364094 research outputs found
Sort by
Outdoor Physical Activity: Exploring Evidence and Health Outcomes in People Living with Chronic Musculoskeletal Diseases
No full textBaggrundKroniske muskuloskeletale sygdomme (MSS) er blandt de væsentligste årsager til funktionsnedsættelse. Hyppige tilstande som artrose, leddegigt, lænderygsmerter, osteoporose og fibromyalgi påvirker millioner af mennesker på verdensplan. Da mange oplever smerter og nedsat livskvalitet, anbefales fysisk aktivitet (FA) som en central del af behandlingen. Imidlertid er det ofte en udfordring for mange med MSS, at fastholde anbefalet aktivitetsniveau. Udendørsmiljøer kan fungere som en lovende ramme for FA interventioner, idet de kombinerer de fysiologiske effekter af FA med psykologiske og motiverende fordele forbundet med naturen. På trods af stigende interesse er evidensen for udendørs FA-interventioner blandt personer med MSS fortsat begrænset.FormålFormålet med denne afhandling er at udforske både den eksisterende evidens og virkningen af en FA-intervention udført i udendørsmiljøer blandt personer med MSS. Ved at kombinere en systematisk gennemgang af litteraturen med evalueringen af en stor national kohorte, tilstræbte afhandlingen at opnå en samlet forståelse af udendørs FA-interventioner, samt de potentielle fordele og begrænsninger ved sådanne interventioner for personer med MSS.MetoderArtikel I identificerede randomiserede kontrollerede forsøg (RCT’er) og observationsstudier, der undersøgte strukturerede udendørs FA interventioner udført i miljøer som parker, skove eller grønne byområder. Den systematiske søgning blev gennemført i marts 2023 i databaserne MEDLINE, CENTRAL, EMBASE og CINAHL. Meta analyser blev udført for helbredsrelateret livskvalitet (HRQOL), fysisk funktion, smerte og mentale helbred, og vurderingsredskabet ’Grading of Recommendations, Assessment, Development, and Evaluations (GRADE)’ evaluerede kvaliteten af den inkluderede evidens.Artikel II og Artikel III beskrev OUTPAC-kohorten, 12-ugers gruppebaseret udendørs FA-forløb med frivillige instruktører, implementeret på landsplan i samarbejde med Gigtforeningen. Deltagere med selvrapporterede MSS gennemførte validerede spørgeskemaer og fysiske tests. Artikel II fokuserede på udviklingen af det overordnede OUTPAC design, kohortens baseline-karakteristika og baselines-scores. Artikel III evaluerede ændringer umiddelbart efter interventionen blandt 925 deltagere, der gennemførte både før- og efter-spørgeskemaer. Lineære mixed-effects modeller blev anvendt til at estimere gennemsnitlige ændringer på tværs af domæner (HRQOL, fysisk aktivitet, fysisk funktion, smerte og mental trivsel), og subgruppeanalyser undersøgte forskelle mellem sygdomsgrupper.ResultaterDen systematiske gennemgang (20 studier; n = 1.759 deltagere) viste små men signifikante effekter, der favoriserede udendørs FA for HRQOL (k = 10, Standardiseret gennemsnitsforskel (SMD) = 0,45; 95% konfidensinterval (CI): 0,19 til 0,71) og fysisk funktion (k = 14, SMD = 0,39; 95% CI: 0,13 til 0,64) samt en moderat effekt på mentale udfald (k = 13, SMD = -0,52; 95% CI: -0,82 til -0,23), men den samlede evidensstyrke var meget lav. Der var for få studier til at vurdere effekten på smerte. Enkelte studier (n = 4) rapporterede bivirkninger, herunder ikke-alvorlige (fald, smerte, træthed) og enkelte alvorlige (indlæggelse, lungebetændelse).OUTPAC-kohorten omfattede 1.943 deltagere (gennemsnitsalder 65 år; 92% kvinder), hovedsageligt med artrose, leddegigt eller lænderygsmerter. Ved baseline rapporterede deltagerne moderate smerter og træthed, men relativt høj HRQOL (0,81) og mental trivsel (63 point). Blandt de 925 deltagere, der gennemførte opfølgning, var en lille, men signifikant forbedring i HRQOL (ændring = 0,01; p = 0,003), mens øvrige selvrapporterede outcomes ikke ændrede sig. De fysiske tests viste derimod signifikante forbedringer i både 40-meter gangtest (Gennemsnitsændring = -2,2 sekunder; p: 0,000) og 30 sekunders rejse-sætte-sig test (Gennemsnitsændring = 2,9 gentagelser; p: 0,000), hvilket overgår grænsen for relevant klinisk forbedring. Højere fremmøde var forbundet med bedre HRQOL og mental trivsel umiddelbart efter interventionen.KonklusionDenne afhandling kombinerer eksisterende evidens med en praksisnær, pragmatisk evaluering for at undersøge de potentielle fordele, ulemper og begrænsninger ved udendørs FA for personer med MSS. Resultaterne giver en samlet forståelse af, hvordan udendørs FA kan påvirke helbredsrelaterede faktorer i denne population. Udendørs FA fremstår som en gennemførbar og skalerbar tilgang med potentiale til at forbedre livskvalitet, fysisk funktion og mental trivsel. Personer med rygrelaterede eller degenerative sygdomme havde dog en tendens til at opnå mindre udbytte, hvilket tyder på, at effekten kan variere afhængigt af typen af MSS. Afhandlingen understreger desuden vigtigheden af tværsektorielt samarbejde, fleksibel lokal implementering og det udendørs miljø interventionen gennemføres i. Det anbefales, at fremtidig forskning anvender mere robuste studiedesigns, eksempelvis et RCT-studie, og inkluderer bredere sociale, psykologiske og kontekst relaterede faktorer for bedre at undersøge kompleksiteten af udendørs FA for personer med MSS.BackgroundChronic musculoskeletal diseases (MSDs) are among the leading contributors to disability worldwide, with highly prevalent conditions such as osteoarthritis, rheumatoid arthritis, low back pain, osteoporosis, and fibromyalgia influencing millions of people. As individuals are often experiencing pain and reduced quality of life, physical activity (PA) is recommended as a vital part of management. Yet, adherence to clinical guidelines remains a challenge. Outdoor environments may represent a promising setting for PA interventions, combining the physiological effects of PA with psychological and motivational benefits linked to nature exposure. Despite growing public interest, the evidence for outdoor PA interventions in people with MSDs remains limited. AimThis thesis aims to explore both the existing evidence and impact of performing PA interventions in outdoor settings for people living with MSDs. By addressing both the current evidence and evaluating a large nationwide cohort, this thesis sought to provide a comprehensive understanding of the outdoor PA concept, and the potential benefits and limitations related to outdoor PA interventions for people with MSDs.MethodsPaper I identified and synthesized randomized controlled trials (RCTs) and observational studies examining structured outdoor PA interventions conducted in outdoor environments such as parks, forests, or urban green areas. The inception for the systematic search was Marts 2023 using MEDLINE, CENTRAL, EMBASE, and CINAHL. Meta-analyses were performed on health-related quality of life (HRQOL), physical function, pain, and mental outcomes, with certainty of evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).Paper II and Paper III reported on the OUTdoor Physical ACtivity (OUTPAC) cohort, a volunteer-led, 12-week group-based outdoor PA intervention implemented nationwide in close collaboration with the Danish Rheumatism Association. Participants with self-reported MSDs completed validated questionnaires and performance-based tests. Paper II focused on the OUTPAC setup, the baseline characteristics of the cohort, and the baseline scores. Paper III evaluated immediate post-intervention changes in 925 participants who completed both pre- and post-intervention questionnaires. Linear mixed-effects models estimated mean changes across outcome domains (HRQOL, physical activity, physical function, pain and mental well-being), with subgroup analyses exploring disease group differences.ResultsThe systematic review (20 studies; n = 1,759 participants) indicated small but significant effects favoring outdoor PA for HRQOL (k = 10, Standardized mean difference (SMD) = 0.45, 95% Confidence Interval (CI): 0.19 to 0.71) and physical function (k = 14, SMD = 0.39, 95% CI: 0.13 to 0.64) and a moderate effect on mental outcomes (k = 13, SMD = -0.52, 95% CI: -0.82 to -0.23), although overall certainty was very low. Due to a lack of studies measuring pain, the review could not conclude on the outdoor PA interventions effect on pain. Few studies (n = 4) reported adverse events including non- serious (falls, pain, fatigue) and serious (hospitalization, pneumonia).The OUTPAC cohort enrolled 1,943 participants (mean age 65 years; 92% women), mostly with osteoarthritis, rheumatoid arthritis, or low back pain. Baseline data showed moderate pain and fatigue but relatively high HRQOL (0.81) and mental well-being (63 points). Among 925 participants completing follow-up, HRQOL improved slightly (mean change = 0.01; p = 0.003), while other self-reported outcomes showed no mean change. Performance-based tests improved significantly in both 40-meter walking test (mean change = -2.2 seconds; p = 0.000) and 30-second chair test (mean change = 2.9; p = 0.000), exceeding minimal clinically important differences. Higher attendance also predicted better HRQOL and mental well-being immediately post-intervention.ConclusionThis thesis combines existing evidence with a real-world, pragmatic evaluation to explore the potential benefits, harms, and limitations of outdoor PA interventions for people with MSDs. The findings provide a comprehensive understanding of how outdoor PA may influence health outcomes in this population. Outdoor PA appears feasible and scalable, with potential to improve HRQOL, physical function, and mental well-being. Yet, people with spine-related or degenerative diseases tended to benefit less, suggesting that outcomes vary depending on type of MSDs. This thesis further emphasizes the importance of cross-sectoral collaboration, flexible community delivery, and the environmental context in outdoor PA initiatives. It is recommended that future research use rigorous designs, such as RCTs, to further examine the effect of outdoor PA interventions, and include broader social, psychological, and environmental outcomes to capture the complexity of performing PA in an outdoor setting for people with MSDs
Biological invasions as burdens to primary economic sectors
No full textMany human-introduced alien species economically impact industries worldwide. Management prioritisation and coordination efforts towards biological invasions are hampered by a lack of comprehensive quantification of costs to key economic sectors. Here, we quantify and estimate global invasion costs to seven major sectors and unravel the introduction pathways of species causing these costs — focusing mainly on primary economic sectors: agriculture, fisheries and forestry. From 1970 to 2020, costs reported in the InvaCost database as pertaining to Agriculture, Fisheries, and Forestry totaled 1.3 bn, and 365 bn), followed by China (36 bn). We further identified 19 countries highly economically reliant on Agriculture, Fisheries, and Forestry that are experiencing massive economic impacts from biological invasions, especially in the Global South. Based on an extrapolation to fill cost data gaps, we estimated total global costs ranging from at least 5.7–6.5 bn for Fisheries, and 600 bn in impacts has been incurred across Agriculture, Fisheries and Forestry, with the largest share reported in Agriculture. We further identify 19 countries, which rely heavily on primary sectors, facing comparatively high impacts from invasions, requiring urgent action. However, gaps in cost reporting across invasive taxa and countries suggest that these impacts are grossly underestimated. Proactive prioritisation by policymakers is needed to mitigate future impacts to primary sectors.</p
Rethinking entrepreneurship in causally entangled crises:A poly-crisis perspective
No full textOver the last few years, the world has witnessed the emergence of a poly-crisis era in which overlapping, causally entangled crises, such as pandemics, war, inflation, natural disasters, etc. converge to challenge assumptions of societal stability upon which much of the field's knowledge base has been developed over the last few decades. In this editorial, we propose a poly-crisis perspective to entrepreneurship and compare it with entrepreneurship under both normal times and a single crisis. In doing so, we highlight the need to reexamine the boundary conditions of our models and to propose some questions, constructs, and methods that deserve increased attention in a world where institutional uncertainty is the rule rather than the exception.</p
The adverse effects with ibuprofen after major orthopedic surgeries:A protocol for the PERISAFE randomized clinical trial
No full textIntroduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for pain treatment after elective hip and knee arthroplasties. However, evidence regarding the incidence of adverse effects with short-term NSAID treatment following surgery is limited. We, therefore, aim to assess the adverse effects with an eight-day postoperative treatment with ibuprofen after elective hip and knee arthroplasties. Methods and Analysis: PERISAFE is a randomized, placebo-controlled, blinded multicenter trial with 90-day and one-year follow-up. Eligible patients undergoing elective hip or knee arthroplasty are allocated 1:1 to either ibuprofen 400 mg ×3/day or identical placebo ×3/day for eight days after surgery. The primary outcome is a composite of either death, acute myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis, renal failure, major bleeding, re-operation, gastrointestinal ulcer, or readmission within 90 days postoperatively. Secondary outcomes are hospital-free days within 90 days postoperatively, a composite of ibuprofen and opioid-related adverse reactions based on eight-day postoperative diary, and health related quality of life after 90 days postoperatively. A total of 2904 patients are needed to demonstrate a relative risk reduction of 33% in the placebo group, accepting a risk of type I error of 5% and type II error of 20% and a proportion of serious adverse events in the ibuprofen group of 8%. The primary analysis will be in the modified intention-to-treat population. Ethics and Dissemination: The trial is approved by the Danish Medicine Agency and the Research Ethics Committee (EU CT no. 2022-502, 502-32-00). We plan to submit for publication in a major international peer-reviewed journal and present results at scientific meetings.</p
Intestinal-derived FIBCD1 – Shedding and functional implications in gut inflammation
No full textInflammatorisk tarmsygdom (IBD) er en kronisk inflammatorisk lidelse i mave-tarmkanalen. Eftersom der ikke er en tilstrækkelig forståelse af sygdommens opståen, samt på grund af den stigende forekomst, begrænsede muligheder for behandling og den store indvirkning på patienternes livskvalitet, er det vigtigt at undersøge biologien og mekanismerne, der ligger til grund for udviklingen af IBD.Membranreceptoren FIBCD1, som udtrykkes apikalt af epitelceller i mave-tarmkanalen, har vist at være beskyttende mod både akut og kronisk tarmbetændelse i dyremodeller for dextrannatriumsulfat (DSS)-induceret colitis. I disse modeller lader det til at FIBCD1 kløves fra overfladen af epitelcellerne i takt med den inflammatorisk udvikling. Hvad de mekanistiske funktioner af kløvet FIBCD1 er i relation til tarmsundhed og -sygdom, er dog endnu ikke forstået.I denne afhandling undersøgte jeg de mekanistiske funktioner af opløselig FIBCD1 i forskellige henseender, herunder kløvning, interaktion med primære humane celler af myeloid oprindelse, stimulatorisk effekt, dets binding til immunceller i tarmvævet og fækal tilstedeværelse af naturligt kløvet FIBCD1 ved tarmsygdomme. Derudover har jeg medvirket til etableringen af Oxford Nanopore Technology (ONT) platformen og 16S sekventering som en del af mit miljøskifte under mit ph.d.-studie.Manuskript I: Udskillelse af tarm-associeret FIBCD1 og dets involvering i aktivering af makrofager under tarmbetændelseI det første studie oprensede vi naturligt kløvet FIBCD1 fra cellekulturer og fækale prøver fra mus, og ved N-terminal sekventering identificerede vi den præcise sekvens af kløvningsmotivet i ektodomænet. Gennem in vitro eksperimenter med både ExpiCHOFIBCD1 og apical-out organoider fra murin tyktarm, identificerede vi ADAM10/17 som potentielle sheddaser for den proteolytiske kløvning af FIBCD1. Baseret på FIBCD1’s homologi med andre Fibrinogen-relaterede proteiner, undersøgte vi yderligere dets evne til at binde et panel af integriner. Via ELISA viste vi, at et rekombinant opløseligt FIBCD1 der størrelsesmæssigt svarer til kløvet FIBCD1, fortrinsvis binder integrinerne aIIbb3, aMb2 og aVb5, som på normalvis udtrykkes af leukocytter. Ved hjælp af flow cytometri bekræftede vi, at det rekombinante opløselige FIBCD1 binder immunceller fra leukocytpopulationen i humant blod, og yderligere viste vi, at det fortrinsvist binder til CD206+ makrofager sammenlignet med monocytter, samt CD68+-, og CD86+-udtrykkende makrofager. Derudover demonstrerede vi også en regulatorisk effekt af det naturligt kløvede FIBCD1, der ved stimulering af MDM, M1 og M2 fremkaldte en inflammatorisk reaktion. For en bredere screening af in vivo-aktiverede immunceller anvendte vi DSS-modellen og observerede overvejende binding til MHCII+CD64+CD206+ makrofager sammenlignet med andre immunceller i lamina propria, i både raske og syge mus. Slutteligt, og for at belyse om det opløselige FIBCD1 kan virke neddæmpende på sværhedsgraden af inflammatoriske tilstande i tarmen, gennemførte vi et pilotstudie der kombinerede DSS-modellen og eksogen behandling med rekombinant opløseligt FIBCD1. Foreløbige resultater demonstrerede at behandling med eksogent opløseligt FIBCD1 kan reducere vægttab hos mus, og muligvis nedsætte sværhedsgraden af inflammation i tarmen.Manuskript II: Påvisning af FIBCD1 hos børn med inflammatorisk tarmsygdomI det andet studie havde vi som mål at udvikle et følsomt analyseredskab baseret på ELISA til at undersøge tilstedeværelsen af naturligt kløvet FIBCD1 i fækale prøver fra frivillige non-IBDindivider og en patientkohorte baseret på nyligt diagnosticerede pædiatriske IBD-patienter. Ved at implementere og teste vores følsomme FIBCD1-specifikke ELISA påviste vi en signifikant stigning af naturligt kløvet FIBCD1 hos IBD-patienter sammenlignet med raske individer. Så vidt vi ved, er dette første gang FIBCD1 er blevet kvantificeret i humane fækale prøver. Interessant nok, giver denne nye opdagelse spændende indikationer på at kløvet FIBCD1 har potentiale som en mulig markør for inflammation i tarmen og en lovende kandidat til fremtidig forskning.Miljøskifte: Etablering af Oxford Nanopore Technology Platform i Inflammation forskningsenhedenUnder mit ph.d.-studie havde jeg mulighed for at lave et miljøskifte til Lukasz Krych’s forskningsgruppe ved Institut for Fødevarevidenskab, Mikrobiologi og Fermentering, Københavns Universitet. Under mit besøg blev jeg trænet i at udføre DNA-ekstraktion fra humane fækale prøver, herunder de laboratoriefærdigheder der er nødvendige for at udføre 16S-sekventering, opsætning af Oxford Nanopore-platformen, databehandling og bioinformatiske analyser heraf. Kapitlet omhandler den tekniske proces for etablering og brugen af ONT platformen til 16S sekventering, samt/inklusive data opnået i denne proces. Til etableringen brugte vi tidligere ekstraherede DNA fra fækale prøver taget fra et studie omhandlende mikrobiel kolonisering. Sekventeringsresultaterne viser nogle af de muligheder der er ved brugen af ONT, når man undersøger dynamikken af den mikrobielle sammensætning i dyremodeller.Sammenfattende giver min ph.d.-afhandling indsigt i den proteolytiske spaltning og dannelse af kløvet FIBCD1. Derudover fremhæver den kløvet FIBCD1's evne til at binde integriner og dets formodede rolle som immunregulator gennem dets interaktion med makrofagpopulationen i både rask og syg tilstand. Endelig giver afhandlingen de første kvantificeringer af kløvet FIBCD1 i humane fækale prøver fra pædiatriske IBD-patienter, hvilket viser FIBCD1's potentiale som en fremtidig kandidat i forskning indenfor inflammatoriske biomarkører i tarmen.Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract. Exploring the biology and mechanisms associated with the development of IBD is an intriguing and essential field of investigation due to insufficient understanding of the disease pathogenesis, rising incidences, limited treatment options, and the profound impact on patients’ quality of life.The membrane receptor Fibrinogen C Domain Containing Protein 1 (FIBCD1), expressed apically by epithelial cells lining the gastrointestinal tract, protects against acute and chronic intestinal inflammation in experimental models where it appears cleaved during inflammatory states. However, the mechanistic functions of native shedded FIBCD1 in intestinal health and disease remain poorly understood.In this thesis, I investigated the mechanistic functions of soluble FIBCD1 in various aspects, including shedding, interaction with primary human cells of the myeloid linage, stimulatory effects, its binding to immune cells of the lamina propria (LP), and the fecal presence of native shedded FIBCD1 in intestinal diseases. Furthermore, I have been involved in establishing the Oxford Nanopore Technology (ONT) platform and 16S sequencing as a part of my environmental exchange during my PhD study.Manuscript I: Shedding of Intestinal-derived FIBCD1 and its Involvement in Macrophage Activation in Gut InflammationIn the first study, we purified native soluble FIBCD1 from mice fecal specimens and cell cultures, and by N-terminal sequencing, we identified the precise sequence of the cleavage motif within the ectodomain. Through in vitro experiments with ExpiCHOFIBCD1 and colon apical-out organoids, we provide evidence for ADAM10/17 as the potential sheddases facilitating the proteolytic release of shedded FIBCD1. Based on FIBCD1’s homology to other Fibrinogen-related proteins (FRePs), we further investigated its capability to bind a panel of integrins. By ELISA, we showed that recombinant soluble FIBCD1, approximately similar in size to shedded FIBCD1, preferentially binds integrin subset, known to be expressed by leukocytes. Using flow cytometry, we confirmed that recombinant soluble FIBCD1 binds immune cells of the leukocyte population in human blood, where further experiments revealed that it preferentially binds to CD206+ macrophages compared to monocytes, CD68+, and CD86+ expressing macrophages. We revealed binding to specific subtypes of macrophages and discovered a regulatory effect by native shedded FIBCD1 on the inflammatory responses elicited by monocyte-derived macrophages (MDM), M1, and M2 upon stimulation. For a more comprehensive screening of in vivo activated immune cells, the Dextran-Sodium-Sulfate model of intestinal inflammation was utilized. We observed binding predominantly to MHCII+CD64+CD206+ macrophages compared to other immune cells of the LP in healthy and diseased mice. Finally, to elucidate the putative role of soluble FIBCD1 in abolishing disease severity of intestinal inflammation, a pilot study was conducted combining the DSS model with recombinant soluble FIBCD1 treatment. Preliminary data demonstrated a putative role for soluble FIBCD1’s in abolishing disease severity of intestinal inflammation by exogenous administration.Manuscript II: Detection of FIBCD1 in children with inflammatory bowel diseaseIn the second study, we aimed to develop a sensitive ELISA set-up to investigate the presence of native shedded FIBCD1 in fecal specimens from a group of non-IBD individuals and a cohort of newly diagnosed pediatric IBD patients. Implementation and test of our sensitive FIBCD1-specific ELISA enabled us to reveal a significant increase of native shedded FIBCD1 in IBD patients compared to non-IBD individuals. To our knowledge, this is the first time native shedded FIBCD1 has been quantified in human fecal specimens. This novel finding provides intriguing indications of shedded FIBCD1’s putative role as a marker of intestinal inflammation and a candidate for future research.Environmental exchange: Establishment of the Oxford Nanopore Technology Platform in the Inflammation Research Unit During my PhD study, I had the opportunity to do an environmental exchange at the laboratories of Lukasz Krych, Department of Food Science, Microbiology and Fermentation, University of Copenhagen. During my visit, I was trained to do DNA extraction from human fecal specimens, in wet-lab skills necessary to perform 16S sequencing, setting up the Oxford Nanopore platform, data processing, and bioinformatic analyses. The chapter concerns the technical process of establishing and utilizing the ONT platform for 16S sequencing, as well as the data obtained in the process. We used DNA extracted from fecal specimens from a colonization study for the implementation. Results from the sequencing show some of the possibilities of ONT when investigating the dynamics of microbial composition in biomedical research.In summary, my PhD thesis provides insight into the proteolytic cleavage and generation of shedded FIBCD1. It furthermore highlights shedded FIBCD1’s capability to bind integrins and its putative role as an immune regulator through its interaction with the macrophage population in health and disease. Finally, it provides novel quantification of shedded FIBCD1 in human fecal specimens of pediatric IBD patients, demonstrating FIBCD1’s potential as a future candidate in the research area of biomarkers for intestinal inflammation.<br/
Welfare becomes Punishment:Penal Nationalism in Danish Social Policy
No full textIn this article, we demonstrate how ‘penal nationalism’ came to influence Danish social policy during the 2000s. While critical evaluations of the Nordic Exceptionalism thesis have underscored the significance of immigration in shaping both penal and border policies of the Nordic welfare states, our analysis delves into the core of the Danish welfare state by examining the implementation of the social policy tool, Parenting and Youth Orders. Through this case study, we show how penal instruments were integrated into social policy to regulate citizens with immigrant backgrounds residing in Denmark. These political innovations encompass the reinforcement and legitimization of (1) the explicit targeting of citizens with ethnic minority background and (2) the utilization of new penal instruments within the social realm.</p
Home service solution for patients treated symptomatically with intrathecal baclofen
No full textPersoner med lidelser i centralnervesystemet, såsom multipel sklerose, cerebral parese, rygmarvsskader eller stroke, oplever ofte svær spasticitet. Denne tilstand, som er kendetegnet ved stive og stramme muskler, kan markant hæmme bevægelighed, forårsage smerte og føre til betydelig funktionsnedsættelse. Selvom oral baklofen ordineres, medfører det ofte systemiske bivirkninger, hvilket gør det vanskeligt at opnå en optimal dosis. Intratekal baklofen (ITB) tilbyder et effektivt alternativ til håndtering af svær spasticitet, især for patienter med betydelige smerter eller ubehag. ITB er et kirurgisk implanteret pumpesystem, som kræver regelmæssig påfyldning, der udføres på hospitalet. Det er afgørende, at patienter og pårørende er velinformerede om behandlingsprotokoller og potentielle risici, da udeblivelse fra aftaler eller en tom pumpe kan resultere i smertefuld spasticitet eller endda livstruende tilstande. Kommunikation om behandlingsmål og individuelle behov er central for at opnå optimal ITB behandling. Patienter med progressive sygdomme har løbende behov for vurdering for at tilpasse behandlingen til deres ændrede behov. For patienter på plejehjem eller institutioner eller hos patienter med kognitive udfordringer, fungerer personalet ofte som bindeled i kommunikationen med sundhedsprofessionelle. Mange patienter møder dog til hospitalsaftaler uden ledsagelse, selvom de har behov for fysisk eller mental støtte. Transport til hospitalet, som ofte kræver specialudstyrede køretøjer, kan være tidskrævende og kan indebære ventetid. Dette skaber yderligere udfordringer for både patienter og sundhedsprofessionelle, som kan have begrænsede ressourcer til at levere nødvendig omsorg og pleje i ventetiden. Potentialet ved hjemmebaserede behandlingsmodeller har fået øget opmærksomhed, især i lyset af de udfordringer, der er forbundet med hospitalsbaseret behandling. Hjemmebaseret behandling, fjernmonitorering og "hospital i hjemmet"-tilgange anerkendes i stigende grad for deres fordele, men har begrænsninger, når det gælder ITB-behandling, grundet dens specialiserede karakter. Under Covid-19-pandemien indførte Odense Universitets Hospital midlertidigt konsultationer i hjemmet for ITB-patienter for at reducere smitterisikoen. Selvom initiativet blev iværksat hurtigt, gav det værdifuld indsigt i patienternes dagligdag og fremhævede behovet for en mere struktureret og evidensbaseret tilgang.Studiets overordnede formål var at forbedre plejen og behandling af personer, der behandles med ITB. De specifikke formål var at:1. Undersøge erfaringer blandt patienter, pårørende og sundhedsprofessionelle med ITB behandling på hospitalet.2. Undersøge nuværende praksis for ITB behandling på hospitalet, herunder kommunikation om behandling og spasticitet og transport til hospitalet.3. Identificere behovet for forbedring af pleje og behandling for patienter, der behandles med ITB.4. Designe og udvikle interventioner baseret på identificerede behov hos patienter, pårørende og sundhedsprofessionelle.5. Evaluere interventionernes indvirkning på patienters helbredsrelaterede livskvalitet.6. Evaluere de økonomiske implikationer af den udviklede intervention sammenlignet med den nuværende praksis.Studiet anvendte et participatory design i tre faser og benyttede både kvalitative og kvantitative metoder.Delstudie 1 var et kvalitativt studie der, ved hjælp af semistrukturerede interviews med patienter, pårørende og sundhedsprofessionelle, undersøgte oplevelser med ITB behandling og kommunikation om spasticitet på hospitalet. Der blev udført deltagerobservationer med patienter under deres transport til og fra hospitalet for behandling.Delstudie 2 var ligeledes et kvalitativt studie, der udviklede en intervention for de identificerede behov fra delstudie 1, i en co-designproces med patienter, pårørende, sundhedsprofessionelle og en IT-specialist.Delstudie 3 var en kvalitativ evaluering af den udviklede intervention ved hjælp af semistrukturerede interviews med patienter, pårørende og sundhedsprofessionelle.Delstudie 4 var en økonomisk evaluering af interventionen og en vurdering af patienters helbredsrelaterede livskvalitet med anvendelse af demografiske data og spørgeskemaer.57 patienter, deres pårørende og sundhedsprofessionelle blev inkluderet i studiet. Gennem interviews og deltagerobservationer i fase 1 fandt studiet, at transporten til hospitalet var anstrengende og tidskrævende for patienterne og adresserede, at der var udfordringer med at imødekomme patientens plejebehov under ambulante besøg på hospitalet. Studiet viste, at der var et behov hos sygeplejerskerne for at styrke kommunikationen med de pårørende for bedre at kunne integrere patienters perspektiver i ITB behandlingen. Disse observationer udgjorde fundamentet for udviklingen af en ny arbejdsgang for patienter i behandling med ITB i hjemmet understøttet af teknologi. I anden fase af studiet deltog patienter, pårørende og sundhedsprofessionelle i en co-design proces omkring udviklingen af en prototype til en ny arbejdsgang med hjemmebehandling og teknologi til at understøtte interventionen. Efter tilpasninger af prototypen blev det muligt at tilbyde konsultationer til alle patienter i deres hjem. Ved nøje planlægning af patientbesøg med hjælp af et udviklet rute- og aftale planlægningsværktøj var det muligt at udnytte den tid, sygeplejerskerne havde til rådighed, så de så patienterne med samme hyppighed som patienterne tidligere havde besøgt hospitalet.I fase 3 blev der udført en evaluering af den nye arbejdsgang og den udviklede teknologi gennem interviews med patienter, pårørende og sundhedsprofessionelle. Den udviklede arbejdsgang bygger på omfattende forskning og erfaring med forskellige hospitalsindsatser i patienters hjem, herunder hjemmebaseret behandling og monitorering. I modsætning til løsninger, der fokuserer på hjemmemonitoreringssystemer, hvor sundhedsprofessionelle arbejder fra deres vanlige miljø, involverede dette studie sygeplejersker, der udførte konsultationer i patienternes hjem. Dette krævede en skræddersyet tilgang, der kombinerede behandling og monitorering, samtidig med at pårørende blev støttet og uddannet i at forstå og håndtere den løbende vurdering af behandlingens effekt. Forbedret kommunikation under hjemmebesøg styrkede pårørendes forståelse af behandlinger som ITB og gav dem mulighed for at varetage patienternes interesser mere effektivt. Pårørende bidrog også med værdifuld indsigt i patienternes dagligdag, hvilket fremmede en helhedsorienteret og patientcentreret tilgang. Patienter, pårørende og sundhedsprofessionelle udtrykte tilfredshed med den nye arbejdsproces og værdsatte den reducerede belastning ved transport og det forbedrede samarbejde. Ved at imødekomme patienters præferencer for at modtage behandling i velkendte omgivelser sigter hjemmebaserede indsatser mod at forbedre livskvaliteten. Selvom spørgeskemaer ikke viste signifikante ændringer i patienternes helbredsrelaterede livskvalitet, fremhævede deltagerne i interviews den positive betydning, hjemmebehandlingen havde for deres generelle trivsel. Desuden fremstår den hjemmebaserede løsning omkostningseffektive og som et attraktivt alternativ for patienter og pårørende, der oplever logistiske og ressourcemæssige udfordringer i forbindelse med hospitalsbesøg. Dette studie bidrager med værdifuld indsigt i potentialet for hjemmebaseret hospitalsbehandling til at styrke patientcentreret sundhedspleje. Ved at fjerne logistiske barrierer og tilbyde behandling i velkendte omgivelser fremmer løsningen både komfort og individualisering. Studiet understreger også den aktive rolle, som pårørende spiller i behandling og beslutningstagning, hvilket fremmer en helhedsorienteret og meningsfuld pleje og behandling. Resultaterne viser, at hjemmebaseret behandling er en gennemførlig og omkostningseffektiv model, der i høj grad harmonerer med patienternes behov og præferencer, selv ved en højt specialiseret behandling hos en meget specifik patientgruppe. Løsningsmodellerne præsenteret i dette studie har derfor potentiale til at tjene som inspiration til lignende løsninger for andre patientgrupper med behov for specialiseret behov for sundhedspleje og behandling i hjemmet.Individuals with central nervous system conditions such as multiple sclerosis, cerebral palsy, spinal cord injuries, or stroke often experience severe spasticity. This condition, characterised by stiff and tight muscles, can significantly impair movement, cause pain, and lead to substantial disability. While oral baclofen is prescribed, it frequently causes systemic side effects which challenges achieving an optimal dose. Intrathecal baclofen (ITB) offers an effective alternative for managing severe spasticity, particularly for patients experiencing significant discomfort or pain. ITB involves a surgically implanted pump that requires regular refills administered in a hospital setting. Ensuring that patients and caregivers are well-informed about treatment protocols and potential risks is critical, as missed appointments or an empty pump can result in painful spasticity or even life-threatening conditions. Communication about treatment goals and individual needs is essential for optimal ITB outcomes. Patients with progressive conditions require ongoing assessment to adapt treatment to their changing needs. This is particularly important for patients in nursing homes or institutions or those with cognitive impairments, where staff often mediate communication with healthcare providers. However, many patients attend hospital appointments unaccompanied despite requiring physical or mental support. Transport to the hospital, often requiring specially equipped vehicles, can be time-consuming and may involve waiting time. This creates additional challenges for both patients and healthcare professionals, who may have limited resources to provide the necessary care and support during the waiting period. The potential of home-based treatment models has gained attention, particularly in light of challenges associated with hospital-based care. Home-based treatment, remote monitoring, and "hospital at home" approaches are increasingly recognised for their benefits but have limitations when applied to ITB treatment due to its specialised nature. During the Covid-19 pandemic, Odense University Hospital implemented temporary home consultations for ITB patients to reduce infection risks. Although hastily executed, this initiative provided valuable insights into patients' daily lives and highlighted the need for a more structured, evidence-based approach.The study's primary objective was to enhance care and treatment for individuals undergoing ITB therapy. The specific aims were to:1. Explore the experiences of patients, caregivers, and healthcare professionals regarding ITB treatment in hospital settings.2. Investigate current practices for ITB treatment at the hospital, encompassing communication about treatment and hospital transportation.3. Determine the need for enhancing care and treatment for patients undergoing ITB therapy.4. Develop interventions based on identified patient, caregiver, and healthcare professional needs.5. Evaluate the impact of interventions on patients' health-related quality of life.6.Assess the economic implications of the developed solution compared to the current practices.The study employed a participatory design approach implemented in three phases, utilising both qualitative and quantitative methods.Sub-study 1 was a qualitative study employing semi-structured interviews with patients, caregivers, and healthcare professionals to examine experiences with ITB and communication regarding spasticity. Participant observations were conducted for patients travelling to and from the hospital for treatment.Sub-study 2 involved the development of interventions to address identified needs through co-creation with patients, caregivers, healthcare professionals, and an IT specialist.Sub-study 3 evaluated the developed solution qualitatively through semi-structured interviews with patients, caregivers, and healthcare professionals.Sub-study 4 entailed an economic evaluation of the intervention and an assessment of patients' health-related quality of life using demographic data and questionnaires.The study included 57 patients, along with their caregivers and healthcare professionals. Phase 1 interviews and participant observations revealed that transport to the hospital were challenging, unsettling, and time-consuming for patients, highlighting difficulties in addressing patient care needs during hospital visits. Enhanced communication between nurses and caregivers was identified as essential to integrate patients' perspectives into ITB treatment. These insights guided the development of a new workflow for ITB patients in home settings supported by technology. During Phase 2, patients, caregivers, and healthcare professionals participated in a co-creation process to develop a prototype of a new workflow and technology supporting the home service solution. Following prototype adjustments, offering consultations at home to all patients became feasible, mirroring the frequency of previous hospital consultations. Effective resource management was achieved through thorough planning and visit scheduling using a developed route- and appointment planning tool, complemented by nurses' input. In Phase 3, an evaluation of the new workflow and technology involved interviews with patients, caregivers, and healthcare professionals. The developed workflow builds on extensive research and experience with various hospital interventions in patients' homes, including home-based treatments and monitoring. Unlike solutions focused on home-monitoring systems where healthcare professionals remain off-site, this study involved nurses conducting consultations in the patients’ homes. This required a tailored approach that combined treatment and monitoring while also supporting and educating caregivers to understand and manage the ongoing assessment of the treatment's impact. Enhanced communication during home consultations empowered caregivers, enabling them to better comprehend treatments like ITB and advocate for patients effectively. Caregivers also provided valuable insights into patients' daily lives, fostering holistic and patient-centred care. Patients, caregivers, and healthcare professionals expressed satisfaction with the new workflow, appreciating the reduced burden of transport and improved collaboration. By aligning with patient preferences for receiving care in familiar surroundings, home-based interventions aim to enhance quality of life. While no significant changes in health-related quality of life were found in the questionnaires, participants in interviews highlighted the positive impact of home treatment on their overall well-being. Additionally, the cost-saving home service presents an appealing alternative for patients and caregivers managing logistical and resource challenges associated with hospital visits. This study contributes valuable insights into the potential of home-based hospital care to enhance patient-centred healthcare delivery.This study provides valuable insights into the potential of home-based hospital care to enhance patient-centred healthcare delivery. By addressing logistical barriers and offering care in familiar surroundings, it promotes comfort and personalisation. The study also highlights the active role of caregivers in treatment and decision-making, fostering holistic and meaningful care and treatment. These findings suggest that home-based care is a feasible, cost-effective model that aligns closely with patients' needs and preferences, even in a very specific patient group requiring highly specialised treatment. The solution presented in this study thereby have the potential to inspire similar solutions in other patient groups with the need for specialised care and treatment at home
Short-term improvements in body composition, fitness levels, well-being, sleep habits and health knowledge for children and adolescents after a ten-week residential stay in the Danish Christmas Seal Homes – effects of adding a team-based health education and physical activity programme
No full textBaggrundOvervægt og svær overvægt hos børn er en global udfordring, der påvirker børn og unge verden over. Prævalensen er steget betydeligt i de seneste årtier; faktisk betragtes overvægt og fedme hos børn som en af de mest alvorlige folkesundhedsudfordringer i det 21. århundrede. Fysisk inaktivitet og svær overvægt hos børn er risikofaktorer for hjertekarsygdomme senere i livet, og der er derfor behov for indsatser for børn og unge. Enkelt-disciplinære interventioner, der fokuserer på enten diæt, fysisk aktivitet (FA), trivsel eller skærmtid har vist at have lille eller ingen effekt. Det ville være interessant at undersøge en multidisciplinær intervention som et ophold med fokus på sundhedsviden, trivsel, madvaner og FA. I Danmark kan det gøres på Julemærkehjemmene (JMH). JMH tilbyder et ti-ugers ophold til socialt udsatte børn og unge i alderen 7-14 år. Opholdet er kendetegnet ved brugen af personaleinitierede aktiviteter, der styrker den positive udvikling af sociale relationer, sundhedsbevidsthed og -viden, trivsel og daglig FA. Under opholdet følger børnene den danske skolekalender med daglig undervisning i mindre grupper – inddelt efter alder. Mellem børn og unge på JMH er der højere forekomst af lav socioøkonomisk status og betydelige fysiske og psykosociale udfordringer sammenlignet med deres jævnaldrende. En stor del af børnene lever med overvægt eller svær overvægt, og mange kæmper med lavt selvværd, mobning, lav selv-rapporteret livsglæde og lav livskvalitet. Derudover inkluderer almindelige psykiatriske diagnoser i denne gruppe Attention Deficit Hyperactivity Disorder (ADHD), autisme og stress-relaterede adfærdsproblemer.Konceptet ”11 for Health” (11fH), som kombinerer sundhedsviden og FA, er baseret på rekreative fodboldøvelser og småspil og kan beskrives som et holdspils koncept. Koncepter som 11fH kan positivt påvirke muskel-skelet, kardiovaskulær og metabolisk sundhed gennem en kombination af udholdenhedstræning, høj-intens interval træning (HIIT) og styrketræning. Desuden kan rekreative holdspil stimulere den indre motivation for deltagelse i FA. Ved at fokusere på sociale relationer med par- og holdøvelser har 11fH positivt påvirket social og mental trivsel med høje tilfredsheds vurderinger og moderate vurderinger af oplevet anstrengelse. De sociale interaktioner i 11fH kan stimulere motivationen gennem en følelse af tilhørsforhold, og holdsport kan medføre en højere grad af fastholdelse til FA sammenlignet med individuelle sportsgrene. For børn og unge på JMH kan 11fH-konceptet fungere som et effektivt værktøj til positiv påvirkning af fysisk og psykosocial sundhed.FormålNærværende afhandling undersøger påvirkningen af et standardophold (SG) på JMH på fysiologiske og psykosociale sundhedsvariable. Afhandlingen evaluerer populariteten af 11fH-programmet på JMH (SG+), og om dets indhold vil resultere i yderligere fysiologiske og psykosociale sundhedsforbedringer end standardprogrammet.Metoder614 børn deltog i undersøgelsen, hvoraf 309 deltog i SG (12,4±1,6 år) og 305 i SG+ (12,4±1,4 år). Et crossover-design blev brugt over to år. Et ti ugers ophold (SG) på JMH fremmer generelt en struktureret og forudsigelig daglig rutine med sunde madvaner, daglig FA og socialt engagement, idet der lægges vægt på en omfattende sundhedsdefinition, der inkorporerer fysisk, socialt og mentalt velvære blandt børn og unge. Standardprogrammet for SG-gruppen er baseret på kost- og motionspolitikker anbefalet af de danske myndigheder. I SG+ blev to ugentlige FA-sessioner fra SG erstattet med 11fH-sessioner. FA og sundhedsuddannelsesprogrammet 11fH omfattede øvelser designet til at være inspirerende og socialt inkluderende med integrerede, evidensbaserede principper for fodboldøvelser. De 20 sessioner bestod af højintensive, engagerende og inkluderende øvelser og aktiviteter.I denne afhandling var den primære undersøgte variabel ændringer i fedtprocent, og sekundære variable var yderligere ændringer på kropssammensætning, fitness og fysisk præstationsevne (målt ved løbetests og testning af balance og stående længdespring), blodtryk og hvilepuls samt FA og søvnmønstre (målt med accelerometre). Endvidere blev ændringer i sundhedsviden, trivsel, følelsesmæssige og adfærdsmæssige vanskeligheder samt søvnkvalitet vurderet gennem spørgeskemaer.ResultaterSom det primære resultat blev fedtprocenten sænket med syv procent points under det ti uger lange ophold på JMH, fra 36% til 29% i SG+ og fra 37% til 30% i SG, uden forskel mellem grupperne. Fedtprocenten faldt med gennemsnitligt seks procent points hos pigerne (fra 37% til 31%) og med otte procent points hos drengene (fra 36% til 28%) (Artikel I). Desuden observerede vi øget intervalarbejdsevne, fitness, hoppelængde, relativ muskelmasse, og reduceret systolisk og diastolisk blodtryk, hvilepuls og fastende insulinniveau uden forskelle mellem grupperne (Artikel I). Deltagerne vurderede 11fH programmet til 3,5±1,0 på en ”popularitets” skala (1–5) med samme niveau på 3,5±1,0 og 3,6±0,9 for henholdsvis piger og drenge.Den generelle sundhedsviden steg signifikant mere i SG+ (6,6%) end SG (3,4%) over ti uger med gruppeforskel til fordel for SG+ på 3,4% (95% CI: 0,6;6,2, p<.05). Sundhedsviden relateret til FA steg med henholdsvis 7,2±20,5% og 4,7±21,7% i SG+ og SG, med en signifikant gruppeforskel til fordel for SG+ (Artikel II). Begge grupper viste en markant øget overordnet trivselsscore med 4,51±7,16 arbitrære enheder (AU) i SG og 4,54±7,17 i SG+, uden forskelle mellem grupperne (Artikel II). Der blev observeret specifikke stigninger i alle trivsels underkategorier, hvilket hævede den samlede trivselsscore til nationale gennemsnitsniveauer. Deltagernes samlede score indenfor følelsesmæssige og adfærdsmæssige vanskeligheder (SDQ) indikerede et forhøjet niveau af psykiske vanskeligheder og følger heraf ved baseline (>95. percentil); begge grupper havde reduceret niveauet af psykosociale vanskeligheder efter ti uger (ingen forskelle mellem grupperne).Resultaterne viste en ændring i deltagernes søvnmønster, målt med accelerometre. De øgede deres tid i sengen, den samlede søvnvarighed og søvn regelmæssighedsindekset. De reducerede ligeledes deres score for søvnbesvær, målt ved spørgeskemaer (ingen forskelle mellem grupper).Kortisolniveauerne blev sænket (NS) med 0,6±5,5 nmol/l og 0,5±4,7 nmol/l for henholdsvis SG og SG+ (Artikel III).KonklusionDe tre artikler i denne afhandling viste samlet set, at et 10-ugers ophold på JMH er en effektiv multidisplinær intervention, der resulterede i klinisk relevante (within-group) forbedringer af fedtprocent, fitness og kardiometaboliske sundhedsvariabler hos socialt sårbare børn og unge. Ydermere havde opholdet en markant påvirkning af trivsel, forbedrede følelsesmæssige og adfærdsmæssige vanskeligheder og søvnkvalitet. Tillige kan det konkluderes, at der var en yderligere positiv effekt på sundhedsviden ved at erstatte FA-sessioner med fodbold- og sundhedsundervisning i form af 11fH, især ift. sundhedsviden om FA og betydningen af høj-intens FA. Derimod var der ingen yderligere effekter af 11fH på sundhedsprofil, fitness niveau, trivsel og øvrige variable, hvilket formentlig kan tilskrives, at der allerede indgår bredspektret og intens FA i standardprogrammet. Fremtidige studier vil undersøge den langsigtede effekt af de ti ugers ophold og undersøge, om deltagelse i inkluderende holdsport, øgede kropslige kompetencer og om øget sundhedsviden om FA vil have betydning for fastholdelse af FA og sund livsstil. BackgroundChildhood overweight and obesity are global challenges affecting children and adolescents worldwide. The prevalence has increased considerably in the past decades; childhood obesity is considered one of the most severe public health challenges for the 21st century. Physical inactivity and childhood obesity are risk factors for cardiovascular disease later in life. Hence, action needs to be taken during childhood and adolescence. Single-component interventions focusing either on diet, physical activity (PA), well-being or screen time have been shown to have little or no effect. It would be interesting to study a multidisciplinary intervention such as a residential stay focusing on health knowledge, well-being, diet and PA. That can be done in Denmark at the Christmas Seal Homes (DCSH). The DCSH offer a ten-week residential stay for socially vulnerable children and adolescents aged 7-14 years, with DCSH staff-initiated activities that enhance the positive development of social interrelations, health awareness and education, well-being and daily physical activity. During the regular school year, the children attend daily sessions in smaller groups according to age. Children and adolescents at the DCSH face higher rates of low socioeconomic status and significant physical and psychosocial challenges compared to their peers. A high fraction of the children live with overweight or severe overweight, and many struggle with low self-esteem, bullying, poor self-reported life satisfaction and low quality of life. Additionally, common psychiatric diagnoses in this group include Attention Deficit Hyperactivity Disorder (ADHD), autism, and stress-related behavioural issues.The combined PA and health education programme 11 for Health (11fH) encompasses recreational football drills and small-sided games and can be characterised as a team-based programme. Programmes like the 11fH, with frequent intense training sessions, can positively affect musculoskeletal, cardiovascular and metabolic fitness capacities through a combination of endurance training, vigorous intensity interval training (HIIT) and strength training. Furthermore, recreational football can stimulate intrinsic motivation for participation in PA. By focusing on social relations in exercises with pairs- and teamwork, recreational soccer has positively affected social and mental well-being with high enjoyment ratings and moderate ratings of perceived exertion. The social interactions in 11fH may stimulate motivation through a sense of belongingness, and team sports are proposed to ensure a higher degree of consistent participation and continuity of exercise compared to individual sports. For the socially vulnerable children and adolescents at the DCSHs, the 11fH programme could serve as an effective tool for positively affecting physical and psychosocial health. AimsThe present thesis examines the impact of the standard (SG) residential stay at the DCSHs on physiological and psychosocial health variables. It evaluates the popularity of the 11fH programme at the DCSH (SG+) and whether its content would result in additional physiological and psychosocial health improvements than the standard programme.Methods614 children participated in the study, of whom 309 participated in SG (12.4±1.6 years) and 305 in SG+ (12.4±1.4 years). A crossover design was used over two years. A ten-week residential stay at the DCSH promotes a structured and predictable daily routine among children and adolescents with healthy food habits, daily PA and social engagement, using a multidisciplinary intervention based on a broad health definition that incorporates physical, social, and mental well-being. The standard programme for the SG group is based on diet and exercise policies recommended by the Danish authorities. In SG+, two weekly PA sessions from SG were replaced with 11fH sessions. The PA and health education programme 11fH comprised exercises designed to be captivating and socially inclusive, with integrated, evidence-based principles of small-sided football exercises. The 20 sessions consisted of activities with vigorous intensity, engaging and inclusive drills and exercises.In this thesis, the primary outcome was the change in body fat percentage (BF%), and secondary outcomes were additional effects on body composition, fitness and exercise performance (measured by running, postural balance and standing long jump tests), blood pressure (BP) and resting heart rate (RHR), and PA and sleep patterns (measured with accelerometers). Furthermore, alterations in health knowledge, well-being, emotional and behavioural difficulties and sleep quality were assessed through questionnaires.ResultsAs the primary outcome, BF% was lowered by seven percentage points during the ten-week residential stay (from 36% to 29% in SG+ and from 37% to 30% in SG), with no differences between groups. The drop in BF% was six percentage points for females (from 37% to 31%) and eight percentage points for males (from 36% to 28%) (Paper I). Furthermore, we observed increased intermittent exercise performance, fitness level, standing long jump performance, relative muscle mass, reduced systolic and diastolic BP, RHR and fasting saliva insulin, with no between-group differences (Paper I). The participants rated the 11fH programme as popular, with similar popularity scores (mean±standard deviations (SD)) of 3.5±1.0 and 3.6±0.9 (on a 1–5 scale) among female and male participants, respectively. Overall health knowledge increased significantly more in SG+ than SG over ten weeks (6.6% and 3.4%, respectively). In particular, health knowledge related to PA was increased by 7.2±20.5% and 4.7±21.7% in SG+ and SG, respectively, with a between-group difference in favour of SG+ by 3.4% (95% CI:0.6;6.2). Both groups increased their overall well-being scores by 4.54±7.17 arbitrary units (AU) in SG+ and 4.51±7.16 AU in SG, with no between-group differences (Paper II). Increased values were seen in all well-being subcategories, raising the well-being scores to national average levels at follow-up. In the strengths and difficulty questionnaire (SDQ), the total difficulty score of the participants indicated an elevated level of overall distress and impairment at baseline (>95th percentile); both groups had a reduced total difficulty score after ten weeks (no between-group differences). The results showed an alteration in the participants’ sleep patterns, as measured by accelerometers. They increased their time in bed, overall sleep duration and regularity index. They also reduced their sleep difficulty score, measured by questionnaires (no between-group differences).The cortisol levels were lowered (non-significant) by 0.6±5.5 nmol/l and 0.5±4.7 nmol/l for SG and SG+, respectively (Paper III). ConclusionThe three manuscripts in this thesis showed that a ten-week residential stay at the DCSH is an effective multidisciplinary intervention that resulted in essential and clinically relevant within-group improvements in BF%, fitness level and cardiometabolic health variables in socially vulnerable children and adolescents. Furthermore, the residential stay resulted in a marked within-group improvement in well-being and positive effects on emotional and behavioural difficulties and sleep quality. Moreover, there was an additional positive effect on health knowledge when substituting PA sessions in SG with a combined recreational football and health education programme, especially related to health knowledge of PA and the importance of vigorous intensity. However, no additional effects of the 11fH programme were observed regarding physiological health profile, fitness level, well-being, and sleep, which can probably be attributed to the fact that broad-spectrum and intense PA were already included in the standard programme. Future studies will examine the long-term impact of the ten-week residential stay and investigate whether participation in a motivating team sports programme and elevated health knowledge related to PA will impact health literacy and long-term adherence to PA and a healthy lifestyle. <br/
Nurses' Experiences and Perceptions of P2/N95 Mask Use During the COVID-19 Pandemic in Australia:A Qualitative Study
No full textExperiencing side effects when wearing N95/P2 masks has negative impacts on health workers and increases exposure to pathogens. While side effects of wearing P2/N95 masks have been reported previously, these masks have never been used as widely as during the COVID-19 pandemic. This study examines Australian hospital nurses' experiences and perceptions of P2/N95 mask usage and its impacts on patient care at a time when P2/N95 masks were widely used. A qualitative exploratory–descriptive design involving semistructured interviews and focus groups was conducted with 12 nurses employed at a public health service in Melbourne, Australia. The data were thematically analyzed. Participants shared experiences resulted in four themes derived from the data: “adverse health impacts,” “occupational challenges caused by scarcity of P2/N95 masks,” “impact of wearing P2/N95 masks on patient care and work practices,” and “adaptive strategies to improve patient care.” Nurses experienced notable adverse effects from P2/N95 masks, affecting patient care quality. This study's findings underscore the importance of enhancing training, education, and policies regarding mask usage to uphold high standards of patient care and reduce exposure to pathogens.</p
Perspectives on empowerment programs, and interventions in maritime settings: A systematic review
No full textBackground: Evidence on workplace safety and health promotion interventions shows that theinterventions have failed to demonstrate substantial benefits for seafarers. It is therefore important to explore what is the evidence of interventions with empowering elements regarding seafarers’ safety and health. This study aims to examine what is known about health promotion interventions in a maritime setting and whether they include an empowerment perspective. And secondly, what were the effects of these efforts. Methods: We systematically searched PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information/Web of Science (ISI/WOS), and SCOPUS up to July 2022 by using standard keywords including empowerment in the maritime setting. Data extraction was done by three independent reviewers. The quality of included studies was assessed by using the critical appraisal checklists from Joanna Briggs institute. Results: From 3313 studies initially identified, 10 articles met the inclusion criteria and were included in this review. Interventions covered a wide range of topics such as educational interventions on safety, first aid training, weight management, healthy eating, sexual harassment, alcohol abuse, and cancer prevention training. None of the studies applied a specific theory or definitions of empowermenteven though their aim was to increase seafarers’ empowerment in these areas. Conclusion: The studies focused on improving the safety and health status of the seafarers, however, they had no explicit focus on participation and empowerment. Increasing research with an empowerment approach in maritime sector is recommended to enhance the feasibility andsuccess of the programs in this hard-to-reach occupation