Frederiksberg Hospital

Virtual reality-based cognitive remediation therapy (VR-CRT) offers an ecologically valid approach to enhance real-world cognitive functioning in mood disorders (MD) or schizophrenia spectrum disorders (SSD). This study investigated baseline cognitive, clinical, and neural predictors of VR-CRT response in MD and SSD. Sixty-two MD and SSD participants were randomized to receive four-week VR-CRT or control with assessments at baseline, treatment completion (week 5), and follow-up (week 17). Univariate general linear models examined predictors of VR-CRT improvement on daily-life cognitive skills, assessed using the Cognition Assessment in Virtual Reality (CAVIR). Predictors included age, diagnosis, baseline cognition, IQ-cognition discrepancy, dorsal prefrontal cortex (dPFC) activation during a working memory task, functional connectivity within the dorsal attention (DAN) and salience (SAL) networks, subjective cognition, and technological acceptance. Higher IQ-cognition discrepancy at baseline (i.e., better cognitive performance than expected from premorbid IQ) predicted greater treatment efficacy at treatment completion (β=0.17, p=0.045) and follow-up (β=0.21, p=0.008), while baseline cognition was not associated with treatment response (ps≥0.15). Higher baseline dPFC activity predicted more improvements at both times (β=2.27 p=0.03; β=1.82; p=0.048, respectively). Higher DAN-SAL connectivity predicted improvements at treatment completion (β=2.81 p=0.047), but not at follow-up (p=0.38). Age, sex, diagnosis, subjective cognition, and technological acceptance were not associated with cognitive change. Better cognitive performance than expected based on IQ, possibly reflecting higher cognitive fitness, and greater task-related engagement of dPFC may enhance VR-CRT responsiveness. This profile may indicate greater readiness for change and propensity to translate cognitive strategies into daily life.

Perfluoroalkyl substances (PFAS) have been linked to immunotoxic effects in children, and the consequences of immune suppression could be particularly severe for children in low-income settings. We thus aimed to investigate associations between infant and maternal PFAS exposure and infant vaccine antibody concentrations in Burkina Faso. Infants (n = 200) were vaccinated against measles at baseline (age 4-7 months) and/or at 9 months. Associations between maternal and infant PFAS concentrations (quantified in serum collected at baseline) and infant measles antibody concentrations before and after vaccination were assessed in confounder-adjusted linear regression models. Influential observations were excluded in sensitivity analyses. Infant PFAS exposure was positively associated with pre-vaccination antibody concentrations, but associations were largely driven by a few influential observations. Maternal and infant PFAS concentrations were not consistently associated with infant measles antibody concentrations after one or two vaccinations. Thus, these results from a low-exposed population did not confirm findings from previous studies.

The rise in physical inactivity among children poses serious health risks impacting physical, mental, and social well-being. Physical literacy (PL) has been identified as an effective approach to encourage long-term physical engagement. Schools and communities, particularly through physical education (PE) programs, play a critical role in promoting PL. However, while there are several PL-focused PE interventions worldwide, no such programs have been specifically tailored to Nordic contexts, making feasibility testing essential for effective implementation. This study investigated the feasibility of a Danish adaptation of an Irish PL program, Y-PATH. The adapted program, the Promoting Pupils' Physical Literacy (3PL) intervention, provided PE teachers with resources, courses, and a website to enhance motivational climates in PE and promote PL among 4th and 5th grade pupils. The study was conducted in accordance with Medical Research Council guidelines and Bowen et al.'s (2009) framework. Feasibility indicators including acceptability, demand, implementation, practicality, adaptation, and integration were investigated using a weekly questionnaire for PE teachers, interviews (n = four teachers and 20 pupils), observations, and field notes. The quantitative data were analyzed descriptively, while the qualitative data were analyzed using thematic analyses. 3PL was found to be feasible and acceptable among pupils and teachers (e.g., materials were used in 71% of lessons). While the materials supported implementation for teachers, workload adjustments are needed. Teachers adapted lessons effectively, balancing an inclusive and motivating learning environment. Despite minor challenges, 3PL fostered engagement among pupils and teachers with potential for expansion. 3PL represents a feasible and promising approach to promote PL in a Danish school setting. Feasibility testing demonstrated the potential for scaling 3PL, while recognizing that large-scale trials are needed to validate its broader impact. A protocol for adaptation of 3PL was published in Open Science Framework, registered in December 2022 (1). The 3PL study was preregistered at ClinicalTrials.gov (ID NCT05822024), April 2023, version 1 ( https://classic. gov/ct2/show/NCT05822024 ), before enrolment. A study protocol was written before intervention start (August 2023) and hereafter officially published in January 2024 (2).

Irreparable rotator cuff tears show increasing incidence with age. In symptomatic cases, first-line therapy should be a minimum of six months of physical training, as many improve over time. Reparability is evaluated clinically and by MRI - assessing tendon retraction, fatty infiltration, and muscle atrophy. If symptoms persist, surgical treatment is considered: reverse shoulder arthroplasty is generally offered to older patients (> 60 years), while joint-preserving procedures such as tendon transfer or superior capsular reconstruction may be suitable for younger patients (less-than 60 years), as argued in this review.

Skin barrier dysfunction is central to inflammation and susceptibility to infection in atopic dermatitis (AD). Cutaneous T-cell lymphoma (CTCL) shares clinical similarities with AD and is also associated with a high prevalence of Staphylococcus aureus (S. aureus) colonisation. However, the mechanisms driving skin barrier damage in CTCL and the contribution of bacteria remain poorly understood. We investigate how the interplay between S. aureus (and staphylococcal enterotoxins (SEs)) and primary malignant- and non-malignant T cells affects keratinocyte expression of skin barrier proteins; invitro, in an EL4 murine lymphoma model of bacteria-driven tumour progression, and in CTCL patient lesions colonised with SE-producing S. aureus before and after bacterial eradication by antibiotic treatment. S. aureus and SEs activate malignant and non-malignant T cells to release barrier-repressing cytokines, including IL-4, IL-13, IL-22, and OSM, and JAK-dependent downregulation of filaggrin and loricrin in keratinocytes. In the EL4 model, bacteria-colonised tumour-bearing mice show significant filaggrin loss in tumour-adjacent epidermis, whereas antibiotic-treated mice maintain near-normal expression. Clinically, antibiotic eradication of SE-producing S. aureus partially restores filaggrin and loricrin expression in three of four patients, paralleling reduced inflammatory signalling. SE-producing S. aureus promotes skin barrier impairment in CTCL through cytokine-driven, JAK-dependent repression of structural proteins in keratinocytes. These findings identify microbial-immune crosstalk as a contributor to CTCL skin pathology and provide mechanistic rationale for strategies targeting S. aureus colonisation as adjunctive therapy in CTCL.

Screen use, physical activity, and sleep independently impact adolescents’ mental health, yet further exploration is needed to understand its dynamic impact. This study aimed to examine how movement behaviour cluster in Danish adolescents and how these movement patterns correlate with mental health. Data were collected among Danish adolescents as part of the cross-sectional Health Behaviour in School-Aged Children (HBSC) study in 2018 and 2022. Study population comprised 4,421 adolescents (51.5% girls, age 11, 13 and 15). Latent class analysis was performed separately for boys and girls based on self-reported screen time (5 items), physical activity level (2 items), and sleep duration (1 item). Associations between classes and mental health (mental wellbeing, psychosomatic complaints, and body image) were evaluated using adjusted regression models stratified on sex. Three movement patterns were identified. Class 1 represented medium screen users with high physical activity (34.3% of boys; 28.1% of girls); class 2 represented medium screen users with low physical activity (41.8%; 42.5%); and class 3 represented high screen users with short sleep duration (23.8%; 29.3%). Compared to class 1, adolescents in class 2 and 3 reported substantially poorer mental wellbeing, more psychosomatic complaints, and poorer body image, especially girls in class 3. Screen use, sleep, and physical activity behaviour tend to group in three movement patterns among Danish adolescents. The identified patterns were associated with notable differences in mental health outcomes. Results emphasize the benefits of high physical activity, low screen time and sufficient sleep, supporting interventions targeting multiple movement behaviours at once. • While the independent risks of excessive screen or sedentary time, low physical activity, and inadequate sleep duration have been studied for decades, little is known about clustering of movement behaviour. • We used latent class analysis to identify patterns of screen use, physical activity, and sleep among adolescents and examined how they correlate with mental health. • Adolescents with high screen use and short sleep duration had significantly poorer mental health than those with more balanced movement behaviours. • The findings show how movement behaviours tend to cluster, supporting interventions targeting multiple movement behaviours rather single ones

Adult patients referred for physical function evaluation by physio- or occupational therapists were evaluated with the Cumulated Ambulation Score (CAS) for basic mobility, 30sec-Sit-To-Stand-test (30s-STS) for muscle strength and function in lower extremities, and handgrip strength (HGS) as a proxy for general muscle strength. Results were categorized as normal (mean+/-1SD) or reduced (<-1SD) according to Danish sex- and age-decade reference values. The day of the first CAS assessment was used as an index for 1-year mortality in Cox regression analysis adjusted for age, sex, and multimorbidity (M3-index >1 point). A total of 5062 unselected patients with a mean±SD age of 74.5±13.9 years (54% women), were evaluated with CAS in an acute (n = 337), surgical (n = 1671) or medical (n = 3054) ward. Of these, the 30s-STS was assessed in 85% (n = 4309) and HGS in 51% (n = 2580) patients, respectively. One-year mortality was 19.3%. The adjusted hazard ratio for 1-year mortality in patients with reduced CAS-mobility (57%), reduced 30s-STS (93%), and reduced HGS (44%) was 1.98 (95%CI, 1.71-2.29), 3.57 (2.21-5.78), and 2.06 (1.66-2.56), respectively, versus those with a normal physical function in respective tests. Correspondingly, hazard ratios for patients ≥85 years of age (n = 1185) were 2.02, 3.34 and 1.98. In older medical and surgical hospitalised patients with reduced physical function (CAS, 30s-STS or HGS) 1-year mortality was markedly increased. This simple test battery is rapid and low-cost and can easily be implemented in other hospitals, acute care facilities, and across sectors.