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Jesper Ryg,1,2 Henriette Engberg,3,4 Pavithra Mariadas,3,4 Solvejg Gram Henneberg Pedersen,5 Martin Gronbech Jorgensen,6 Kirsten Laila Vinding,7 Karen Andersen-Ranberg1,2 1Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; 2Geriatric Research Unit, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; 3Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 4Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark; 5Medical Department, Holbæk Hospital, Holbæk, Denmark; 6Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark; 7Medical Department, Kolding Hospital, Kolding, Denmark Purpose: The Barthel Index (BI)-100 is used to measure geriatric patients’ activities of daily living (ADL). The aim of this study was to explore whether BI at hospital admission is associated with mortality. Patients and methods: In a nationwide population-based cohort study, patients aged ≥65 years admitted during 2005–2014 to Danish geriatric departments were assessed with BI at admission. Data were entered into the Danish National Database of Geriatrics and linked at the individual level to the Danish health registers (Civil Registration System, National Patient Register, and National Database of Reimbursed Prescriptions). The BI was categorized into four predefined standard subcategories according to the national Danish version of the statistical classification of diseases (BI =80–100 [independent ADL], BI =50–79 [moderate reduced ADL], BI =25–49 [low ADL], and BI =0–24 [very low ADL]). Patients were followed until death, emigration, or end of the study (December 31, 2015). Associations with mortality adjusted for age, admission year, marital status, body mass index, Charlson comorbidity index, polypharmacy, and ­hospitalizations during the preceding year were analyzed by multivariable Cox regression analysis. Results: Totally, 74,603 patients were included. Women (63%) were older than men (mean [SD] age; 83 [7] vs 81 [7] years) and had higher BI (median [IQR]; 55 [30–77] vs 52 [26–77]). Median survival (years [95% CI]) was lowest in the subcategory “BI =0–24” in both women (1.3 [1.2–1.4]) and men (0.9 [0.8–0.9]). Adjusted mortalities (HR [95% CI]; reference BI =80–100) in women were 2.41 (2.31–2.51) for BI =0–24, 1.66 (1.60–1.73) for BI =25–49, and 1.34 (1.29–1.39) for BI =50–79 and in men were 2.07 (1.97–2.18) for BI =0–24, 1.58 (1.51–1.66) for BI =25–49, and 1.29 (1.23–1.35) for BI =50–79. Conclusion: BI at admission is strongly and independently associated with mortality in geriatric patients. BI has the potential to provide useful supplementary information for the planning of treatment and future care of older patients. Keywords: ADL, prognostic, death, older, longitudinal

Objectives: This study investigates vocal outcome after cordectomy by transoral CO 2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy., Study Design: Prospective, longitudinal, quasi-experimental time series., Methods: Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings., Results: Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy., Conclusion: Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to examine a number of pause-and-speech-measurements in patients with unilateral vocal fold paralysis, before and after injection laryngoplasty. The non-invasive measurements were selected to investigate and explain the treatment effect on connected speech in these patients., Study Design: Retrospective study with repeated measurements design., Method: Voice recordings of 24 patients with unilateral vocal fold paralysis from before and after injection laryngoplasty in local anesthesia were analyzed retrospectively with the computer program Praat. Measurements examined were number of pauses, average pause duration, pause ratio (expressing the amount of pausing during a reading-aloud task), number of breath groups, average duration of breath groups, articulation rate, speaking rate, maximum phonation time, and Voice Handicap Index., Results: Injection laryngoplasty had a significant improving effect on the number of pauses, pause ratio, number of breath groups, average duration of breath groups, articulation rate, speaking rate, maximum phonation time, and Voice Handicap Index. Maximum phonation time before treatment correlated with several pause and speech measurements., Conclusion: The results showed that treatment with injection laryngoplasty had a clear effect on several pause and speech measurements and that these measurements correlated with maximum phonation time, but not with Voice Handicap Index., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This cross-sectional study investigated the relationship between metacognition and mood symptoms four years post-stroke and examined fatigue as a potential moderator for this relationship., Methods: A number of 143 participants completed a survey that included the Hospital Anxiety and Depression Scale (HADS), the Metacognition Questionnaire-30 (MCQ-30), the Fatigue Severity Scale (FSS), and the modified Rankin Scale (mRS) (functional status) four years after stroke. Multiple regression analyses adjusting for demographic and stroke-specific covariates were performed with anxiety and depression as dependent variables and fatigue as a moderator., Results: The proportions of participants satisfying the caseness criteria for anxiety and depression were 20% and 19%, respectively, and 35% reported severe fatigue. Analysed separately, all MCQ-30 subscales contributed significantly to anxiety, whereas only three MCQ-30 subscales contributed significantly to depression. In the adjusted analyses, the MCQ-30 subscales 'positive beliefs' (p < 0.05) and 'uncontrollability and danger' (p < 0.001), as well as fatigue (p < 0.001) and functional status at four years (p < 0.05) were significantly associated with anxiety symptoms. Similarly, the MCQ-30 subscales 'cognitive confidence' (p < 0.05) and 'self-consciousness' (p < 0.05), as well as fatigue (p < 0.001), stroke severity at baseline (p < 0.01), and functional status at four years (p < 0.01) were significantly associated with depression symptoms. Fatigue did not significantly moderate the relationship between any MCQ-30 subscale and HADS scores., Conclusion: Maladaptive metacognitions were associated with the mood symptoms of anxiety and depression, independent of fatigue, even after controlling for demographic and stroke-specific factors. Future studies should implement longitudinal designs to determine whether metacognitions precede anxiety or depression after a stroke, and more strongly indicate the potential of metacognitive therapy for improving the mental health of individuals after a stroke., Competing Interests: The authors declared no competing interests with respect to the research, authorship and publication of this article, (Copyright: © 2024 Pedersen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To explore trajectories that describe change in post-stroke health-related quality of life with fatigue as outcome., Design: Observational and prospective study., Subjects: Stroke survivors (N = 144) with predominantly mild or moderate strokes., Methods: The multidimensional Stroke-Specific Quality of Life scale was used at 1 and 4 years, and the Fatigue Severity Scale at 4 years post-stroke. Latent class growth analyses were used as person-oriented analyses to identify meaningful trajectories. Socio-demographic and stroke-related covariables provided customary adjustment of the outcome, as well as prediction of class membership., Results: The latent class growth analysis models were estimated for "physical health", "visual-language", and "cognitive-social-mental" components of the Stroke-Specific Quality of Life scale, which extracted trajectories describing a variation in stable, deteriorating and improving functional patterns. The stable, well-functioning trajectory was most frequent across all components. More pronounced fatigue was associated with trajectories describing worse functioning, which was more prominent among females compared with males. Living alone implied more fatigue in the "cognitive-social-mental" component. Within the "visual-language" components' trajectories, younger and older participants reported more fatigue compared with middle-aged participants., Conclusion: Most participants belonged to the stable, well-functioning trajectories, which showed a consistently lower level of fatigue compared with the other trajectories.

Objective: Post-stroke fatigue may be associated with functioning even in patients with mild stroke. In order to guide rehabilitation, the aim of this study was to investigate the independent contribution of 12 function-related domains to severe long-term fatigue., Design: Observational follow-up study., Subjects: A total of 144 stroke survivors (mean age 67.3, standard deviation (SD) 10.9 years) were included., Methods: Fatigue 3-4 years post-stroke was measured with the Fatigue Severity Scale (cut-off ≥5). Independent variables were the multidimensional Stroke-Specific Quality of Life scale with 12 domains, demographics, and baseline stroke characteristics., Results: Most of the participants had mild and moderate stroke. Thirty-five percent (n = 51) reported severe fatigue 3-4 years after stroke. Those living with a significant other, and working participants reported significantly less fatigue. All domains of the Stroke-specific Quality of Life scale were significantly associated with the Fatigue Severity Scale. Adjusted for age, sex, marital status, and work status, the domains "energy", "mood", and, unexpectedly, the domain "vision", were all variables independently associated with severe long-term fatigue., Conclusion: Stroke survivors with prominent self-reported visual problems were more likely to experience fatigue. This finding should be verified in further studies. Visual examination and visual rehabilitation may reduce fatigue in selected stroke survivors.

Purpose: To compare stroke-specific health related quality of life in two country-regions with organisational differences in subacute rehabilitation services, and to reveal whether organisational factors or individual factors impact outcome., Materials and Methods: A prospective multicentre study with one-year follow-up of 369 first-ever stroke survivors with ischaemic or haemorrhagic stroke, recruited from stroke units in North Norway ( n  = 208) and Central Denmark ( n  = 161). The 12-domain Stroke-Specific Quality of Life scale was the primary outcome-measure., Results: The Norwegian participants were older than the Danish ( M age = 69.8 vs. 66.7 years, respectively), had higher initial stroke severity, and longer stroke unit stays. Both cohorts reported more problems with cognitive, social, and emotional functioning compared to physical functioning. Two scale components were revealed. Between-country differences in the cognitive-social-mental component showed slightly better function in the Norwegian participants. Depression, anxiety, pre-stroke dependency, initial stroke severity, and older age were substantially associated to scale scores., Conclusions: Successful improvements in one-year functioning in both country-regions may result from optimising long-term rehabilitation services to address cognitive, emotional, and social functioning. Stroke-Specific Quality of Life one-year post-stroke could be explained by individual factors, such as pre-stroke dependency and mental health, rather than differences in the organisation of subacute rehabilitation services.IMPLICATIONS FOR REHABILITATIONThe stroke-specific health related quality of life (SS-QOL) assessment tool captures multidimensional effects of a stroke from the perspective of the patient, which is clinically important information for the rehabilitation services.The cognitive-social-mental component and the physical health component, indicate specific functional problems which may vary across and within countries and regions with different organisation of rehabilitation services.For persons with mild to moderate stroke, longer-term functional improvements may be better optimised if the rehabilitation services particularly address cognitive, emotional, and social functioning.

Objectives: To translate the voice-related quality of life (V-RQOL) questionnaire into Danish and to test the validity and reliability of this Danish version of the V-RQOL instrument., Methods: The translation process was done using forward and backward translation followed by pretesting interviews, performed on 21 participants. The final Danish version was then tested for validity and reliability on 80 cases with voice disorders and 21 controls without voice disorders., Results: The Danish version proved to be valid and reliable. Validity was confirmed by convergent and discriminant validity, known-groups validity, clinical validity (Spearman correlation coefficient 0.64), confirmatory factor analysis, and Rasch analysis. The instrument showed no ceiling effects, but all items and the Social-Emotional domain showed substantial floor effects. The item-total correlations were all high (0.58-0.82) and none of the interitem correlations were low. Reliability was confirmed with regard to internal reliability (Cronbach's alpha 0.92) and test-retest reliability (interclass correlation coefficient 0.89)., Conclusion: Our study shows that the Danish translation of the V-RQOL questionnaire is a valid and reliable instrument suitable for the assessment of the dysphonic patient. The high floor effects, however, indicate that minor differences in voice problems between patients may not be captured in the lower end of the scale with regard to the individual item and the Social-Emotional domain., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To examine patient-reported needs for care and rehabilitation in a cohort following different subacute pathways of rehabilitation, and to explore factors underpinning met and unmet needs., Design: Observational multicentre cohort study., Patients and Methods: A total of 318 Norwegian and 155 Danish patients with first-ever stroke were included. Participants answered questions from the Norwegian Stroke Registry about perceived met, unmet or lack of need for help and training during the first 3 months post stroke. The term "training" in this context was used for all rehabilitative therapy offered by physiotherapists, occupational or speech therapists. The term "help" was used for care provided by health professionals., Results: Need for training: 15% reported unmet need, 52% reported met need, and 33% reported no need. Need for help: 10% reported unmet need, 58% reported met, and 31% reported no need. Participants from both Norway and Denmark had similar patterns of unmet/met need for help or training. Unmet need for training was associated with lower functioning, (odds ratio (OR) = 0.32, p < 0.05) and more anxiety (OR = 0.36, p < 0.05). Patients reporting unmet needs for help more often lived alone (OR = 0.40, p < 0.05) and were more often depressed (OR = 0.31, p < 0.05)., Conclusion: Similar levels of met and unmet needs for training and help at 3 months after stroke were reported despite differences in the organization of the rehabilitation services. Functioning and psychological factors were associated with unmet rehabilitation needs.

Some social arthropods engage in mutualistic symbiosis with antimicrobial compound-producing microorganisms that provide protection against pathogens. Social spiders live in communal nests and contain specific endosymbionts with unknown function. Bacteria are also found on the spiders' surface, including prevalent staphylococci, which may have protective potential. Here we present the genomic and phenotypic characterization of strain i1, isolated from the surface of the social spider Stegodyphus dumicola. Phylogenomic analysis identified i1 as novel strain of Staphylococcus sciuri within subgroup 2 of three newly defined genomic subgroups. Further phenotypic investigations showed that S. sciuri i1 is an extremophile that can grow at a broad range of temperatures (4 °C-45 °C), high salt concentrations (up to 27%), and has antimicrobial activity against closely related species. We identified a lactococcin 972-like bacteriocin gene cluster, likely responsible for the antimicrobial activity, and found it conserved in two of the three subgroups of S. sciuri. These features indicate that S. sciuri i1, though not a specific symbiont, is well-adapted to survive on the surface of social spiders and may gain a competitive advantage by inhibiting closely related species.

Objectives: To investigate changes in health-related quality of life between 3- and 12-months post-stroke in a north Norwegian and a Danish region that organize their rehabilitation services differently, and to identify clinically relevant predictors of change., Design: Prospective multicentre cohort study., Subjects: In total, 304 patients with first-ever stroke (male sex 59%, mean age 68.7 years) participated from Norway (n = 170) and Denmark (n = 134)., Methods: The Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS) was administered twice to measure change in satisfaction with function and wellbeing., Results: QOLIBRI-OS scores showed a small statistically significant difference in favour of Norway at 12 months post-stroke (p = 0.02; Cohen's d = 0.26). Using a calculated minimal clinically important difference score of 12, 20% reported worse, 54% unchanged and 26% better QOLIBRI-OS scores between 3 and 12 months. Age below 65 years predicted a negative change (odds ratio (OR) 0.4, p = 0.007)., Conclusion: In this population with mild and moderate stroke, QOLIBRI-OS scores were slightly higher in the Norwegian region. Approximately 50% of participants experienced clinically important changes in satisfaction with functioning and wellbeing between 3 and 12 months post-stroke. Younger age predicted negative change. This result could indicate increased rehabilitation needs over time in young patients and should be investigated further.

Purpose: This study aims to explore quality of life (QOL) during the first year of recovery after stroke in North Norway and Central Denmark. Method: Individual in-depth interviews with 11 stroke survivors were performed twelve months after stroke onset. An interpretative, inductive approach shaped the interview process and the processing of data. Results: We found that QOL reflected the individuals' reconstruction of the embodied self, which was identified by three intertwined and negotiating processes: a familiar self, an unfamiliar self, and a recovery of self. Further, we found that reconstruction of the embodied self and QOL could be framed as an ongoing and interrelated process of " being, doing, belonging and becoming ". Enriching social relations, successful return to work, and continuity and presence in professional support during recovery enhanced the experience of QOL. Fatigue and sustained reduced function hindered participation in meaningful activities and influenced the perceived QOL negatively. Conclusions: The two countries differed in descriptions of continuity and support in the professional follow-up during the recovery process, influencing the degree of encouragement in reconstructing the embodied self. Reconstruction of the embodied self is a means of understanding stroke survivors' QOL during the first year of recovery, supporting an individualized and tailored rehabilitation practice.

Background: Brief measures of health-related quality of life (HRQOL) that assess both patient-reported functioning and well-being after stroke are scarce. The objective of this study was to examine reliability and validity of one of these measures, the patient-reported Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), in patients after stroke., Methods: Stroke survivors were examined prospectively using survey methods. Core survey data (n = 125) and retest data (n = 36) were obtained at 3 and 12 months, respectively. Item properties (distribution, floor and ceiling effects), psychometric properties (reliability and model fit), and validity (correlations with established measures of anxiety, depression and HRQOL) of the QOLIBRI-OS were examined., Results: Missing responses on the questionnaire were low (0.5%). All items were positively skewed. No floor effects were present, whereas five out of six items showed ceiling effects. The summary QOLIBRI-OS score exhibited no floor or ceiling effects, and had excellent internal consistency (Cronbach's α =0.93). All item-total correlations were high (0.73-0.88). The test-retest reliability of single items varied from 0.74 to 0.91 and was 0.93 for the overall score. The confirmatory factor analysis yielded an excellent fit for a five-item version and provided tentative support for the original six-item version. The convergent validity correlations were in the hypothesized directions, thus supporting the construct validity., Conclusions: The brief QOLIBRI-OS is a valid and reliable brief health-related outcome measure that is appropriate for screening HRQOL in patients after stroke.

Objective: In auditory-perceptual voice analysis, a multiparameter approach and a more reductionist approach may be compared with narrow and broad phonetic transcription and used interchangeably, depending on the purpose. The aim of this study was to investigate the perspectives of a translation of the terminology used in the multiparameter Danish Dysphonia Assessment (DDA) approach into the five-parameter GRBAS system., Methods: Voice samples illustrating type and grade of the voice qualities included in DDA were rated by five speech language pathologists using the GRBAS system with the aim of estimating inter- and intrarater reliability. The same samples were then rated using the DDA terminology., Results: Both inter- and intrarater reliability were found to be very high for the GRBAS parameters grade, rough, and breathy, but somewhat lower for asthenic and strained. Further, strong and clear associations were found between the DDA and GRBAS rating for grade, rough, breathy, and strained, whereas the relation between DDA ratings and asthenic was weaker and less clear., Conclusion: The data strongly support that the DDA system can be translated into the GRBAS system for auditory-perceptual voice analysis. The consensus discussion prior to the listening test is believed to have contributed to the high degree of inter- and intrarater reliability. We suggest for future use of the GRBAS system that rater reliability for asthenic and strained can increase, if these parameters are defined as behavioral terms and antagonists, reflecting muscular hypo- and hyperfunction., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: There is a paucity of stroke-specific instruments to assess health-related quality of life in the Norwegian language. The objective was to examine the validity and reliability of a Norwegian version of the 12-domain Stroke-Specific Quality of Life scale., Methods: A total of 125 stroke survivors were prospectively recruited. Questionnaires were administered at 3 months; 36 test-retests were performed at 12 months post stroke. The translation was conducted according to guidelines. The internal consistency was assessed with Cronbach's alpha; convergent validity, with item-to-subscale correlations; and test-retest, with Spearman's correlations. Scaling validity was explored by calculating both floor and ceiling effects. A priori hypotheses regarding the associations between the Stroke-Specific Quality of Life domain scores and scores of established measures were tested. Standard error of measurement was assessed., Results: The Norwegian version revealed no major changes in back translations. The internal consistency values of the domains were Cronbach's alpha = 0.79-0.93. Rates of missing items were small, and the item-to-subscale correlation coefficients supported convergent validity (0.48-0.87). The observed floor effects were generally small, whereas the ceiling effects had moderate or high values (16%-63%). Test-retest reliability indicated stability in most domains, with Spearman's rho = 0.67-0.94 (all p < 0.001), whereas the rho was 0.35 (p < 0.05) for the 'Vision' domain. Hypothesis testing supported the construct validity of the scale. Standard error of measurement values for each domain were generated to indicate the required magnitudes of detectable change., Conclusions: The Norwegian version of the Stroke-Specific Quality of Life scale is a reliable and valid instrument with good psychometric properties. It is suited for use in health research as well as in individual assessments of persons with stroke., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

VoiceRelease is a progressively structured treatment system that aims to release the voice through muscle tension reduction by manual therapy, thereby facilitating healthy voice production. The VoiceRelease treatment should closely interact with functional voice training and should therefore be carried out by the speech-language therapist (SLT). The aim of this paper is not to present the treatment in detail, but to describe the benefits of using the techniques in the voice clinic and to argue that laryngeal manual therapy complements the skills of the SLT and that it in a natural and integrated way applies to the treatment of voice problems. In order to comply with the present skills of the SLT, VoiceRelease is progressively structured in four levels.

Connective tissue of the human tendon plays an important role in force transmission. The extracellular matrix turnover of tendon is influenced by physical activity. Blood flow, oxygen demand, and the level of collagen synthesis and matrix metalloproteinases increase with mechanical loading. Gene transcription and especially post-translational modifications of proteins of the extracellular matrix are enhanced following exercise. Conversely, inactivity markedly decreases collagen turnover. Training leads to a chronically increased collagen turnover, and dependent on the type of collagen also to some degree of net collagen synthesis. These changes modify the biomechanical properties of the tissue (for example, viscoelastic characteristics) as well as the structural properties of the in collagen (for example, cross-sectional area). Mechanical loading of human tendon does result in a marked interstitial increase in growth factors that are known potentially to stimulate synthesis of collagen and other extracellular matrix proteins. Taken together, human tendon tissue mounts a vigorous acute and chronic response to mechanical loading in terms of metabolic-circulatory changes as well as of extracellular matrix formation. These changes may contribute to training-induced adaptation of biomechanical properties consisting of altered resistance to loading and enhanced tolerance to strenuous exercise. Understanding of such changes is a pre-requisite in the development of measures aimed at prevention of overuse tendon injuries occurring during sport, work or leisure-related activities.