North Denmark Region

The chronic obstructive pulmonary disease (COPD)-specific comorbidity test (COTE) aims to predict long-term mortality in patients with COPD, whereas the Charlson comorbidity index (CCI) score is used as a validated tool for predicting long-term mortality across medical conditions. Comparison of the two comorbidity scores' ability to predict mortality has only been studied scarcely. This study aimed to compare the predictive ability of the COTE and CCI scores including the updated CCI score with updated weights (CCI (Quan)) in patients with COPD following acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Using nationwide registry data, all Danish patients at first admission due to AECOPD during 2005-2018 were included in this retrospective cohort study. 1-year mortality was explored including age, sex and CCI or COTE comorbidity scores. Logistic regression was performed with fivefold cross-validation comparing area under the curve (AUC) and optimal threshold using Youden index. The logistic regression models were furthermore examined using 10 000 bootstrap analyses and comparing the distribution of accuracy using a T-test. Cox regression analysis was used to compare Brier scores over time for models including combinations of age, sex, COTE, CCI and CCI (Quan). A total of 87 271 individuals were identified with a first-time AECOPD during the study period. The median age was 74 IQR (66, 81) and 48.4% were males.The logistic regression revealed an AUC of the CCI and CCI (Quan) models of 0.714 and for the COTE model 0.707 (p<0.001).Comparison using T-test on 10 000 bootstrap samples revealed small differences with an accuracy of 0.7281 (95% CI 0.7241 to 0.7320) for the COTE model and 0.7275 (95% CI 0.7235 to 7314) for the CCI model (p<0.001).Brier scores were 0.1793 for CCI, 0.1789 for CCI (Quan) and 0.1802 for COTE, only slightly favouring the CCI model. In a cohort of patients with first-time AECOPD, we found similar predictive abilities of 1-year mortality comparing the CCI, CCI (Quan) and COTE score.

PRELUCA is a randomised, intervention, non-inferiority study designed to use real-time, longitudinal circulating tumour DNA (ctDNA) measurements to evaluate the efficacy of immunotherapy in patients with advanced non-small cell lung cancer (NSCLC). The primary outcome is overall survival between the two groups: the standard of care group (computer tomography scan evaluation) and intervention group (ctDNA evaluation). The inclusion and exclusion criteria align with European Society for Medical Oncology treatment guidelines and permit broad inclusion of NSCLC patients, ensuring 'real-world' representativeness. The study uses a tumour-informed method, using baseline next generation sequencing analyses to design patient-specific droplet digital PCR assays, which are run with collected blood samples 1 week prior to the intended treatment, enabling real-time evaluation via ctDNA Response Evaluation Criteria in Solid Tumours. Inclusion began in July 2023 and patients are now being actively included in five locations across Denmark. Approval by The Committee on Health Research Ethics of Region Zealand was gained on 4 May 2023. NCT05889247.

Background: Remote ischemic conditioning (RIC) initiated in the prehospital setting did not improve functional outcome at 90 days in patients with acute stroke in the RESIST trial. Trials of other neuroprotective therapies have identified the duration of treatment received prior to reperfusion (“dwell time”) as a treatment effect modifier. We examined whether the effects of RIC might be modified by the duration of prehospital treatment that patients received. Methods: In this post-hoc analysis of the RESIST randomized-controlled trial (Clinicaltrials.gov: NCT03481777), we compared outcomes in patients with prehospital stroke symptoms for less than 4 hours, assigned to RIC versus sham, and diagnosed with acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) – the modified intention-to-treat (mITT) population – stratified by time from randomization to hospital admission (i.e. prehospital treatment duration). The primary outcome was improvement in the ordinal 90-day modified Rankin Scale (mRS) score. Secondary outcomes included 90-day mRS 0-2 and neurological improvement according to the National Institutes of Health Stroke Scale (NIHSS) at 24-hours. Results: Among 902 patients in the mITT population with AIS (n=737) and ICH (n=165), the median randomization-to-admission time was 29.4 minutes (IQR 19.6-39.4 minutes). Upon examining the effect of RIC treatment by pre-hospital treatment duration, there were no significant treatment effects in either the combined mITT, ICH, or AIS groups in any of the transport time groups. Further stratifying patients with AIS based on receipt of reperfusion therapies also revealed no significant differences in RIC efficacy across time. There was no interaction between RIC and pre-hospital treatment duration in relation to 90-day mRS or early NIHSS improvement in the AIS or ICH populations. Conclusion: Longer prehospital treatment duration was not associated with efficacy of RIC in patients with AIS or ICH in the RESIST trial including among AIS patients who received reperfusion therapies, although durations were generally under an hour.

No randomized clinical trial has directly compared the effectiveness of sodium-glucose cotransporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment in reducing acute and chronic kidney outcomes. To examine the comparative effectiveness of SGLT2i and GLP-1RA treatment for acute and chronic kidney outcomes in individuals with type 2 diabetes. This comparative effectiveness study with a target trial emulation design used nationwide, population-based data from Denmark. Participants were individuals with metformin-treated type 2 diabetes who initiated SGLT2i or GLP-1RA treatment from January 2014 to November 2020, with follow-up through October 2024. Initiation of an SGLT2i or a GLP-1RA. The 2 coprimary outcomes were chronic kidney disease (CKD; 40% reduction in estimated glomerular filtration rate [eGFR], severe albuminuria, or kidney failure) and acute kidney injury (AKI). Secondary outcomes included the individual components of CKD, albuminuria, and death. Intention-to-treat effects were estimated using inverse probability of treatment weights, comparing risks for CKD assessed by the Aalen-Johansen estimator, and AKI burden by mean cumulative counts (MCCs; mean number of events per individual as multiple AKI events were possible). Subgroup analyses included stratification by preexisting cardiovascular or kidney disease. The study included 36 279 individuals who initiated an SGLT2i and 18 782 who initiated a GLP-1RA (median [IQR] age, 63 [55-71] years vs 61 [52-70] years), with comparable diabetes duration, eGFR, and urine albumin-creatinine ratios. The weighted 5-year risk of CKD was 6.7% (95% CI, 6.4%-7.0%) for SGLT2i initiators and 8.2% (95% CI, 7.8%-8.6%) for GLP-1RA initiators (risk ratio: 0.81 [95% CI, 0.76-0.87]; risk difference: -1.5% [95% CI, -2.0% to -1.0%]). The 5-year MCC of AKI per 100 individuals was 25.2 (95% CI, 24.4-26.1) for SGLT2i initiators and 28.7 (95% CI, 27.4-30.0) for GLP-1RA initiators (MCC ratio: 0.88 [95% CI, 0.83-0.93]; MCC difference: -3.5 [95% CI, -5.0 to -2.0]). In contrast, the secondary outcomes of albuminuria and mortality were slightly reduced in GLP-1RA initiators. Results were consistent across subgroups, with the most pronounced CKD and AKI reductions with SGLT2i observed among individuals without preexisting kidney disease. This comparative effectiveness study found that initiation of SGLT2i vs GLP-1RA treatment in individuals with type 2 diabetes was associated with a lower 5-year risk of CKD and a lower 5-year count of AKI. These findings underscore the potential of SGLT2i treatment for primary prevention of kidney disease in individuals with type 2 diabetes.

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality worldwide. Survival following OHCA largely depends on whether the initial heart rhythm is shockable or non-shockable. Previous research has suggested that drugs with an off-target effect of blocking cardiac depolarization (non-cardiac depolarization-blocking (DB) drugs) may be associated with a higher likelihood of having a non-shockable rhythm. In this study, we examined whether the use of non-cardiac DB-drugs affects the initial rhythm and survival in OHCA. We identified all patients with OHCA of medical causes from the nationwide Danish Cardiac Arrest Registry (2001-2020). Non-cardiac DB-drug use was defined by prescriptions within 90days prior to OHCA. Multiple logistic regression models with adjustments for relevant confounders were employed to estimate the odds ratio (OR) for the association between non-cardiac DB-drugs and initial heart rhythm and 30-day survival following OHCA. Additionally, stratified analyses were performed based on sex, age, cardiovascular and psychiatric comorbidities, and the year of OHCA occurrence. We included 54,370 OHCA patients (63.1% male, median age 74years). Non-cardiac DB-drugs was used by 6284 (11.6%) OHCA patients and was associated with increased odds of non-shockable rhythm compared with non-users after adjustment for relevant confounders (OR 1.62, 95% CI: 1.48-1.79). This increased odds of non-shockable rhythm was consistent in men and women (ORmen: 1.72, 95% CI: 1.53-1.95, ORwomen 1.46, 95% CI: 1.26-1.70), in all age categories (OR<60 years 1.91, 95% CI: 1.54-2.39, OR>60 years 1.57, 95% CI: 1.41-1.74), in the absence of pre-existing psychiatric or non-cardiovascular disease, or when stratified by the year of OHCA occurrence. Finally, we found that users of non-cardiac DB-drugs had lower 30-day survival chances following OHCA when compared to non-users (OR 0.81, 95% CI: 0.69-0.95). Use of non-cardiac DB-drugs was associated with increased odds of non-shockable rhythm in OHCA and with lower 30-day survival following OHCA.

BackgroundConstruction workers in Europe are, like other employees in the future, expected to work until they are in their late sixties. Physically demanding work in the construction sector may challenge older workers. Still, little is known about their perspective on work participation, which could contribute to a deeper understanding of how to keep construction workers in the labour force.ObjectiveTo explore how older construction workers experience their work participation to gain a deeper understanding of their perspectives on work life and factors influencing their decision to remain or leave the labour market.MethodsTwenty semi-structured individual interviews with male construction workers between 56 and 66 of age were conducted, and thematic narrative analysis was performed to identify their perspectives on work participation.ResultsThree core narratives were identified, illustrating how former work life shaped construction workers' perspectives on current work participation and future work life. One narrative gave insight about a demanding work life, another narrative how they found ways to manage and lastly a narrative emphasised work ethics and economy. Years of hard labour and health risks had influenced their current work life and how they view future work, yet they had adapted and managed construction work while ageing.ConclusionsFindings emphasize how construction workers' continuing work participation depends on their physical capability, a supportive work environment and their financial situation. Future interventions targeting construction worker's work participation while ageing need to consider how employers and labour market policies can help retain construction workers in the workforce.

The carcinogenicity of HPV genotypes is well established. However, HPV genotypes have sublineages with individual risk profiles, and these are much less described with respect to carcinogenicity. Research to characterize HPV sublineages by next‐generation sequencing (NGS) on screening‐derived liquid‐based cytology (LBC) samples is limited because of the technical and quality assurance challenging nature of sublineage analysis. This study aimed to evaluate the feasibility of detecting HPV sublineages from 14 HPV genotypes in SurePath LBC samples from Danish cervical cancer screening. We included 41 HPV plasmids (the Global HPV LabNet DNA Genotyping Proficiency Panel 2023) to quality assure the NGS approach and 120 SurePath LBC samples from the screening program for proof of concept. Our results of the HPV plasmids showed the correct sublineage for all included HPV genotypes except for HPV68b, where the coverage was inadequate for sublineage analysis. The NGS analysis enabled HPV sublineage analysis in 99.1% (112/113) of HPV‐positive SurePath LBC samples. Sublineages belonging to the A lineage were most frequent for HPV16, 18, 31, 33, 35, 39, 51, 52, 58, 59, and 68, while B‐type sublineages showed the highest frequency in HPV45, 56, and 66. The most diverse sublineage data was obtained for HPV31 with sublineages from the A, B, and C lineages. In conclusion, our method enables the identification of HPV sublineages in SurePath LBC screening samples. This information can be used in future studies to determine the usefulness of HPV sublineage analysis in screening settings for risk stratification and clinical management of HPV‐positive women.

BackgroundThe Danish Prehospital Medical Record (DPMR) represents a pioneering nationwide electronic prehospital medical record system. While routinely collected data from the DPMR are increasingly used for research, a comprehensive description of its system and content is needed.ObjectiveTo provide an overview of the DPMR as a tool for research, including its structure, variables, and current volume of records.MethodsWe examined the DPMR’s history, data structure, content, and data usage. We also analyzed aggregated DPMR data from 2016 to 2023 for selected key variables. Further, we searched MEDLINE to identify studies utilizing this data source in the past decade.ResultsSince 2016, the DPMR system has grown to include 1.8 million unique prehospital patients with over 6 million associated patient contacts. For each patient contact, the DPMR compiles information on the emergency medical call (dispatch criteria, level of urgency, and pre-arrival treatment), characteristics of the incident (patient examination, treatment, response time, on-scene time, and transport time), emergency medical services units (ambulances, rapid response vehicles with paramedics, anesthesiologists in ground-based mobile emergency care units and/or helicopters, or patient transports without treatment capability), and extensive patient-related data. The system currently encompasses 528 variables, standardized across all emergency medical services units. There are a limited number of studies on the data quality of the system and the proportion of patients with missing civil registration numbers has varied between approximately 5% and 9%, which should be taken into account when using it for research.ConclusionThe DPMR is growing in importance as a research tool in Denmark. It provides nationwide patient-related and logistical prehospital data going back to 2016, enabling linkage with national registries for outcome research.

ECT is a well-established treatment for adults with mood disorders. The use of ECT in child and adolescent psychiatry is, however, less common, although there is a need for effective treatment of mania when the medical treatment has been exhausted. This case was made to elaborate on the experiences from a clinical department, and the focus was on the effectiveness of ECT in treatment-resistant mania. In line with previous studies, the two cases presented show the positive effect of ECT with few side effects. However, further research is still needed.