Search

Summary: In this systematic review and realist synthesis, we aimed to identify strategies to improve dietary and physical activity behaviors for parents with small children. A systematic literature search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO in July 2021. Included studies had to: (i) target one or both parents with at least one child (0–3 years), (ii) aim to improve diet and physical activity, and (iii) report on diet and physical activity outcomes. Intervention context, delivery, and outcomes were extracted, and behavior change techniques were coded. A program theory was developed, and context‐mechanism‐outcome configurations were identified. In total, 17 interventions reported in 28 studies (19 effectiveness studies; nine protocols) were included. Nine interventions showed small improvements: in diet (n = 5), physical activity (n = 2), or both (n = 2) in mothers. The realist synthesis revealed three strategies to improve health behaviors: (1) using knowledge and role modelling to improve family dynamics, (2) providing various home‐based activities to change home environment, and (3) offering flexible delivery, for example, phone or website‐based to increase social support. Future interventions for parents with small children should consider involving the whole family, focusing on home‐based and practical components, and offering various delivery modes. The protocol for the systematic review and realist synthesis was registered in Research Registry (registration ID: reviewregistry860) March 30th, 2020. [ABSTRACT FROM AUTHOR]

Background: Understanding individual health literacy needs is crucial when designing supportive and effective health care. However, tools assessing health literacy in practice are lacking. The Conversational Health Literacy Assessment Tool (CHAT) was recently developed, but its ability to assess health literacy remains unexplored. We aimed to investigate the implementation and adoption of CHAT, its ability to increase awareness of health literacy among healthcare providers, and if CHAT could assess health literacy needs in patients. Methods: We performed a qualitative feasibility study of CHAT among healthcare providers (nurses, physiotherapists and occupational therapists) who provide rehabilitation services for patients with noncommunicable diseases in a municipal healthcare centre in Denmark. The study used the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to structure interview guide and analysis. We collected qualitative data from four small focus groups with healthcare providers (n = 11). The data were analysed using a deductive thematic three-step method for organising and interpreting data. All informants provided written informed consent prior to data collection. Results: CHAT seems to be a feasible and efficient tool for assessing health literacy needs among individuals with different socio-demographic characteristics and with different diagnoses. CHAT was easiest implemented and adopted by healthcare providers, who were already familiarly with the concept of health literacy. The informants emphasised that an introduction to CHAT and health literacy as concept was valuable for the adoption. Some of them felt frustrated that they did not have opportunity and options to meet the health literacy needs identified by CHAT. Conclusions: CHAT is a promising tool for assessing individual health literacy needs and increasing awareness of health literacy among healthcare providers. For successfully implementation of CHAT, we recommend developing a structured implementation programme, including an introduction to health literacy and an outline of the options for acting upon CHAT results. [ABSTRACT FROM AUTHOR]

Abstract Transfer of full-length genes including regulatory elements has been the preferred gene therapy strategy for clinical applications. However, with significant drawbacks emerging, targeted gene alteration (TGA) has recently become a promising alternative to this method. By means of TGA, endogenous DNA repair pathways of the cell are activated leading to specific genetic correction of single-base mutations in the genome. This strategy can be implemented using single-stranded oligodeoxyribonucleotides (ssODNs), small DNA fragments (SDFs), triplex-forming oligonucleotides (TFOs), adeno-associated virus vectors (AAVs) and zinc-finger nucleases (ZFNs). Despite difficulties in the use of TGA, including lack of knowledge on the repair mechanisms stimulated by the individual methods, the field holds great promise for the future. The objective of this review is to summarize and evaluate the different methods that exist within this particular area of human gene therapy research.

Background: Gestational diabetes mellitus (GDM) is associated with an increased risk of future diabetes in both mother, father and offspring. More knowledge is needed about how to effectively reduce the risk of diabetes through sustained behavioural interventions in these families. The Face-it intervention is a complex health promotion intervention embedded in multi-level supportive environments. The aim of the intervention is to reduce type 2 diabetes risk and increase quality of life among families in the first year following a GDM-affected pregnancy by promoting physical activity, healthy dietary behaviours and breastfeeding through a focus on social support, motivation, self-efficacy, risk perception and health literacy.Methods: This national multicentre study is a two-arm randomised controlled trial including 460 women with GDM in a ratio of 2 (intervention):1 (usual care). The Face-it intervention consists of three main components: 1) additional visits from municipal health visitors, 2) digital health coaching tailored to family needs and 3) a structured cross-sectoral communication system in the health care system. The intervention runs from 3 to 12 months after delivery. The primary outcome is maternal body mass index at 12 months after delivery as a proxy for diabetes risk. The women will be examined at baseline and at follow-up, and this examination will include blood tests, oral glucose tolerance test (OGTT), anthropometrics, blood pressure, self-reported diet and physical activity, breastfeeding, quality of life, health literacy, physical and mental health status, risk perception and social support. Aside from those data collected for OGTT and breastfeeding and offspring parameters, the same data will be collected for partners. Data on offspring anthropometry will also be collected. Information on pregnancy- and birth-related outcomes will be derived from the medical records of the woman and child.Discussion: This randomised controlled trial seeks to demonstrate whether the Face-it intervention, addressing the individual, family and health care system levels, is superior to usual care in reducing diabetes risk for mothers and their families. Coupled with a process evaluation and an economic analysis, the study will provide evidence for policymakers and health services about health promotion among families affected by GDM and the potential for reducing risk of type 2 diabetes and associated conditions.Trial Registration: ClinicalTrials.gov NCT03997773. Registered June 25, 2019 - Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background and Aim: Pain is the primary symptom of chronic pancreatitis (CP) and associates with a number of patient and disease characteristics. However, the complex interrelations of these parameters are incompletely understood, and pain treatment remains unsatisfactory in a large proportion of patients. The aim of this study is to investigate multiple pain risk factors in a large population of CP patients, with a special emphasis on patients' patterns of smoking and alcohol use. Methods: This was a multicenter, cross‐sectional study including 1384 patients with CP. Patient demographics and disease characteristics, as well as current patterns of smoking and alcohol use, were compared for patients with pain (n = 801) versus without pain (n = 583). Multivariate logistic regression models were performed to assess the variables associated with the presence and type of pain (constant vs intermittent pain). Results: The mean age of participants was 52.1 ± 14.6 years, and 914 (66%) were men. Active smoking (odds ratio 1.6 [95% confidence interval 1.1–2.2], P = 0.005) and alcohol consumption (odds ratio 1.8 [95% confidence interval 1.1–3.0], P = 0.03) were independently associated with the presence of pain. In addition, patients' age at diagnosis, pancreatic duct pathology, and the presence of pseudocysts, duodenal stenosis, and exocrine pancreatic insufficiency were confirmed as pain risk factors (all P ≤ 0.01). Constant pain, as opposed to intermittent pain, was more frequently reported by smokers (P = 0.03), while alcohol consumption was associated with intermittent pain (P = 0.006). Conclusion: Multiple patient and disease characteristics, including patterns of smoking and alcohol consumption, associate with the presence and type of pain in patients with CP. [ABSTRACT FROM AUTHOR]

Background: Understanding individual health literacy needs is crucial when designing supportive and effective health care. However, tools assessing health literacy in practice are lacking. The Conversational Health Literacy Assessment Tool (CHAT) was recently developed, but its ability to assess health literacy remains unexplored. We aimed to investigate the implementation and adoption of CHAT, its ability to increase awareness of health literacy among healthcare providers, and if CHAT could assess health literacy needs in patients., Methods: We performed a qualitative feasibility study of CHAT among healthcare providers (nurses, physiotherapists and occupational therapists) who provide rehabilitation services for patients with noncommunicable diseases in a municipal healthcare centre in Denmark. The study used the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to structure interview guide and analysis. We collected qualitative data from four small focus groups with healthcare providers (n = 11). The data were analysed using a deductive thematic three-step method for organising and interpreting data. All informants provided written informed consent prior to data collection., Results: CHAT seems to be a feasible and efficient tool for assessing health literacy needs among individuals with different socio-demographic characteristics and with different diagnoses. CHAT was easiest implemented and adopted by healthcare providers, who were already familiarly with the concept of health literacy. The informants emphasised that an introduction to CHAT and health literacy as concept was valuable for the adoption. Some of them felt frustrated that they did not have opportunity and options to meet the health literacy needs identified by CHAT., Conclusions: CHAT is a promising tool for assessing individual health literacy needs and increasing awareness of health literacy among healthcare providers. For successfully implementation of CHAT, we recommend developing a structured implementation programme, including an introduction to health literacy and an outline of the options for acting upon CHAT results., (© 2020 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Objectives: Chronic pancreatitis (CP) is a multifaceted disease associated with several risk factors and a complex clinical presentation. We established the Scandinavian Baltic Pancreatic Club (SBPC) Database to characterise and study the natural history of CP in a Northern European cohort. Here, we describe the design of the database and characteristics of the study cohort., Methods: Nine centres from six different countries in the Scandinavian-Baltic region joined the database. Patients with definitive or probable CP (M-ANNHEIM diagnostic criteria) were included. Standardised case report forms were used to collect several assessment variables including disease aetiology, duration of CP, preceding acute pancreatitis, as well as symptoms, complications, and treatments. The clinical stage of CP was characterised according to M-ANNNHEIM. Yearly follow-up is planned for all patients., Results: The study cohort comprised of 910 patients (608 men: 302 women; median age 58 (IQR: 48-67) years with definite 848 (93%) or probable CP 62 (7%). Nicotine (70%) and alcohol (59%) were the most frequent aetiologies and seen in combination in 44% of patients. A history of recurrent acute pancreatitis was seen in 49% prior to the development of CP. Pain (69%) and exocrine pancreatic insufficiency (68%) were the most common complications followed by diabetes (43%). Most patients (30%) were classified as clinical stage II (symptomatic CP with exocrine or endocrine insufficiency). Less than 10% of the patients had undergone pancreatic surgery., Conclusion: The SBPC database provides a mean for future prospective, observational studies of CP in the Northern European continent.

A general overview is given of the causes of anemia with iron deficiency as well as the pathogenesis of anemia and the para-clinical diagnosis of anemia. Anemia with iron deficiency but without overt GI bleeding is associated with a risk of malignant disease of the gastrointestinal tract; upper gastrointestinal cancer is 1/7 as common as colon cancer. Benign gastrointestinal causes of anemia are iron malabsorption (atrophic gastritis, celiac disease, chronic inflammation, and bariatric surgery) and chronic blood loss due to gastrointestinal ulcerations. The following diagnostic strategy is recommended for unexplained anemia with iron deficiency: conduct serological celiac disease screening with transglutaminase antibody (IgA type) and IgA testing and perform bidirectional endoscopy (gastroscopy and colonoscopy). Bidirectional endoscopy is not required in premenopausal women < 40 years of age. Small intestine investigation (capsule endoscopy, CT, or MRI enterography) is not recommended routinely after negative bidirectional endoscopy but should be conducted if there are red flags indicating malignant or inflammatory small bowel disease (e.g., involuntary weight loss, abdominal pain or increased CRP). Targeted treatment of any cause of anemia with iron deficiency found on diagnostic assessment should be initiated. In addition, iron supplementation should be administered, with the goal of normalizing hemoglobin levels and replenishing iron stores. Oral treatment with a 100-200 mg daily dose of elemental iron is recommended (lower dose if side effects), but 3-6 months of oral iron therapy is often required to achieve therapeutic goals. Intravenous iron therapy is used if oral treatment lacks efficacy or causes side effects or in the presence of intestinal malabsorption or prolonged inflammation. Three algorithms are given for the following conditions: a) the paraclinical diagnosis of anemia with iron deficiency; b) the diagnostic work-up for unexplained anemia with iron deficiency without overt bleeding; and c) how to proceed after negative bidirectional endoscopy of the gastrointestinal tract.

Introduction: The 1-year mortality of cirrhotic patients with hepatic encephalopathy (HE) is approximately 60-80% in recent studies. We aimed to establish a rehabilitation out-patient clinic (RC) for alcoholic cirrhotic patients sur-viving HE., Material and Methods: Prospectively, patients surviving HE were offered participation in the RC and were seen by a nurse for a one-hour interview with 1-3 weeks' interval after discharge and by a physician, if needed. Clinical, psychological and social problems were identified and addressed. Alcohol consumption was recorded and alcohol cessation was encouraged at each visit. Minimal or overt HE prompted referral to the Liver Unit. The patients were compared with HE patients discharged in 2008 (the control group)., Results: A total of 19 patients were included in the RC group and compared with the 14 patients of the control group. The Child-Pugh score was higher in the RC group (median 13; range 8-14) than in the control group (median 11; range 7-13) (p = 0.033), whereas other clinical, demographic and biochemical parameters did not differ between the two groups. One-year survival was higher in the RC group (16/19; 84%) than in the control group versus (5/14; 36%) (p = 0.012). The log-rank test confirmed an improved survival for the RC group (p = 0.008). The economic costs of subsequent hospital admissions did not differ between the two groups. In the RC group, alcohol consumption was reduced in all but two patients., Conclusion: Survival was significantly improved for patients in the rehabilitation clinic. The improved survival did not subsequently cause higher hospital admission costs., Funding: not relevant., Trial Registration: not relevant.

Introduction: Bispebjerg Hospital has implemented a multidisciplinary team reception of critically ill and severely injured patients at the Emergency Department (ED), termed emergency call (EC) and trauma call (TC). The aim of this study was to describe the course, medical treatment and outcome for patients received by this multidisciplinary team and to evaluate the quality of acute medical treatment of these patients., Material and Methods: A retrospective evaluation was made of all ECs and TCs registered during a six-month period. Information on sex, age, interventions at the ED, time spent at the ED and outcome measures (admission, Intensive Care Unit (ICU) admission and death) were obtained. The quality of the acute medical treatment during the ED stay and the first 48 hours of admission were evaluated by senior consultants from the departments receiving the patients., Results: A total of 150 ECs and 47 TCs were included. The median time spent at the ED was 65 minutes for ECs and 95 minutes for TCs. In EC patients a median of eight interventions were performed at the ED, while a median of five interventions were performed in TC patients. A total of 137 EC patients were admitted to hospital including 32 patients admitted to the ICU. In all, 49 EC patients died during admission. Forty percent of TC patients were discharged to their homes. Only one trauma patient died and none were admitted to the ICU. The acute medical treatment was found to be satisfactory in 87% of EC patients and 96% of TC patients., Conclusion: A multidisciplinary team reception ensures early initiation of diagnostic procedures and treatment, short ED stays and admission to relevant departments in critically ill and severely injured patients.

Introduction: Studies have shown that early warning score systems can identify in-patients at high risk of catastrophic deterioration and this may possibly be used for an emergency department (ED) triage. Bispebjerg Hospital has introduced a multidisciplinary team (MT) in the ED activated by the Bispebjerg Early Warning Score (BEWS). The BEWS is calculated on the basis of respiratory frequency, pulse, systolic blood pressure, temperature and level of consciousness. The aim of this study is to evaluate the ability of the BEWS to identify critically ill patients in the ED and to examine the feasibility of using the BEWS to activate an MT response., Material and Methods: This study is based on an evaluation of retrospective data from a random sample of 300 emergency patients. On the basis of documented vital signs, a BEWS was calculated retrospectively. The primary end points were admission to an intensive care unit (ICU) and death within 48 hours of arrival at the ED. This study was registered at clinicaltrials.gov (NCT01243021)., Results: A BEWS ≥ 5 is associated with a significantly increased risk of ICU admission within 48 hours of arrival (relative risk (RR) 4.1; 95% confidence interval (CI) 1.5-10.9) and death within 48 hours of arrival (RR 20.3; 95% CI 6.9-60.1). The sensitivity of the BEWS in identifying patients who were admitted to the ICU or who died within 48 hours of arrival was 63%. The positive predictive value of the BEWS was 16% and the negative predictive value 98% for identification of patients who were admitted to the ICU or who died within 48 hours of arrival., Conclusion: The BEWS is a simple scoring system based on readily available vital signs. It is a sensitive tool for detecting critically ill patients and may be used for ED triage and activation of an MT response.

Introduction: Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have a "primary criterion" or a BEWS ≥ 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital., Material and Methods: Retrospective evaluation of the triage of a random sample of 300 ED patients. ED medical charts were searched for "primary criteria", documentation of vital signs and a BEWS score. If a BEWS score had not been calculated, this was done retrospectively by the author. An evaluation was made to determine whether ECs or TCs had been correctly activated., Results: In 47 patients, all five vital signs for calculation of a BEWS had been documented. A BEWS had been calculated in 22 patients. Nine patients had a TC activation criterion, and in all these cases a TC was activated. A total of 48 patients had an EC activation criterion, but an EC had only been activated in 24 patients. Among the 24 patients for whom an EC had not been activated, eight had a "primary criterion" and 16 patients had a retrospective BEWS ≥ 5., Conclusion: The triage system is not being used systematically and documentation of vital signs is insufficient at Bispebjerg Hospital. As a consequence, many patients who are presumed to be critically ill are not allocated to an EC. Initiatives have been taken to raise compliance with the system.