Copenhagen University Hospital
CURIS (Copenhagen University Research Information System)Not a member yet
395145 research outputs found
Sort by
When the Home Becomes the Setting for Hospital Treatment:A Qualitative Study of Relatives' Experiences
No full textAim: The aim of the study is to explore the experiences of adult relatives who cohabit with patients receiving hospital-at-home (HaH) care. The healthcare system is increasingly adopting HaH as a response to hospital overcrowding and the growing need for personalised, home-based care. While HaH has been shown to benefit patients, there is limited understanding of the impact on cohabiting relatives, who often assume a caregiving role without adequate preparation or support. Design: A qualitative inductive approach. Method: Semi-structured interviews were carried out with 10 cohabiting relatives of HaH patients from North Zealand and Denmark. Data collection took place over two periods between March 2023 and February– April 2024. Data were analysed using inductive qualitative content analysis to identify key themes in the relatives' experiences. Results: Relatives reported mixed feelings about HaH. While they appreciated the ability to be close to their loved ones and maintain a more normal daily routine, some felt overwhelmed by the caregiving responsibilities imposed upon them. The lack of involvement in treatment decisions, sometimes inadequate communication from healthcare professionals, and the pressure to manage both practical and emotional aspects of care were among the concerns. However, despite these challenges, relatives strongly preferred HaH over conventional hospital admissions due to the reduced disruption to their daily lives and the perceived improvement in their loved ones' well-being. Conclusions: Although HaH presents additional burdens and concerns for relatives, they prefer this model of care over traditional hospitalisations. However, it is crucial that relatives are actively involved in the decision-making process and provided with adequate support to manage the caregiving responsibilities effectively. This involvement can help ensure a more positive experience for both relatives and patients, contributing to the overall success of HaH. Implications for the Profession and/or Patient Care: This study emphasises the vital role of relatives in HaH care, highlighting their preference for HaH despite the additional burden. Healthcare professionals must involve relatives in decision-making and provide adequate support to manage caregiving responsibilities. A more individualised approach can enhance the caregiving experience, reduce stress and improve patient outcomes. Impact: This study fills a gap in understanding relatives' experiences in HaH care, stressing the need for better communication and support. By involving relatives more effectively, healthcare professionals can improve the success of HaH and reduce strain on healthcare systems. Reporting Method: This study adhered to the COREQ criteria. Patient or Public Contribution: No patient or public contribution.</p
Kulturhistorisk metode
No full textLærebog med casebaserede introduktioner til kulturhistoriske metoder for kultur- og æstetiske fa
Season of birth and variations in male reproductive health:A population-based cohort study
No full textBackgroundSeason of birth has been associated with various later reproductive health outcomes in women, but little is known on the potential associations in men.ObjectivesTo investigate the association between season of birth and semen characteristics, testes volume and reproductive hormone levels in young men.Materials and methodsWe conducted a follow-up study of 1058 young men, born 1998 to 2000, from the Fetal Programming of Semen Quality (FEPOS) cohort, Denmark, 2017–2019. Information on season of birth was obtained from the Danish Civil Registration System, and information on male reproductive health outcomes was obtained at a clinical examination, where the men provided a semen and a blood sample and measured testes volume. Percentage differences in semen characteristics, testes volume and reproductive hormone levels were calculated according to season of birth (binary (main analysis): summer; winter and categorised by four calendar seasons and by calendar month (subanalyses)) using adjusted regression models and visualisalised according to month of birth.ResultsTestosterone levels were lower (−3% (95% CI: −7%; 0%)) and oestradiol levels were higher (10% (95% CI: 2%; 20%)) in men born during the winter half-year than the summer half-year. The finding of higher oestradiol in men born during the winter was corroborated in analyses of calendar season and month of birth. Other reproductive health outcomes displayed some variation; however, estimates were generally close to null.DiscussionAlthough oestradiol levels seemed higher in men born during the winter half-year, this could be a chance finding. Since pregnancies usually span three seasons, this finding could therefore also reflect an association between early pregnancy during the summer and oestradiol levels.ConclusionWe observed higher oestradiol levels in men born during the winter than during the summer half-year. For the remaining reproductive health outcomes, the observed fluctuations may reflect random variation.BackgroundSeason of birth has been associated with various later reproductive health outcomes in women, but little is known on the potential associations in men.ObjectivesTo investigate the association between season of birth and semen characteristics, testes volume and reproductive hormone levels in young men.Materials and methodsWe conducted a follow-up study of 1058 young men, born 1998 to 2000, from the Fetal Programming of Semen Quality (FEPOS) cohort, Denmark, 2017-2019. Information on season of birth was obtained from the Danish Civil Registration System, and information on male reproductive health outcomes was obtained at a clinical examination, where the men provided a semen and a blood sample and measured testes volume. Percentage differences in semen characteristics, testes volume and reproductive hormone levels were calculated according to season of birth (binary (main analysis): summer; winter and categorised by four calendar seasons and by calendar month (subanalyses)) using adjusted regression models and visualisalised according to month of birth.ResultsTestosterone levels were lower (-3% (95% CI: -7%; 0%)) and oestradiol levels were higher (10% (95% CI: 2%; 20%)) in men born during the winter half-year than the summer half-year. The finding of higher oestradiol in men born during the winter was corroborated in analyses of calendar season and month of birth. Other reproductive health outcomes displayed some variation; however, estimates were generally close to null.DiscussionAlthough oestradiol levels seemed higher in men born during the winter half-year, this could be a chance finding. Since pregnancies usually span three seasons, this finding could therefore also reflect an association between early pregnancy during the summer and oestradiol levels.ConclusionWe observed higher oestradiol levels in men born during the winter than during the summer half-year. For the remaining reproductive health outcomes, the observed fluctuations may reflect random variation
Risk of alcohol-related liver disease and cause-specific mortality in individuals seeking treatment for alcohol use disorder
No full textBackground & Aims: Screening for alcohol-related liver disease (ALD) is recommended in individuals with alcohol use disorder (AUD). Our aim was to compare absolute risk estimates of ALD, cancer and cardiovascular disease in individuals seeking treatment for AUD and the general population. Methods: Using nationwide healthcare registries in Denmark (2006–2022), we identified individuals in outpatient AUD treatment and matched general population comparators (1:10). Participants were followed for hospital diagnoses and cause-specific mortality. Cumulative incidence and mortality were analyzed using competing risk methods. Results: Among 47,806 individuals seeking treatment for AUD, the median age was 46 years, 71% were men, 52% drank ≥20 units of alcohol per week and 2.6% had type 2 diabetes. For individuals seeking treatment for AUD, the cumulative incidence of ALD after 10 years was 7.1% (95% CI 6.9-7.4) overall and 13% in those with type 2 diabetes, much higher than the 10-year risk of 0.6% in the 477,850 age- and sex-matched comparators. The AUD cohort had a fourfold higher 10-year all-cause mortality (17.8% vs. 4.5%), including a 10-year risk of death from ALD of 2.1% vs. 0.2%. Half of the excess deaths among individuals seeking treatment for AUD were due to alcohol-related causes or external causes. Individuals in AUD treatment were two-to threefold more likely than comparators to die from cancer or cardiovascular disease after 10 years despite a more similar disease incidence. Conclusion: This study showed the substantial burden of ALD and mortality in individuals seeking treatment for AUD. Specifically, the risk of ALD was 7% after 10 years and 13% in those with type 2 diabetes. Impact and implications: Knowledge of the absolute risk of alcohol-related liver disease (ALD) and cause-specific death among individuals in treatment for alcohol use disorder is crucial to make decisions on screening for ALD. This study highlights the need for improved care of individuals in treatment for alcohol use disorder to prevent morbidity and mortality due to ALD, other alcohol-related causes, as well as cancer and cardiovascular disease. The higher risk of ALD in those with type 2 diabetes suggests that clinicians should be specifically aware of alcohol consumption and liver disease in their patients with type 2 diabetes.</p
Bruises, abrasions, and scars in children aged 4–14 years in Denmark:A comparison between police-reported cases of physical child abuse and a control group
No full textDifferentiating between abusive and accidental skin lesions in children presents significant challenges. Previous studies of skin lesion patterns have mainly focused on bruises in younger children. In this study, we compare the number, location, and distribution of recent (bruises and abrasions) and older (scars) skin lesions between police-reported cases of physical violence and controls of similar age (4–14 years) in a Danish setting. The study included 262 cases and 119 controls. Skin lesions in 19 body regions were assessed. Univariate and multivariate logistic regression models were conducted including body regions, age group, sex, and activity level. Having scars on the buttocks was conclusively associated with the case group (OR: 5.0; 95% CI: 1.5–17). There was a tendency for cases to have more scars on the upper arms, hands, lower parts of the back (midline), and legs. We did not find an association between recent skin lesions (bruises and abrasions) and physical violence. A difference in activity levels between cases and controls may explain the higher number of recent lesions in the control group. It is crucial to promptly examine children exposed to violence. If this is not possible, examining for older skin lesions remains important
Angiotensin Receptor-Neprilysin Inhibitors and Mortality Among Patients With HFrEF
No full textWhile trial evidence supports the benefit of angiotensin receptor-neprilysin inhibitor (ARNI) therapy in heart failure with reduced ejection fraction (HFrEF), its effectiveness in routine clinical practice is less explored. This study investigated the relative and absolute effectiveness of ARNI in patients with HFrEF. This nationwide Danish database study included patients with left ventricular ejection fraction (LVEF) ≤40%, 2018 to 2023. Using a prevalent new user design, 2,446 ARNI initiators were matched 1:2 to 4,892 users of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) based on propensity scores, age, LVEF, and NT-proBNP. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular mortality and hospitalization. There were 279 deaths among ARNI initiators (5.6/100 person-years) and 533 among ACE-I/ARB users (6.7/100 person-years), yielding a hazard ratio (HR) of 0.85 (95% CI, 0.74 to 0.98) for all-cause mortality. A significant interaction was observed for recent hospitalization (p = 0.04), with ARNI yielding a lower HR in this group. HRs were otherwise consistent across age, sex, LVEF, NT-proBNP, NYHA class, ischemic heart disease, chronic kidney disease, and type 2 diabetes. The largest absolute mortality reductions were seen in subgroups with recent hospitalization, NYHA class III to IV, and severely elevated NT-proBNP. ARNI was also associated with a lower risk of cardiovascular death (HR, 0.81; 95% CI, 0.65 to 0.99), but not with other secondary outcomes. In this study, ARNI was associated with a 15% reduction in all-cause mortality vs ACE-I/ARB. Patients with advanced or symptomatic heart failure appeared to experience the greatest absolute benefit.While trial evidence supports the benefit of angiotensin receptor-neprilysin inhibitor (ARNI) therapy in heart failure with reduced ejection fraction (HFrEF), its effectiveness in routine clinical practice is less explored. This study investigated the relative and absolute effectiveness of ARNI in patients with HFrEF. This nationwide Danish database study included patients with left ventricular ejection fraction (LVEF) ≤40%, 2018 to 2023. Using a prevalent new user design, 2,446 ARNI initiators were matched 1:2 to 4,892 users of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) based on propensity scores, age, LVEF, and NT-proBNP. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular mortality and hospitalization. There were 279 deaths among ARNI initiators (5.6/100 person-years) and 533 among ACE-I/ARB users (6.7/100 person-years), yielding a hazard ratio (HR) of 0.85 (95% CI, 0.74 to 0.98) for all-cause mortality. A significant interaction was observed for recent hospitalization (p = 0.04), with ARNI yielding a lower HR in this group. HRs were otherwise consistent across age, sex, LVEF, NT-proBNP, NYHA class, ischemic heart disease, chronic kidney disease, and type 2 diabetes. The largest absolute mortality reductions were seen in subgroups with recent hospitalization, NYHA class III to IV, and severely elevated NT-proBNP. ARNI was also associated with a lower risk of cardiovascular death (HR, 0.81; 95% CI, 0.65 to 0.99), but not with other secondary outcomes. In this study, ARNI was associated with a 15% reduction in all-cause mortality vs ACE-I/ARB. Patients with advanced or symptomatic heart failure appeared to experience the greatest absolute benefit.</p
ESTRO recommendations on preoperative radiation therapy in breast cancer:current and future perspectives – Endorsed by ASTRO
No full textBACKGROUND AND PURPOSE: Preoperative radiation therapy (RT) for breast cancer is not a novel concept, though available data are insufficient to translate current knowledge into clinical practice. Nonetheless, potential advantages of this approach are emerging in multiple scenarios, incorporating increasing treatment personalization and technological improvements in RT. This paper aims to synthesize and summarize the literature on preoperative RT in distinct breast cancer treatment settings, providing perspectives based on existing evidence and gaps in knowledge.METHODS: The ESTRO Breast subgroup proposal for elaborating perspectives on preoperative RT was approved by the ESTRO Guidelines Committee, and a panel of experts in the field was identified. Four working groups were created, focusing on the different clinical settings where preoperative RT has been investigated: patients with early-stage breast cancer at low risk of recurrence, patients with breast cancer at high risk of recurrence, and patients with an indication for mastectomy. The fourth group focused its search on cross cutting themes, such as preclinical and translational aspects, radiobiology, RT techniques and quality assurance. After a literature search including the identification of key points and gaps in the literature, the four working groups presented their findings and perspectives were formulated, discussed and approved by the panel.RESULTS: Overall, 27 phase I and phase II studies enrolling patients from the year 2000 onward were considered, collecting data such as RT dose and fractionation, clinical outcomes, and complications rates. The expert panel stated perspectives for the different clinical scenarios based on available evidence and current gaps in knowledge, to be addressed by future clinical research CONCLUSION: Given the current lack of clinical data to support the development of formal guidelines, we present our perspectives, which can be useful for implementing new clinical trials and research projects, overcoming current limitations, and potentially generating high-quality practice-changing data, introducing preoperative RT in specific breast cancer treatment settings in the future.</p
Motility-Induced Phase Separation Is Maxwell-like Fluid with an Extended and Nonmonotonic Crossover
No full textPrenatal exposure to acrylamide and metabolic health at 20 years of age A biomarker-based Danish cohort study
No full textAdult obesity and metabolic health may be influenced by prenatal exposure to acrylamide (AA). AA forms in carbohydrate-containing foods and beverages during high-temperature processing. AA disrupts metabolic homeostasis and induces adiposity in mice offspring following gestational exposure. In humans, AA has been associated with intrauterine growth restriction and childhood overweight. It is unknown if prenatal exposure to AA influences metabolic health in young adults. We examined the associations between prenatal exposure to AA and metabolic health in singletons born in 1988–1989, Denmark.Hemoglobin adducts from AA (HbAA) and glycidamide were measured in maternal blood collected at 30 weeks’ gestation together with information on maternal dietary and smoking habits (n = 638). At 20 years of age, offspring waist circumference, weight, height, blood pressure, blood glucose, insulin, leptin, adiponectin and lipid levels were measured at a clinical follow-up.Median HbAA concentration was 85 (interquartile range 63–136) pmol/g Hb. For most outcomes examined, there was no evidence of an association with prenatal exposure to AA. However, higher HbAA levels were associated with a minor increase in the offspring waist circumference of 0.06 cm (95 % confidence interval (CI): -0.07, 0.20) and low-density lipoprotein (LDL) cholesterol concentrations of 0.01 mmol/L (95 % CI: <0.01, 0.03) per 10 pmol/g Hb increments in HbAA. Furthermore, we observed that HbAA levels were associated with increased risk of metabolic syndrome in offspring of non-smokers.We found no overall compelling evidence that prenatal exposure to AA was associated with metabolic health of young adults, but the observations that higher prenatal exposure to AA were associated with higher waist circumference and LDL cholesterol levels in young adults warrants replication.Adult obesity and metabolic health may be influenced by prenatal exposure to acrylamide (AA). AA forms in carbohydrate-containing foods and beverages during high-temperature processing. AA disrupts metabolic homeostasis and induces adiposity in mice offspring following gestational exposure. In humans, AA has been associated with intrauterine growth restriction and childhood overweight. It is unknown if prenatal exposure to AA influences metabolic health in young adults. We examined the associations between prenatal exposure to AA and metabolic health in singletons born in 1988-1989, Denmark. Hemoglobin adducts from AA (HbAA) and glycidamide were measured in maternal blood collected at 30 weeks' gestation together with information on maternal dietary and smoking habits (n = 638). At 20 years of age, offspring waist circumference, weight, height, blood pressure, blood glucose, insulin, leptin, adiponectin and lipid levels were measured at a clinical follow-up. Median HbAA concentration was 85 (interquartile range 63-136) pmol/g Hb. For most outcomes examined, there was no evidence of an association with prenatal exposure to AA. However, higher HbAA levels were associated with a minor increase in the offspring waist circumference of 0.06 cm (95 % confidence interval (CI): -0.07, 0.20) and low-density lipoprotein (LDL) cholesterol concentrations of 0.01 mmol/L (95 % CI: <0.01, 0.03) per 10 pmol/g Hb increments in HbAA. Furthermore, we observed that HbAA levels were associated with increased risk of metabolic syndrome in offspring of non-smokers. We found no overall compelling evidence that prenatal exposure to AA was associated with metabolic health of young adults, but the observations that higher prenatal exposure to AA were associated with higher waist circumference and LDL cholesterol levels in young adults warrants replication.</p
Atmospheric chemistry of (E)-1,2-difluoroethene: kinetics and mechanisms of the reactions with Cl atoms, OH radicals and O3
No full textSmog chamber experiments were used to investigate the kinetics and mechanisms of the Cl atom, OH radical and O3 initiated oxidation of (E)-1,2-difluoroethene (CHF[double bond, length as m-dash]CHF) at (298 ± 2) K under atmospheric conditions. Relative and absolute rate methods were used to measure k(Cl + (E)-CHF[double bond, length as m-dash]CHF) = (1.00 ± 0.12) × 10−10, k(OH + (E)-CHF[double bond, length as m-dash]CHF) = (8.42 ± 1.29) × 10−12, and k(O3 + (E)-CHF[double bond, length as m-dash]CHF) = (1.16 ± 0.07) × 10−18 cm3 molecule−1 s−1 in 700 Torr of N2/air diluent. A slight pressure dependence for the kinetics of the Cl initiated oxidation was observed: 13% reduction at 50 Torr compared to atmospheric pressure. The observed products from the reaction of (E)-CHF[double bond, length as m-dash]CHF with Cl were HC(O)F and the corresponding (Z)-CHF[double bond, length as m-dash]CHF isomer (14% at 700 Torr, 62% at 50 Torr total pressure). In the OH radical initiated oxidation, the major product observed was HC(O)F in a yield of (205 ± 8)%. The O3 initiated oxidation leads to HC(O)F and HF in yields of (148 ± 4)% and (53 ± 2)%, respectively. As part of this study the chlorine kinetics of the Z-isomer of the title compound was determined as k(Cl + (Z)-CHF[double bond, length as m-dash]CHF) = (1.21 ± 0.25) × 10−10 cm3 molecule−1 s−1. The photochemical ozone creation potential, the radiative efficiency, and global warming potentials are estimated, and the results are discussed in the context of the atmospheric chemistry of (E)-CHF[double bond, length as m-dash]CHF and other halogenated alkenes