Zealand University Hospital

Obstructive Sleep Apnoea (OSA) is a highly prevalent disease often treated with CPAP therapy, but long-term adherence remains a challenge. This study aimed to explore which phenotypes of OSA patients are more or less likely to achieve high adherence to CPAP therapy, based on pre-treatment characteristics. We analysed demographic, socioeconomic, and clinical characteristics across predefined CPAP adherence groups (high, low, and no adherence) in a multicentre cohort of newly diagnosed OSA patients. Multivariate logistic regression was used to assess predictive accuracy, and observed patterns were synthesised into rule-based clinical phenotypes. Among 2845 patients, 41% were highly adherent, 20% had low adherence, and 39% were non-adherent after one year. High adherence was associated with cohabitation, higher education, employment, and greater disease severity. Low or no adherence was linked to comorbidity burden and social vulnerability. The predictive model yielded an accuracy of 60%. Based on group-level differences and model outputs, three clinically reasoned phenotypes were identified: (1) Symptomatic severe OSA with social support, (2) Multimorbidity-dominated, and (3) Non-employed working-age adults. Distinct demographic, socioeconomic, and clinical profiles were associated with CPAP adherence. The identified phenotypes offer a practical framework for understanding adherence variation and may support more individualised approaches to treatment and follow-up.

Smoking and adiposity are risk factors for poor postoperative outcomes after hernia surgery. This study evaluated a real-world hospital-based prehabilitation program covering smoking cessation and weight loss prior to ventral hernia repair. In this retrospective single-center cohort study, patients enrolled in a non-standardized smoking cessation or weight loss program prior to ventral hernia repair between June 2021 and December 2024 were included. Patients in the smoking cessation program were offered counseling and motivational interviews by nurse specialists. Patients in the weight loss program received the same in addition to a target weight and dietary guidance. Follow-up occurred every 2–8 weeks according to patient preference. Success was defined as cessation of smoking for ≥ 6 weeks or reaching target weight followed by ventral hernia repair. A total of 107 patients were identified: 12 (11.2%) participated in the smoking cessation program, 77 (72.0%) in the weight loss program, and 18 (16.8%) in both programs. Of these, 28 patients (26.2%) completed prehabilitation and underwent surgery, whereas 28 (26.2%) did not and remained in the program at the end of follow-up. A total of 27 (25.2%) patients dropped out, 14 (13.1%) were discontinued due to lack of progress, 8 (7.4%) were lost to follow-up, and 3 (2.8%) required emergency surgery. The median time from intervention to surgery was 325 days [IQR: 225.3, 496.5]. Only one in four patients completed prehabilitation and underwent surgery. The program was resource-intensive, with substantial dropouts and failure rates. These results highlight the challenges associated with preoperative lifestyle modification prior to hernia surgery.

Physical inactivity is a major stroke risk factor. In 2016, over one-third of adults in high-income countries did not fulfil the World Health Organization recommendations for physical activity. Evidence on pre-stroke physical activity is limited and inconsistent. We sought to assess pre-stroke physical activity in patients with stroke and its associations with medical conditions and sociodemographic variables. This project was a cross-sectional study of patients hospitalised with stroke. Pre-stroke physical activity was assessed using the Physical Activity Scale-2, to identify whether the World Health Organization recommendations were fulfilled. Patients were stratified into the following: none, 1 to 149 minutes, or ≥150 minutes of moderate- or vigorous-intensity physical activity per week. Crude and age-adjusted logistic regressions were performed to identify associations. Among 122 patients (mean age 71 years (standard deviation = 11.8), 40% women, 70% with a mild stroke), 55% did not fulfil the World Health Organization recommendations. Nonfulfilment was associated with age >75 years (odds ratio [OR] = 0.36; 95% confidence interval [CI], 0.15-0.89), smoking (OR = 0.25; 95% CI, 0.08-0.77), and use of mobility aid (OR = 0.18; 95% CI, 0.05-0.68). Thirty-four per cent reported no moderate- or vigorous-intensity physical activity. Fifty-five per cent of the patients did not fulfil the World Health Organization recommendations before stroke, and one-third did not engage in moderate- or vigorous-intensity activity. Fulfilling the recommendations was linked to older age, smoking, and use of mobility aids.

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.

Renal cell carcinoma (RCC) primarily affects older adults who often present with frailty, increasing their risk of surgical complications and delayed recovery. Prehabilitation, incorporating exercise, nutrition, and psychological support, may improve postoperative outcomes. However, no studies have investigated prehabilitation prior to surgery for RCC. The aim is to assess whether a one-month multimodal prehabilitation program including geriatric interventions improves recovery in patients with frailty undergoing surgery for localized RCC≤7cm. 60 patients, aged ≥65, with a Clinical Frailty Scale (CFS) score of 3-6 are randomized 1:1 to standard care or prehabilitation involving home-based exercise, geriatric assessment with tailored interventions, and smoking cessation support. The primary outcome is change in Quality of Recovery-15 (QoR-15) 21days postoperatively. Secondary outcomes include changes in QoR-15, health-related quality of life (EQ-5D-5L) and physical performance (30-s chair-stand test, handgrip strength) assessed preoperatively, 1, 21 and 90days postoperatively. Postoperative complications will be evaluated using the Clavien-Dindo classification, alongside a cost-effectiveness analysis. Long-term outcomes include 1- and 5-year recurrence-free, cancer-specific, and overall survival. Pre-KiT explores if a pragmatic geriatric prehabilitation strategy is effective and feasible for older frail patients with RCC. The intervention is designed for easy implementation in clinical practice: administered by a single healthcare professional, requiring only one additional hospital visit, and consists of home-based exercises. This low-resource approach also aims to minimize financial costs, which is of importance for implementation possibilities. If successful, it could improve standard care and outcomes after surgery. ClinicalTrials.gov ID: NCT06745609. Prospectively registered December 12th, 2024.

To assess whether menopausal hormone therapy increases the risk of all cause mortality. Nationwide, registry based cohort study. Denmark. Danish women born between 1950 and 1977 and alive at 45 years. Follow-up began on each woman's 45th birthday and ended on 31 July 2023. Of 969 424 eligible women, 92 619 were excluded because of thrombophilia, liver disease, arterial thrombosis or venous thrombosis, breast cancer, endometrial cancer, ovarian cancer, previous use of menopausal hormone therapy, or previous bilateral oophorectomy. Systemic menopausal hormone therapy was the intervention of interest. Death as registered in the Central Persons Register. Secondary outcomes were cause specific mortality registered in the cause of death register (cardiovascular, cancer, or other mortality). Hazard ratios were estimated using Cox regression, adjusted for age, calendar year, parity, educational degree, income group quarter (based on quartiles), country of birth, diabetes, hypercholesterolemia, hypertension, atrial fibrillation, valvular disease, heart failure, and three or more hospital contacts between 44 and 45 years of age. Of 876 805 women, 104 086 (11.9%) redeemed a prescription for menopausal hormone therapy, and 47 594 (5.4%) died, with a median follow-up time of 14.3 years (interquartile range (IQR) 7.9-21.0 years). Women who used menopausal hormone therapy had an incidence rate of 54.9 deaths per 10 000 person years compared to 35.5 per 10 000 person years in the unexposed group, corresponding to an adjusted hazard ratio of 0.96 (95% confidence interval (CI) 0.93 to 0.98). Stratifying this by cumulative duration of menopausal hormone therapy use gave an adjusted hazard ratio after <1 years of menopausal hormone therapy of 1.01 (95% CI 0.98 to 1.05), after 1-2.9 years of use 0.94 (0.89 to 0.98), 3-4.9 years of use 0.90 (0.84 to 0.95), 5-9.9 years of use 0.89 (0.84 to 0.95), and over ≥10 years of use 0.98 (0.90 to 1.07). No unequivocal differences in cause-specific mortality were found between groups. Among the 703 women who underwent bilateral oophorectomy between 45-54 years, those who used menopausal hormone therapy experienced a 27-34% lower mortality hazard as compared to women who did not (median age at death for those who had taken menopausal hormone therapy 60.9 years (IQR 55.3-66.6 years) v 56.6 years (52.9-62.0 years) for those who had not). This nationwide cohort study did not find menopausal hormone therapy was associated with increased mortality.

Smoking is associated with hidradenitis suppurativa (HS), but the clinical significance of smoking history is poorly understood. To examine the impact of smoking history and change in smoking behaviour on disease severity and treatment outcomes in patients with HS. Patients with hospital-diagnosed HS from two independent prospective cohorts, the Copenhagen Hidradenitis Suppurativa Cohort (HIS-COP) and the Danish Skin Cohort (DSC), were included. Data on Hurley stage, International Hidradenitis Suppurativa Severity Score System (IHS4), Dermatology Life Quality Index (DLQI), boil-associated pain and disease-related bother were extracted from HIS-COP to assess the association between smoking status at baseline and treatment outcomes. The DSC was used to assess the effect of change in smoking status on self-reported disease severity and DLQI. In HIS-COP (n = 787), current smoking (53.9%) was associated with being Hurley stage III relative to I (OR = 2.38, 95% CI: 1.02-5.56, p = 0.044), higher IHS4 (OR = 1.05, 95% CI: 1.01-1.10, p = 0.018), higher DLQI (OR = 1.06, 95% CI: 1.03-1.09, p < 0.001) and greater overall disease-related bother (OR = 1.14, 95% CI: 1.07-1.22, p < 0.001) relative to never smokers when adjusted for. Increasing pack years smoked and the number of cigarettes smoked per day were significantly associated with higher IHS4 (p < 0.01 and p < 0.05, respectively); however, after adjusting for age and sex, p > 0.05. Among patients initiated on tetracycline-class treatment, current smokers had a significantly smaller mean (SD) reduction in IHS4 (2.5 (3.2) vs. 4.7 (4.9), p < 0.001), DLQI (4.2 (6.2) vs. 6.0 (6.4), p < 0.05) and percentage reduction in overall disease-related bother (2.9 (4.0) vs. 4.3 (4.0), p < 0.05), compared to non-smokers at follow-up. Smoking cessation and initiation both showed a trend towards increased self-reported disease severity after 12 months follow-up; however, data were limited. Smoking is associated with greater disease severity, poorer quality of life and worse treatment outcomes among patients with HS.

Stoma self-care is critical for long-term adaptation. Personalised approaches may help identify patients needing additional guidance during initial admission. This study aimed to examine factors associated with not achieving stoma self-care proficiency and develop a risk model for use in clinical practice. We linked prospective health data from the Danish Stoma Database Capital Region and the Danish Anaesthesia Database. Multiple logistic regression analysis provided risk factors associated with not achieving stoma self-care proficiency. The C-statistic was used to evaluate the discriminative ability of logistic regression models. Data were randomly split into training and validation sets to develop models and estimate risk in predefined groups. Of 5826 pre-determined for ostomy self-care, 4910 (84%) achieved proficiency at discharge, while 916 (16%) did not. Patients of older age, female sex, smokers, higher BMI and ASA scores were more likely not to perform stoma self-care. Significant treatment factors were the type of surgery, surgical approach and 'stoma not visible to patient'. The risk model included five dichotomous factors: age ≥ 50, age ≥ 70, ASA score ≥ III, acute surgery and female sex. Each risk factor provided a score of 0 or 1 point, resulting in a maximum of five points for high-risk patients. The C-index was 0.66. Baseline characteristics, treatment factors and stoma visibility were associated with a reduced likelihood of achieving stoma self-care proficiency. The risk model, which incorporates readily known variables, may help clinicians identify patients at risk. The model should be further tested in a clinical setting.