Nykøbing F. Hospital

The disease course of microscopic colitis is largely unknown and current knowledge is based on retrospective data. The aim of the PRO-MC Collaboration is to prospectively describe the long-term disease course and prognostic factors. Incident patients of microscopic colitis were included in a prospective, European, multicenter, web-based registry. Data on patient characteristics, symptoms, treatment, and quality of life were systematically registered at baseline and during fixed follow-up intervals. Four disease course phenotypes were defined. Of 422 registered incident patients, 220 had a complete 5-year follow-up. After 5 years, 6% had a quiescent disease course, 54% achieved remission after treatment, 33% had a relapsing disease course, and 7% a chronic active disease course. Patients with a relapsing or chronic active disease course had a more impaired quality of life and were more often in need for long-term budesonide treatment. The disease course in the first year after diagnosis was the only predictor of the disease course. Microscopic colitis is a chronic condition with relapsing or continuous disease course in nearly half of the patients during the first 5 years after diagnosis. The disease course in the first year predicts the long-term disease course.

The purpose of this study is to evaluate the patterns of eruptive movements of ectopic mandibular canines observed on series of orthopantomograms from each individual. The hypothesis is that the eruption direction might be predicted from the location and morphology of the permanent canine. Radiographic material was forwarded from orthodontic colleagues in Denmark and the Nordic countries. In 16 cases/individuals with unilateral or bilateral mandibular canine ectopia, more than one orthopantomogram from each individual was forwarded. The material consists of 41 radiographs from these 16 individuals. In each, the primary mandibular canine existed in the first taken orthopantomogram. The radiographs were taken with the same radiographic equipment, but not necessarily with the same settings and patient orientation. The material was divided according to unilateral ectopia (10 individuals) and bilateral ectopia (6 individuals), and according to the initial location of the permanentcanine, compared to the axis of the primary canine (Ax) in the posterior location and anterior location. The following were registered: ages, lengths of age interval between orthopantomograms, canine maturity, root morphology, crown morphology, and location of permanent canines expressed in distances and angles. The following were concluded. Ectopia was diagnosed earlier in bilateral cases (about 9 years of age) than in unilateral cases (about 12 years of age). More radiographs were taken for each child in the bilateral group, compared to the unilateral group. Extraction of the primary canines occurred often in the bilateral group, but seldom in the unilateral group. The posteriorly located unilateral ectopic canine was located further posterior, compared to the Ax, than bilateral cases. The crown morphology changed during the eruption movements. Curved root morphology appeared in the bilateral cases. Three different patterns were registered in canine eruption (upward, downward, and anterior movements), seemingly dependent on the location and crown morphology of the permanent canine. In bilateral cases, the eruption deviation was most severe on the left side. There are considerable differences between unilateral and bilateral ectopic permanent mandibular canines. The differences are predominantly in the age of the children when ectopia is diagnosed, the number of orthopantomograms taken, and furthermore the location, crown morphology and eruptive movements of the ectopic permanent mandibular canine.

Objective To identify risk factors for and outcomes after SARS-CoV-2 infection and severe COVID-19 in pregnancy Design Prospective population-based cohort study Setting Denmark Population All pregnancies between 1 March and 31 October 2020 Methods Using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records, we compared women with a positive SARS-CoV-2 test during pregnancy to non-infected pregnant women. Severe infection was defined as hospital admission due to COVID-19. Main Outcome Measures Pregnancy, delivery, maternal, and neonatal outcomes. Results Among 82,682 pregnancies, 418 women had SARS-CoV-2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID-19. Risk factors for infection were asthma (OR 2.19 [1.41–3.41]) and being foreign born (OR 2.12 [1.70–2.64]). Risk factors for hospital admission due to COVID-19 included obesity (OR 2.74 [1.00–7.51]), smoking (OR 4.69 [1.58–13.90]), infection after gestational age in weeks (GA) 22 (GA 22–27: OR 3.77 [1.16–12.29]; GA 28–36: OR 4.76 [1.60–14.12]) and having asthma (OR 4.53 [1.39–14.79]). We found no difference in any obstetric or neonatal outcomes. Conclusions Severe outcomes of SARS-CoV-2 infection in pregnancy are rare. Funding The Danish Ministry of Higher Education and Science (Reg. 0237-00007B) and The Region of Southern Denmark and Region Zealand’s shared fund for joint health research projects (Reg. A767) Keywords Severe acute respiratory syndrome coronavirus 2; COVID-19; Obstetric delivery; Pregnancy complications; Pregnancy outcome; Cohort studies; Prospective studies.

DeliriumDelirium is common in hospitalised patients, and there is currently no specific treatment. Identifying and treating underlying somatic causes of delirium is the first priority once delirium is diagnosed. Several international guidelines provide clinicians with an evidence-based approach to screening, diagnosis and symptomatic treatment. However, current guidelines do not offer a structured approach to identification of underlying causes.A panel of 37 internationally recognised delirium experts from diverse medical backgrounds worked together in a modified Delphi approach via an online platform. Consensus was reached after five voting rounds. The final product of this project is a set of three delirium management algorithms (the Delirium Delphi Algorithms), one for ward patients, one for patients after cardiac surgery and one for patients in the intensive care unit.

To investigate changes in culinary practices associated with the arrival of farming, we analysed the organic residues of over 1,000 pottery vessels from hunter-gatherer-fisher and early agricultural sites across Northern Europe from the Lower Rhine Basin to the Northeastern Baltic. Here, pottery was widely used by hunter-gatherer-fishers prior to the introduction of domesticated animals and plants. Overall, there was surprising continuity in the way that hunter-gatherer-fishers and farmers used pottery. Both aquatic products and wild plants remained prevalent, a pattern repeated consistently across the study area. We argue that the rapid adaptation of farming communities to exploit coastal and lagoonal resources facilitated their northerly expansion, and in some cases, hunting, gathering, and fishing became the most dominant subsistence strategy. Nevertheless, dairy products frequently appear in pottery associated with the earliest farming groups often mixed with wild plants and fish. Interestingly, we also find compelling evidence of dairy products in hunter-gatherer-fisher Ertebølle pottery, which predates the arrival of domesticated animals. We propose that Ertebølle hunter-gatherer-fishers frequently acquired dairy products through exchange with adjacent farming communities prior to the transition. The continuity observed in pottery use across the transition to farming contrasts with the analysis of human remains which shows substantial demographic change through ancient DNA and, in some cases, a reduction in marine consumption through stable isotope analysis. We postulate that farmers acquired the knowledge and skills they needed to succeed from local hunter-gatherer-fishers but without substantial admixture.

AimEvidence suggests low-grade inflammation (LGI) to be associated with multimorbidity. Furthermore, there are links between inflammation markers, physical activity (PA), and labour market participation. The aims of this study were to examine the association between PA and LGI in people with multimorbidity and if this association was moderated by self-reported labour market attachment.MethodsCross-sectional data were collected in the Lolland-Falster Health Study (LOFUS) from 2016–2020. We included 1,106 participants with multimorbidity and valid accelerometer data. PA was measured as the average counts per minute (CPM) per day during wake time and split in time spent in moderate to vigorous intensity (MVPA) and light intensity (LPA). Degree of inflammation was determined by high sensitive C-reactive protein (hsCRP) level. Associations were investigated using multiple logistic regression analyses, stratified by labour market attachment.ResultsThe odds of having LGI was higher with lower amount of daily LPA. The highest odds of LGI was observed for CPM < 200 per day (odds ratio (OR) 2.55; 95% confidence interval (CI) 1.46–4.43), MVPA < 15 minutes per day (OR 2.97; 95 % CI 1.56–5.62), and LPA < 90 (OR 2.89; 95 % CI 1.43–5.81) with the reference groups being CPM ≥ 400 per day, MVPA ≥ 30, and LPA ≥ 180 min per day, respectively. We could not preclude an interaction between LPA and labour market attachment (p = 0.109).ConclusionPA recommendations should be developed with attention to people with chronic diseases, who may experience barriers to reach PA at high intensities. People with no labour market attachment may benefit from primary and secondary prevention of multimorbidity.

Among ICU patients with COVID-19, it is largely unknown how the overall outcome and resource use have changed with time, different genetic variants, and vaccination status. For all Danish ICU patients with COVID-19 from March 10, 2020 to March 31, 2022, we manually retrieved data on demographics, comorbidities, vaccination status, use of life support, length of stay, and vital status from medical records. We compared patients based on the period of admittance and vaccination status and described changes in epidemiology related to the Omicron variant. Among all 2167 ICU patients with COVID-19, 327 were admitted during the first (March 10-19, 2020), 1053 during the second (May 20, 2020 to June 30, 2021) and 787 during the third wave (July 1, 2021 to March 31, 2022). We observed changes over the three waves in age (median 72 vs. 68 vs. 65 years), use of invasive mechanical ventilation (81% vs. 58% vs. 51%), renal replacement therapy (26% vs. 13% vs. 12%), extracorporeal membrane oxygenation (7% vs. 3% vs. 2%), duration of invasive mechanical ventilation (median 13 vs. 13 vs. 9 days) and ICU length of stay (median 13 vs. 10 vs. 7 days). Despite these changes, 90-day mortality remained constant (36% vs. 35% vs. 33%). Vaccination rates among ICU patients were 42% as compared to 80% in society. Unvaccinated versus vaccinated patients were younger (median 57 vs. 73 years), had less comorbidity (50% vs. 78%), and had lower 90-day mortality (29% vs. 51%). Patient characteristics changed significantly after the Omicron variant became dominant including a decrease in the use of COVID-specific pharmacological agents from 95% to 69%. In Danish ICUs, the use of life support declined, while mortality seemed unchanged throughout the three waves of COVID-19. Vaccination rates were lower among ICU patients than in society, but the selected group of vaccinated patients admitted to the ICU still had very severe disease courses. When the Omicron variant became dominant a lower fraction of SARS-CoV-2 positive patients received COVID treatment indicating other causes for ICU admission.

Few family interaction processes are more detrimental to children's health than family conflicts. Conflictual relationships in childhood predict a host of adverse health outcomes across the life course. The current study examines associations between household conflicts and the health of children aged 6-12 years and explores to which extent this may vary by socioeconomic status (SES) and multimorbidity (MM) in the household. Cross-sectional study using questionnaire data gathered between 2016 and 2020 as part of the Lolland-Falster Health Study (LOFUS) combined with routine register data on health care use and socio-demography from the Danish nationwide administrative databases. The study sample consisted of 1065 children 6-12 years old, who answered LOFUS4 or LOFUS11, from 777 households for which at least one adult answered LOFUS18. Main outcome was children's health complaints, defined as headache, abdominal pain, back pain, and sleep difficulties. Covariates included MM, SES, and conflicts, all three measured at household level. Multivariable logistic regression models were used. Conflicts were negatively associated with children's health. This was most pronounced for general conflicts in the household, with increased complaints of abdominal pain, back pain, and sleep difficulties. The associations varied when we stratified the households according to MM and SES. Significant associations were found within households without MM for abdominal pain, and within households with MM and low SES, and without MM and with high SES for sleep difficulties. While the higher level of abdominal pain for the above indicated households were found for both internal and external conflicts in the household, the higher level in sleep difficulties was mostly driven by internal conflicts. Children reporting frequent health complaints have a higher future health care use compared with children without such complaints. Our results indicate that growing up in a household with a high conflict level might be a predisposing factor.