The aim of this study was to compare the sensitivity of self-collected versus healthcare worker (HCW)-collected swabs for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing. ...Symptomatic individuals referred for SARS-CoV-2 testing were invited to provide mobile-phone video-instructed self-collected oropharyngeal and nasal samples followed by a HCW-collected oropharyngeal sample. All samples were sent for analysis to the same microbiology laboratory, and the number of SARS-CoV-2-positive participants in the two tests was compared. A total of 109 participants were included, and 19 participants had SARS-CoV-2-positive results. The diagnostic sensitivity of the self-collected and HCW-collected swabs was 84.2% and 89.5%, respectively, with an acceptable agreement, Cohens kappa 0.82, p < 0.001. Further, results from a questionnaire answered by the participants found that loss of smell as a self-reported symptom was a strong predictor for a SARS-CoV-2-positive test. In conclusion, we found that self-collected oropharyngeal and nasal swabs for SARS-CoV-2 testing can be reliable compared to HCW-collected oropharyngeal samples.
To examine the gradual association between self-reported health status and mortality in patients with heart failure (HF) as current research has focused on poor health status and increased risk of ...mortality.
This is a substudy of the DANISH (Defibrillator Implantation in Patients with Nonischemic Systolic HF) trial in which 1116 patients were randomized to receive or not receive an implantable cardioverter-defibrillator. Health status was assessed by a single question of the Short-Form 36. Patients were classified as having excellent/very good, good, fair (reference) or poor health status. We assessed the association between health status and mortality using multivariable Cox proportional hazard models.
Self-reported health status was completed by 943 (84%) patients at randomization with a median follow-up of 67 months and a health status distribution of; excellent/very good (n = 79, 8%), good (n = 369, 39%), fair (n = 409, 43%), and poor (n = 86, 9%). All-cause mortality (death events/ 100 person-years) occurred with gradual differences according to health status from excellent/ very good (2.14), good (3.74), fair (5.21) to poor health status (5.57). The gradual difference yielded a crude hazard ratio (HR) of 0.40, 95% CI 0.20–0.80 (adjusted HR 0.47 (95% CI 0.23–0.95) for excellent/ very good health status, HR 0.71, 95% CI 0.52–0.97 (adjusted HR 0.78 (95% CI 0.56–1.08) for good health status. Poor being worse than fair health status yielded a crude HR of 1.07, 95% CI 0.67–1.69.
Excellent/very good self-reported health status as assessed by a single question was associated with lower long-term mortality in patients with HF.
•In this study, the association between health status and mortality was gradual.•Patients with excellent/ very good health status have a lower long-term mortality risk.•Patients with excellent/very good health status can be informed of the positive implications.
Purpose
The “distressed” (Type D) personality trait has been reported to be over-represented in patients with heart failure (HF) compared to the background population and may provide prognostic ...information for mortality. We examined the association between Type D personality and outcomes in the DANISH trial (The Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart Failure on Mortality).
Methods
The DANISH trial included a total of 1116 patients with non-ischemic HF on guideline-recommended therapy. Type D personality was assessed with the Type D Scale (DS14) at baseline and investigated through follow-up accordingly. Multivariable Cox proportional hazard models were used to compare hazard ratios (HR) of cardiovascular and all-cause mortality.
Results
Type D personality assessment was completed by 873 (78%) patients at baseline and Type D personality was found in 120 (14%) patients. The median follow-up was 67 months (interquartile range IQR 48–83). Among patients with versus without Type D personality, 22% versus 19% died from all-cause yielding similar incidence rates of 4.62 (95% CI 3.14–6.87) versus 3.95 (95% CI 3.37–4.66) per 100 person-years. The adjusted risk of all-cause mortality was not significantly different in patients with versus without Type D personality with an adjusted HR of 1.31 (95% CI 0.84–2.03,
p
= 0.23) with similar results for cardiovascular death (HR 1.46 (95% CI 0.88–2.44,
p
= 0.15).
Conclusion
Type D personality was not significantly associated with increased risk of all-cause mortality or cardiovascular death in patients with non-ischemic HF.
To examine the association between health-related quality of life (HRQoL) and mortality in patients with heart failure (HF).
The potential association of HRQoL and mortality in patients with HF is ...unclear. We investigated this association in The Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators (ICD) in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH).
In DANISH, a total of 1116 patients with non-ischemic systolic HF on guideline-recommended therapy were randomized to ICD therapy or usual clinical care. HRQoL was assessed at randomization using the disease-specific Minnesota Living with Heart Failure Questionnaire (MLHFQ, 0–105, high score indicating worse HRQoL). Multivariable Cox proportional hazard models were used to compare hazard ratios (HR) for all-cause mortality according to MLHFQ above or below 45, as recommended by a recent meta-analysis, to identify patients with poor HRQoL.
HRQoL was completed by 935 (84%) patients at baseline with a median follow-up of 67 months (IQR 47–83). Patients with poor HRQoL (MLHFQ score > 45, median 60 (IQR 53–71),n = 350) had a higher incidence of all-cause mortality than patients with moderate/good HRQoL (MLHFQ ≤45, median 23 (IQR 13–33), n = 585), respectively 26% vs. 18% with an unadjusted HR of 1.57 (95% CI 1.19–2.08, p = .002), and an adjusted HR of 1.39 (95% CI 1.01–1.91, p = .04).
Poor HRQoL was associated with an increased risk of all-cause mortality after adjustment for traditional risk factors.
https: //clinicaltrials.gov/ct2/show/NCT00542945(DANISH).
•Poor quality of life is associated with mortality in patients with nonischemic heart failure•The association was obtained following adjustment for multiple traditional risk factors•Cardiovascular mortality was likewise associated to poor quality of life in crude models•Patients who experienced deteriorating quality of life within 8 months had a higher rate of mortality
Abstract
Aim
The Danish Study to Assess the Efficacy of Implantable Cardioverter-Defibrillators (ICD) in Patients with Non-ischaemic Systolic Heart Failure (HF) on Mortality (DANISH) found no overall ...effect on all-cause mortality. The effect of ICD implantation on health-related quality of life (HRQoL) remains to be established as previous trials have demonstrated conflicting results. We investigated the impact of ICD implantation on HRQoL in patients with non-ischaemic systolic HF, a prespecified secondary endpoint in DANISH.
Methods and results
In DANISH, a total of 1116 patients with non-ischaemic systolic HF were randomly assigned (1:1) to ICD implantation or usual clinical care (control). Patients completed disease-specific HRQoL as assessed by Minnesota Living with Heart Failure Questionnaire (MLHFQ; 0–105, high indicating worse). Changes in HRQoL 8 months after randomization were assessed with a mixed-effects model. At randomization, MLHFQ was completed by 935 (84%) patients (n = 472 in the ICD group and n = 463 in the control group) and was reassessed in 274 (58%) and 292 (63%) patients, respectively after 8 months for the primary analysis. Patients in the ICD group vs. the control group had similar improvements in MLHFQ after 8 months least square mean −7.0 vs. −4.2 (P = 0.13). A clinically relevant improvement (decrease ≥5) in the MLHFQ overall score at 8 months was observed in 151 patients in the ICD group and 148 patients in the control group 55% vs. 51%, respectively (P = 0.25).
Conclusion
Implantable cardioverter-defibrillator implantation in patients with non-ischaemic systolic HF did not significantly alter HRQoL compared with patients randomized to usual clinical care.
Volition and motivations influence on weight maintenance Elsborg, Peter; Nielsen, Johan Bundgaard; Pfister, Gertrud Ursula ...
Health education (Bradford, West Yorkshire, England),
05/2019, Letnik:
119, Številka:
2
Journal Article
Recenzirano
Purpose
The purpose of this paper is to explore how the psychological constructs volition and motivation influence successful and unsuccessful weight maintainers’ experiences during the difficult ...period following an intensive lifestyle intervention.
Design/methodology/approach
Post lifestyle intervention semi-structured interviews with 11 successful and four unsuccessful weight maintainers were conducted.
Findings
The eight themes that emerged and the differences between successful and unsuccessful maintainers were theoretically explained applying the self-determination theory (motivation) and the personal systems interaction (volition).
Practical implications
The study validates and coheres with previous findings on the importance of self-regulation and autonomous motivation for weight loss maintenance. Additionally, the study’s findings expand the literature by explaining both empirically and theoretically how the quality of motivation concerning an activity influences the level of volitional intensity needed when wanting to either engage in goal oriented or refrain from goal opposing activities.
Originality/value
Developing effective obesity interventions has become essential, as obesity is a growing health threat in most countries in the world. However, there is a gap in the literature with regards to qualitative psychological studies with a clear theoretical framework informing intervention development.
Abstract
Background
In randomised clinical trials, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium–glucose cotransporter 2 (SGLT-2) inhibitors reduced cardiovascular events in ...patients with type 2 diabetes (T2D) at high cardiovascular risk, as compared to standard care. However, data comparing these agents in patients with T2D who are at moderate risk is sparse.
Methods
From Danish national registries, we included patients with T2D previously on metformin monotherapy, who started an additional glucose-lowering agent GLP-1 RA, SGLT-2 inhibitor, dipeptidyl peptidase-4 (DPP-4) inhibitor, sulfonylurea (SU), or insulin in the period 2010-2016. Patients with a history of cardiovascular events heart failure (HF), myocardial infarction (MI) or stroke were excluded. Patients were followed for up to 2 years. Cause-specific adjusted Cox regression models were used to compare the risk of hospitalisation for HF, a composite endpoint of major adverse cardiovascular events (MACE) (MI, stroke or cardiovascular death), and all-cause mortality for each add-on therapy. Patients who initiated DPP-4 inhibitors were used as reference.
Results
The study included 46,986 T2D patients with a median age of 61 years and of which 59% were male. The median duration of metformin monotherapy prior to study inclusion was 5.3 years. Add-on therapy was distributed as follows: 13,148 (28%) GLP-1 RAs, 2343 (5%) SGLT-2 inhibitors, 15,426 (33%) DPP-4 inhibitors, 8917 (19%) SUs, and 7152 (15%) insulin. During follow-up, 623 (1.3%, range 0.8-2.1%) patients were hospitalised for HF—hazard ratios (HR) were 1.11 (95% CI 0.89–1.39) for GLP-1 RA, 0.84 (0.52–1.36) for SGLT-2 inhibitors, 0.98 (0.77–1.26) for SU and 1.54 (1.25–1.91) for insulin. The composite MACE endpoint occurred in 1196 (2.5%, range 1.5–3.6%) patients, yielding HRs of 0.82 (0.69–0.97) for GLP-1 RAs, 0.79 (0.56–1.12) for SGLT-2 inhibitors, 1.22 (1.03–1.49) for SU and 1.23 (1.07–1.47) for insulin. 1865 (3.9%, range 1.9–9.0%) died from any cause during follow-up. HRs for all-cause mortality were 0.91 (0.78–1.05) for GLP-1 RAs, 0.79 (0.58–1.07) for SGLT-2 inhibitors, 1.13 (0.99–1.31) for SU and 2.33 (2.08–2.61) for insulin.
Conclusion
In a nationwide cohort of metformin-treated T2D patients and no history of cardiovascular events, the addition of either GLP-1 RA or SGLT-2 inhibitor to metformin treatment was associated with a similar risk of hospitalisation for HF and death, and a lower risk of MACE for GLP-1 RA when compared with add-on DPP-4 inhibitors. By contrast, initiation of treatment with SU and insulin were associated with a higher risk of MACE. Additionally, insulin was associated with an increased risk of all-cause mortality and hospitalisation for HF.
Mellem orden og kaos Nielsen, Johan Bundgaard
BUKS - tidsskrift for børne- og ungdomskultur,
05/2023, Letnik:
39, Številka:
67
Journal Article
Recenzirano
I denne artikel bliver der med udgangspunkt i forfatterens erfaring fra LegeKunst, undersøgt hvilke nye muligheder for at sanse, eksperimentere, tænke og lege der kan opstå, når børn går deres egne ...veje. Formålet er, at belyse hvordan æstetiske processer kan åbne op for børns eksperimentering. Analysen viser, at der kan opstå nye forståelser for verden gennem æstetisk eksperimentering og at disse kan blive til fantasileg. Derudover viser artiklen hvordan leg kan udspringe af noget kaotisk, men at børn selv er i stand til at regulere fantasilegen. Leg kan fremstå både ordentlig og kaotisk, men begge dimensioner er vigtige, for det er herigennem børn forstår og udfordrer omverdens krav, hvilket giver mulighed for dannelse.
I denne artikel bliver der med udgangspunkt i forfatterens erfaring fra LegeKunst, undersøgt hvilke nye muligheder for at sanse, eksperimentere, tænke og lege der kan opstå, når børn går deres egne ...veje. Formålet er, at belyse hvordan æstetiske processer kan åbne op for børns eksperimentering. Analysen viser, at der kan opstå nye forståelser for verden gennem æstetisk eksperimentering og at disse kan blive til fantasileg. Derudover viser artiklen hvordan leg kan udspringe af noget kaotisk, men at børn selv er i stand til at regulere fantasilegen. Leg kan fremstå både ordentlig og kaotisk, men begge dimensioner er vigtige, for det er herigennem børn forstår og udfordrer omverdens krav, hvilket giver mulighed for dannelse.
Observational evidence suggests that mask wearing mitigates transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is uncertain if this observed association arises through ...protection of uninfected wearers (protective effect), via reduced transmission from infected mask wearers (source control), or both.
To assess whether recommending surgical mask use outside the home reduces wearers' risk for SARS-CoV-2 infection in a setting where masks were uncommon and not among recommended public health measures.
Randomized controlled trial (DANMASK-19 Danish Study to Assess Face Masks for the Protection Against COVID-19 Infection). (ClinicalTrials.gov: NCT04337541).
Denmark, April and May 2020.
Adults spending more than 3 hours per day outside the home without occupational mask use.
Encouragement to follow social distancing measures for coronavirus disease 2019, plus either no mask recommendation or a recommendation to wear a mask when outside the home among other persons together with a supply of 50 surgical masks and instructions for proper use.
The primary outcome was SARS-CoV-2 infection in the mask wearer at 1 month by antibody testing, polymerase chain reaction (PCR), or hospital diagnosis. The secondary outcome was PCR positivity for other respiratory viruses.
A total of 3030 participants were randomly assigned to the recommendation to wear masks, and 2994 were assigned to control; 4862 completed the study. Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%). The between-group difference was -0.3 percentage point (95% CI, -1.2 to 0.4 percentage point;
= 0.38) (odds ratio, 0.82 CI, 0.54 to 1.23;
= 0.33). Multiple imputation accounting for loss to follow-up yielded similar results. Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection.
Inconclusive results, missing data, variable adherence, patient-reported findings on home tests, no blinding, and no assessment of whether masks could decrease disease transmission from mask wearers to others.
The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use. The data were compatible with lesser degrees of self-protection.
The Salling Foundations.
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