We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Guidelines recommend screening for psychiatric co-morbidities in patients with congenital heart defects alongside cardiac outpatient follow-ups. These recommendations are not implemented in Denmark. This study aimed to investigate the psychiatric co-morbidities in children and adolescents with Fontan circulation in Denmark and to evaluate the feasibility of an online screening measure for psychiatric disorders.
Methods:
Children, adolescents, and their families answered the Development and Well-Being Assessment questionnaire and a questionnaire about received help online. Development and Well-Being Assessment ratings present psychiatric diagnoses in accordance with ICD-10 and DSM-5. Parent-reported received psychiatric help is also presented. Feasibility data are reported as participation rate (completed Development and Well-Being Assessments) and parental/adolescent acceptability from the feasibility questionnaire.
Results:
The participation rate was 27%. Of the participating children and adolescents, 53% (ICD-10)/59% (DSM-5) met full diagnostic criteria for at least one psychiatric diagnosis. Of these, 50% had not received any psychiatric or psychological help. Only 12% of participants had an a priori psychiatric diagnosis.
Conclusions:
We found that a large proportion of children and adolescents with Fontan circulation are underdiagnosed and undertreated for psychiatric disorders. The results from our study emphasise the need for psychiatric screening in this patient group. Development and Well-Being Assessment may be too comprehensive for online electronic screening in children and adolescents with CHD.
This Element outlines the origins and evolution of an international award-winning development intervention, index-based livestock insurance (IBLI), which scaled from a small pilot project in Kenya to a design that underpins drought risk management products and policies across Africa. General insights are provided on i) the economics of poverty, risk management, and drylands development; ii) the evolving use of modern remote sensing and data science tools in development; iii) the science of scaling; and iv) the value and challenges of integrating research with operational implementation to tackle development and humanitarian challenges in some of the world's poorest regions. This title is also available as Open Access on Cambridge Core.
Background: This post hoc analysis evaluated the efficacy of eptinezumab vs placebo across 24 weeks of treatment in the placebo-controlled period of the DELIVER study in subgroups defined by prior treatment failure. Methods: DELIVER (NCT04418765) randomized adults with migraine to eptinezumab 100 mg, 300 mg, or placebo intravenous infusion every 12 weeks. Eligible patients needed documented evidence of 2–4 prior preventive treatment failures within the past 10 years. This post hoc analysis focused on subgroups of patients with prior treatment failure on topiramate, beta blockers, amitriptyline, and/or flunarizine. Results: The full analysis set included 890 patients: 633 previously failed topiramate, 538 failed beta blockers, 508 failed amitriptyline, and 333 failed flunarizine; within each subgroup, most patients had 2 prior treatment failures (51–56%). Across Weeks 1–12 in all subgroups, patients treated with eptinezumab experienced greater reductions from baseline in MMDs than those receiving placebo, with larger reductions observed over Weeks 13–24. Similarly, ≥50% MRRs were higher with eptinezumab than with placebo and increased following a second infusion. Conclusions: Eptinezumab demonstrated greater reductions in MMDs compared with placebo across all subgroups of prior preventive treatment failure, with evidence to suggest that a second dose provides additional benefit.
To assess how the presence of surfactant in lung airways alters the flow of mucus that leads to plug formation and airway closure, we investigate the effect of insoluble surfactant on the instability of a viscoplastic liquid coating the interior of a cylindrical tube. Evolution equations for the layer thickness using thin-film and long-wave approximations are derived that incorporate yield-stress effects and capillary and Marangoni forces. Using numerical simulations and asymptotic analysis of the thin-film system, we quantify how the presence of surfactant slows growth of the Rayleigh–Plateau instability, increases the size of initial perturbation required to trigger instability and decreases the final peak height of the layer. When the surfactant strength is large, the thin-film dynamics coincide with the dynamics of a surfactant-free layer but with time slowed by a factor of four and the capillary Bingham number, a parameter proportional to the yield stress, exactly doubled. By solving the long-wave equations numerically, we quantify how increasing surfactant strength can increase the critical layer thickness for plug formation to occur and delay plugging. The previously established effect of the yield stress in suppressing plug formation (Shemilt et al., J. Fluid Mech., vol. 944, 2022, A22) is shown to be amplified by introducing surfactant. We discuss the implications of these results for understanding the impact of surfactant deficiency and increased mucus yield stress in obstructive lung diseases.
Although the effect of lithium treatment on kidney and endocrine systems has been extensively investigated, this literature, however, suffers from substantial heterogeneity and many prior studies are limited by short follow-up on just one marker of interest.
Objectives
We aimed to determine the impact of long-term lithium therapy on renal, thyroid and parathyroid function within a large real-world cohort.
Methods
We performed a cohort study within the Central Region of Denmark (approximately 1.3 million inhabitants). Using the Electronic Patient Record system, we identified all patients with at least one serum-lithium (se-Li) measurement in the period from January 1, 2013 to July 20, 2022, and a reference group of patients diagnosed with bipolar disorder (ICD-10: F30, F31) was matched on age, sex and creatinine level. The outcomes were renal, thyroid, and parathyroid function as indicated by all blood tests taken during follow-up measuring creatinine, estimated glomerular filtration rate (eGFR), thyroid-stimulating hormone (TSH), parathyroid hormone (PTH) and calcium. Multilevel regression analyses adjusted for age, sex, severity of the mental disorder (as indicated by the number of hospitalizations), and somatic comorbidity calculated the association between lithium treatment and development in renal, thyroid, and parathyroid function over time.
Results
A total of 4,709 lithium users (61.5% females, median age 46 years [IQR: 32-60]) and 4,027 control individuals were identified with a total follow-up period of 14,686 person-years (median = 1.7 years, range: 1-9.5). Out of the 4,709 lithium users, a total of 3,157 were incident lithium users. The final results will be shown at the 2023 EPA Congress.
Conclusions
The conclusions will be presented at the congress.
On average, thirty percent of patients in internet based treatments do not complete the treatment program. The majority of studies predicting adherence have focused on baseline variables. While some consistent predictors have emerged (e.g. gender, education), they are insufficient for guiding clinicians in identifying patients at risk for dropout. More precise predictors are needed. More recently, studies on prediction have started to explore process variables such as early response to treatment or program usage.
Objectives
To investigate:
i) How much variance in adherence is explained by baseline symptoms and sociodemographic variables?
ii) Can we improve the model by including early response and program usage as predictors?
iii) What is the predictive accuracy of the most parsimonious regression model?
Methods
Data will be extracted from the Danish ‘Internetpsychiatry’ clinic, which delivers guided internet based cognitive behavioural therapy for depression. Sociodemographic data is collected upon application, and symptoms of depression and anxiety are measured at the start of treatment. Further, symptoms of depression are measured between each session of the online treatment program. Early response to treatment will be conceptualized as the individual regression slope of depression scores for each patient, during the first four weeks of treatment. Program usage data will be collected from the online treatment platform (e.g. number of words per message to therapists, time spent on each session during the first four weeks, number of logins during the first four weeks).
Predictors for adherence will be examined in a hierarchical logistic regression. Models will be compared using ANOVA. The most parsimonious model will be determined using the Aikake Information Criterion. Receiver operating characteristic curve analyses will be used to classify the accuracy of the model.
Results
Analyses have not yet been conducted. Results will be available for presentation at the conference.
Conclusions
Determining more accurate predictors for adherence in internet based treatments is the first step towards improving adherence. Research findings need to be translated into clinically useful guidelines that may inform clinical decision making. Findings from this study could potentially be implemented as a system that monitors patients’ program usage and symptom development and signals therapists if a patient is at risk for dropout.
Motivation is an important factor in therapy and potentially even more so in an online setting. Earlier research shows that more autonomously motivated patients have better outcomes and completion rates than more controlled motivated patients´. However, little is known about how motivation type influences treatment effect in an online setting and in patients with binge eating disorder specifically.
Objectives
This study set out to investigate how motivation type as per the Self-Determination Theory would affect treatment adherence and effect in a sample of 148 patients, undergoing an Internet-based Cognitive Behavioral Therapy (iCBT) for BED.
Methods
The study was mixed-methods. A sample of 148 patients gave two written qualitative statements regarding their motivation for seeking treatment and reasons for choosing online therapy
The statements were transformed into quantitative units via the condensation method. The themes were categorized according to the model by Ryan and Deci based on level of autonomy and perceived locus of causality.
This was compared with completion rate and outcomes on eating disorder symptomatology. Completion was designated into three groups. Low adherers - less than six sessions (n=54), high adherers – between 7 and 10 sessions (n =56) and full adherers - 10 session plus follow up (n=37).
The effect of the treatment was measured via the Eating Disorder Examination Questionnaire (EDEQ) and Binge Eating Disorder Questionnaire (BEDQ).
Results
Table 1
shows the distribution of patients’ motivational types regarding therapy aims
Controlled
→
Autonomous
Motivational type:
Introjection
Introjection
Identification
Integration
Patient motivation:
Shame
Weight loss
Psychologicalstress
Insight
In all
In all
25
25
50
48
148
Table 2
shows the distribution of patients´motivational types regarding online treatment
Controlled
→
Autonomous
Motivational type:
Introjection
Introjection
Identification
Integration
Patient motivation:
External
Avoidance
Convenience
Reflection
In All
In all
31
21
81
15
148
Table 3
shows the results from morivational types in each setting on BEDQ and EDEQ scores. No significant correlation was found.
Therapy Aims
BEDQ
0.92
EDEQ
0.51
Why Online Therapy
BEDQ
0.99
EDEQ
0.23
Conclusions
Perceived locus of causality and level of autonomy, did not affect level of adherence or outcome of treatment in either setting. This unexpected result may suggest that internet-based therapy is less dependent on motivation types, when comparing with face-to-face treatment.
Current evidence on the risk of admission- or medication-requiring psychiatric sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is limited to selected populations, short durations, and loss to follow-up. This study examined if SARS-CoV-2 infection was associated with increased long-term risk of psychiatric admissions and de novo prescription of psychoactive medication in the general population of Denmark.
Methods
Adults (≥18 years) were assigned to either the control or SARS-CoV-2 group based on polymerase chain reaction (PCR) tests between 1 January 2020 and 27 November 2021. Infected subjects were matched 1:5 to control subjects by propensity score. Incidence rate ratios (IRRs) were calculated. Adjusted Cox regression was applied to the unmatched population with SARS-CoV-2 infection as a time-dependent covariate. Follow-up time was 12 months or until the end of the study.
Results
A total of 4,585,083 adults were included in the study. Approximately 342,084 had a PCR-confirmed SARS-CoV-2 infection and were matched 1:5 with 1,697,680 controls. The IRR for psychiatric admission was 0.79 in the matched population (95% confidence interval [CI]: 0.73–0.85, p < 0.001). In the unmatched population, the adjusted hazard ratios (aHR) for psychiatric admission were either below 1.00 or with a 95% CI lower limit of 1.01. SARS-CoV-2 infection was associated with an increased risk of de novo prescription of psychoactive medication in both the matched (IRR 1.06, 95% CI: 1.02–1.11, p < 0.01) and unmatched population (HR 1.31, 95% CI: 1.28–1.34, p < 0.001).
Conclusions
We found a signal of increased use of psychoactive medication, specifically benzodiazepines, among SARS-CoV-2-positive persons, but the risk of psychiatric admissions did not increase.
We present new data from the debris-rich basal ice layers of the NEEM ice core (NW Greenland). Using mineralogical observations, SEM imagery, geochemical data from silicates (meteoric 10Be, εNd, 87Sr/86Sr) and organic material (C/N, δ13C), we characterize the source material, succession of previous glaciations and deglaciations and the paleoecological conditions during ice-free episodes. Meteoric 10Be data and grain features indicate that the ice sheet interacted with paleosols and eroded fresh bedrock, leading to mixing in these debris-rich ice layers. Our analysis also identifies four successive stages in NW Greenland: (1) initial preglacial conditions, (2) glacial advance 1, (3) glacial retreat and interglacial conditions and (4) glacial advance 2 (current ice-sheet development). C/N and δ13C data suggest that deglacial environments favored the development of tundra and taiga ecosystems. These two successive glacial fluctuations observed at NEEM are consistent with those identified from the Camp Century core basal sediments over the last 3 Ma. Further inland, GRIP and GISP2 summit sites have remained glaciated more continuously than the western margin, with less intense ice-substratum interactions than those observed at NEEM.
The aim of this study was to assess unconsciousness in pigs during exposure to CO2 through changes in the middle latency auditory evoke potentials (MLAEP) of the central nervous system (CNS), blood parameters (pH, carbon dioxide partial pressure [pCO2], oxygen partial pressure [pO2], oxygen saturation [SatO2] and bicarbonate [HCO−3]), behaviour and the corneal reflex. The MLEAP did not decrease significantly until after 60 s exposure to CO2. The blood parameters (decreased pH, pO2 and SatO2 and increased pCO2 and HCO3) changed 53 s after the onset of immersion. The burst suppression index (BS%) and the A-line ARX index (AAI) from the MLEAP recovered basal levels at 136 and 249 s, respectively. The first blood parameter to return to basal levels was HCO−3 at 76 s of exposure, followed by SatO2 at 180 s, pH and pO2 at 210 s and pCO2 at 240 s. During exposure to the gas, pigs exhibited lateral head movements and sneezing (10.3 s), gasping (23.5 s) and vocalisation (26.1 s). Furthermore, all pigs demonstrated muscular excitation after between 19 and 39 s exposure, when the AAI and BS% values were not significantly different from basal values. It was suggested, therefore, that these excitatory movements represent conscious movement, indicative of aversion to the gas. According to our results, loss of consciousness began, on average, after 60 s inhalation of 90% CO2. During exposure to the gas, decreased brain activity was seen, immediately following the changes in blood parameters. Following exposure, the restoration of blood parameters to basal levels allows a return to normal brain activity.
The objective of this study was to describe the availability and use of designated hospital pens in Danish dairy herds and to analyse the association between availability and use of hospital pens and the herd-level incidence of reported disease treatments. Hospital pens were divided into either ‘individual hospital pens’ designed for only one animal or ‘group hospital pens’ designed for two or more animals. Questionnaires were sent to 350 dairy cattle herd owners. These questionnaires focused on four animal categories: dairy cows, heifers, males six months or older, and calves younger than six months. Depending on the category of animal, between 50 and 82% of the herds had access to individual hospital pens and between 39 and 65% of the herds had access to group hospital pens. Between nine and 24% of the herds did not have access to any type of hospital pens. The availability of hospital pens was generally higher for dairy cows than the other animal groups. There were significantly more reported treatments for hoof/leg disorders in herds with one or more cows in hospital pens at the day of visit.
One mechanism for airway closure in the lung is the surface-tension-driven instability of the mucus layer which lines the airway wall. We study the instability of an axisymmetric layer of viscoplastic Bingham liquid coating the interior of a rigid tube, which is a simple model for an airway that takes into account the yield stress of mucus. An evolution equation for the thickness of the liquid layer is derived using long-wave theory, from which we also derive a simpler thin-film evolution equation. In the thin-film case we show that two branches of marginally yielded static solutions of the evolution equation can be used to both predict the size of the initial perturbation required to trigger instability and quantify how increasing the capillary Bingham number (a parameter measuring yield stress relative to surface tension) reduces the final deformation of the layer. Using numerical solutions of the long-wave evolution equation, we quantify how the critical layer thickness required to form a liquid plug in the tube increases as the capillary Bingham number is increased. We discuss the significance of these findings for modelling airway closure in obstructive conditions such as cystic fibrosis, where the mucus layer is often thicker and has a higher yield stress.
The ‘thrifty phenotype’ hypothesis proposed that fetal undernutrition increases risk of diabetes in later life. Undernourished low birthweight Indian babies are paradoxically more adipose compared to well-nourished European babies, and are at higher risk of diabetes in later life. Twin pregnancies are an example of in utero growth restrictive environment due to shared maternal nutrition. There are few studies of body composition in twins. We performed secondary analysis of anthropometric body composition of twins and singletons in Guinea-Bissau, an economically deprived African country.
Anthropometric data were available on 7–34 year-old twins (n = 209, 97 males) and singletons (n = 182, 86 males) in the Guinea-Bissau Twin Registry at the Bandim Health Project. Twins had lower birthweight (2420 vs 3100 g, p < 0.001); and at follow-up, lower height (HAZ mean Z-score difference, −0.21, p = 0.055), weight (WAZ −0.73, p = 0.024) and BMI (BAZ −0.22, p = 0.079) compared to singletons but higher adiposity (skinfolds: +0.33 SD, p = 0.001). Twins also had higher fasting (+0.38 SD, p < 0.001) and 2-hour OGTT glucose concentrations (+0.29 SD, p < 0.05). Linear mixed-effect model accounting for intrapair correlations and interactions confirmed that twins were thinner but fatter across the age range. Data on maternal morbidity and prematurity were not available in this cohort.
African populations are known to have a muscular (less adipose) body composition. Demonstration of a thin-fat phenotype in twins in a low socio-economic African country supports the thesis that it could be a manifestation of early life undernutrition and not exclusive to Indians. This phenotype could increase risk of diabetes and related conditions.
This longitudinal study examined the influence of child-specific and environmental factors on the development of English receptive vocabulary and grammar by two groups of Danish children: Early Starters (ES) and Late Starters (LS). Age of onset, gender, language aptitude and SES significantly predicted both outcome measures. English competence beliefs (ECB) were positively related to L2 proficiency but only for children with low foreign language classroom anxiety (FLCA), suggesting a dynamic relationship between ECB and FLCA. Extramural audiovisual viewing and reading played a differential role for ES vs. LS whereas extramural English speaking significantly interacted with gender. Finally, child-specific factors explained more of the variance in English proficiency than environmental factors. This finding, which contradicts results obtained in instructed settings (e.g., Sun, Steinkrauss, Tendeiro & de Bot, 2016) but parallels those in naturalistic settings (e.g., Paradis, 2011), supports the special status of English in countries with a high degree of informal contact with English.
This pioneering volume explores the long-neglected history of social rights, from the Middle Ages to the present. It debunks the myth that social rights are 'second-generation rights' – rights that appeared after World War II as additions to a rights corpus stretching back to the Enlightenment. Not only do social rights stretch back that far; they arguably pre-date the Enlightenment. In tracing their long history across various global contexts, this volume reveals how debates over social rights have often turned on deeper struggles over social obligation – over determining who owes what to whom, morally and legally. In the modern period, these struggles have been intertwined with questions of freedom, democracy, equality and dignity. Many factors have shaped the history of social rights, from class, gender and race to religion, empire and capitalism. With incomparable chronological depth, geographical breadth and conceptual nuance, Social Rights and the Politics of Obligation in History sets an agenda for future histories of human rights.