Published in 2022

Using a novel smartphone application for capturing of patient-reported outcome measures among patients with inflammatory arthritis:A randomized, crossover, agreement study

Uhrenholt, L., Christensen, R., Dreyer, L., Schlemmer, A., Hauge, E-M., Krogh, N. S., Abildtoft, M. K., Taylor, P. C. & Kristensen, S., jan. 2022, I: Scandinavian Journal of Rheumatology. 51, 1, s. 25-33 9 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Objectives: In Denmark, patients with inflammatory arthritis (IA) have completed patient-reported outcome measures (PROMs) via touchscreens in the outpatient clinic since 2006. However, current technology makes it possible for patients to use their own smartphone via an application (app) developed for the Danish Rheumatology Database (DANBIO). This study aims to evaluate the agreement of PROMs between the DANBIO app and outpatient touchscreen in patients with IA.Method: Patients with IA (rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis) were enrolled in a randomized, crossover, agreement study. Participants answered PROMs through the two device types in a randomized order. Differences in PROM scores with 95% confidence intervals (CIs) were evaluated for similarity according to prespecified equivalence margins.Results: The touchscreen invitation was accepted by 138 patients. Sixty patients (20 with each diagnosis) were included. The difference in Health Assessment Questionnaire Disability Index between the two device types was -0.007 (95% CI -0.043 to 0.030); thus, equivalence was demonstrated. In addition, all other PROMs obtained with the two device types were equivalent, except for the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), which was within the limits of minimally clinically important difference (MCID). In total, 78.3% preferred the DANBIO app.Conclusion: In patients with IA, equivalence was demonstrated between two device types for all PROMs except BASDAI; however, BASDAI was within the limits of the MCID. Implementation of the DANBIO app is expected to optimize outpatient visits, thereby improving healthcare for the individual patient and society.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Rheumatology
Vol/bind 51
Udgave nummer 1
Sider (fra-til) 25-33
Antal sider 9
ISSN 0300-9742
DOI
Status Udgivet - jan. 2022

UTI assessment tool for intermittent catheter users: a way to include user perspectives and enhance quality of UTI management

Lauridsen, S. V., Averbeck, M. A., Krassioukov, A., Vaabengaard, R. & Athanasiadou, S., 6 okt. 2022, I: BMC Nursing. 21, 1, s. 272

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Urinary Tract Infections (UTIs) are among the most severe complications for users of intermittent catheterisation (IC), with numerous risk factors contributing to their occurrence. The aim of this study was to develop a tool to assess UTI risk factors among IC users in a systematic way that considers the perspective of the individual user.

METHODS: The Design Thinking Process was used to guide the development of the content and format of the tool. The UTI Risk Factors model by Kennelly et al. was used as a basis for developing the content. Insights on the appropriate content and format were collected via the Coloplast Nurse Advisory Boards and by conducting a qualitative evidence synthesis on user perspectives and practices in relation to UTIs.

RESULTS: The literature search identified a total of 3544 articles, out of which 22 met the inclusion criteria. Additionally, three rounds of meetings were conducted with approximately 90 nurses from the Nurse Advisory Boards across Europe. The qualitative evidence synthesis showed that users describe their UTI symptoms in different terms and that personal needs and priorities impact their adherence and catheter selection. Furthermore, some users lack relevant and updated knowledge about IC and UTIs. The nurses described that correct UTI diagnosis is essential. They pointed that they would assess the user's general condition, adherence, technique, and catheter type as potential areas of risk factors and emphasised the importance of adequate support for users. The study resulted in the development of the UTI assessment tool for intermittent catheter users, which comprises three elements: a guide for healthcare professionals, a dialogue board, and a notepad. The tool starts with a confirmation of the UTI incidence, and then assesses risk factors via questions on health, adherence, technique, and catheter, and concludes with a support section.

CONCLUSIONS: The UTI assessment tool for intermittent catheter users is designed to help healthcare professionals assess UTI risk factors in a systematic way, while engaging users and taking their perspective into account. By identifying the relevant risk factors, the use of this tool has the potential to reduce the occurrence of UTIs for the individual IC user.

Originalsprog Engelsk
Tidsskrift BMC Nursing
Vol/bind 21
Udgave nummer 1
Sider (fra-til) 272
ISSN 1472-6955
DOI
Status Udgivet - 6 okt. 2022

Bibliografisk note

© 2022. The Author(s).

BACKGROUND: Low vitamin D in pregnancy may impair the development of the fetal immune system and influence the risk of later development of rheumatoid arthritis (RA) in the offspring. The aim was to examine whether lower 25-hydroxyvitamin D3 (25(OH)D) concentrations at birth were associated with the risk of developing RA in early adulthood.

METHODS: This case-cohort study obtained data from Danish registers and biobanks. Cases included all individuals born during 1981-1996 and recorded in the Danish National Patient Register with a diagnosis of RA with age >18 years at first admission. The random comparison consisted of a subset of Danish children. Vitamin D concentrations were measured in newborn dried blood. In total, 805 RA cases and 2416 individuals from the subcohort were included in the final analysis. Weighted Cox regression was used to calculate hazard ratio (HR).

RESULTS: The median (interquartile rage (IQR)) 25(OH)D concentrations among cases were 24.9 nmol/L (IQR:15.4;36.9) and 23.9 nmol/L (IQR:13.6;36.4) among the subcohort. There was no indication of a lower risk of RA among individuals in the highest vitamin D quintile compared with the lowest (HRadj.:1.21 (0.90;1.63)).

CONCLUSION: The risk of RA in early adulthood was not associated with vitamin D concentrations at birth.

Originalsprog Engelsk
Artikelnummer 447
Tidsskrift Nutrients
Vol/bind 14
Udgave nummer 3
ISSN 2072-6643
DOI
Status Udgivet - 20 jan. 2022

What goes on in digital behaviour change interventions for weight loss maintenance targeting physical activity: A scoping review

Encantado, J., Palmeira, A. L., Silva, C., Sniehotta, F. F., Stubbs, R. J., Gouveia, M. J., Teixeira, P. J., Heitmann, B. L. & Marques, M. M., 2022, I: Digital Health. 8, s. 20552076221129089

Publikation: Bidrag til tidsskriftReviewpeer review

OBJECTIVE: To identify the core components of digital behaviour change interventions for weight loss maintenance targeting physical activity, in terms of: (i) behaviour change techniques, (ii) mechanisms of action, (iii) modes of delivery, (iv) dose and (v) tailoring/personalization. In addition, the links between these components were investigated.

METHODS: A literature search was performed in five electronic databases: PubMed, Embase, CINHAL, PsycINFO and Web of Science. Two reviewers independently screened the identified articles and extracted data related with the study characteristics and behaviour change techniques, mechanism of action, mode of delivery, dose, and tailoring, using standardized classifications whenever available (e.g. behaviour change techniques taxonomy).

RESULTS: Seventeen articles reporting 11 original studies were selected. Two studies were protocols, 9 studies presented results for weight change and all but one showed no significant differences between the intervention and control groups. Eight studies (73%) provided adequate information on behaviour change techniques. Five studies (45%) provided partial information about how the behaviour change techniques were linked to mechanisms of action, and only one study (0.9%) described these links for all the techniques. Around half of the studies reported the modes through which behaviour change techniques were delivered. Descriptions of dose were present in most studies, but with minimal information. The use of tailoring or personalization approaches was mentioned in eight studies (73%), but descriptions of what was tailored and how were minimal.

CONCLUSIONS: The compilation of information regarding intervention components was difficult due to the lack of information and systematization in reporting across papers. This is particularly true for the reporting of the links between behaviour change techniques and the other core intervention components. This information is crucial to help us understand in the context of behaviour change interventions what works or does not work, how it works and why.

Originalsprog Engelsk
Tidsskrift Digital Health
Vol/bind 8
Sider (fra-til) 20552076221129089
ISSN 2055-2076
DOI
Status Udgivet - 2022

Bibliografisk note

© The Author(s) 2022.

OBJECTIVE: To identify contextual factors that modify the treatment effect of the 'Good Life with osteoArthritis in Denmark' (GLAD) exercise and education programme compared to open-label placebo (OLP) on knee pain in individuals with knee osteoarthritis (OA).

METHODS: Secondary effect modifier analysis of a randomised controlled trial. 206 participants with symptomatic and radiographic knee OA were randomised to either the 8-week GLAD programme (n = 102) or OLP given as 4 intra-articular saline injections over 8 weeks (n = 104). The primary outcome was change from baseline to week 9 in the Knee injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale (range 0 (worst) to 100 (best)). Subgroups were created based on baseline information: BMI, swollen study knee, bilateral radiographic knee OA, sports participation as a young adult, sex, median age, a priori treatment preference, regular use of analgesics (NSAIDs or paracetamol), radiographic disease severity, and presence of constant or intermittent pain.

RESULTS: Participants who reported use of analgesics at baseline seem to benefit from the GLAD programme over OLP (subgroup contrast: 10.3 KOOS pain points (95% CI 3.0 to 17.6)). Participants with constant pain at baseline also seem to benefit from GLAD over OLP (subgroup contrast: 10.0 points (95% CI 2.8 to 17.2)).

CONCLUSIONS: These results imply that patients who take analgesics or report constant knee pain, GLAD seems to yield clinically relevant benefits on knee pain when compared to OLP. The results support a stratified recommendation of GLAD as management of knee OA.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03843931. EudraCT number 2019-000809-71.

Originalsprog Engelsk
Tidsskrift Osteoarthritis and Cartilage
ISSN 1063-4584
DOI
Status E-pub ahead of print - 8 sep. 2022

Bibliografisk note

Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

OBJECTIVES: The COVID-19 pandemic has changed the working environment, how we think of it and how it stands to develop into the future. Knowledge about how people have continued to work on-site and adjusted to working from home during the COVID-19 lockdown will be vital for planning work arrangements in the post-pandemic period. Our primary objective was to investigate experiences of working from home or having colleagues working from home during a late stage of the COVID-19 lockdown among researchers and healthcare providers in a hospital research setting. Second, we aimed to investigate researchers' productivity through changes in various proxy measures during lockdown as compared with pre-lockdown.

DESIGN: Mixed-method participatory Group Concept Mapping (GCM).

SETTING AND PARTICIPANTS: GCM, based on a mixed-method participatory approach, was applied involving researchers' and healthcare providers' online sorting and rating experiences working from home during the COVID-19 pandemic. At a face-to-face meeting, participants achieved consensus on the number and labelling of domains-the basis for developing a conceptual model.

RESULTS: Through the GCM approach, 47 participants generated 125 unique statements of experiences related to working from home, which were organised into seven clusters. Using these clusters, we developed a conceptual model that illustrated the pros and cons of working from home.

CONCLUSION: The future work setting, the role of the office and the overall work environment need to respond to workers' increased wish for flexible work arrangements and co-decision.

Originalsprog Engelsk
Tidsskrift BMJ Open
Vol/bind 12
Udgave nummer 8
Sider (fra-til) e063279
ISSN 2044-6055
DOI
Status Udgivet - 3 aug. 2022

Bibliografisk note

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

The REPORT guide is a 'How to' guide to help you report your clinical research in an effective and transparent way. It is intended to supplement established first choice reporting tools, such as Consolidated Standards of Reporting Trials (CONSORT), by adding tacit knowledge (ie, learnt, informal or implicit knowledge) about reporting topics that we have struggled with as authors or see others struggle with as journal reviewers or editors. We focus on the randomised controlled trial, but the guide also applies to other study designs. Topics included in the REPORT guide cover reporting checklists, trial report structure, choice of title, writing style, trial registry and reporting consistency, spin or reporting bias, transparent data presentation (figures), open access considerations, data sharing and more. Preprint (open access): https://doi.org/10.31219/osf.io/qsxdz.

Originalsprog Engelsk
Artikelnummer 105058
Tidsskrift British Journal of Sports Medicine
Vol/bind 56
Udgave nummer 12
Sider (fra-til) 683-691
Antal sider 9
ISSN 0306-3674
DOI
Status Udgivet - jun. 2022

Bibliografisk note

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Published in 2021

'Standing together - at a distance': Documenting changes in mental-health indicators in Denmark during the COVID-19 pandemic

Clotworthy, A., Dissing, A. S., Nguyen, T-L., Jensen, A. K., Andersen, T. O., Bilsteen, J. F., Elsenburg, L. K., Keller, A., Kusumastuti, S., Mathisen, J., Mehta, A., Pinot de Moira, A., Rod, M. H., Skovdal, M., Strandberg-Larsen, K., Tapager, I. W., Varga, T. V., Vinther, J. L., Xu, T., Hoeyer, K., & 1 flereHulvej Rod, N., feb. 2021, I: Scandinavian Journal of Public Health. Supplement. 49, 1, s. 79-87 9 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Aims: There is a need to document the mental-health effects of the COVID-19 pandemic and its associated societal lockdowns. We initiated a large mixed-methods data collection, focusing on crisis-specific worries and mental-health indicators during the lockdown in Denmark. Methods: The study incorporated five data sources, including quantitative surveys and qualitative interviews. The surveys included a time series of cross-sectional online questionnaires starting on 20 March 2020, in which 300 (3×100) Danish residents were drawn every three days from three population groups: the general population (N=1046), families with children (N=1032) and older people (N=1059). These data were analysed by trend analysis. Semi-structured interviews were conducted with 32 people aged 24-83 throughout Denmark to provide context to the survey results and to gain insight into people's experiences of the lockdown. Results: Absolute level of worries, quality of life and social isolation were relatively stable across all population groups during the lockdown, although there was a slight deterioration in older people's overall mental health. Many respondents were worried about their loved ones' health (74-76%) and the potential long-term economic consequences of the pandemic (61-66%). The qualitative interviews documented significant variation in people's experiences, suggesting that the lockdown's effect on everyday life had not been altogether negative. Conclusions: People in Denmark seem to have managed the lockdown without alarming changes in their mental health. However, it is important to continue investigating the effects of the pandemic and various public-health measures on mental health over time and across national contexts.

Originalsprog Engelsk
Bogserie Scandinavian Journal of Public Health. Supplement
Vol/bind 49
Udgave nummer 1
Sider (fra-til) 79-87
Antal sider 9
ISSN 1403-4956
DOI
Status Udgivet - feb. 2021

A biomarker perspective on the acute effect of exercise with and without impact on joint tissue turnover: an exploratory randomized cross-over study

Bjerre-Bastos, J. J., Nielsen, H. B., Andersen, J. R., Karsdal, M., Boesen, M., Mackey, A. L., Byrjalsen, I., Thudium, C. S. & Bihlet, A. R., okt. 2021, I: European Journal of Applied Physiology. 121, 10, s. 2799-2809 11 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Purpose: To investigate acute changes in biochemical markers of bone and cartilage turnover in response to moderate intensity exercise with and without joint impact in healthy human subjects.

Methods: A randomized, cross-over, exploratory, clinical study was conducted. Twenty healthy subjects with no history of joint trauma completed 30 min interventions of standardized moderate intensity cycling and running as well as a resting intervention 1 week apart. Blood samples were taken immediately before, four times after exercise and again the next day. Urine was sampled, before, after and the next day. On the day of rest, samples were taken at timepoints similar to the days of exercise. Markers of type I (CTX-I), II (C2M, CTX-II) and VI (C6M) collagen degradation, cartilage oligomeric matrix protein (COMP) and procollagen C-2 (PRO-C2) was measured.

Trial registration number: NCT04542655, 02 September 2020, retrospectively registered.

Results: CTX-I was different from cycling (4.2%, 95%CI: 0.4-8.0%, p = 0.03) and resting (6.8%, 95%CI: 2.9-10.7%, p = 0.001) after running and the mean change in COMP was different from cycling (10.3%, 95%CI: 1.1-19.5%, p = 0.03), but not from resting (8.6%, 95%CI: - 0.7-17.8%, p = 0.07) after running. Overall, changes in other biomarkers were not different between interventions.

Conclusion: In this exploratory study, running, but not cycling, at a moderate intensity and duration induced acute changes in biomarkers of bone and cartilage extra-cellular matrix turnover.

Originalsprog Engelsk
Tidsskrift European Journal of Applied Physiology
Vol/bind 121
Udgave nummer 10
Sider (fra-til) 2799-2809
Antal sider 11
ISSN 1439-6319
DOI
Status Udgivet - okt. 2021

Bibliografisk note

Funding Information:
JJB received funding from Nordic Bioscience Clinical Development and the Danish Research Fund. IB and CT are full-time employees of Nordic Bioscience. JRA, MK and ARB are full-time employees and shareholders of Nordic Bioscience. MB and ALM have no conflict of interest.

Funding Information:
This study was funded by Nordic Bioscience Clinical Development and the Danish Research Fund.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

A new tool to assess Clinical Diversity In Meta-analyses (CDIM) of interventions

Barbateskovic, M., Koster, T. M., Eck, R. J., Maagaard, M., Afshari, A., Blokzijl, F., Cronhjort, M., Dieperink, W., Fabritius, M. L., Feinberg, J., French, C., Gareb, B., Geisler, A., Granholm, A., Hiemstra, B., Hu, R., Imberger, G., Jensen, B. T., Jonsson, A. B., Karam, O., & 25 flereKong, D. Z., Korang, S. K., Koster, G., Lai, B., Liang, N., Lundstrøm, L. H., Marker, S., Meyhoff, T., Nielsen, E. E., Nørskov, A. K., Munch, M. W., Risom, E. C., Rygård, S. L., Safi, S., Sethi, N., Sjövall, F., Lauridsen, S. V., van Bakelen, N., Volbeda, M., van der Horst, I., Gluud, C., Perner, A., Møller, M. H., Keus, F. & Wetterslev, J., jul. 2021, I: Journal of Clinical Epidemiology. 135, s. 29-41 13 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: To develop and validate Clinical Diversity In Meta-analyses (CDIM), a new tool for assessing clinical diversity between trials in meta-analyses of interventions.

STUDY DESIGN AND SETTING: The development of CDIM was based on consensus work informed by empirical literature and expertise. We drafted the CDIM tool, refined it, and validated CDIM for interrater scale reliability and agreement in three groups.

RESULTS: CDIM measures clinical diversity on a scale that includes four domains with 11 items overall: setting (time of conduct/country development status/units type); population (age; sex; patient inclusion criteria/baseline disease severity, comorbidities); interventions (intervention intensity/strength/duration of intervention; timing; control intervention; cointerventions);and outcome (definition of outcome; timing of outcome assessment). The CDIM is completed in two steps: first two authors independently assess clinical diversity in the four domains. Second, after agreeing upon scores of individual items a consensus score is achieved. Interrater scale reliability and agreement ranged from moderate to almost perfect depending on the type of raters.

CONCLUSION: CDIM is the first tool developed for assessing clinical diversity in meta-analyses of interventions. We found CDIM to be a reliable tool for assessing clinical diversity among trials in meta-analysis.

Originalsprog Engelsk
Tidsskrift Journal of Clinical Epidemiology
Vol/bind 135
Sider (fra-til) 29-41
Antal sider 13
ISSN 0895-4356
DOI
Status Udgivet - jul. 2021
Originalsprog Engelsk
Tidsskrift Archives of Physiotherapy
ISSN 2057-0082
Status Afsendt - jun. 2021

A systematic review and meta-analysis of observational studies on the association between animal protein sources and risk of rheumatoid arthritis

Asoudeh, F., Jayedi, A., Kavian, Z., Ebrahimi-Mousavi, S., Nielsen, S. M. & Mohammadi, H., jul. 2021, I: Clinical nutrition (Edinburgh, Scotland). 40, 7, s. 4644-4652 9 s.

Publikation: Bidrag til tidsskriftReviewpeer review

OBJECTIVE: The aim of this study was to investigate the linear and nonlinear dose-response associations of animal-based dietary protein intake and risk of developing rheumatoid arthritis (RA).

METHODS: A systematic search of MEDLINE, Scopus and Embase was conducted up to October 2020. Observational studies that report risk estimates of RA for animal-based protein consumption were included. We calculated pooled relative risks (RRs) by using a random-effects model. Linear and non-linear dose-response analyses were performed to examine the dose-response relations between animal-based protein consumption and RA.

RESULTS: Seven cohort studies (n = 457,554) with 3545 incident cases and six case-control studies with 3994 cases and 5252 controls were identified. Highest compared with the lowest category of fish consumption was inversely associated with risk of RA (RR: 0.89; 95% CI, 0.80 to 0.99; I2 = 0%, n = 10). Also, a 100 g/day increment in fish intake was associated with a 15% decreased risk of RA. Dose-response analysis showed a modest U-shaped association between fish consumption and incidence of RA, with the lowest risk at a fish intake of 20-30 g/day (Pnon-linearity = 0.04). We found no significant association between consumption of red meat, poultry or dairy and the risk of RA.

CONCLUSION: The present study revealed a significant reverse association between fish consumption and risk of RA. While we observed no association between red meat, dairy or poultry consumption and risk of RA. Further well-designed prospective studies are needed to support our findings.

Originalsprog Engelsk
Tidsskrift Clinical nutrition (Edinburgh, Scotland)
Vol/bind 40
Udgave nummer 7
Sider (fra-til) 4644-4652
Antal sider 9
ISSN 0261-5614
DOI
Status Udgivet - jul. 2021

A Systematic Review of Job Loss Prevention Interventions for Persons with Inflammatory Arthritis

Madsen, C. M. T., Bisgaard, S. K., Primdahl, J., Christensen, J. R. & von Bülow, C., dec. 2021, I: Journal of Occupational Rehabilitation. 31, 4, s. 866-885 20 s.

Publikation: Bidrag til tidsskriftReviewpeer review

Purpose To present an overview of the evidence of the effect of job loss prevention interventions, aiming to improve work ability and decrease absenteeism and/or job loss in persons with inflammatory arthritis (IA). Method A systematic literature search in the databases PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library was conducted. A search strategy used in a review from 2014 was copied and additional keywords were added with no time restriction. The Cochrane Risk of Bias Tool (RoB 1) was used for quality assessment and the overall quality of each study was determined using predetermined cut-off criteria, categorising studies to be of good-, acceptable- or low quality. Results were summarised narratively. Results Six randomised controlled trials (published in seven articles) were included, one of good quality and five of acceptable quality. One study identified significant improvements in work ability, while three found no significant difference between groups. One study identified significant difference in absenteeism, while two studies identified no difference between the intervention and control groups. Two studies identified significant reduction in job loss, while two studies identified no group difference. The inconsistent results may be due to heterogeneity in interventions and outcome measures used, and the results should therefore be interpreted with caution. Conclusion The results indicate that job loss prevention interventions may have an effect on work ability, absenteeism and in particular job loss among persons with IA. Further good-quality studies regarding job loss prevention interventions for people with IA are still recommended.

Originalsprog Engelsk
Tidsskrift Journal of Occupational Rehabilitation
Vol/bind 31
Udgave nummer 4
Sider (fra-til) 866-885
Antal sider 20
ISSN 1053-0487
DOI
Status Udgivet - dec. 2021

Bibliografisk note

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study

Marques, M. M., Matos, M., Mattila, E., Encantado, J., Duarte, C., Teixeira, P. J., Stubbs, R. J., Sniehotta, F. F., Ermes, M., Harjumaa, M., Leppänen, J., Välkkynen, P., Silva, M. N., Ferreira, C., Carvalho, S., Palmeira, L., Horgan, G., Heitmann, B. L., Evans, E. H. & Palmeira, A. L., 3 dec. 2021, I: Journal of Medical Internet Research. 23, 12, s. e25305 e25305.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union's Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention.

OBJECTIVE: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing.

METHODS: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit.

RESULTS: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep.

CONCLUSIONS: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance.

Originalsprog Engelsk
Artikelnummer e25305
Tidsskrift Journal of Medical Internet Research
Vol/bind 23
Udgave nummer 12
Sider (fra-til) e25305
ISSN 1439-4456
DOI
Status Udgivet - 3 dec. 2021

Bibliografisk note

©Marta M Marques, Marcela Matos, Elina Mattila, Jorge Encantado, Cristiana Duarte, Pedro J Teixeira, R James Stubbs, Falko F Sniehotta, Miikka Ermes, Marja Harjumaa, Juha Leppänen, Pasi Välkkynen, Marlene N Silva, Cláudia Ferreira, Sérgio Carvalho, Lara Palmeira, Graham Horgan, Berit Lilienthal Heitmann, Elizabeth H Evans, António L Palmeira. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.12.2021.

This study reports age- and sex-specific incidence rates of juvenile idiopathic arthritis (JIA) in complete Danish birth cohorts from 1992 through 2002. Data were obtained from the Danish registries. All persons born in Denmark, from 1992-2002, were followed from birth and until either the date of first diagnosis recording, death, emigration, 16th birthday or administrative censoring (17 May 2017), whichever came first. The number of incident JIA cases and its incidence rate (per 100,000 person-years) were calculated within sex and age group for each of the birth cohorts. A multiplicative Poisson regression model was used to analyze the variation in the incidence rates by age and year of birth for boys and girls separately. The overall incidence of JIA was 24.1 (23.6-24.5) per 100,000 person-years. The rate per 100,000 person-years was higher among girls (29.9 (29.2-30.7)) than among boys (18.5 (18.0-19.1)). There were no evident peaks for any age group at diagnosis for boys but for girls two small peaks appeared at ages 0-5 years and 12-15 years. This study showed that the incidence rates of JIA in Denmark were higher for girls than for boys and remained stable over the observed period for both sexes.

Originalsprog Engelsk
Artikelnummer 8331
Tidsskrift International Journal of Environmental Research and Public Health
Vol/bind 18
Udgave nummer 16
ISSN 1661-7827
DOI
Status Udgivet - 6 aug. 2021

Appraisal of Candidate Instruments for Assessment of the Physical Function Domain in Patients with Psoriatic Arthritis

Leung, Y. Y., Orbai, A-M., Ogdie, A., Hojgaard, P., Holland, R., Goel, N., Chau, J., Coates, L. C., Strand, V., Gladman, D. D., Mease, P. J., Christensen, R. & Tillett, W., 1 jan. 2021, I: Journal of Rheumatology. 48, 1, s. 58-66 9 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: Numerous patient-reported outcome measures (PROM) exist for the measurement of physical function for psoriatic arthritis (PsA), but only a few are validated comprehensively. The objective of this project was to prioritize PROM for measuring physical function for potential incorporation into a standardized outcome measurement set for PsA.

METHODS: A working group of 13 members including 2 patient research partners was formed. PROM measuring physical function in PsA were identified through a systematic literature review and recommendations by the working group. The rationale for inclusion and exclusion from the original list of existing PROM was thoroughly discussed and 2 rounds of Delphi exercises were conducted to achieve consensus.

RESULTS: Twelve PROM were reviewed and discussed. Six PROM were prioritized: Health Assessment Questionnaire (HAQ) and 4 modifications (HAQ-Disability Index, HAQ-Spondyloarthritis, modified HAQ, multidimensional HAQ), Medical Outcomes Study 36-item Short Form survey physical functioning domain, and the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning module.

CONCLUSION: Through discussion and Delphi exercises, we achieved consensus to prioritize 6 physical function PROM for PsA. These 6 PROM will undergo further appraisal using the Outcome Measures in Rheumatology (OMERACT) Filter 2.1.

Originalsprog Engelsk
Tidsskrift Journal of Rheumatology
Vol/bind 48
Udgave nummer 1
Sider (fra-til) 58-66
Antal sider 9
ISSN 0315-162X
DOI
Status Udgivet - 1 jan. 2021

By utilizing historical changes in Danish legislation related to mandatory vitamin D fortification of margarine, which was implemented in the mid 1930s and abruptly abandoned in June 1985, the studies in the D-tect project investigated the effects of vitamin D on health outcomes in individuals, who during gestation were exposed or unexposed to extra vitamin D from fortified margarine. This paper reviews and narratively summarizes the analytic approaches alongside the results of the societal fortification experiment studies from the D-tect project and addresses the challenges in designing societal experiment studies and evaluating their results. The latter are discussed as lessons learned that may be useful for designers of similar studies, expected to be extensively utilized while researching the health consequences of the COVID-19 pandemic by comparing individuals born before and after the epidemic. In the D-tect project, 16 articles based on the societal fortification experiment were published analyzing 10 different outcomes and using different statistical approaches. Lessons learned included the detail of the analysis of the historical information on the exposure, availability and validity of the outcome data, variety of analytical approaches, and specifics concerning vitamin D effect evaluation, such as consideration of the influence of sunshine or season. In conclusion, the D-tect project clearly demonstrated the cost-effectiveness and research potential of natural- or societal-experiment-based studies.

Originalsprog Engelsk
Artikelnummer 8136
Tidsskrift International Journal of Environmental Research and Public Health
Vol/bind 18
Udgave nummer 15
ISSN 1661-7827
DOI
Status Udgivet - 31 jul. 2021

Assessing methods for evaluating the number of components in non-negative matrix factorization

Maisog, J. M., Demarco, A. T., Devarajan, K., Young, S., Fogel, P. & Luta, G., 1 nov. 2021, I: Mathematics. 9, 22, 2840.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Non-negative matrix factorization is a relatively new method of matrix decomposition which factors an m×n data matrix X into an m×k matrix W and a k×n matrix H, so that X≈W×H. Importantly, all values in X, W, and H are constrained to be non-negative. NMF can be used for dimensionality reduction, since the k columns of W can be considered components into which X has been decomposed. The question arises: how does one choose k? In this paper, we first assess methods for estimating k in the context of NMF in synthetic data. Second, we examine the effect of normalization on this estimate's accuracy in empirical data. In synthetic data with orthogonal underlying components, methods based on PCA and Brunet's Cophenetic Correlation Coefficient achieved the highest accuracy. When evaluated on a well-known real dataset, normalization had an unpredictable effect on the estimate. For any given normalization method, the methods for estimating k gave widely varying results. We conclude that when estimating k, it is best not to apply normalization. If underlying components are known to be orthogonal, then Velicer's MAP or Minka's Laplace-PCA method might be best. However, when orthogonality of the underlying components is unknown, none of the methods seemed preferable.

Originalsprog Engelsk
Artikelnummer 2840
Tidsskrift Mathematics
Vol/bind 9
Udgave nummer 22
DOI
Status Udgivet - 1 nov. 2021

Bibliografisk note

Funding Information:
Funding: This research was funded by several sources. The work of K.D. was supported in part by NIH Grant P30 CA06927 and an appropriation from the Commonwealth of Pennsylvania. Work of A.D. was supported in part by NIH grants U10NS086513 and K12HD093427.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

OBJECTIVE: We assessed the association of suPAR (soluble urokinase plasminogen activator receptor) plasma levels with fibrotic and vascular manifestations in patients with systemic sclerosis (SSc).

METHODS: suPAR plasma levels were measured in 121 consecutive patients with SSc and correlated to pulmonary and vascular features of SSc, including interstitial lung disease as characterized by percentage of predicted CO diffusing capacity (DLco) and forced vital capacity (FVC), pulmonary fibrosis by computed tomography, and pulmonary arterial hypertension, telangiectasias, and digital ulcers.

RESULTS: Overall, 121 SSc patients (84% females; mean age, 57 ± 12 [range: 22-79] years) were enrolled; 35% had diffuse cutaneous SSc. suPAR plasma levels ranged from 1.3-10.2 [median: 2.9 (p25-p75: 2.3-3.9)] ng/mL. Log(suPAR) levels correlated with DLco (r = -0.41, p <0.0001) and FVC (r = -0.26, p = 0.004), also when adjusted for age, sex, and pulmonary hypertension. A suPAR cut-off level of >2.5 ng/mL showed a sensitivity of 91% for identifying patients with either DLco <50% or FVC < 60% of the predicted values. Similarly, 19 (90%) had a suPAR >2.5 ng/mL among those diagnosed with pulmonary fibrosis vs. 59 (60%) among those who did not (p = 0.008). suPAR values were not associated with vascular manifestations.

CONCLUSION: suPAR levels strongly correlated with pulmonary involvement in SSc. Future studies should test if suPAR estimation can be used for surveillance of severe pulmonary involvement in SSc.

Originalsprog Engelsk
Tidsskrift PLoS One
Vol/bind 16
Udgave nummer 2
Sider (fra-til) e0247256
ISSN 1932-6203
DOI
Status Udgivet - 22 feb. 2021

Pickiness is an eating behavior that many families with young children face. Having joint family meals may impact the child's pickiness, for instance by influencing their willingness to try novel foods. Moreover, picky children have been shown to display greater emotionality. The aim of this study was to investigate if children's mental well-being and parent-reported conflicts during mealtime were associated with pickiness among obesity-prone children. Data was obtained from the baseline examination of the Healthy Start intervention study, the Danish Medical Birth registry and the Danish Health Visitor's Child Health Database, and included 635 children aged 2-6 years that were all at high risk for becoming overweight later in life. Children's mental well-being was measured by the strengths and difficulties questionnaire. Crude and adjusted ordinal logistic regressions were used to investigate the cross-sectional associations. Children had a higher odds associated with changing from a category of less pickiness to a category of more pickiness for each one point higher SDQ score (ORadj. = 1.35, 95% CI = 1.14; 1.61) and lower odds (ORadj. = 0.57, 95% CI = 0.38; 0.86) associated with changing pickiness category towards more pickiness for each one point higher SDQ prosocial score. Moreover, children with conflicts during mealtime had higher odds of being in a worse pickiness category compared to children without conflicts (ORadj. = 3.37, 95% CI = 2.27; 5.01). This study showed that among obesity-prone children, behavioral problems, as well as conflicts during mealtime, were associated with more picky behaviors. Further longitudinal studies are needed to confirm the findings, as are studies including general child population subsets.

Originalsprog Engelsk
Artikelnummer 5621
Tidsskrift International Journal of Environmental Research and Public Health
Vol/bind 18
Udgave nummer 11
ISSN 1661-7827
DOI
Status Udgivet - jun. 2021

Pages