Holbæk Sygehus

Abstract Background: Type 2 diabetes (T2D) is a major risk factor for cardiovascular disease (CVD), but the relationships between myocardial function, microvascular function, and atherosclerotic burden remain underexplored in asymptomatic individuals. This study investigates the associations between left ventricular ejection fraction (LVEF)-reserve, myocardial flow reserve (MFR), perfusion defects, coronary artery calcium score (CACS), and global longitudinal strain (GLS) in individuals with T2D but without overt CVD. Methods: Cross-sectional analysis of 871 individuals with T2D without overt CVD, recruited between 2020-2023. All underwent cardiac 82-Rubidium PET/CT to assess LVEF-reserve, MFR, perfusion defects, and CACS. GLS was measured using echocardiography. Associations were examined using linear regression adjusted for cardiovascular risk factors. Results: Mean (SD) age was 64.9 (±9.0) years, diabetes duration was 13.9 (±8.4) years, and 262 (30%) were women. Higher MFR was associated with higher LVEF-reserve (β = 1.64, 95% CI: 1.18 to 2.11, p<0.001). Individuals with CACS > 300 had lower LVEF-reserve than those with CACS ≤ 300 (β = -1.31, 95% CI: -2.01 to -0.60, p<0.001). Presence of Perfusion defects were associated with lower LVEF-reserve (β = -1.58, 95% CI: -2.32 to -0.85, p<0.001). LVEF-reserve was not associated with GLS (p=0.28). Sensitivity analysis excluding 248 participants with perfusion defects confirmed the association between MFR and LVEF-reserve (β = 1.52 (95% CI: 1.01, 2.04), p<0.001). Conclusions: In individuals with T2D without overt CVD, lower MFR, presence of perfusion defects, and CACS >300 were associated with lower LVEF-reserve. Underscoring a potential role of microvascular dysfunction in subclinical systolic impairment.

Penelitian ini bertujuan untuk mengetahui pembelajaran praktikum shalat oleh guru PAI pada anak disabilitas tuna rungu melalui media gambar di SLB Negeri Rasau Jaya Kalimantan Barat. Penelitian ini menggunakan pendekatan kualitatif dengan teknik pengumpulan data observasi, wawancara, dan dokumentasi. Hasil penelitian diketahui bahwa 1) pelaksanaan pembelajaran praktikum shalat oleh guru PAI pada anak disabilitas tuna rungu melalui media gambar di SLB Negeri Rasau Jaya Kalimantan Barat bahwa media gambar dan strategi pembelajaran oleh guru PAI dapat membantu siswa dengan keterbatasan pendengaran memahami dan menguasai gerakan shalat dengan lebih baik. 2) langkah-langkah pembelajaran praktikum shalat oleh guru PAI pada anak disabilitas tuna rungu melalui media gambar di SLB Negeri Rasau Jaya Kalimantan Barat terdapat; a) Persiapan Media Gambar. b) Penggunaan Bahasa Isyarat. c) Demonstrasi Gerakan Shalat, Praktik Shalat. 3) faktor-faktor pendukung dan penghambat pembelajaran praktikum shalat oleh guru PAI pada anak disabilitas tuna rungu melalui media gambar di SLB Negeri Rasau Jaya Kalimantan Barat. Adapun pendukung; a) Penggunaan media gambar b) Guru PAI yang terlatih dan berpengalaman. c) Lingkungan belajar yang kondusif. d) Dukungan orang tua. Penghambat; a) Keterbatasan Sumber Daya. b) Kesulitan dalam Mengikuti Instruksi. c) Keterbatasan Kemampuan Guru. d) Kurangnya dukungan dari orang tua. Dengan demikian dapat disimpulkan Pembelajaran praktikum shalat oleh guru PAI pada anak disabilitas tuna rungu melalui media gambar di SLB Negeri Rasau Jaya Kalimantan Barat berjalan dengan baik dan membantu meningkatkan kemampuan peserta didik anak disabilitas tuna rungu yang dilakukan oleh guru PAI. Hal ini terlihat Media gambar dapat menjadi strategi pembelajaran shalat yang efektif untuk anak disabilitas tuna rungu, Penggunaan media gambar dapat meningkatkan kemampuan anak disabilitas tuna rungu dalam memahami gerakan shalat dan bacaan shalat, Guru PAI memiliki peran penting dalam menggunakan media gambar untuk membantu anak disabilitas tuna rungu memahami praktikum shalat

BackgroundPreventing infection in primary sutured perineal tears after childbirth is crucial to avoid systemic antibiotic use and potential complications from poor healing. This study aimed to investigate the efficacy of an antibacterial, triclosan-coated suture (VicrylPlus®) in reducing infection in primary sutured childbirth-related perineal tears.MethodsThe PLUS study was a single-center, single-blinded, adaptive parallel-group randomized trial conducted at Lund University Hospital, Sweden. Women aged ≥ 18 years with a perineal tear at childbirth were randomly assigned in a 1:1 ratio to either the control group (conventional-absorbable suture, Vicryl®) or the intervention group (triclosan-coated- absorbable suture, VicrylPlus®).ResultsOut of 1921 eligible women, 1890 were randomized to either Vicryl® (n = 953) or VicrylPlus® (n = 937). There were no significant demographic differences between the groups. The most common type of tear in both groups was a second-degree tear (Vicryl® 66.2% (n = 625), VicrylPlus® 67.5% (n = 625)). Encompassing all types of deeper tears in the analysis there was a significantly decrease in infection after suturing with VicrylPlus® 4% (n = 28) versus Vicryl® 6.8% (n = 47); (OR 0.57, 95% CI 0.35–0.91, P = 0.024). When analyzing different tears separately, there was a non-significant increase in infection for first-degree tears with VicrylPlus® 0.8% (n = 2) versus Vicryl® 3.9% (n = 8); (OR 4.75, 95% CI 1.00-22.63, P = 0.050). However, for second-degree tears, the infection rate was significantly reduced with VicrylPlus® 4.4% (n = 27) versus Vicryl® 7.2% (n = 44); (OR 0.63, 95% CI 0.36–0.98, P = 0.05) and for third-degree and unclassified tears there was a non-significant decrease in infections with VicrylPlus® 5.3% (n = 1) versus Vicryl® 14.3% (n = 2); (OR 0.33, 95% CI 0.03–4.10, P = 0.561), respectively, VicrylPlus® 0% versus Vicryl® 1.7% (n = 1); (OR 0.98, 95% CI 0.95–1.02, P = 0.462).ConclusionThe use of triclosan coated sutures significantly reduces the risk of infection in primary sutured childbirth-related perineal tears by 43%, except for first-degree tears. Further research is needed to determine whether their effectiveness remains consistent across the other specific types of deeper tears in a larger study population.Trial registrationClinicalTrials (NCT02863874), posted 11/08/2016, retrospectively registered. Approved by the regional ethical committee before start of enrollment (Dnr 2015/774).

Abstract Pediatric obesity is associated with multi-organ inflammation and an increased risk of cardiometabolic disease. To identify novel biomarkers of early-onset obesity-related cardiometabolic risk, we performed targeted proteomics, analyzing 149 proteins related to inflammation and cardiovascular disease in a cross-sectional sample of 2,377 children and adolescents with overweight/obesity and 1,647 with normal weight. In addition, we analyzed 64 circulating inflammation-related proteins in 184 children and adolescents, who participated in a 1-year family-based obesity management program. We identified a three plasma protein panel (CDCP1, FGF21 and HAOX1) that improved prediction of hepatic steatosis, compared with the predictive value of liver enzymes alone. In the prospective trial, we found that the non-pharmacological intervention induced a decline in circulating inflammatory cytokine levels, some of which were linked to improvements in cardiometabolic phenotypes. Our results may suggest that circulating proteomic signatures may mediate the associations between pediatric obesity and cardiometabolic risk.

BackgroundMaking appropriate end-of-life decisions in the intensive care unit (ICU) requires shared interprofessional decision-making. Thus, a decision-making climate that values the contributions of all team members, addresses diverse opinions and seeks consensus among team members is necessary. Little is known about religion’s influence on ethical decision-making climates. Therefore, this study aimed to examine the association between religious belief and ethical decision-making climates.MethodsThe study was a cross-sectional analytical observation study as a part of the prospective observational DISPROPRICUS study. A total of 2,275 nurses and 717 physicians from 68 ICUs representing 12 countries in Europe and the US participated. All participants were asked which religion (if any) they belonged to and how important their religion (if any) was for their professional attitude towards end-of-life care. Perceptions of ethical decision-making climates were evaluated using a validated, 35-item self-assessment questionnaire that evaluates seven factors. Using cluster analysis, ICUs were categorised into four ethical decision-making climates: good, average (with nurses’ involvement at the end of life), average (without nurses’ involvement at the end of life) and poor.ResultsOf the 2,992 participants, 453 (15%) were religious (had religious convictions and found them important or very important for their attitude towards end-of-life care). The remaining 2,539 were non-religious (i.e. had religious convictions but assessed that they were not important for their attitude towards end-of-life care). When adjusting for country and ICU, the overall perception of the four ethical climates was associated with religious beliefs, with non-religious healthcare providers having more positive perceptions of the ethical climates compared to religious healthcare providers (p < 0.01). Within good climates, non-religious healthcare providers rated leadership by physicians (p < 0.01), interdisciplinary reflection (p = 0.049) and active decision-making by physicians (p = 0.02) as more positive compared to religious participants. In poor climates, religious healthcare providers had a more positive perception of the active involvement of nurses (p = 0.01). Within the other climates, no differences were found.ConclusionsOverall perceptions of ethical decision-making climates were associated with religious beliefs, with non-religious healthcare providers generally having a more positive perception of the ethical climates than religious healthcare providers.

Introduction: Osteoporosis is a disease that is often suffered by the elderly because the elderly's bones have lost a lot of nutrients. With the prevalence of osteoporosis in the elderly, to find out how to prevent osteoporosis, action is needed that can cover all aspects that cause a decrease in bone strength in the elderly and actions that can reach this aspect are by eating healthy food and doing physical exercise. The purpose of this research: To identify that physical exercise and healthy eating can prevent osteoporosis in the elderly. Research methods: By using a literature review as a search guide for research articles obtained from the internet using internet sites and Google Scholar. The results: Analysis of 10 selected research articles shows that physical exercise and healthy food can have several benefits: physical benefits can improve physical fitness, maintain body health and increase bone strength. The psychological benefits can increase the quality of life and keep feelings positive. Physical exercise and eating healthy foods can help prevent osteoporosis in the elderly due to a lack of protein and nutrients in their bones. Conclusion: The results of this literature review are that physical exercise and healthy eating have several benefits, namely: physical benefits can improve physical fitness, maintain body health and increase bone strength. The psychological benefits can improve the quality of life and keep feelings positive. Doing physical exercise 3 times a week with a minimum duration of 30 minutes and a maximum of 40 minutes with a time of &gt;4 weeks will be more effective in getting many benefits and the quality of life for the elderly will also increase.

ObjectivesThis study aimed to investigate healthcare professionals’ experiences with using the PRO Palliative Care questionnaire (PRO-Pall) to identify palliative care symptoms and problems in non-specialized palliative care settings among patients with heart, lung, and kidney disease, and cancer. The study also investigated the PRO-Pall’s potential to ensure further initiatives and care.MethodsA national, multicenter, observational study employing a mixed-methods approach. It includes quantitative analysis using an evaluation survey (n = 286) and qualitative analysis from workshops (n = 11). Quantitative data were analyzed descriptively, while qualitative data were analyzed thematically.ResultsQuantitative and qualitative data were organized according to 3 a priori-defined themes: Theme 1: Assessment of palliative symptoms, Theme 2: Support for dialogue, and Theme 3: Timely initiation of initiatives and care. The evaluation survey and qualitative interviews with healthcare professionals indicated that it was valuable to use PRO-Pall in a non-specialist palliative context to screen for symptoms and problems, as well as to initiate actions. PRO-Pall helped to structure the dialogue and had a positive effect on the quality of the conversation.Significance of resultsThe findings highlight that it can be valuable to utilize the PRO-Pall in general palliative care settings for patients with heart, lung, or kidney diseases as well as cancer. When implementing PRO-Pall in practice, it is crucial to carefully consider the entire process, from administering the questionnaire to planning initiatives informed by patients’ PRO responses.