD and/or IBD treatment might result in severe COVID-19. Women, patients taking immunomodulators and patients who considered their IBD to be severe were significantly more worried than the remaining population. Age, type of IBD, co-morbidity, level of education, work capacity and mental health were not associated with an increased level of COVID-19-specific worries. CONCLUSIONS: In this selected IBD population, medical IBD treatment was rarely stopped or paused during the initial phase of the COVID-19 epidemic even though 70% of the respondents expressed COVID-19-specific worries. These worries should, nevertheless, be addressed and the characteristics of the population who expressed concerns may be used in future targeted information to secure compliance. FUNDING: none. TRIAL REGISTRATION: not relevant.


Asunto(s)
Ansiedad , Miedo , Enfermedades Inflamatorias del Intestino/psicología , Salud Mental , Adulto , Estudios Transversales , Dinamarca , Femenino , Conductas Relacionadas con la Salud , Humanos , Factores Inmunológicos/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Encuestas y Cuestionarios
17.
Zootaxa ; 4927(2): zootaxa.4927.2.4, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33756709

RESUMEN

No species of freshwater Nematomorpha have been described from Iceland, but they have been identified anecdotally. Recent surveys in Iceland using freshwater gastropods as biodiversity indicators resulted in the collection of adult free-living hairworms and their non-adult stages including cysts in snail paratenic hosts and juvenile worms in ground beetle definitive hosts. Additionally, specimens acquired from the Icelandic Institute of Natural History indicate nematomorphs are common in Iceland. A single specimen from the Faroe Islands National Museum represents a new species record. Our morphological and molecular characterization indicated all the samples belong to the species Gordionus wolterstorffii, a common nematomorph found throughout Europe. Also, we provide the first descriptions of the cyst stage for the genus Gordionus. Molecular phylogenetic analysis based on 10 species of Gordionus and one species of the closely related genus Parachordodes indicates that Gordionus is not monophyletic. Combining our morphological and phylogenetic investigations, we discuss the lack of clarity in diagnostic morphological characters and the need for additional global collections to clarify the taxonomy of Gordionus.


Asunto(s)
Helmintos , Animales , Dinamarca , Documentación , Helmintos/genética , Islandia , Filogenia
18.
Proc Natl Acad Sci U S A ; 118(15)2021 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-33771934

RESUMEN

We introduce a method for making short-term mortality forecasts of a few months, illustrating it by estimating how many deaths might have happened if some major shock had not occurred. We apply the method to assess excess mortality from March to June 2020 in Denmark and Sweden as a result of the first wave of the coronavirus pandemic; associated policy interventions; and behavioral, healthcare, social, and economic changes. We chose to compare Denmark and Sweden because reliable data were available and because the two countries are similar but chose different responses to COVID-19: Denmark imposed a rather severe lockdown; Sweden did not. We make forecasts by age and sex to predict expected deaths if COVID-19 had not struck. Subtracting these forecasts from observed deaths gives the excess death count. Excess deaths were lower in Denmark than Sweden during the first wave of the pandemic. The later/earlier ratio we propose for shortcasting is easy to understand, requires less data than more elaborate approaches, and may be useful in many countries in making both predictions about the future and the past to study the impact on mortality of coronavirus and other epidemics. In the application to Denmark and Sweden, prediction intervals are narrower and bias is less than when forecasts are based on averages of the last 5 y, as is often done. More generally, later/earlier ratios may prove useful in short-term forecasting of illnesses and births as well as economic and other activity that varies seasonally or periodically.


Asunto(s)
/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Dinamarca/epidemiología , Femenino , Predicción , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Suecia/epidemiología , Adulto Joven
19.
Undersea Hyperb Med ; 48(1): 33-42, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33648031

RESUMEN

Introduction: This study aimed to assess the capability of a pulse CO-oximeter to continuously monitor carboxyhemoglobin (COHb) during hyperbaric oxygen (HBO2) therapy. We estimated limits of agreement (LOA) between blood gas analysis and pulse CO-oximeter for COHb during HBO2 therapy in patients suffering from acute CO poisoning. Furthermore, we did a medicotechnical evaluation of the pulse CO-oximeter in hyperbaric conditions. Methods: We conducted a prospective, non-clinical, observational study in which we included n=10 patients with acute CO poisoning referred for HBO2 therapy. We did five repeated measurements of COHb for each patient during the HBO2 therapy. Bland-Altman analysis for multiple observations per individual was used to assess the agreement. The a priori LOA was ±6% for COHb. For the medicotechnical evaluation continuous measurements were obtained throughout each complete HBO2 therapy. The measurements were visually inspected and evaluated. Results: The Bland-Altman analysis showed that the pulse CO-oximeter overestimated COHb by 2.9 % [±1.0%] and the LOA was ±7.3% [±1.8%]. The continuous measurements by pulse CO-oximetry showed fluctuating levels of COHb and summarized saturations reached levels above 100%. Measurements were not affected by changes in pressure. Conclusion: To our knowledge, this study is the first to assess LOA and demonstrate use of a non-invasive method to measure COHb during HBO2 therapy. The pulse CO-oximeter performed within the manufactures reported LOA (±6%) despite hyperbaric conditions and was unaffected by changes in pressure. However, summarized saturations reached levels above 100%.


Asunto(s)
Intoxicación por Monóxido de Carbono/sangre , Intoxicación por Monóxido de Carbono/terapia , Carboxihemoglobina/análisis , Oxigenación Hiperbárica , Oximetría/instrumentación , Adulto , Análisis de los Gases de la Sangre , Dinamarca , Femenino , Semivida , Humanos , Masculino , Oximetría/métodos , Estudios Prospectivos , Pigmentación de la Piel
20.
Mol Cell ; 81(5): 893-895, 2021 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-33667378

RESUMEN

Here, we talk to first authors Kyosuke Nakamura and Georg Kustatscher, as well as co-corresponding author Anja Groth, about their paper "Proteome dynamics at broken replication forks reveal a distinct ATM-directed repair response suppressing double-strand break ubiquitination" (in this issue of Molecular Cell) and their scientific journeys until now.


Asunto(s)
Investigación Biomédica/organización & administración , Selección de Profesión , Replicación del ADN , Proteómica/tendencias , Adulto , Dinamarca , Historia del Siglo XXI , Humanos , Masculino , Mentores
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